Mar 2, 2021

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Scot: The podcast is called "Who Cares About Men's Health." We talk about health things here to make it seem normal, and also to educate you as well. And we're some guys that are not afraid to say we care about our health. It's cool to care about your health. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I also care about men's health.

Scot: No, Troy, say like you mean it. Come on. One more time, with feeling.

Troy: Scot, this is Troy. And I really care about my health and men's health. I love men's health.

Scot: Perfect. A little less sarcasm next time. And we have Dr. Chris Gee on. Go ahead. Say your thing.

Dr. Gee: How do I follow up with that, right?

Troy: You could do it a little more sincerely than I did.

Dr. Gee: Yeah, I'm Dr. Chris Gee. I'm a sports medicine physician for the University of Utah, and I care about men's health.

Scot: Today's topic: forward head posture. It's something that you see . . . do you see this a lot now? I mean, with people in their phones and their devices, looking at monitors, computer monitors, do you just walk around and go, "Oh my gosh, look at that person, look at that person, look at that person"?

Dr. Gee: For sure. Once you start thinking about it, I think we all start to adjust our posture a little bit, and I'll start talking about it to patients and notice they start to sit up more appropriately and take notice.

Scot: All right. So I'm going to make a confession. I'm going to try to keep this somewhat reasonably timed. I have this forward head posture. I think I've had it my whole life. Some other names for it, by the way . . . these are good. Have you heard other names for it, Dr. Gee?

Dr. Gee: I've heard the dowager's hump. That's one I've heard.

Scot: Yep. That's great as a guy.

Troy: Scot has a dowager's hump.

Scot: Yeah, as a guy, that's exactly what you want to hear about yourself.

Troy: Dowager. Didn't we figure dowager is like an old British lady or something like that? It's a British term for some hunched over old lady.

Scot: I think so. It's an old lady. So some other terms that they use, they call it text neck, iHunch, iPosture, nerd neck, poking chin posture, computer neck, and tech neck. I could imagine programmers looking at their monitors all day. And if your eyesight is little bad, I suppose you're probably sticking that head out just a little bit more.

Troy: I like tech neck. That's a great one.

Scot: I don't like any of them, Troy. I look at people that have the proper posture, and I'm just jealous of them all the time.

Troy: I like the term. I like the term "tech neck." I'm not asking for tech neck, but I like it.

Scot: They have that rounded hump. So I've been trying to untangle that, Dr. Gee. And I know that this is a problem that a lot of people have. So where should we start? Now, I'm going to confess, I have been doing some exercises, but I want to hear your take.

Dr. Gee: So just a little anatomy, when we look at our spines, they're not straight up and down. They actually have a normal curve. So in our lower back, it actually curves kind of with the apex of the curve towards your abdomen. In your back, your upper back, your thorax, the curve goes the opposite direction, kind of with the apex towards your back. And then our necks do the opposite. They kind of curve towards the front.

Now, what that ends up doing is when we relax our posture, when we allow our muscles to not contract, we basically start to slip or exacerbate some of those curvatures. And so our neck curves more to the front, putting our head more forward. Our back curves out, causing that hump effect.

And this is really a problem because so much of what we do logically is in front of us, and as we're focusing in on smaller items, phones, and desktops, and computers, we allow our shoulders to rotate forward, and we allow our head to move forward. And we basically lose a lot of that appropriate posture in our neck and back, and it exacerbates this and causes a lot of pain and dysfunction for people.

Scot: I mean, for me, a big part of it obviously . . . I saw a picture of myself just a couple weeks ago from the side that somebody took, and I'm just like, "Oh my God, that's terrible." I don't want to have that the rest of my life. But I also put this in the category of nagging health issues, and you can tell me . . . it sounds like you're saying the same thing. You've got a structural compromise, right? So we start making accommodations. Then, as a result, muscles stop doing the job that they're supposed to do. They atrophy or other muscles get tight, and they're not able to do the job they're supposed to do. Is that kind of what's going on there?

Dr. Gee: Exactly. If you're not using a muscle routinely, it's going to lose its strength and its control. It's not going to go away entirely. It's just not as strong. And when you look at our spines, they are surrounded with muscle. So if we tend to be looking more at something in front of us, our neck is going to pull forward, and we're going to be using the neck muscles in the front, but not in the back, and we're going to lose some of that control. And it's going to naturally go into that position where it's kind of head forward, hunched back position that none of us like to see in ourselves.

Scot: Is part of that now because when it gets worse and worse, those back neck muscles are getting weaker and weaker, so to make it better, do you just strengthen those?

Dr. Gee: Yeah. It's one thing when you . . . everybody can kind of sit up straight and bring their shoulders back. But there are some things that we should be doing to kind of keep these muscles strong. And you want to balance them. You want to think about your neck muscles maybe in the front are getting extra work. They're stronger. The muscles in the back of the neck are getting weaker.

And so you want to work on stretching those anterior muscles and strengthening the posterior muscles, or the muscles in the back, so that you effectively, if you looked at your spine kind of in cross-section or across it, you would see that the muscles that are in the front are as equally strong as in the back and they can hold position throughout the day without getting fatigued and getting into that position.

Troy: So, Chris, I'll share with you one thing, and I don't know if it's something you've tried or have used with anyone who has had this issue, but something that's helped me is a Pilates exercise. And it's called swimming, if you just Google "Pilates swimming."

So basically, you're lying flat on the ground, stomach on the ground, you lift your back legs up, and your front legs are up, and your head is back, and then you're kind of up and down alternating like you're swimming.

