Orthopedic & Pelvic Health Physical Therapy and Restorative Exercise Blog

Healing the core: Are you tensing up just a little too much?

6/13/2018

Healing abdominal wall separation (diastasis recti), urinary incontinence and pelvic organ prolapse

Many clients that I work with are coming in to see me in order to heal from abdominal wall separation (diastasis recti), urinary incontinence and pelvic organ prolapse. Our culture admires the look of rock hard bodies, and we are taught at a very young age to "hold it in", to look toned and fit.
Unfortunately, down the road, this holding and tensing interferes with our functional mobility, and the full range of motion of lengthening and shortening of muscle fibers.
What will it take for our muscle system to be at rest when we are at rest, and to be able to move through full range of motion when we are ready to move?

Rather than DO such and such exercise to strengthen this and that, we need to UNDO!

It takes practice to UNDO tensions. Our tension patterns are so hard-wired. Healing DR, UI and POP requires integration of the core system: head and neck, ribcage, diaphragm, abdominals, pelvic floor AND re-establishing new connection to our nervous system.
Try this right now:
Sit for a moment and notice your breathing.
Now start to nod your head up and down as if you are saying yes, or lift your arm up and down.
Did you hold your breath?
It is a simple move, and yet more than likely, you held your breath. We should be able to move and breathe at the same time.
When we hold our breath we are tensing muscles and increasing pressure into our body wall. This load to the tissue adds up over time. Doesn't this make you curious how often you might be holding your breath all day long? One of the keystones to healing the pelvic floor and the abdominal wall is to connect to our breath, allow the abdominals and pelvic floor to move, decrease the tensions in the neck, shoulder girdle, ribcage and lower back.

Core integration sequence: UNDOING tension in the neck and ribcage

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT. Helpful tips and other self care strategies can be found at www.alignforhealth.com.

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How to sit with a neutral pelvis and spine

11/9/2016

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There are so many different ways to sit yet most of us spend time sitting in chairs at work, at school, at the movies, etc. And yes, there a lot of different ways to sit in a chair, but mostly when we sit we are leaning back into the chair, allowing our spine and pelvis to collapse. Over time, this constant load onto the flexed spine, the sacrum and supporting ligaments can create muscular and connective tissue adaptations. If we can make some simple changes in our sitting habits, we can change the loads and environment within the tissues to improve blood flow, cellular remodeling to potentially get us out of a back ache or even a pelvic floor issue.

Neutral Pelvis

Neutral Pelvis with Prop

Neutral Pelvis & Spine

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Know Your Core

6/21/2016

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A big part of my time in a session involves education. Education and information for the client (anatomy, pain science, muscle function, etc.), and reeducation of the client's neuromuscular system. Our body is super smart; it finds a way to move and will continue to do this movement over and over again even though this particular strategy may not be the most effective for the health of the tissue or system. Part of my job as a therapist is to see the non optimal strategy and teach the client how to reeducate their system for health and longevity.
One of the biggest areas of poor strategies and body confusion is at the core. The core is an area of the body that has a lot of hype. Fitness pros are making bank teaching people how to strengthen their core to look ripped and lean. Unfortunately a "fit looking" core doesn't mean it is a functional core.

The Core

The core is the area where your head and extremities attach. We have an inner core: throat, diaphragm, deep abdominal (transversus abdominis), pelvic floor, deep back (multifidus) AND I personally like to include the psoas. The outer core is all of the other muscles.

Understanding how the core works

To understand the core, I like to start with the breath. Little do we know that many of us are 1) holding our abs in all day so that the muscles don't get to fully move and relax or 2) barely breathing.
In an ideal world, when we are at rest whether sitting or in standing, all of our muscles should be at their resting length. Muscles can generate the greatest amount of force at their resting length: not too short, or not too long.

