Personal Responsibility: A 'Manifesto' For Self-Care

The World Health Organization (WHO) Constitution states: ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being’. Reducing vulnerability to ill-heath implies human rights to the basic pre-requisites of health including access to information, education, nutrition and clean water1. Where these elements are in place, vulnerability to ill health is determined to an important degree by the choices of the individual. It is, of course, perfectly possible to be living without disease but leading an unhealthy lifestyle which makes future disease more likely or even inevitable.

This paper focusses on the responsibilities and even duties that healthy people have to maintain their own health, through self-care. Self-care for health has many elements including appropriate nutrition, sufficient physical activity and the avoidance of risks such as tobacco consumption2. Through self-care an individual can remain healthy into their seventh, eighth and ninth decades, prevent or delay ‘lifestyle’ diseases, and maintain mental health. Conversely, without successful self-care the emerging epidemic of lifestyle diseases threatens to swamp healthcare systems around the world.

The reasonable responsibilities of the average healthy citizen to care for themselves and help prevent lifestyle diseases are therefore of great interest, but have received relatively little attention. There is a substantial literature on the duties of healthcare professionals, rather less on the duties of the patient, and very little on the duties of the healthy individual3.

Individuals have a right to information and education on how to maintain good health but ultimately they bear the responsibility to take action. The environment in which we live and the support we receive from healthcare professionals can help determine our lifestyle choices, but we alone can make them. Therefore we propose that a manifesto for self-care is needed. This fundamental expression of the responsibilities of individuals to take care of their own health could serve as a touchstone to guide the development of enabling tools and policies.

SELF-CARE AND THE LIFESTYLE DISEASES CHALLENGE

The need for people to undertake self-care to prevent or delay ‘lifestyle’ diseases (also called non-communicable diseases) is particularly pressing. The incidence of these diseases – particularly heart attack and stroke, cancer, chronic lung diseases and diabetes – has reached epidemic proportions in most countries around the world. Worldwide, 63% of all deaths annually, an estimated 36 million people, are as a result of lifestyle diseases4. The proportion is much higher in the most developed countries – 88% of deaths in the UK and 87% in the USA for example5. Lifestyle diseases are projected to increase by 15% globally between 2010 and 2020. These diseases are often particularly costly to the individual and healthcare systems because of their chronic nature.

Lifestyle diseases are strongly associated with, and causally linked to, four behaviours: physical inactivity, unhealthy diet, tobacco use and the harmful use of alcohol. Up to 80% of heart disease, stroke and type-2 diabetes, and over a third of cancers could be prevented by modifying these behaviours4,6. If people were to undertake more self-care, the benefits to themselves, their families, and to the health systems that serve them would be enormous. However for this to happen there are significant challenges to be overcome.

Firstly people have to recognise what is healthy and unhealthy and, having recognised that they are at risk through their lifestyle choices, possess sufficient knowledge to know what action to take. With some behaviours (e.g. smoking) the risks are relatively well known and the action to be taken clear, however difficult. For others the judgements involved can be more difficult and influenced by evolving societal norms.

A warning lesson is provided by the trend towards the ‘normalisation’ of being overweight. A substantial proportion of overweight men and women think they are ‘about the right weight’7,8. Manufacturers of clothes have increased the space in clothes without changing the label size – ‘size inflation’ in clothing9. A recent study showed that 79% of parents of overweight children did not recognise that their offspring were overweight10, and of those who did, 41% did not perceive this to be a health risk.

The implication of evolving societal attitudes is that being overweight or even obese could become ‘normalised’, rather than approached as a serious but preventable personal and public health problem. People can only accept responsibility for their health if they can agree about what is unhealthy.

The medical consequences of being overweight are clear: the risk of coronary heart disease, ischaemic stroke and type 2 diabetes grows steadily with increasing body mass, as do the risks of cancers of the breast, colon, prostate and other organs. Chronic overweight contributes to osteoarthritis, a major cause of disability. Globally, 44% of diabetes burden, 23% of ischaemic heart disease burden and 7-41% of certain cancer burdens are attributable to overweight and obesity6.

Even when a problem is recognised, knowing how to deal with it can be demanding. People may recognise that they lead an unhealthy lifestyle through inactivity or an unhealthy diet, but may still struggle to know what action to take. Mixed messages in the mass media and the plethora of biased information online may contribute to lack of clarity about what constitutes a healthy lifestyle.