And I'll tell you, I've dealt with this, and have dealt with a lot of thoracic spine pain, mid-thoracic pain. I know we've talked about it before. I don't know if you've used this or recommended similar exercises or have other things you've recommended for people, but it's one thing I've tried to do that seems to help.

Dr. Gee: For sure. That's a great exercise. As we're looking at these areas, one of the other things that we'll often see is we tend to focus less on our backs and more on our anterior parts of our bodies, obviously. So, for example, in the arm, you always want to have your big biceps, right? Nobody cares as much about their triceps. And the same thing with your upper back, your thorax. You want to have a nice healthy pec muscle, but we care less about what our backs look like.

And so, because of that, we tend to have a lot more musculature there. Like you talked about in that Pilates swimming position, you're basically stretching out the anterior chest, getting those muscles kind of stretched in the pec, but at the same time, strengthening the back muscles that are going to pull your shoulder blades back, open up your chest, and get you in a better position.

So yeah, a couple of things I'll have people do is . . . you can do this in your office, or your home, or wherever. Basically, you put your hands on either side of a doorjamb and lifting your arms up to about 90 degrees and just kind of step into the doorjamb and just let that stretch your anterior chest. You'll feel kind of a pull in your in your pec muscles, your chest muscles.

You can even do it more by bringing your hands up kind of to that 90-degree position. So you bend your elbow 90 degrees with your hand up over your head, and your arm out to 90 degrees as well. And then doing that. Letting that stretch the anterior chest can be helpful.

And then working on strengthening those back muscles like Troy was talking about, there's a number of different ways you can do that. I like the swimming kind of thing. I'll have people sometimes lay down just flat on the ground, so you're on your face, and you can work on having your arms straight out to the side, and just even just lifting them up off the ground, almost like a leg lift but for your arms. You're just lifting them up off the ground. That's going to stretch the chest, strengthen the back. You can even add weights to kind of lift up some of that.

Those things can be helpful to open the chest, strengthen the back, and get you where you need to be.

Troy: This has come up before too. I've even seen just some studies that looked at just simple back exercises, essentially doing the same thing you're talking about with that motion on the ground, but just while you're sitting at your desk, just moving your shoulders back and trying to touch your scapula together behind . . . just reaching back far. And that seems to at least also give you a little bit of a stretch and maybe some strengthening in the back as well.

Dr. Gee: Exactly. So when I've had patients that are coming in and they've got a problem with this, I will basically have them set a reminder on their phone. Sometimes, it has to be every hour, sometimes a couple times a day, just their alarm goes off and they say, "Oh, yeah, I need to do my exercises."

Those are super simple where you're sitting at your desk, you just sit up a little more straight, pull your shoulder blades together, and you do that four or five times, just tightening the muscle between your shoulder blades. That'll help to kind of open that up.

And then I'll even have them do some chin translations or kind of pulling their neck back. So this might be a little weird to describe. But what people can do is you basically want to not extend your neck, so you're not tipping your head back, but you're pulling your head backwards.

So imagine if you stand up against a wall, and you push your head back against the wall, so you're kind of pushing it back there. You can do this with your hand behind your head. You can kind of push back and just work on pulling your head back, and then you push it forward to kind of stretch the muscle and pull it back and push it forward. Almost like a cobra strike. But those can be really helpful.

Troy: I was going to come up with something else. I was going to call the chicken head. It's like a chicken walk.

Dr. Gee: There you go.

Troy: That's not nearly as cool as the cobra strike, so I like your word better. Let's go with cobra strike.

Scot: If you're going to try to cure your dowager's hump, you need a really cool exercise.

Troy: Do the cobra head, the cobra strike. Exactly.

Scot: So yeah, I went into a physical therapist, and they gave me some exercises to do. But what I really like what you said that I think can help somebody as they're working through these exercises . . . because you can find I think a lot of the ones online. And if you want to have somebody work through it, then a physical therapist appointment is great.

But it's this notion of stretching and strengthening. So you're stretching one muscle and you're strengthening the opposite muscle, which, as I start doing the exercise, it took a couple weeks, but I started becoming more in touch with, "My pectoral muscles were tight," or I started coming in touch with some of my back muscles that apparently must have been tight as well.

I just really had to stick with it for a couple weeks. Now, how long is it going to take me to actually get over this?

Troy: That's a tough one, and it depends a lot on how good you are or consistent you are about doing these things. If you think about it's taken you your entire life to this point to develop that posture, it's going to take you some time, sometimes some months, to correct that posture and to get yourself into a position where you naturally just sit in that pose.

And that's where I tell people, too, sometimes they're starting off doing these exercises hourly, but sometimes it can get down to where maybe towards the end of the day, you have an alarm go off on your phone, and you go, "Oh, yeah, just check your posture. Just make sure you're doing all right," and pull yourself back up where you need to be.

Scot: I'm noticing, too, after doing the exercise, I became more aware too of my posture when I was walking, or when I was sitting, and when I'd stick my head out. I have a weird thing where I actually tip my head back. Does that make any sense?

Dr. Gee: Yeah. I mean . . .

Scot: I've got a picture of it if you want to see. But when I'm walking or sitting, instead of just having a nice straight kind of thing going on, I tip my head back. I don't know. Am I trying to support the weight by resting it on my spine or what?

Dr. Gee: Just neutralizing the size of your head maybe?

Scot: I don't know.

