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Stomach Sleeping - Perhaps Your Back's Worst Nightmare

After my first decade in practice as a chiropractor, and seeing occasional patients who were not at all responding to care as expected, I discovered that most often they had a common underlying problem: they were stomach sleepers -- for either all or some portion of the night. 

As soon as I became aware of a patient's sleeping habits, and recommended side or back sleeping instead, their back and neck conditions showed signs of rapid improvement.  The results were so markedly positive, I eventually wrote an additional question on the front of my intake medical history forms directly asking "Do You Sleep on Your Stomach?  [ ] Yes  [ ] No".

In so doing, I could identify this problem on a patient's first visit.  I began to tell people at the outset that if they continued to sleep on their stomach, even for as short a period as 5 minutes during the night, I probably would not be able to help them with their back and neck conditions.  This conveyed the message pretty clearly on how important it was to begin work immediately to completely eliminate this habit.

It's amazing, but in 28 years of practice treating hundreds of people, I've found only 2 patients who were not able to completely discontinue stomach sleeping!   It appears that there is a part of the mind that remains aware at night – ever so subtly -- when we are turning in our sleep.  Thus, we can teach ourselves new sleeping habits, even in later adulthood, and in my experience it has been quite possible "to teach old dogs new tricks". 

Stomach sleeping may be defined as any position where, in part or as a whole, your chest and stomach are in contact with the bed, and your head is turned to the side.  So many patients ask if the semi side-lying position with one leg up and one arm up at 90 degrees counts as stomach sleeping, and the answer is definitely "yes".

As a demonstration of how the stomach sleeping position is truly stressful, I often suggest to a patient during their 15-20 min. initial history taking interview, that if the stomach sleeping position is so comfortable, why not turn their chair sideways and conclude the rest of our interview with their head facing me, fully turned towards their shoulder.  Some of them try it for a moment, but after a short while we both laughingly agree that no one would never sit and talk to someone like this if they had the choice.  In other words, if we were conscious even for a few minutes, we would prefer a position with much less rotation of the head.  If our neck stiffens in a few minutes while fully turned, imagine the effect of hours spent with our heads in such a position all night.

From an anatomical perspective, sleeping with a full neck turn, especially with slight backward pressure as we lay on our stomach, shuts down many of the nerves exiting our spine in the neck region.  This probably contributes to a dulling of consciousness and the senses, and sleep sets in.   But this also causes spinal nerve pressure, which sets off cascades of abnormal reflexes, interfering with the brain's communication with vital parts of the body, such as the thyroid gland, organs in the throat and upper chest, and triggering muscle spasms in the shoulders, arms, and hands.   Many people who wake up with stiff necks or who get recurring headaches or neck pain can relate to these effects.  Recurring shoulder problems or numbness in the arms/hands are also very common.  Even if you don't wake-up with any noticeable problems, your weakened neck ligaments, irritated nerves, muscles, and joints may become easy targets for the slightest provocation by activities later in the day.  I had an 18 year old boy with intractable chronic neck pain who had developed clear arthritis, due only to a history of stomach sleeping; he never had any past injuries to his neck nor had he suffered any accidents or sports related trauma.  Not uncommon also were so many patients I've treated, young and old, whose complaints of recurring headaches finally cleared up after discontinuing stomach sleeping.

In addition to causing injury to the area of the neck, another portion of the spine which is typically traumatized in stomach sleepers is the lower back.  The region of our spine our rib cage is connected to (the thoracic spine) has vertebrae which are designed for turning; however the 5 adjacent vertebrae below this area (the lumbar spine), are built primarily for forward and backward bending, and they turn very little.  So when we stomach sleep, this transition area ends up suffering the most damage with our back twisted at night.  Thus spasm, nerve irritation, and weakening of the lower back at this vital spot can lead to problems early on in active individuals, especially athletes who do sports such as golf, racquet sports, baseball, etc., which involve a lot of turning of the torso.  It is a very common area of the spine to develop disc degeneration and arthritis early in life.  In addition to lower back pain, the nerves in this region supply the bladder, pelvic organs, and lower digestive tract, which can also become targets of regular irritation.

The best way to avoid the myriad of  adverse consequences of stomach sleeping is to retrain ourselves to sleep on our side or back.  Some people find that willpower and positive intention alone are sufficient to change the habit.  Other people need props like a pillow "wall" that alerts them when they are turning at night.  Some others find taping a Ping-Pong ball or similar object to their nightshirt provides a needed reminder if they are turning onto their stomachs in their sleep.

