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.

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). 

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. 

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.

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?  

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.

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.

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. 

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.alignintegrationandmovement.com.

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

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.

Recently I had a conversation with a doula about fetal positioning.  She and many of her doula colleagues have noticed an increase in clients that struggle during labor due to posterior positioning of the fetus.  Posterior occiput position is when the baby's head is down and facing mom's belly.  A normal presentation is when the head is down and the baby's head is facing the mom's sacrum as in the picture to the left.   I would like to share some information from the workshop I presented to our Salt Lake Birth Circle group.
Incidence and consequences of Occiput Posterior (OP):

• 15-30% present posterior at onset of labor  
• 5% presentation at delivery
• 5.5% of OP accounts for 12% of all cesarean deliveries for lack of progress or dystocia
• 7 fold increase in the incidence of 3-4th degree perineal tears (into anal sphincter) 

Penny Simkin, PT and author of  The Labor Progress Handbook attributes fetal malposition to cultural habits and trauma.
Cultural Habits:

• Slouching
• Crossing legs
• Sitting too much, driving
• Standing with pelvis imbalanced
• Too little or too much exercise

Traumas:

• Sport injuries/falls
• Motor vehicle accidents
• Assault
• Fears                                                                           

If you are in the Salt Lake area you can learn about the topics introduced in this blog and more, in my prenatal workshop, Birth Mechanics: Get Your Body Tuned up for Delivery.  

1.  Take a piece of blank paper.  Stand barefoot on the paper and outline your foot with a pen.  Take this paper to your closet and compare the width of your shoes to the outline.  Don't wear the shoes where you can't fit your toes in the toe box, and the outline extends beyond the shoe.  Notice that the shoe sits inside of the outline in some places; don't wear these shoes!  Find shoes that do not have a heel.  If you are used to wearing a higher heel you will need to gradually transition to lower heels so your tissues have time to adapt (give yourself 4-6 wks before you transition for each .5 to 1 inch).
2.   Learn how to stand in alignment.  See pic above. Or read this blog.
3.   Wear toe spacers.  Yes, you should be able to see space between your toes!  There are many products on the market. These are my favorite: Correct Toes.  Cool thing about these is that you can wear them in your shoes!  Very comfortable (but you have to have a wide enough toe box in your shoe). If you have a bunion you may want to test to see if this will be comfortable for you before purchase: take your big toe and pull it away from your other toes as far as you can, and then lift it up.  If there is discomfort in the joint then your toe is probably compressed, and it would be good for you to see me, or your local PT (or chiro, osteo, etc) to work with you.