Troy: Your gigantic head.

Dr. Gee: Yeah. A lot of times, what I tell people is it's important to think about those things. And the fact that you have a picture and you've looked at that and said, "Hey, I'm doing this," those are very insightful.

A picture is worth a thousand words sometimes. When you see yourself sitting in a certain way, and you said, "That's my posture?" and then you realize, "Okay, I need to adjust this." And sometimes it's a different muscle group that you need to strengthen so that your posture brings back into a normal way that's not going to cause arthritis and problems down the road.

Scot: I guess what it is, is I'm constantly looking at the sky or something, as opposed to if I kind of get back into the position that these exercises have taught me that I should be in, I'm looking more straight forward or even down just a little bit.

Troy: Well, do you think you're looking back to try and compensate? Is that your way of being like, "I can't hunch over. I've got to tilt my head back"?

Scot: No. It's the way I've been carrying my body, and I don't know what started it. I don't know if it's a result of this dowager hump, and now this is just three or four steps down the chain of degradation. I don't know.

Dr. Gee: Yeah, that's interesting.

Troy: You're a medical mystery, Scot.

Scot: I am a medical mystery. True.

So as I've been doing some of these exercises and even becoming more aware of my posture and trying to get my head from that forward position back into more of a neutral position, am I going to notice some muscular tension/soreness? Is it going to get fatiguing after a while when I'm sitting the right way after I've done it wrong for so long?

Dr. Gee: That's a great point. And yes, you actually should. Like I mentioned another time, if you are working out a muscle appropriately, you're stretching it, you are kind of breaking it down a little bit, and causing it to hypertrophy and get stronger. And so if you're doing it right, you're probably going to feel a little bit of soreness in that area. It might be a little tired. I wouldn't expect it to be painful. But if you feel like, "Ah, my back is a little tired from doing this," that shows me that you're kind of doing the right thing.

Now, over the long term, as those muscles get strong and they get balanced out, you should have less pain in your back because of the fact that now everything is equal. You're not over-pulling one direction or another. And that will prevent a lot of pain down the road.

Scot: And I'm noticing it between my shoulder blades kind of gets tired after a while. Would that be one of the places?

Dr. Gee: Yes, very much so. The rhomboids are a group of muscles that sit in between your shoulder blades. And they tend to be pretty weak in most of us just because of the fact that we pull our shoulders forward, we stretch those muscles out, and they don't really get activated as much as they should.

And so, yeah, feeling a little bit of soreness in there is fine. You can always use a little heat and ice to kind of calm some of that down. But most of the time, that's a good sign that you're using the right muscles and starting to get these stronger.

Scot: What about that bump, the actual physical bony bump process, that's sticking out? Sometimes I've noticed that now starts getting kind of sore in and around there. I don't think it's the bump itself. I think it's the muscles, but . . .

Dr. Gee: Yeah, exactly. There are muscles that go right alongside the spinous processes, which are the little bumps that stick out on your neck. And they're going to get activated. Their tendons attach right on to the bone, and so as they get used, that's going to get a little sore sometimes.

And it is normal . . . I should stress to people that the C7, kind of the bottom of your neck, top of your chest naturally does stick out a little more because of the change from one angle to another within the thorax to the neck. So it's impossible to make that perfectly straight, or it shouldn't be perfectly straight.

But working on building those muscles around there will get you in a good position to offload the weight of your head and neck, and allow them to prevent degeneration and arthritis and those things.

Scot: So it seems like if somebody is suffering from this . . . I think, for me, becoming aware was the first step. And believe it or not, it was those stretches and exercises . . . it took a couple weeks. Then I started becoming even more aware as a result of those stretches and exercises, and I'll catch myself periodically throughout the day and I've got to straighten stuff out again.

So becoming aware, I'd imagine, is the first thing, and then start doing some of those stretch and strengthen exercises would be the next step. Does that sound reasonable?

Dr. Gee: Totally. Yeah, just being aware of what your posture is. And sometimes . . . well, a lot of times . . . things like this, with a podcast to just make you think of it and go, "Oh, yeah, I should improve my posture." And then you start working on doing some of those exercises. That's going to remind you when you get into a bad posture, you're going to feel it a little bit more and, "Okay, straighten things back up."

Troy: And the thing I like about this, too, Chris, it's not like you're always thinking about your posture. I think for so long, I always felt like, "Oh, I have to think about it. I have to roll my shoulders back or walk around with a book on my head to practice my posture," or something. It's more like, "Hey, let's just stretch in the right spots. Let's strengthen the right spots." And then it sounds like the posture then follows naturally as you balance out that stretching and strengthening.

Dr. Gee: Yeah, exactly. It's really one of those things that as the muscles get stronger, they're going to hold it in a better position and they're not going to let that crouch forward as often. And so, yeah, being aware, gradually increasing the strength and stability, you're going to notice that posture improve over time.

Scot: Some very good tips today. Thank you very much for helping me through this. I'll keep doing my stretches and my exercises. And thank you for caring about men's health.

Dr. Gee: Yeah, excellent. Glad to help out.

Scot: Our core four we talk about is nutrition, activity, make sure that you're mentally healthy, and get that sleep. And this falls in the mental health category.

I wanted to talk about an article I found that is titled "Five Strategies for Cultivating Hope This Year." This is from a website called The Conversation.

First of all, Troy, do you know the difference between hope and optimism? There is a difference, and I found this fascinating.