So what is the ideal way to sleep on one's side or back?  Here are some postural hints to maximize your support and comfort...   While side sleeping, it is good to use one pillow under your head that can be puffed-up to keep your neck more level horizontally, and another pillow between your legs to take pressure off the hip and back muscles.  While back sleeping, it is good to use one thin pillow under the head, which allows the head to sink down, avoiding any propped-up neck position.  Additionally, another pillow can be placed under the knees, raising them slightly to take pressure off the lower back.  With regard to pillow type, I recommend either a ‘down’ or ‘down alternative’ filling, allowing it to be flatter for back sleeping while also being more puffy for side sleeping.  I haven't personally found that the well advertised contour cervical pillows have been very helpful for my patients.  I don’t believe they truly re-shape the neck curvature, and often they have appeared to aggravate certain neck conditions in some individuals.  Thus, I am of the opinion that the most comfortable pillow is the best way to go.  With regard to recommendations for the best mattress types, please see my website for a more extensive explanation:
                                        http://depthhealing.com/files/Mattress_Reviews.pdf

So even during the portion of our day in which we are largely unconscious, it is clear that a lot can happen due to the effects of poor posture, especially if we consider 1/3 of our lives could be spent in positions which may be aggravating our spine and nervous system.  Ignorance is definitely not bliss, especially for the many patients I’ve treated who suffered the pain and effects wreaked by stomach sleeping --  not only interfering with their day-to-day activities, but also compromising their athletic performance.  Stomach sleeping can clearly create long term damage to the spine and nerves, speeding  degeneration and arthritis, and likely aggravating organ systems in our body.  It's important to consider taking time now to develop proper side and back sleeping postures which can contribute substantially to our long term health, vitality, and wellbeing.  It's a relatively easy fix!

The Un-realized Health Hazzards of Plastic Water Bottles

Dear Readers,

I just received an e-mail which was very informative and quite alarming regarding the growing health and environment hazards posed by the use of plastic water bottles.  It is definitely worth a quick read, and has some great information on safer alternatives...  Here is a link to the website below.

https://www.waterfiller.com/home/information

Warm wishes,
Dr. Michael

Food Handling Safety Tips Everyone Should Know

I just completed an on-line learning program about food handling which is required for all food workers in the Washington State because I will be up there helping out on a retreat.

Even though I have taken numerous courses during my years of medical training and have passed tests before for food handling in my teens and twenties for summer jobs, etc., I can't believe how informative this 30 minute on-line course is.

There are so many opportunities for contaminating food due to our incomplete understanding of correct practices in the kitchen, I recommend everyone in your household who is involved in preparing and storing food watch this excellent presentation!

At the end of the course you are asked if you want to receive a Food Worker's Card good for WA State, but you obviously needn't apply for one.  This is just a very good education to keep you and your family safe from food borne illness which can produce chronic intestinal problems and serious diseases.

Click on the following link to begin the course... it's truly worth a few minutes of your time ;-)..

www.foodworkercard.wa.gov

ARE CHIROPRACTIC DOCTORS SIMILAR TO PHYSICAL THERAPISTS OR MASSAGE THERAPISTS? WHAT TYPE OF EDUCATIONAL TRAINING DO THEY RECEIVE?

Chiropractic doctors undergo a course of training after college which includes 4 years of chiropractic medical schooling, followed by 1 year of internship, and then often by 1 or 2 years in an associateship or preceptorship to further learn a specialty. They have a license similar to a medical doctor, dentist, or osteopath, etc., who are all primary care physicians.

Physical therapists usually have a minimum of 2 years of college, followed by 2 years of physical therapy school. They then become licensed "therapists" who require the orders of a medical doctor, a chiropractic doctor, or osteopath, etc., to legally treat patients.

Massage therapists are not required to have a college degree, and currently there is no statewide requirement in California for certification. Different cities have their own licensing requirements, ranging from a few month course of a minimum of 100 hours in Northern California to a minimum of 500 hours of massage education for most of Southern California.

CHIROPRACTIC EDUCATION

After college, it may require as much as 5 to 7 years of further study before a Chiropractic Doctor enters into private practice! The education process for a Chiropractic Doctor (D.C.) is much like that of a Medical Doctor (M.D.), Dentist (D.D.S.), or Osteopath (D.O.). After college, the Chiropractic Doctor completes 4 years of education at an accredited chiropractic university. This is followed by 1 year of internship at a university affiliated clinic.