There is no shortage of sound, practical, evidence-based advice on healthy lifestyles11,12,13, but this guidance is often assumed to be aimed primarly at those with responsibility for supporting individuals to change behaviours, rather than to the individuals themselves. To be effective at a population level, these initiatives have to change societal attitudes to what is accepted as normal and this necessarily involves everyone11.

We suggest that an important part of this change is attitudinal and involves people accepting responsibility for their own lifestyle rather than devolving responsibility for their future health to health care professionals or the government.

ACCEPTING RESPONSIBILITY FOR SELF-CARE: THE MORAL GROUNDING

The moral imperative to keep healthy through self-care is based in part on responsibility to others, primarily:

1. Other users of public healthcare services i.e. to current and future patients, and
2. Future generations, including one’s own children.

Current and future patients.
In a resource-constrained healthcare system, medical treatment offered to one patient represents an opportunity cost to other patients with potentially more pressing healthcare needs. We have a duty to others whenever our choices impact on them. People leading healthy lifestyles and practising self-care for self-limiting conditions will consume fewer healthcare resources, leaving more capacity to treat those requiring those resources most.

People readily accept responsibilities that recognise the needs of others in many spheres of society. Cars and properties have to be maintained so as to be at least minimally safe with regard to others as well as to the primary user. Smoking bans in public spaces are now ubiquitous and widely accepted public health measures. The excessive consumption of alcohol, tobacco smoking, an inactive lifestyle or an unhealthy diet may all appear to be purely personal choices but as the cause of lifestyle diseases which consume a large proportion of constrained healthcare resources, their impact on others should be similarly recognised.

Future generations.
Parents have a major influence on the lifestyle habits of their children, making parents suitable agents for change14. Children of parents who engage in physical exercise such as sports, who try to eat ‘5-a-day’ fruit and vegetables and who do not smoke are more likely to be aware of, and adopt, healthy habits when they are adults (and parents) themselves.

There is also a need to improve parental self-awareness of their children’s health determinants. As mentioned, it is well documented that parents are often unaware that their child is overweight10,15, or that their child’s weight poses a risk to their health16,17. Parents are, at least initially, primarily responsible for the lifestyle choices of their offspring and therefore for the consequences of those choices.

POTENTIAL OBJECTIONS TO THE IDEA OF PERSONAL RESPONSIBILITY FOR HEALTH

The ‘nanny state’ argument.
One possible objection to governments (local or national) encouraging more individual responsibility for health is that this implies some interference with personal choice. However, the healthy person who takes no steps to avoid lifestyle diseases will ultimately consume more healthcare resources than someone leading a healthy lifestyle. These resources are not just scarce but are also commonly held, being publicly funded. It does not seem unreasonable for society as a whole to expect individuals to behave responsibly when they have the opportunity to do so.

Popular opinion seems to support this approach – in 2004, The King’s Fund, an independent think tank, conducted a survey of more than 1,000 people and found that most favoured policies that combatted behaviour such as eating a poor diet and public smoking18. The ‘nanny state’ argument may have lost some force given the positive results of self-care enhancing policies such as public place smoking bans, mandated vehicle seatbelt and motorcycle helmet use.

The budget argument.
Some critics have suggested that promotion of self-care is driven by the vested interest of governments to curb their healthcare budgets by shifting responsibility to the individual. But even if healthcare resources were abundant, people would still benefit personally from self-care. Within a financially constrained system, responsible use of resources is intrinsically important and has ethical weight. The disadvantaged in society may need more support to achieve self-care, but whatever their socio-economic status, giving the healthy the means and responsibility to take care of themselves frees resources to constantly improve the care of those that become ill. The moral imperative to conserve shared resources remains, irrespective of the size of those resources. And the moral imperative towards the next generation is much more than an issue of funding.

Objections on societal grounds.
There is a practical objection that placing duties or responsibilities upon people should take into account the societal context and external environment in which the individual lives. It is more difficult for an inner-city tower block resident to take exercise than it is for a person living near green spaces. There is a positive association between the density of unhealthy food outlets in a neighbourhood and the prevalence of overweight and obesity in children19.

It is clear that there may be structural circumstances that inhibit positive self-care behaviours, but these difficulties do not dissolve the responsibility for self-care. The disadvantaged in society may have particular difficulties in adopting a healthy lifestyle and will require more support from the community, and from the healthcare system, than those with more physical or financial resource available to them. Giving people the means to make healthy choices is a legitimate obligation for govenments and their agents. However this does not change the priniciple that ultimately the individual is responsible for the choices that they do make.

