Active Care Rehab


Respiration or breathing is not just important to maintain life and function of the organs but plays a role in the development of pain and pain syndromes. When breathing is not ideal one must use many other muscles to aid the body in expanding the lungs so sufficient amount of oxygen is taken into the lungs. It is estimated that 75% of individuals with pain or anxiety do not use proper respiration.

Ideal breathing is not as easy as taking a breath in through the nose and exhaling through the mouth. It consists of lung andlower rib cage expansion with 360 degree core expansion. The neck and shoulders should not be involved in proper breathing. Breathe Strong, Perform Better

Ideal proper breathing starts with proper core expansion and use of the diaphragm. When one inhales through the nose theentire core (belly, sides, and back) should expand due to dropping of the diaphragm. The air should be pushed downward towards the pelvis. The ribs should move downward and out while they expand. Exhaling should be performed slowly and naturally. You should not force air out of your lungs and exhalation should be twice as long as inhalation.

Proper respiration helps restore alignment of trunk and spine, decreases stress and over activity of muscles in the shoulder, neck and hips, improves oxygen consumption, and improves many more organ and nervous system functions. The most efficient way to stabilize the core is to breathe properly.

Improper respiration can aid in many dysfunctions and the development in pain. Many of us hold our stomachs tight to appear to be smaller than we are. Doing this blocks the diaphragm and does not let it push downward when we inhale. This decreases the strength of the protective muscles of the spine and hips.

When the diaphragm can not fall properly, other muscles have to assist in rib expansion. The neck and shoulder muscles pull the ribs upward, instead of them moving downward and out. This type of respiration can lead to shoulder and neck pain along with headaches.

Long term improper breathing can lead to overuse injuries and syndromes in the spine and extremities. Over using the neck and shoulder muscles can cause tendinitis in the shoulder and below, nerve entrapments that mimic carpal tunnel, and disc injuries in the spine. See the exercises to help correct your breathing.

Yours in Health,

Dr. Justin Hildebrand

Active Care Rehab

Lower Cross Syndrome and Anterior Hip

LCSLower cross syndrome is named for the crossing tightness and weakness that occurs in the lower back, core, and hip muscles.  In LCS, tightness of the low back muscles crosses with tightness of the iliopsoas (hip flexors) and rectus femoris (main quad muscle). Weakness of the deep abdominal muscles crosses with weakness of the gluteus maximus and medius.

This pattern of imbalance creates joint dysfunction, particularly in the lumbar spine, pelvis, hips, and knees. Specific postural changes seen in LCS include anterior pelvic tilt, increased lumbar curve, and knee straightening. Stress is increased on the low back and hips due to tight muscles and can cause pain in the low back when running, walking, and standing for long periods of time.

LCS is common in females, individuals that sit for most of the day and individuals that perform repetitive activities such as running and jumping. Many common injuries that plaques the active person can stem from LCS. Treatments for lower cross syndrome consist of postural training, Active Release/Graston on overactive muscles, and rehab exercises for underactive muscles. Additional home treatments for Lower Cross are foam rolling the quad and anterior hip muscles, Nature Made High Potency Magnesium 400 mg – 150 Liquid Softgels
for overactive and sore muscles, and anti-inflammatory nutrition for proper healing. Anti-inflammtory book.

Foam Roll

In Lower Cross Syndrome the anterior hip is chronically tight and lacks motion due to muscle overactivity and posture. If one can not move through the anterior hip, the low back has to become hypermobile or have too much motion. This can lead to low back pain and inhibition or weak core muscles.

The anterior hip consists of the large muscle of the quadriceps, Rectus Femoris, and the large hip flexor, Psoas. When these muscles become chronicalant hiply tight, the anterior hip capsule or ligaments begin to shorten. Now the hip can not translate or move through its proper range of motion and the gluts are put into a weakened, elongated state. The lumbar spine compensates by increasing its curve which causes the core muscles to weaken and shut off.

This process leads to overuse of the low back and pain, glut and core weakness, and hip impingements. If you have hip or low back pain, and/or Lower Cross Syndrome the click here to see this weeks exercises.

Yours in health

Dr. Justin Hildebrand

Active Care Rehab

Lumbar Disc Injury Prevention

The low back consist of five lumbar vertebrae and the sacrum or “tail” bone. Between these vertebrae are discs that act as ligaments and allow the spine to be flexible. A disc is a little like a jelly donut, with a softer center encased within a tougher exterior. When the discs become irritate they can begin to migrate posterior or backwards and cause pain. When the disc migrates it can become a bulge or herniation.

Many factors play a role in disc herniation. The most common are flat-back posture (plumber’s crack), prolonged sitting, working in a slumped position, and incorrect lifting/bending posture. All of these factors place increased pressure on the disc and can lead to irritation and possible herniation.

The symptoms of disc irritation or herniation are pain in the low back, buttock or hip (most common) and radiating pain down one leg. Pain is generally worse in the morning and subsides with movement, increases with sitting or driving, and is irritated with changing of position such as sitting to a standing and rolling over in bed.