Holding in abs: When we are holding are abs in all the time, the muscles are already contracted in the shortened position. When the body moves and the muscles are required for support, there is not adequate movement (because it is already shortened) to generate the greatest force. That means that the smooth orchestration of timing, coordination of the muscles have also been glitched. Misuse of the core happens and compensations result. Holding in the abdominals also increases pressure in the system: upward toward the diaphragm or downward toward the pelvic floor. These pressures and tensions can affect digestion/GERD, menstruation, organ prolapse, abdominal wall separation/hernias.
Barely breathing: Many people breathe shallow, with minimal diaphragm movement and mostly upper chest and neck movement. This does not allow for the natural active range of motion that should happen with each breath. On the inhale the diaphragm shortens, pushing downward to make room for the lungs to fill with air. As the diaphragm shortens, the abdominals and the pelvic floor oppose by lengthening. Then on the exhale, the abs and pelvic floor shorten and the diaphragm goes back to its resting length. This movement allows for blood flow, oxygen delivery, optimal muscle function and management of internal pressures. Shallow breathing can lead to a hyper-ventilatory state which can present as: increased tension, aches and pains, poor concentration and weird sensations in the body (numb, tingling).

I love this gif from Burrell Education. If you are interested in living your most healthy self, check out her programs: prenatal, postpartum and peri-menopause. Click on the pic to take you to her website.

The First Step to Strengthening Core:

The first step to strengthening the core is to move all the parts. The gif above shows the movement of the deeper canister: diaphragm, pelvic floor and abdominals. The abs and pelvic floor are opposing the diaphragm during inhale and exhale. Can you feel your pelvic floor move during breathing? Can you feel your abs move? You might notice that you can only move your chest at first. See if you can start to bring awareness into: upper abdominals, then belly button, then lower abdominals, then pelvic floor (typically I have people sense the anus- we are used to holding our sphincter muscles to prevent passing gas. See if you can let the sphincter go on the inhale, then notice if it lifts back up on the exhale). Don't force or try to take big breaths, just direct your focus. Allow your breathing to be effortless, inhale/exhale are balanced. Remember your core cannot be strong unless is can access it's full range of motion.
Know your core: 1) stop holding your core tight all the time (that includes wearing spanx) and 2) learn how to let your core move during breathing.

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Chair Busting

2/8/2016

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For many of us, our day is spent sitting at work, sitting at school and then we come home, maybe exercise and then sit and watch TV.
How can we minimize the deleterious effects of sitting? Stand more, walk more, and move more throughout the day. In this post I have included 3 chair busting strategies that emphasize strengthening the posterior oblique sling: gluteus maximus, thoracolumbar fascia and the opposite latissimus dorsi. This muscular sling is very important for lumbo-pelvic-hip stability during our gait and rotation patterns.

Get Moving!

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Healthy Nerves, Healthy Body

9/21/2015

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Do you know what it takes to have healthy nerves?
Our nervous system is comprised of 3 parts:

The central nervous system: brain and spinal cord.
The peripheral nervous system: nerves that exit the spinal cord and go to the head, torso and extremities.
The autonomic nervous system: responsible for control of the bodily functions not consciously directed, such as breathing, digestion, etc.

The brain, spinal cord and nerves are protected and encased in connective tissue. There are 3 membranes that line the skull and vertebral canal and enclose the brain and spinal cord. These layers are called the meninges: pia mater, arachnoid mater and dura mater.

The falx cerebri and the tentorium cerebelli are folds of the dura mater that separate the hemispheres and the cerebellum.

The dura mater surrounding the spinal cord. The dura mater is the outer most layer and is the strongest of the membranes.

The end of the spinal cord comes to a cone and then a fine strand (the filum terminale) attaches to the coccyx.

The outermost membrane, the dura mater extends from the base of the skull to the sacrum and coccyx. The dura is attached to the lining of the base of the skull and the upper cervical vertebra. Through the remainder of the vertebral canal, the dura does not attach to the vertebra until the end of the dural sac at the second sacral vertebrae. Extensions of the dura surround the nerve roots and continue into the connective tissue coverings of the spinal nerves. So this tube that protects the brain, spinal cord and the spinal nerves is pretty important! In order to have healthy dura and healthy nerves we need proper movement, hydration, nutrition and sleep to keep the connective tissue vital. A lot of our days are full of stress, spent in static positions that lead to neck or sacral compression (sitting at the computer, driving in the car) or repetitive movements that can stress and dehydrate the tissues. Try these movements to keep your nervous system healthy.

Exercises To Mobilize Your Nervous System

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Skinny Jeans and Your Pelvis

7/20/2015

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If you follow the news or stay updated with current events via Facebook or Twitter, you probably read the story about a woman who sustained nerve damage in both of her legs after helping her friend move. This woman wore skinny jeans and spent most of her day in a squat position cleaning out cupboards. By the end of the day her feet felt tight and numb and she couldn't walk, she kept losing her balance and falling. Apparently the jeans had to be cut off of her due to the swelling, and it took her 4 days in the hospital to recover.