Goverments may try to ‘enforce’ self-care responsibilities.
An important question arises as to whether fulfilling self-care responsibilities will come to be seen as an expectation (assuming that monitoring behaviours is even possible).

Denying provision of healthcare services to people who have neglected to lead a healthy lifestyle would be highly contentious, and in the context of societal inequalities that skew the ability to adopt such a lifestyle, morally indefensible. Nevertheless, there are clearly adverse consequences for the individual who adopts an unhealthy lifestyle, apart from ultimate ill-health. Those that smoke or drink heavily pay considerable taxes in the process. If one seeks health insurance, smoking, drinking alcohol to excess and evidence of being overweight will all have a marked effect on the level of premium paid.

Disincentives to an unhealthy lifestyle therefore already exist, and are a legitimate tool of government policy.

DEVELOPING PUBLIC POLICY APPROACHES

Establishing the principle of individual responsibilities in health leads to the question of what mechanisms and supports could be provided to help people with a potentially challenging objective.

Some general policy directions are clear. Policies which focus on supporting positive behaviours in healthy people are more appropriate and useful than those which penalise sick people. Policies which are universal in their application are also likely to be better accepted than those that appear to target individuals. For example, if the evidence continues to mount for the role of sugar in causing obesity and diabetes, then a general ‘sugar tax’ has clear advantages compared with penalising the obese.

The influence of public policies on the ability of people to self-care is extensive. Self-care may be substantially outside the reach of health and social systems, but many government policy decisions have a bearing on the practice. The UN 2011 resolution on Noncommunicable Diseases, Article 3620 illustrates this:

…(We) recognize that effective non-communicable disease prevention and control require leadership and multisectoral approaches for health at the government level, including, as appropriate, health in all policies and whole-of-government approaches across such sectors as health, education, energy, agriculture, sports, transport, communication, urban planning, environment, labour, employment, industry and trade, finance, and social and economic development…

Many programmes and policies which impact on self-care and lifestyle behaviours have already been implemented around the world. However, the results of these programmes have not been assessed and organised systematically. A consolidation of programme documentation and outcomes would provide a valuable reference database for policymakers and programme managers, and provide the basis for planning a comprehensive, articulated research strategy. In addition to providing evidence for policy-makers, a systematic review of such data could help to identify practical ways and means which could help individuals to undertake lifestyle changes.

THE SELF-CARE RESPONSIBILITIES OF HEALTHY PEOPLE

We suggest that healthy people should aim to preserve and promote their own health and wellbeing so far as it is reasonably open to them so to do. They should follow a healthy lifestyle through being aware of, and following, health promotion guidelines. This means that they should eat a healthy diet and avoid inactivity. They should not put their health at risk, for example, through smoking or consuming excess alcohol. They should seek to understand the risk factors for chronic diseases particularly relevant to them, and address them as far as possible.

The healthy person should not put at risk the health and safety of others when this can be avoided. Examples include not smoking in spaces shared with others, good hygiene practices in hand washing, in food preparation and when coughing or sneezing.

It is the responsibility of a healthy person to consume healthcare resources in a responsible way and therefore to self-care whenever possible for self-limiting illnesses.

People should also promote health and wellbeing in their families, not least their own children. Examples include encouraging their children to exercise, teaching them about healthy and unhealthy foods, and having them vaccinated.

There are clearly many qualifications and reservations in these proposed responsibilities. Questions obviously arise as to the meaning of ‘aim to’, ‘avoidable’ and so on. However, these are questions of scope and extent, which are open to debate, rather than matters of principle.

Figure 1: A Self Care Manifesto: Responsibilities and Expectations in Self-Care.

A MANIFESTO FOR SELF-CARE

Taken together, the responsibilities of the individual can be seen as  defining a ‘manifesto’ for self-care (Fig. 1). These responsibilities interact with, and are interdependent on those of healthcare professionals, and society as a whole, through government policy at a national and community level. This manifesto is proposed as an agenda and framework for discussion. There are gaps in our knowledge of what works in changing behaviour at the  level of the individual and thus a clear need for research to underpin future policy within this conceptual framework.

CONCLUSION

The Declaration of Alma-Ata, the International Conference on Primary Health Care in 197821 stated that ‘The people have the right and duty to participate individually and collectively in the planning and implementation of their health care’.