Troy: Maybe hope is more focused on a specific thing, like you're hoping for something, where optimism is more just your general outlook on life and what happens to you.

Scot: Yeah, you're pretty close. On the optimism, you got that part right. According to this article, optimism is a general expectation that good things will happen in the future. So it's about expecting good things. However, hope is defined as the tendency to see desired goals as possible.

Troy: That's interesting. It's kind of like optimism is more . . . yeah, like you said, it's more your outlook, but hope is more something that drives you to action. I like that.

Scot: And optimism, too, comes with a very dark side, which is you tend to then avoid the negative and the real sometimes, and that's not necessarily mentally healthy as well. Sometimes you do have to face that type of stuff, those roadblocks and failure, where people . . . With hope, they realize that stuff is going to happen, and they deal with it, as opposed to optimism perhaps avoiding it.

So this article, hope versus optimism, talks about then how you can cultivate hope. And the first thing you need to do is just do something. So imagine an act and start with goals. So pick something, and then decide that you're going to do it, and set some goals, set a path to help you get closer to that outcome that you want. So the first thing is just do something and start with goals.

The second thing . . . I thought this was fascinating. Nobody likes uncertainty, right? You kind of want to know what's going to happen. But number two in this article is harness the power of uncertainty. And they say that uncertainty is a reason for hope because it gives you the ability to perceive the possibility of success. It's not written in stone, "You're going to fail at this. Nobody has ever done this before." There's a chance that you might be able to achieve this. So that uncertainty actually helps feed hope.

Number three, manage your attention. They say hopeful people did not necessarily seek out emotionally positive information. However, people high on hope spend less time paying attention to emotionally sad or threatening information.

Number four, seek community. Don't go it alone. You've heard the saying "you are the five people you surround yourself with." So try to avoid negative interactions with people and connect with others who hold us accountable and remind us why our struggles matter.

And then number five, when you're trying to cultivate hope this year, according to this article in The Conversation, is to look at the evidence. So hopeful people stake their trust in data, particularly in the evidence of history. For example, the example they gave here, which I love, anti-poverty activists drew hope from knowing that historically, when people join together in resistance, they are actually able to create change.

So that is the article. That's the summary. I highly encourage you to go to theconversation.com and read "Five Strategies for Cultivating Hope This Year." But it's been a year where I think all of us could use a little bit of hope. And I think also that differentiation between Are you an optimistic person? I want to strive to be an optimistic person," it might not be bad, but I think striving to be a hopeful person is better.

"Just Going To Lave This Here." It might have something to do with health or it might be something completely random. Troy, go ahead and start for us.

Troy: Scot, I'm just going to leave this here. I was thinking recently about one of my teachers, one of my attending physicians in med school. This guy's name is Tyler Cymet. Great teacher. Great guy. But he seemed like he definitely wanted something named after him in medicine. You hear these different things, and they're named after different physicians or different researchers.

So he had named something on his hand after him. He called it the Cymet bump. And it's on your ring finger. It's the place where your pencil rests. I guess if you rest your pencil or pen on your ring finger, the bump you get there. He submitted it to a medical journal, and they rejected it. I looked him up recently, and I found out he finally had something named after him. It was some rare syndrome that's on his Wikipedia page.

So following in Dr. Cymet's footsteps, I have found something I am going to name after myself, and I discovered this on myself recently. It's on my thumb. It's on my right thumb. I don't know if you experience this as well. Maybe this is a phenomenon more unique to Utah where we have very dry weather and cold dry winters. But on my thumb, on the middle part of my thumb right next to my thumbnail, it's where I tap my phone as I'm typing with my right hand or tapping on my phone, I've got what I'm now going to call the Madsen fissure. It's a crack on my thumb, next to my thumbnail.

I probably need to really do more of a survey here to find out if other people have the Madsen fissure. But if so, I'm going to submit this to a medical journal, the Madsen fissure. Just keep your eyes out for it.

Scot: So the definition would be the crack in the skin that occurs from living in a cold, dry, arid climate when you use your cell phone?

Troy: Yes. Essentially, yes. So I will go down in history as having a crack named after me.

Scot: Oh, wow. I'm so proud.

Troy: You should be.

Scot: Just going to leave this here. I found kind of a new squat form thing that you could try. It's called a dumbbell drop squat, although I use a kettlebell. You take the dumbbell or the kettlebell, and you put both hands on it, and hold it between your legs. So you're standing up straight. I guess you kind of hold it straight in front of you. You're standing up straight, and you hold it next to your body right in front of you, so it's right in front of your hips, I guess. And then you just squat straight down so it goes down in a straight line.

And what I like about that is . . . I've done traditional barbell squats, that sort of thing. This squat kind of forces you to be in a little bit better form, so you can kind of learn your form. So if you've struggled with your squat form before, this is a good way to kind of do this exercise to get what it should feel like. It's kind of tough, because you end up staying in a little bit more of an upright position.

But anyway, I thought that was cool. You could Google it if you want to, a dumbbell drop squat. But perhaps something new to add to your exercise regimen, especially if you don't feel a lot of confidence about doing back barbell squats and eventually you want to get to the point where you can.

Troy: That's a kettlebell squat then.

Scot: Well, the way I saw it, it used a dumbbell, but I used a kettlebell because that's what I have.

Troy: So either way, it works.

Scot: Yeah, you could do it either way. Exactly.

Troy: Okay, nice. I have not done that. I'll have to check it out.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. Leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This is a transcript for the main segment of the show. You can read it if you like, but we encourage you to subscribe and listen for the full experience. It's more fun that way.