When our body can't move freely and our tissues are compressed, this will lead to decreased blood flow, decreased nerve conduction and decreased tissue hydration. Over time this can lead to lymphatic congestion, stiff joints, poor circulation and pain. Tight pants also affect how we are able to sit, bend and squat. Have you noticed how you sit in yoga pants versus jeans or pants?

Here I am in tight pants. In the pic on the left I am sitting like I normally want to do: tucked and posteriorly tilted with my pelvis. The red line shows the tilt of my pelvis. On the right, I am trying to sit as best that I can to neutral with my pubis and ASIS vertical. The blue line shows how far I am from neutral.

Here I am in loose pants. In the pic on the left again I am sitting in a posterior pelvic tilt. In the pic on the right I have positioned my pelvis to neutral (I am a little off on this as shown by the blue line. Don't judge, my mobility is a work in progress).

Chronic positioning of the pelvis into a posterior tilt can lead to all sorts of bad things like:

Changes in pelvic organ position. A tipped uterus can cause painful menstruation, urinary frequency and urgency. For more info on this click here.
Changes in muscle and connective tissue. Tissue adapts to how it is used, so habitual chronic positioning sets the stage for potential low back issues, SI pain, decreased hip mobility, tight and weak pelvic floor, hip flexors, hamstrings and calves.
Meralgia paraesthetica, pain and numbness on the front of the thigh.
Digestive issues: abdominal pain, bloating, heartburn, indigestion.

Please consider how your pants might be affecting your pelvic health. Even if you wanted to try to sit with a neutral pelvis, your jeans may not allow you to get there. Sometimes it is the simple changes that get you moving in a healthy direction.

Neutral Pelvis in Sitting

Untuck Your Pelvis

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Freedom From Pelvic Pain

7/6/2015

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Freedom From Pelvic Pain owner, David McCoid and Katy Bowman, creator of Restorative Exercise™

David McCoid, owner of Freedom From Pelvic Pain with Katy Bowman, creator of Restorative Exercise™.

Back in May I travelled to the Netherlands to be a teaching assistant for the Restorative Exercise™ Specialist (RES) Certification Week. I was fortunate to meet so many amazing people from all over the world! One person that made a big impression on me was David McCoid (pictured here on the left). David certified as a RES back in April 2014 and was in the Netherlands for a few days to soak in the learning.
I got to chat with him on our commute one morning and was so blown away by his personal journey out of pelvic pain. As a pelvic health specialist, his experience really lit up for me: David lived with pelvic pain for 14 years, he travelled to see specialists in Italy for prostate injections, and in the US for pelvic PT treatments with renown therapists, and finally had pudendal nerve surgery (3 different times!).
Eventually he found Restorative Exercise™ and he was able to move himself out of pain! I was so inspired by his story that I wanted share his experience. Below is a link to our podcast Interview. Living pain free is possible!

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Exercises For Computer Posture

1/12/2015

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A common computer position

Computer posture:

Forward head
Upper cervical extension
Round (internally rotated and forward) shoulders
Hyperkyphosis of the thoracic spine
Flexion of the lumbar spine
Tucked pelvis
Stiffness in the entire body from long-term sitting

Does this look familiar? Look around your office... Let's face it, it is prevalent, and we all do it to some extent. Hopefully you know that this position over time is hazardous to your health.... Just say "no". This post is dedicated to beating the slump: 2 exercises to de-slouch the spine, and free up the neck, arm and shoulder girdle.

STEP 1: Get some stimulus to the lats and the muscles between the shoulder blades. As the arms have moved forward to type on the keyboard, these muscles are now resting in a lengthened position. This active shoulder girdle stretch takes the muscles into more of a stretch, just like a sling shot, so they can contract back into resting position.

STEP 2: Stretch the neck and arm. Lengthen the tissues in the entire arm and neck by holding onto a door jam and leaning away. This provides a traction stimulus to the wrist and shoulder, which is a wonderful reprieve after sitting hunched in a ball at the computer.

STEP 3: Get up out of your chair every 30 minutes. Walk to the water cooler, stretch your arms to the ceiling, stretch your legs, something simple before sitting down again.