To a large extent the maintenance of good health is not a ‘gift’ of a government or a healthcare system, but a ‘purchase’ that each individual makes by expending some effort. There is an urgent need to accept the duty we owe to ourselves and each other to maintain our health through self-care. A world in which we believe that we have important duties in this regard, even where they are difficult to achieve, will differ materially from a world in which we continue to delegate the responsibility for our health to others.

We propose the ‘Self-Care Manifesto’ as a conceptual framework to consider a new alignment of responsibilities, whereby the healthy assume the principal responsibility for maintaining their own health, and other agencies and resources work to enable this to happen.

Correspondence to: David Webber, International Self-Care Foundation (www.isfglobal.org),
davidwebber@isfglobal.org

Acknowledgements: The authors are grateful to Professor H. Martyn Evans for comments.

Statement of Interests: The authors have no conflict of interest relating to the publication of this paper.

Funding: The International Self-Care Foundation is a charity registered in the UK.

References

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17. Park MH, Falconer CL, Saxena S, Kessel AS, Croker H, Skow A, et al. Perceptions of health risk among parents of overweight children: a cross-sectional study within a cohort. Preventive medicine. 2013;57(1):55-9.
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19. Cetateanu A, Jones A. Understanding the relationship between food environments, deprivation and childhood overweight and obesity: evidence from a cross sectional England-wide study. Health & place. 2014;27:68-76.
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This article originally appeared on the Self Care Journal and was written by D E Webber*, Z Guo*, S Mann**

4 Exercises to Prevent Back Pain From Cycling

Lower back pain is one of the most common injuries among cyclists. What you might not realize is that most of these injuries are due to muscular imbalances that can easily be prevented.

While serious conditions such as a herniated disc or a strained muscle warrant a break from the bike, most low-level chronic back pain that results from muscular imbalances can be fixed before resulting in injury.

A muscular imbalance occurs when the workload is not being distributed evenly or efficiently, and can cause certain muscles to work either too hard or not enough.

More: Exercises to Treat Shoulder and Neck Pain From Cycling

The transversus abdominus, or TVA—the deep abdominal muscles that wrap around the entire core—and the gluteus maximus are two common muscles that can lead to back pain if they aren't working efficiently. The correlation between weakness in these muscles and low back pain is directly related to the order in which these muscles activate.

If they aren't firing correctly, and in the right order, these muscles won't provide the stabilization needed to support the lumbar spine.

In a healthy person, the TVA should activate a fraction of a second before any movement takes place in the limbs. If the TVA doesn't fire, the pelvis and lumbar spine aren't properly stabilized during movement and the low back is allowed to move around too much, stressing the muscles of that area and eventually causing chronic pain.

More: How to Avoid Lower Back Pain While Cycling

The solution is to follow a core exercise routine that helps strengthen the TVA and gluteus maximus. Stay away from abdominal crunches; the crunch movement only exacerbates the rounded shoulders and tucked pelvis that contributes to low back pain.

Below are four core-strengthening exercises that will help to alleviate chronic low back pain. Start with one set of each exercise and rest 30 seconds between. Increase your repetitions gradually until you can complete 2 to 3 sets of each exercise.

Opposite Arm/Leg Reach

Start on your hands and knees. Keep the back of your neck long and don't look up or let your chin drop toward the ground. Gently pull your belly button up, being careful not to round your upper back. Keep your hips and shoulders parallel to the ground and lift your right foot and left hand at the same time...

More: 7 Simple Stretches for Cyclists

...Extend your left fingertips forward and squeeze your left gluteus. Hold this extension for 5 seconds before slowly returning to the starting position. Continue alternating sides until you have completed 10 repetitions on each side.

Prone Snow Angels

Lie face down on a mat with your arms extended along your sides (palms down). Gently squeeze your glutes and begin to raise your feet, chest and hands off the ground. Don't lift your feet more than 6 inches. Create a "snow angel" by sweeping your arms overhead and separating your feet. Without bending your arms, try to bring your hands together above your head. Return to starting position, take a deep breath, and repeat until you have completed 10 to 15 repetitions.

Shoulder Blade Squeeze

Start on your hands and knees. Place your hands directly below your shoulders as if you were going to do a push-up. Keep your arms straight and drop your shoulder blades down, squeezing the lower edges together. Don't let your low back sway or your chin push forward. Hold the shoulder blade squeeze for 5 seconds and release. Take a breath, then continue to repeat this 5-second hold until you have completed 10 repetitions.