Scot: The podcast is called "Who Cares About Men's Health." We talk about health things here to make it seem normal, and also to educate you as well. And we're some guys that are not afraid to say we care about our health. It's cool to care about your health. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I also care about men's health.

Scot: No, Troy, say like you mean it. Come on. One more time, with feeling.

Troy: Scot, this is Troy. And I really care about my health and men's health. I love men's health.

Scot: Perfect. A little less sarcasm next time. And we have Dr. Chris Gee on. Go ahead. Say your thing.

Dr. Gee: How do I follow up with that, right?

Troy: You could do it a little more sincerely than I did.

Dr. Gee: Yeah, I'm Dr. Chris Gee. I'm a sports medicine physician for the University of Utah, and I care about men's health.

Scot: Today's topic: forward head posture. It's something that you see . . . do you see this a lot now? I mean, with people in their phones and their devices, looking at monitors, computer monitors, do you just walk around and go, "Oh my gosh, look at that person, look at that person, look at that person"?

Dr. Gee: For sure. Once you start thinking about it, I think we all start to adjust our posture a little bit, and I'll start talking about it to patients and notice they start to sit up more appropriately and take notice.

Scot: All right. So I'm going to make a confession. I'm going to try to keep this somewhat reasonably timed. I have this forward head posture. I think I've had it my whole life. Some other names for it, by the way . . . these are good. Have you heard other names for it, Dr. Gee?

Dr. Gee: I've heard the dowager's hump. That's one I've heard.

Scot: Yep. That's great as a guy.

Troy: Scot has a dowager's hump.

Scot: Yeah, as a guy, that's exactly what you want to hear about yourself.

Troy: Dowager. Didn't we figure dowager is like an old British lady or something like that? It's a British term for some hunched over old lady.

Scot: I think so. It's an old lady. So some other terms that they use, they call it text neck, iHunch, iPosture, nerd neck, poking chin posture, computer neck, and tech neck. I could imagine programmers looking at their monitors all day. And if your eyesight is little bad, I suppose you're probably sticking that head out just a little bit more.

Troy: I like tech neck. That's a great one.

Scot: I don't like any of them, Troy. I look at people that have the proper posture, and I'm just jealous of them all the time.

Troy: I like the term. I like the term "tech neck." I'm not asking for tech neck, but I like it.

Scot: They have that rounded hump. So I've been trying to untangle that, Dr. Gee. And I know that this is a problem that a lot of people have. So where should we start? Now, I'm going to confess, I have been doing some exercises, but I want to hear your take.

Dr. Gee: So just a little anatomy, when we look at our spines, they're not straight up and down. They actually have a normal curve. So in our lower back, it actually curves kind of with the apex of the curve towards your abdomen. In your back, your upper back, your thorax, the curve goes the opposite direction, kind of with the apex towards your back. And then our necks do the opposite. They kind of curve towards the front.

Now, what that ends up doing is when we relax our posture, when we allow our muscles to not contract, we basically start to slip or exacerbate some of those curvatures. And so our neck curves more to the front, putting our head more forward. Our back curves out, causing that hump effect.

And this is really a problem because so much of what we do logically is in front of us, and as we're focusing in on smaller items, phones, and desktops, and computers, we allow our shoulders to rotate forward, and we allow our head to move forward. And we basically lose a lot of that appropriate posture in our neck and back, and it exacerbates this and causes a lot of pain and dysfunction for people.

Scot: I mean, for me, a big part of it obviously . . . I saw a picture of myself just a couple weeks ago from the side that somebody took, and I'm just like, "Oh my God, that's terrible." I don't want to have that the rest of my life. But I also put this in the category of nagging health issues, and you can tell me . . . it sounds like you're saying the same thing. You've got a structural compromise, right? So we start making accommodations. Then, as a result, muscles stop doing the job that they're supposed to do. They atrophy or other muscles get tight, and they're not able to do the job they're supposed to do. Is that kind of what's going on there?

Dr. Gee: Exactly. If you're not using a muscle routinely, it's going to lose its strength and its control. It's not going to go away entirely. It's just not as strong. And when you look at our spines, they are surrounded with muscle. So if we tend to be looking more at something in front of us, our neck is going to pull forward, and we're going to be using the neck muscles in the front, but not in the back, and we're going to lose some of that control. And it's going to naturally go into that position where it's kind of head forward, hunched back position that none of us like to see in ourselves.

Scot: Is part of that now because when it gets worse and worse, those back neck muscles are getting weaker and weaker, so to make it better, do you just strengthen those?

Dr. Gee: Yeah. It's one thing when you . . . everybody can kind of sit up straight and bring their shoulders back. But there are some things that we should be doing to kind of keep these muscles strong. And you want to balance them. You want to think about your neck muscles maybe in the front are getting extra work. They're stronger. The muscles in the back of the neck are getting weaker.

And so you want to work on stretching those anterior muscles and strengthening the posterior muscles, or the muscles in the back, so that you effectively, if you looked at your spine kind of in cross-section or across it, you would see that the muscles that are in the front are as equally strong as in the back and they can hold position throughout the day without getting fatigued and getting into that position.

Troy: So, Chris, I'll share with you one thing, and I don't know if it's something you've tried or have used with anyone who has had this issue, but something that's helped me is a Pilates exercise. And it's called swimming, if you just Google "Pilates swimming."