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Self Care for Hip, Groin, and Back Pain

10/1/2014

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Result of Butt Gripping: The hip rotator muscles (the small arrows) pulls the greater trochanter of the femur (large arrow) moving the head of the femur forward or anteriorly.

This blog is for those of you who have hip pain, groin pain, hip impingement, sciatica, SI joint pain, or low back pain. And if you don't have any of these, then you are lucky and prevention is the best medicine!
Hip mobility is paramount for a healthy body and spine. During an evaluation I like to observe a static standing assessment, a functional movement assessment, and then perform a passive mobility assessment.
People with back/hip/groin pain often have a postural position of "butt gripping" (read a great article about it here Diane Lee). In this position, the pelvis is thrust forward and the deep hip rotators are contracted. When these muscles are overactive, they push the head of the femur into the front part (anterior) of the hip capsule which can interfere with hip motion: hip flexion (bringing the knee toward the chest) and internal rotation (turning the thigh inward).
On the functional exam I will see an inability to go into a deep squat, or the hips will shift to the opposite side during the squat. On the passive motion test there will be a limitation in hip flexion, and they may express pain with a combination of movements: hip flexion, adduction and internal rotation.
Standing in alignment and learning how to let go of the grip in the rotator muscles is essential for healing, as well as reprograming the normal glide of the head of the femur. In normal motion, as the knee moves toward the chest, the head of the femur should glide back and down. Due to the tightness of the rotators, the back (posterior) hip capsule can be restricted. Restoring the tissues and the hip motion can be achieved through simple self mobilizations.

Self Care Steps:

Standing alignment for back and hip health

1. Standing Alignment: vertical leg, torso stacked over the legs. Think about a plumbline going through the midpoints of the shoulder, hip, knee and front of the ankle bone.

2. Release Deep Hip Rotators: Lie down on your back with your knees bent. Place a tennis ball under your left butt cheek just to the side of your sacral bone. Rock your knees to the side and return to start position 3 times. Find a new spot and repeat. Complete in 3-5 different areas and then switch sides.

3. Hip Release and Hip Glides: this is a video demonstrating how to do the self mobilizations to regain normal motion.

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How to Squat

3/20/2014

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Posterior chain muscles used during the squat.

If you didn't know already, the squat is hot. Everybody is doing it..... The squat is one of the most effective ways to strengthen your glutes. But.... not every body is ready to bust the move and go deep into the squat position without losing their balance or hurting their knees.
This post demonstrates how to perform a double leg squat and a single leg squat with a vertical shin. A vertical shin helps take the load from the knees and puts the weight back into the posterior chain: hamstrings and glute max. The single leg squat also engages the gluteus medius, which is important for stabilizing the pelvis.

Double Leg Squat

Single Leg Squat

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<<Previous

Healing the core: Are you tensing up just a little too much?

Rather than DO such and such exercise to strengthen this and that, we need to UNDO!

Core integration sequence: UNDOING tension in the neck and ribcage

How to sit with a neutral pelvis and spine

Neutral Pelvis

Neutral Pelvis with Prop

Neutral Pelvis & Spine

Know Your Core

The Core

Understanding how the core works

The First Step to Strengthening Core:

Chair Busting

Get Moving!

Healthy Nerves, Healthy Body

Exercises To Mobilize Your Nervous System

Skinny Jeans and Your Pelvis

Neutral Pelvis in Sitting

Untuck Your Pelvis

Freedom From Pelvic Pain

Exercises For Computer Posture

Self Care for Hip, Groin, and Back Pain

Self Care Steps:

How to Squat

Double Leg Squat

Single Leg Squat

Author

FEEL GOOD SERIES:
Movement videos for download

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Archives

Rather than DO such and such exercise to strengthen this and that, we need to UNDO!

Core integration sequence: UNDOING tension in the neck and ribcage

Neutral Pelvis

Neutral Pelvis with Prop

Neutral Pelvis & Spine

The Core

Understanding how the core works

The First Step to Strengthening Core:

Get Moving!

Exercises To Mobilize Your Nervous System

Neutral Pelvis in Sitting

Untuck Your Pelvis

Self Care Steps:

Double Leg Squat

Single Leg Squat

Author

FEEL GOOD SERIES:Movement videos for download

Products I love:

Categories

Archives

FEEL GOOD SERIES:
Movement videos for download