More: 8 Single-Leg Exercises to Increase Power

Time Trial Position (Plank Hold)

The TT Hold is performed on your forearms and toes. The exercise is isometric and there should be no movement. Keep your elbows directly beneath your shoulders, and your feet should be 8 to 10 inches apart. Keep the back of your neck long and look down at the floor.

Work to bring your shoulder blades onto your back by squeezing them together slightly. Your lower back should not be excessively rounded, and your neck should be long (don't look up). Hold this position for 20 to 30 seconds. As you become stronger, extend the hold time.

This article originally appeared on Active.com and was written by Allison Westfahl

Avoid This When Foam Rolling

These days, foam rollers are everywhere — the gym, your physical therapist’s office, your living room and even your suitcase. After all, foam rolling has emerged as the darling of the fitness world and the cure-all for many different aches.

Essentially, foam rolling is a form of self-myofascial release, or self-massage, that gets rid of adhesions in your muscles and connective tissue. These adhesions can “create points of weakness or susceptibility in the tissue,” according to Chris Howard, C.S.C.S. and LMT at Cressey Performance. “If the muscle isn’t contracting uniformly from end-to-end, it could lead to injury and pain.” Foam rolling also increases blood flow to your muscles and creates better mobility, helping with recovery and improving performance.

Sounds great, right? Yes, foam rolling offers tremendous potential to relieve pain and help you move better — if used the right way. If not, you risk irritating, and possibly injuring, your body further.

Here’s a breakdown of five common mistakes people often make when using the foam roller.

Mistake #1: You roll directly where you feel pain. When we feel pain, our first inclination is to massage that spot directly. However, this might be a big mistake. “Areas of pain are the victims that result from tension imbalances in other areas of the body,” says Sue Hitzmann, MS, CST, NMT, manual therapist, creator and author of The MELT Method.

Let’s take the IT band, for example. Foam rolling is a commonly prescribed remedy for iliotibial band syndrome (ITBS). While religiously rolling out your IT band might feel good, “the idea that you are going to relax or release the IT band is a misconception,” Hitzmann says. The phrase roll out your IT band itself makes it sound like you are rolling out a piece of dough, but your IT band is anything but pliable. It’s a remarkably strong piece of connective tissue, and research has shown that it cannot be released or manipulated by manual techniques such as foam rolling. “If you iron out areas of inflammation, you can increase inflammation. And if you are in pain, your body will be too stressed to repair itself,” says Hitzmann.

The fix: Go indirect before direct. “If you find a spot that’s sensitive, it’s a cue to ease away from that area by a few inches. Take time and work a more localized region around areas that feel sore before using larger, sweeping motions,” suggests Hitzmann. For the IT band, work on the primary muscles that attach to the IT band first — specifically the gluteus maximus (the largest muscle in the buttocks) and the tensor fasciae latae (a muscle that runs along the outer edge of the hip).

Mistake #2: You roll too fast. While it might feel great to roll back and forth on a foam roller quickly, you’re not actually eliminating any adhesions that way. “You need to give your brain enough time to tell your muscles to relax,” says Monica Vazquez, NASM certified personal trainer and USA Track and Field Running Coach.

The fix: Go slower so that the superficial layers and muscles have time to adapt and manage the compression. Feel where the tender spots are with the roller, and use short, slow rolls over that spot. “There’s no reason to beat up the whole muscle if there are only a few sensitive areas,” Howard says.

Mistake #3: You spend too much time on those knots. We’re often told that if you feel a knot, spend time working that spot with the foam roller. However, some people will spend five to 10 minutes or more on the same area and attempt to place their entire body weight onto the foam roller. If you place sustained pressure on one body part, you might actually hit a nerve or damage the tissue, which can cause bruising, according to Vazquez.

The fix: “Spend 20 seconds on each tender spot then move on,” Vazquez recommends. You can also manage how much body weight you use. For example, when working your IT band, plant the foot of your leg on the floor to take some of the weight off the roller.

Mistake #4: You have bad posture. Wait, what does your posture have to do with foam rolling? A lot. “You have to hold your body in certain positions over the roller,” says Howard, and that requires a lot of strength. “When rolling out the IT band, you are supporting your upper body weight with one arm.” When you roll out the quads, you are essentially holding a plank position. If you don’t pay attention to your form or posture, you may exacerbate pre-existing postural deviations and cause more harm.