So basically, you're lying flat on the ground, stomach on the ground, you lift your back legs up, and your front legs are up, and your head is back, and then you're kind of up and down alternating like you're swimming.

And I'll tell you, I've dealt with this, and have dealt with a lot of thoracic spine pain, mid-thoracic pain. I know we've talked about it before. I don't know if you've used this or recommended similar exercises or have other things you've recommended for people, but it's one thing I've tried to do that seems to help.

Dr. Gee: For sure. That's a great exercise. As we're looking at these areas, one of the other things that we'll often see is we tend to focus less on our backs and more on our anterior parts of our bodies, obviously. So, for example, in the arm, you always want to have your big biceps, right? Nobody cares as much about their triceps. And the same thing with your upper back, your thorax. You want to have a nice healthy pec muscle, but we care less about what our backs look like.

And so, because of that, we tend to have a lot more musculature there. Like you talked about in that Pilates swimming position, you're basically stretching out the anterior chest, getting those muscles kind of stretched in the pec, but at the same time, strengthening the back muscles that are going to pull your shoulder blades back, open up your chest, and get you in a better position.

So yeah, a couple of things I'll have people do is . . . you can do this in your office, or your home, or wherever. Basically, you put your hands on either side of a doorjamb and lifting your arms up to about 90 degrees and just kind of step into the doorjamb and just let that stretch your anterior chest. You'll feel kind of a pull in your in your pec muscles, your chest muscles.

You can even do it more by bringing your hands up kind of to that 90-degree position. So you bend your elbow 90 degrees with your hand up over your head, and your arm out to 90 degrees as well. And then doing that. Letting that stretch the anterior chest can be helpful.

And then working on strengthening those back muscles like Troy was talking about, there's a number of different ways you can do that. I like the swimming kind of thing. I'll have people sometimes lay down just flat on the ground, so you're on your face, and you can work on having your arms straight out to the side, and just even just lifting them up off the ground, almost like a leg lift but for your arms. You're just lifting them up off the ground. That's going to stretch the chest, strengthen the back. You can even add weights to kind of lift up some of that.

Those things can be helpful to open the chest, strengthen the back, and get you where you need to be.

Troy: This has come up before too. I've even seen just some studies that looked at just simple back exercises, essentially doing the same thing you're talking about with that motion on the ground, but just while you're sitting at your desk, just moving your shoulders back and trying to touch your scapula together behind . . . just reaching back far. And that seems to at least also give you a little bit of a stretch and maybe some strengthening in the back as well.

Dr. Gee: Exactly. So when I've had patients that are coming in and they've got a problem with this, I will basically have them set a reminder on their phone. Sometimes, it has to be every hour, sometimes a couple times a day, just their alarm goes off and they say, "Oh, yeah, I need to do my exercises."

Those are super simple where you're sitting at your desk, you just sit up a little more straight, pull your shoulder blades together, and you do that four or five times, just tightening the muscle between your shoulder blades. That'll help to kind of open that up.

And then I'll even have them do some chin translations or kind of pulling their neck back. So this might be a little weird to describe. But what people can do is you basically want to not extend your neck, so you're not tipping your head back, but you're pulling your head backwards.

So imagine if you stand up against a wall, and you push your head back against the wall, so you're kind of pushing it back there. You can do this with your hand behind your head. You can kind of push back and just work on pulling your head back, and then you push it forward to kind of stretch the muscle and pull it back and push it forward. Almost like a cobra strike. But those can be really helpful.

Troy: I was going to come up with something else. I was going to call the chicken head. It's like a chicken walk.

Dr. Gee: There you go.

Troy: That's not nearly as cool as the cobra strike, so I like your word better. Let's go with cobra strike.

Scot: If you're going to try to cure your dowager's hump, you need a really cool exercise.

Troy: Do the cobra head, the cobra strike. Exactly.

Scot: So yeah, I went into a physical therapist, and they gave me some exercises to do. But what I really like what you said that I think can help somebody as they're working through these exercises . . . because you can find I think a lot of the ones online. And if you want to have somebody work through it, then a physical therapist appointment is great.

But it's this notion of stretching and strengthening. So you're stretching one muscle and you're strengthening the opposite muscle, which, as I start doing the exercise, it took a couple weeks, but I started becoming more in touch with, "My pectoral muscles were tight," or I started coming in touch with some of my back muscles that apparently must have been tight as well.

I just really had to stick with it for a couple weeks. Now, how long is it going to take me to actually get over this?

Troy: That's a tough one, and it depends a lot on how good you are or consistent you are about doing these things. If you think about it's taken you your entire life to this point to develop that posture, it's going to take you some time, sometimes some months, to correct that posture and to get yourself into a position where you naturally just sit in that pose.

And that's where I tell people, too, sometimes they're starting off doing these exercises hourly, but sometimes it can get down to where maybe towards the end of the day, you have an alarm go off on your phone, and you go, "Oh, yeah, just check your posture. Just make sure you're doing all right," and pull yourself back up where you need to be.

Scot: I'm noticing, too, after doing the exercise, I became more aware too of my posture when I was walking, or when I was sitting, and when I'd stick my head out. I have a weird thing where I actually tip my head back. Does that make any sense?

Dr. Gee: Yeah. I mean . . .

Scot: I've got a picture of it if you want to see. But when I'm walking or sitting, instead of just having a nice straight kind of thing going on, I tip my head back. I don't know. Am I trying to support the weight by resting it on my spine or what?

Dr. Gee: Just neutralizing the size of your head maybe?