According to the Mayo Clinic “Conservative treatment… relieves symptoms in nine out of 10 people with a herniated disk. Many people get better in a mo

nth or two with conservative treatment.” Treatments consist of correcting seated posture, adjusting activities of daily living, corrective exercise, and treating dysfunctions with manipulation, Active Release, and anti-inflammatory nutrition.

The classic disc presents with the symptoms: pain in the low back and/or buttocks area that may or may not travel down one leg. The pain is generally in the SI joint or back of the hip. It will increase with sitting or being slumped over.

The disc patient generally has a flat low back and tight posterior muscles. The hamstrings are tight so the patient can not generally bend down and touch their toes easily and the “piriformis” muscles are tight so sitting in a cross legged position is not comfortable. This presentation generally looks as if the back is rounded and the buttocks is clinched while standing.

Most disc presentations state “I just bent over to pick something up and had pain in my back.” Repetitive flexion (bending) or rotation movements set up the low back for injury.

So if you are dealing with disc-like symptoms click here to see rehab exercises.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab, Manual Therapy

The Importance of Hip Mobility: The Posterior Hip

In this weeks post we are going to discuss the importance of the posterior hip and what the lack of movement in the hips does to the body.

Being able to move through the hips is very important in any athletic movement but also in day to day activities. Every time one goes to sit down, squat, or bend over proper posterior hip movement is crucial and necessary for injury prevention.  Without proper posterior hip movement the lower back and knees are put under tremendous stress and have to work much harder than they should.

The posterior hip is made up of primarily six muscles, a fibrous joint capsule and the hip joint. These muscles help rotate the leg and control pelvic stability. When they have to over-work to control the pelvis they become tight and restrict hip motion. Once motion has become restricted, the hip capsule then begins to shrink further limiting motion. Treatment of the posterior hip is a combination of mobilization, soft tissue techniques such as Active Release Techniques and/or Graston, and home rehab exercises.

Individuals that lack posterior hip mobility and have tight hip external rotators commonly have a posture that is termed “Butt Gripper”.  This is due to the appearance that one is squeezing the buttocks muscles together and the flattening of the low back.

The “Butt Gripper” appears to not have a well-defined back side and is aware that they are not very flexible, especially in the hamstrings and hips. Their lower back will be very flat if not rounded and may have trouble finding pants that fit or stay up on their waist. This individual may be guilty of showing off his “plumber’s crack” when bending over or stumping down.

“Butt Grippers” appear to have very strong back, hip and core muscles, but they actually have very weak core and glut stabilizing muscles. This posture and weakness places them at higher risk for lumbar disc injuries and low back pain. If you or someone you know is a “Butt Gripper” check out the posterior hip exercises by clicking here.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab

Desk Job Hurting Your back?

Our bodies are bipedal, meaning that we were meant to stand on two feet. Sitting for long periods of time is biomechanically insufficient and places large amounts of stress on the spine. Sustained sitting can cause specific muscles to become shorter and joints to become hypomobile.

Classic seated posture:

Classic Seated Posture
Classic Seated Posture
  • Places one’s head forward and rolls the shoulders, shortening muscles that commonly cause headaches.
  • The shoulder blades more upward and outward increasing tension in the neck and shoulder muscles and inhibiting the stabilizing muscles of the shoulder blades.
  • The mid back and low back round out forming a kyphosis, placing the disc of the spine under uneven pressure.
  • The hip flexor muscles are shortened and the gluts are inhibited which can lead to Lower Cross Syndrome.

Commonly, sitting at a desk for a sustained period of time causes headaches, shoulder and/or neck pain, mid back pain, or low back pain. All of these can be prevented or decreased by taking microbreaks and performing a simple exercise.

A Microbreak consists of standing up, stretching and walking about for 30 secs. This should be performed every 30 minutes to an hour that one is sitting. Performing microbreaks will decrease the risk of muscles becoming shorter and joints becoming stiff.

Bruegger’s exercise will help relax short muscles and help strengthen inhibited muscles due to sitting.


  1. Sit down and spreading your feet shoulder width apart and your toes out.
  2. Pretend there is a string pulling your chest up and out, extending your upper back.
  3. Your arms should be at your side with your head looking straight in front of you.
  4. Gently tuck your chin and rotate your palms forward.
  5. Hold position for 30 secs every 30 minutes seated.
Corrective Exercise for Seated Posture
Corrective Exercise for Seated Posture


– You might feel a slight muscle squeeze between your shoulder blades, but not a strong contraction.

– You should still be able to talk when your chin is tucked, if you are unable to talk, relax a little bit!

Next time you are at your desk and you start to feel tension or pain, try taking a microbreak and performing Bruegger’s exercise. You will notice that you can sit for longer periods without pain.

Yours in health,

Dr. Justin Hildebrand