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The Right And Wrong Ways To Strengthen Your Core Muscles

What do slouching, back pain, and a middling forehand or weak shot off the tee have in common? Often it’s a weak core—the girdle of muscles, bones, and joints that links your upper and lower body. Your core gives you stability and helps power the moves you make every day. Whether it’s bending to pick up a laundry basket, swinging a golf club, paddling a kayak, or reaching to pull a vase from the top shelf of a cabinet, a strong and flexible core makes the move more fluid, efficient, and robust. Strong, well-balanced core muscles can also improve your posture and help prevent back injuries. And if back pain does strike, core exercises are usually part of the rehab regimen.

Core Muscles

Click image to enlarge.

Your core is composed of many different muscles in the abdomen, back, sides, pelvis, and buttocks. These muscles work together to allow you to bend, twist, rotate, and stand upright.

For all these reasons, more and more people are incorporating core exercises into their fitness routines. If you’re among them, or planning to be, it’s critical to pay attention to proper form. “Good form protects you from injury and helps you gain the most benefit from each exercise,” says Joy Prouty, a master trainer who helped develop Harvard Medical School’s Core Exercise report, which includes tips on proper alignment, form, and posture. “But when I walk around the gym, I see people doing these exercises the wrong way all the time.”

Lunges, squats, and planks (a move that looks a bit like a push-up and is often substituted for sit-ups) are key moves in most good core workouts. Sit-ups and crunches—once the bread and butter of core work—have fallen out of favor in recent years. Why? They can actually cause back pain, partly by focusing only on abdominal muscles. Exercises like planks efficiently work many more core muscles at once. So whether you’re launching into your first core workout or have been planking, lunging, and squatting your way to a tightly toned core for quite some time, reviewing the right—and wrong—ways to do these three fundamental moves is worthwhile.

Core Exercises: 6 workouts to tighten your abs, strengthen your back, and improve balance is available from Harvard Health Publications. You can read an excerpt here from the report with tips on checking and improving your posture.

Core Exerise #1: Plank

Right

  • Abdominal muscles are tight.
  • Shoulders are aligned directly over the elbows.
  • Body is properly aligned so that neck and spine are neutral. Model is looking down at the floor.
  • Shoulders are down and back.
  • Only toes, forearms, and hands are touching the floor.

Wrong

  • Head is lifted and neck is craned
  • Torso sags toward the floor. Only toes, forearms, and hands should be touching the floor.
  • Neck and spine are not in a straight line.

Core Exerise #2: Squat

Right

  • Knees, hips, and toes are pointing forward.
  • Buttocks stay above knee level.
  • Knees aren’t extending beyond toes.
  • Chest is lifted, and shoulders are down and back
  • Back is neutral, not arched.
  • Feet and knees are pointing straight ahead.
  • Shoulders, hips, and knees are even.
  • Abdominal muscles are pulled in.

Wrong

  • Back is arched, and chest isn’t lifted.
  • Arms are overextended.
  • Knees extend beyond her toes.
  • Knees and toes are turned in.

Core Exerise #3: Lunge

Right

  • Knee of the forward leg is aligned with the ankle.
  • Heel of the rear leg is lifted off the floor.
  • Back knee bends enough to form a straight line from shoulder to hip to knee.
  • Back is neutral, and chin is parallel to the floor
  • Shoulders and hips are even.
  • Abdominal muscles are pulled in.

Wrong

  • Body is slouching forward, not upright.
  • Knee is not properly bent to form a straight line from shoulders to knees to hips.
  • Back is curved and head is lifted.

*This blog post was originally published at Harvard Health Blog*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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