Scot: I don't know.

Troy: Your gigantic head.

Dr. Gee: Yeah. A lot of times, what I tell people is it's important to think about those things. And the fact that you have a picture and you've looked at that and said, "Hey, I'm doing this," those are very insightful.

A picture is worth a thousand words sometimes. When you see yourself sitting in a certain way, and you said, "That's my posture?" and then you realize, "Okay, I need to adjust this." And sometimes it's a different muscle group that you need to strengthen so that your posture brings back into a normal way that's not going to cause arthritis and problems down the road.

Scot: I guess what it is, is I'm constantly looking at the sky or something, as opposed to if I kind of get back into the position that these exercises have taught me that I should be in, I'm looking more straight forward or even down just a little bit.

Troy: Well, do you think you're looking back to try and compensate? Is that your way of being like, "I can't hunch over. I've got to tilt my head back"?

Scot: No. It's the way I've been carrying my body, and I don't know what started it. I don't know if it's a result of this dowager hump, and now this is just three or four steps down the chain of degradation. I don't know.

Dr. Gee: Yeah, that's interesting.

Troy: You're a medical mystery, Scot.

Scot: I am a medical mystery. True.

So as I've been doing some of these exercises and even becoming more aware of my posture and trying to get my head from that forward position back into more of a neutral position, am I going to notice some muscular tension/soreness? Is it going to get fatiguing after a while when I'm sitting the right way after I've done it wrong for so long?

Dr. Gee: That's a great point. And yes, you actually should. Like I mentioned another time, if you are working out a muscle appropriately, you're stretching it, you are kind of breaking it down a little bit, and causing it to hypertrophy and get stronger. And so if you're doing it right, you're probably going to feel a little bit of soreness in that area. It might be a little tired. I wouldn't expect it to be painful. But if you feel like, "Ah, my back is a little tired from doing this," that shows me that you're kind of doing the right thing.

Now, over the long term, as those muscles get strong and they get balanced out, you should have less pain in your back because of the fact that now everything is equal. You're not over-pulling one direction or another. And that will prevent a lot of pain down the road.

Scot: And I'm noticing it between my shoulder blades kind of gets tired after a while. Would that be one of the places?

Dr. Gee: Yes, very much so. The rhomboids are a group of muscles that sit in between your shoulder blades. And they tend to be pretty weak in most of us just because of the fact that we pull our shoulders forward, we stretch those muscles out, and they don't really get activated as much as they should.

And so, yeah, feeling a little bit of soreness in there is fine. You can always use a little heat and ice to kind of calm some of that down. But most of the time, that's a good sign that you're using the right muscles and starting to get these stronger.

Scot: What about that bump, the actual physical bony bump process, that's sticking out? Sometimes I've noticed that now starts getting kind of sore in and around there. I don't think it's the bump itself. I think it's the muscles, but . . .

Dr. Gee: Yeah, exactly. There are muscles that go right alongside the spinous processes, which are the little bumps that stick out on your neck. And they're going to get activated. Their tendons attach right on to the bone, and so as they get used, that's going to get a little sore sometimes.

And it is normal . . . I should stress to people that the C7, kind of the bottom of your neck, top of your chest naturally does stick out a little more because of the change from one angle to another within the thorax to the neck. So it's impossible to make that perfectly straight, or it shouldn't be perfectly straight.

But working on building those muscles around there will get you in a good position to offload the weight of your head and neck, and allow them to prevent degeneration and arthritis and those things.

Scot: So it seems like if somebody is suffering from this . . . I think, for me, becoming aware was the first step. And believe it or not, it was those stretches and exercises . . . it took a couple weeks. Then I started becoming even more aware as a result of those stretches and exercises, and I'll catch myself periodically throughout the day and I've got to straighten stuff out again.

So becoming aware, I'd imagine, is the first thing, and then start doing some of those stretch and strengthen exercises would be the next step. Does that sound reasonable?

Dr. Gee: Totally. Yeah, just being aware of what your posture is. And sometimes . . . well, a lot of times . . . things like this, with a podcast to just make you think of it and go, "Oh, yeah, I should improve my posture." And then you start working on doing some of those exercises. That's going to remind you when you get into a bad posture, you're going to feel it a little bit more and, "Okay, straighten things back up."

Troy: And the thing I like about this, too, Chris, it's not like you're always thinking about your posture. I think for so long, I always felt like, "Oh, I have to think about it. I have to roll my shoulders back or walk around with a book on my head to practice my posture," or something. It's more like, "Hey, let's just stretch in the right spots. Let's strengthen the right spots." And then it sounds like the posture then follows naturally as you balance out that stretching and strengthening.

Dr. Gee: Yeah, exactly. It's really one of those things that as the muscles get stronger, they're going to hold it in a better position and they're not going to let that crouch forward as often. And so, yeah, being aware, gradually increasing the strength and stability, you're going to notice that posture improve over time.

Scot: Some very good tips today. Thank you very much for helping me through this. I'll keep doing my stretches and my exercises. And thank you for caring about men's health.

Dr. Gee: Yeah, excellent. Glad to help out.

Scot: Our core four we talk about is nutrition, activity, make sure that you're mentally healthy, and get that sleep. And this falls in the mental health category.

I wanted to talk about an article I found that is titled "Five Strategies for Cultivating Hope This Year." This is from a website called The Conversation.

First of all, Troy, do you know the difference between hope and optimism? There is a difference, and I found this fascinating.