After graduating, Chiropractic Doctors must pass several stringent National Board Examinations, then take oral, written, and practical examinations for the states in which they choose to practice. Oftentimes, Chiropractic Doctors will then decide to enter a 1 or 2 year associateship or preceptorship in an existing clinic which emphasizes treatment methods in which they wish to specialize. This does not mark the end of the education process! Chiropractic Doctors are required to complete yearly postgraduate courses for license renewal and to stay current on the latest scientific research.

WHICH YOGA EXERCISES MAY BE DANGEROUS

I have treated many yoga students as well as many yoga instructors, and I have found that about 25-30% of the postures they are doing in their yoga routines could be quite injurious to their spines.  If you have any questions about your individual yoga practice, it is good to consult a chiropractic doctor who can examine your spine and make specific recommendations to you for your ideal exercise routine.


Potentially Dangerous Yoga Postures Include:

(1) Bending while twisting -
Especially triangle poses and their modifications. Research has shown that bending as little as 30 degrees forward (or more) with any amount of twisting will rupture disc fibers!

(2) Straight leg lifts -
Such as Boat pose, leg lifts, the 'bicycle' are often advocated as "core" strengthening exercises for your abdominal muscles. They aren't, they actually use your "hip flexing" muscle (psoas muscle) which attaches to your spine and puts undue stress on your lower back. Many military personnel and athletes come to my office as a result of low back pain from doing leg lifts and full sit-ups.

(3) Full Sit Ups -
Again, while these are often advocated as "core"strengthening exercises, they also use predominantly your "hip flexing" (psoas) muscles. These exercises are one of the main reasons military personnel come to me for low back problems after basic training! A better alternative exercise would be "crunches", which strengthen only your abdominal muscles.

(4) Head or Shoulder Stands -
While there are many benefits to inversion, the dangers of head and shoulder stands greatly outweigh their benefits. The plough posture is o.k., but too much spinal stress occurs from these other weight bearing inverted yoga poses, and permanent ligament, disc damage, and cartilage damage could occur. Using a "Roman chair" or other form of inversion machine would be a much better alternative.

(5) Neck Rolls -
Rotating the neck for flexibility can and will aggravate underlying joint problems. There are many other forms of safe and effective stretches for the neck.

(6) Ballistic Movements -
Stretching should involve very conscious, slow, and precise movements, done over a 30-60 second period of time, without any bouncing, flinging, or fast (ballistic) movements. This will result in a more lasting length change for the muscles being stretched, and minimize the chances for injuries.


Please click on the following link below for a chart of some examples of
dangerous yoga poses you should avoid. This chart is not comprehensive,
and depending on your spinal condition, there may be more exercises your doctor would suggest avoiding for the long term or just temporarily.


CHART OF POTENTIALLY DANGEROUS YOGA POSES


* ALWAYS CONSULT YOUR DOCTOR BEFORE BEGINNING ANY FORM OF
STRETCHING OR STRENGTHENING EXERCISES! *

CAN I DO YOGA OR ANY EXERCISES INSTEAD OF SEEING A CHIROPRACTOR?

When we have stiffness or pain in the body, we cannot always tell if we have a problem involving only a muscle or if we also have a joint problem, which may involve the malfunctioning of the vertebrae within our spine.

When attempting to treat spinal problems primarily with yoga or exercise, if you are unsuccessful, or if your problem worsens, further yoga or exercise may prove dangerous. Yoga and exercise are designed to restore movement and function to the spine as a whole, but research has shown that individual inflammed, fixated, or degenerating joints of the spine may persist and even be worsened by attempted stretching or strengthening exercises. Once a skilled chiropractic doctor treats you and restores proper function to the problem areas of your spine, when inflammation subsides, stretches and other exercises can then be very beneficial and supportive to healing. Chiropractic care, proper stretching and strengthening exercises, and massage are each vital parts of a "holistic" approach to successfully treating spinal and joint conditions.

I have treated many yoga students as well as many yoga instructors, and I often have found that about 25-30% of the postures they are doing are potentially quite dangerous. If you have any questions about your individual yoga routine, it is good to consult a chiropractic doctor who can examine your spine and make specific recommendations to you for your ideal exercise routine.