The fix: Work with an experienced personal trainer, physical therapist or coach who can show you proper form and technique. Or, consider setting up your smartphone to videotape yourself while foam rolling, suggests Howard. That way, you can see what you are doing right and what you are doing wrong, like sagging in the hips or contorting the spine.

Mistake #5: You use the foam roller on your lower back. “The thing that makes me cringe is when people foam roll their lower back. You should never ever do that,” say Vazquez. Hitzmann agrees. “Your spine will freak out and all the spinal muscles will contract and protect the spine.”

The fix: According to Vazquez, you can use the foam roller on your upper back because the shoulder blades and muscles protect the spine. “Once you hit the end of the rib cage, stop.” If you want to release your lower back, try child’s pose or foam roll the muscles that connect to your lower back — the piriformis (a muscle located deep within the glutes), hip flexors and rectus femoris (one of the main muscles in your quads).

Most importantly, understand what the origin of your pain is before you start. Know what you are trying to achieve through foam rolling and how to do it properly. And don’t forget to stick with it. “To get the benefits of self-massage, it’s repeated exposure that’s most important,” says Howard. “You have to show up and put in the work.”

This article originally appeared on http://www.huffingtonpost.com/2014/03/18/foam-rolling-mistakes_n_4980975.html and was written by Christine Yu

What To Do For Muscle and Joint Stiffness

Q: I went to see a chiropractor today to get orthopaedic lifts for my shoes, and he gave me a bit of an examination at the same time.

He told me that I was very stiff and I was likely feeling a lot of back pain. Actually I have no back pain but I am very stiff. I have always struggled with flexibility.

These days my upper shoulders and back of my neck are often sore and tight. I have been slowly working on some of the stretches on your website, but this guy wanted me to go see him and he would help me with adjustments, etc., etc.

I'm wondering if I can just rely on stretching (seriously 30 minutes a day) to regain flexibility and deal with these problems instead of actually seeing this guy.

A: Generally, my feeling is that it's best to see what you can accomplish with a regular stretching routine.

In the absence of chronic inflammation or pain from an acute injury, stiffness in the back, shoulder, and neck regions is typically caused by one or both of the following:

• Stiffness within the joints in the area

• Tight muscles

Joint stiffness can cause surrounding muscles to become tight from lack of use, and tight muscles can cause underlying joints to become stiff, also from lack of use. So for practical purposes, in addressing stiffness, it doesn't really matter which one is causing the other; the vast majority of stretches promote joint flexibility and healthy muscle length.

Chiropractic adjustments aim to prevent joint stiffness, typically by delivering a "short amplitude, high velocity" thrust through one of the planes through which the involved joints are designed to move.

Though chiropractic adjustments can be immensely helpful in promoting optimal joint motion, my experience has been that without regular stretching and awareness of daily activities and postures that are at the root of chronic stiffness, adjustments can become a short term fix.

In my opinion, it's better to adopt a lifelong program of stretching to establish and maintain healthy length and blood flow in all major muscle groups, which should help your joints and surrounding ligaments to stay healthy as well.

I would add foam rolling to your stretching routine, as I find it to be an invaluable tool for keeping muscles, ligaments, and the joints they service healthy.

Also keep in mind that beyond stretching and foam rolling, you can likely benefit from some resistance training that promotes a strong core and good body balance. For example, instead of doing conventional push-ups, by doing push-ups with one hand on the ground and one on a medicine ball, you force muscles, ligaments, and proprioceptors (joint receptors that register joint position sense) throughout your body to develop a high level of functional strength. By functional strength, I mean strength that your body can consciously and subconsciously use to stay balanced and be less prone to injury as you go about your daily activities.

Another example of an exercise that promotes good body balance is one-leg squats, where you keep your core strong, balance your weight on one leg, and do slow, controlled squats - even just a few degrees will yield big dividends to your functional core strength and balance.

But not to move too far away from your question, a regular program of stretching and foam rolling is where I would begin - this really needs to be the foundation of your self care program. If you try to do too much with strength and balance-related exercises without ensuring that your muscles are healthy and your joints are moving properly, you might just reinforce faulty patterns of being and moving.

Archive of Stretching and Foam Rolling Posts

After spending a few months taking care of your body, if you feel that you haven't experienced significant improvement and can use some help, that's when I might visit a chiropractor, physiotherapist, kinesiologist, or any other practitioner that specializes in functional movement work. If your stiffness is severe enough that you can't stretch and exercise effectively, then it makes sense to seek treatment from day one.

Find more info at: http://drbenkim.com/what-do-muscle-stiffness