Troy: Maybe hope is more focused on a specific thing, like you're hoping for something, where optimism is more just your general outlook on life and what happens to you.

Scot: Yeah, you're pretty close. On the optimism, you got that part right. According to this article, optimism is a general expectation that good things will happen in the future. So it's about expecting good things. However, hope is defined as the tendency to see desired goals as possible.

Troy: That's interesting. It's kind of like optimism is more . . . yeah, like you said, it's more your outlook, but hope is more something that drives you to action. I like that.

Scot: And optimism, too, comes with a very dark side, which is you tend to then avoid the negative and the real sometimes, and that's not necessarily mentally healthy as well. Sometimes you do have to face that type of stuff, those roadblocks and failure, where people . . . With hope, they realize that stuff is going to happen, and they deal with it, as opposed to optimism perhaps avoiding it.

So this article, hope versus optimism, talks about then how you can cultivate hope. And the first thing you need to do is just do something. So imagine an act and start with goals. So pick something, and then decide that you're going to do it, and set some goals, set a path to help you get closer to that outcome that you want. So the first thing is just do something and start with goals.

The second thing . . . I thought this was fascinating. Nobody likes uncertainty, right? You kind of want to know what's going to happen. But number two in this article is harness the power of uncertainty. And they say that uncertainty is a reason for hope because it gives you the ability to perceive the possibility of success. It's not written in stone, "You're going to fail at this. Nobody has ever done this before." There's a chance that you might be able to achieve this. So that uncertainty actually helps feed hope.

Number three, manage your attention. They say hopeful people did not necessarily seek out emotionally positive information. However, people high on hope spend less time paying attention to emotionally sad or threatening information.

Number four, seek community. Don't go it alone. You've heard the saying "you are the five people you surround yourself with." So try to avoid negative interactions with people and connect with others who hold us accountable and remind us why our struggles matter.

And then number five, when you're trying to cultivate hope this year, according to this article in The Conversation, is to look at the evidence. So hopeful people stake their trust in data, particularly in the evidence of history. For example, the example they gave here, which I love, anti-poverty activists drew hope from knowing that historically, when people join together in resistance, they are actually able to create change.

So that is the article. That's the summary. I highly encourage you to go to theconversation.com and read "Five Strategies for Cultivating Hope This Year." But it's been a year where I think all of us could use a little bit of hope. And I think also that differentiation between Are you an optimistic person? I want to strive to be an optimistic person," it might not be bad, but I think striving to be a hopeful person is better.

"Just Going To Lave This Here." It might have something to do with health or it might be something completely random. Troy, go ahead and start for us.

Troy: Scot, I'm just going to leave this here. I was thinking recently about one of my teachers, one of my attending physicians in med school. This guy's name is Tyler Cymet. Great teacher. Great guy. But he seemed like he definitely wanted something named after him in medicine. You hear these different things, and they're named after different physicians or different researchers.

So he had named something on his hand after him. He called it the Cymet bump. And it's on your ring finger. It's the place where your pencil rests. I guess if you rest your pencil or pen on your ring finger, the bump you get there. He submitted it to a medical journal, and they rejected it. I looked him up recently, and I found out he finally had something named after him. It was some rare syndrome that's on his Wikipedia page.

So following in Dr. Cymet's footsteps, I have found something I am going to name after myself, and I discovered this on myself recently. It's on my thumb. It's on my right thumb. I don't know if you experience this as well. Maybe this is a phenomenon more unique to Utah where we have very dry weather and cold dry winters. But on my thumb, on the middle part of my thumb right next to my thumbnail, it's where I tap my phone as I'm typing with my right hand or tapping on my phone, I've got what I'm now going to call the Madsen fissure. It's a crack on my thumb, next to my thumbnail.

I probably need to really do more of a survey here to find out if other people have the Madsen fissure. But if so, I'm going to submit this to a medical journal, the Madsen fissure. Just keep your eyes out for it.

Scot: So the definition would be the crack in the skin that occurs from living in a cold, dry, arid climate when you use your cell phone?

Troy: Yes. Essentially, yes. So I will go down in history as having a crack named after me.

Scot: Oh, wow. I'm so proud.

Troy: You should be.

Scot: Just going to leave this here. I found kind of a new squat form thing that you could try. It's called a dumbbell drop squat, although I use a kettlebell. You take the dumbbell or the kettlebell, and you put both hands on it, and hold it between your legs. So you're standing up straight. I guess you kind of hold it straight in front of you. You're standing up straight, and you hold it next to your body right in front of you, so it's right in front of your hips, I guess. And then you just squat straight down so it goes down in a straight line.

And what I like about that is . . . I've done traditional barbell squats, that sort of thing. This squat kind of forces you to be in a little bit better form, so you can kind of learn your form. So if you've struggled with your squat form before, this is a good way to kind of do this exercise to get what it should feel like. It's kind of tough, because you end up staying in a little bit more of an upright position.

But anyway, I thought that was cool. You could Google it if you want to, a dumbbell drop squat. But perhaps something new to add to your exercise regimen, especially if you don't feel a lot of confidence about doing back barbell squats and eventually you want to get to the point where you can.

Troy: That's a kettlebell squat then.

Scot: Well, the way I saw it, it used a dumbbell, but I used a kettlebell because that's what I have.

Troy: So either way, it works.

Scot: Yeah, you could do it either way. Exactly.

Troy: Okay, nice. I have not done that. I'll have to check it out.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. Leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

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