Tension in the piriformis muscle can trigger irritation of surrounding tissues.  The sciatic nerve exits the pelvis just below the piriformis.  When there is dysfunction in the lumbo/pelvic/hip complex, the piriformis often gets overworked, creating compression and friction on the sciatic nerve.  Sciatica is defined as aching/burning/stinging pain along the distribution of the sciatic nerve: buttock, back of the thigh, lower leg and foot.
Stretching the piriformis can be a very effective way of diminishing the compression, and therefore irritation of the nerve.  Pictured to the left is a very common stretch given as treatment to relieve sciatica.

A traditional piriformis stretch, is often done with a tucked pelvis (and/or flexed spine) and can irritate the nerve if the leg is pulled  too aggressively.  Instead, using the wall and props can be an effective way of maintaining a neutral spine and pelvis. By staying in alignment, and by being able to adjust the load by gradually bending the knee to 90 degrees, the tissues will begin to yield and let go, rather than work to hold the body in position.  
Picture on the left: The half cylinder and block supports my shoulders and head to allow me to rest with a neutral spine, with my ribs down and a level pelvis.  Due to my current tension patterns, I also have to support my lumbar area with a rolled yoga mat so I can comfortably attain neutral pelvis (pubis and ASIS level).  
Middle picture:  I place my left leg straight on the wall and cross my right leg over the left, making sure not to tilt the pelvis. Picture on the right:  I begin to slide my heel down the wall and stop when I feel that I am at my resistance barrier, or my pelvis begins to shift.  Hold at least one minute and repeat on the other side.  If you can tolerate the stretch stay longer, up to 5 minutes on each side.

Some people will try to get a deeper stretch by pressing the right knee down.  Make sure that you don't drag your whole pelvis when you do that (as shown in the pic on the left).  The purpose of this refinement is to maintain neutral, and that means a level pelvis (as shown on the right).   
Even if you don't have sciatica, this is a wonderful stretch to open the hips, and allow more freedom to your pelvis!  Enjoy!

Legs on the wall pose is a restorative position that should be a staple for every person that has a pelvis! Traditionally, the pose is taught by placing the butt close to the wall, and then bringing the legs up against the wall so the back of the legs touch, and the soles of the feet are facing the ceiling.  A variation to the pose is to widen the legs into a "V" position to stretch the inner thighs and groin.


Recently I have rediscovered the beauty of this pose by modifying the position to be able to maintain neutral pelvis (pubis and ASIS in line) and rib alignment.  The benefit of maintaining the alignment markers during this pose allows the connective tissue and muscles to fully release.  When the alignment markers are not in place, there is more load to the tissues which can potentially maintain tension, and prevent a full yield ("letting go") of the muscles and fascia.

In order to do this pose in alignment, you may need to get out props.  Due to the tightness of my psoas muscles and the increased kyphosis of my thoracic spine, I have used a thin yoga mat rolled up to maintain neutral pelvis: pubis and ASIS level, and a half cylinder & block to prop up my upper back to get my lower ribs down and flush with my abdomen. In order to get my pelvis level, I needed to scoot away from the wall, get the props set up, and then place my legs on the wall (see pics below).  

Benefits to Legs on the Wall Pose:

• Gently stretches the back of the legs, inner thighs and low back to relieve aches and pains
  
• Improves lymphatic/venous return from the feet and legs 
• Eases stress/anxiety
• Alleviates symptoms of menstrual cramps, PMS and menopause 
• Helps testicular and ovarian problems
• Relieves swollen ankles and varicose veins

In my practice I work with a lot of people who have low back pain, and sacroiliac (SI) pain.  How we stand, how we sit, and how we move in our bodies over time, contributes to our dysfunctions and potential pain syndromes.

Being mindful of HOW we stand and sit are simple steps to begin to unravel the increased loading and compression on the spine and SI joints, as well as the tension and pull on corresponding ligaments and muscles. 

Before going over standing and sitting, let’s look at the anatomy:  The pelvic girdle is comprised of the 2 pelvic (inominate) bones and the sacrum.  The inominate bones join in the front by a thick fibrocartilage disc similar to that of the vertebral discs.  This area is called the pubis or pubic symphysis.  In the back, the inominate bones attach to the sacrum, creating the sacroiliac joints.  

The function of the pelvic girdle is to transfer the loads between the trunk and the lower extremities via the spine and hips (lumbopelvic-hip complex).  There are 35 muscles that attach directly to the pelvic girdle.  Therefore, the mobility and stability of the SI joints depends on the interaction of these muscles, ligaments, fascia and nerves that surround the pelvic girdle.

Sucking in the stomach
Pulling in the gut to “look” slimmer freezes and shuts down the diaphragm, not to mention increases pressure in the cavities above and below.    Read more about sucking in here:  So my client learned how to breathe.

Tension in the pelvic floor
All muscles need to be able to contract and relax optimally.  When the pelvis is out in front, the muscles in the pelvic floor are held in a shortened position.  When there is increased pressure in the abdomen and pelvic cavities from sucking in, the pelvic floor muscles try to create balance by increasing contraction to maintain continence.  Chronic tension means decreased blood flow, decreased oxygen, decreased waste removal = potential for pain signals.  So, my client learned how to relax her pelvic floor.

Very shortly my client returned to the clinic with noticeable improvements:

Within a week she felt less heaviness and pressure in her vaginal area.  She felt pressure only with heavy lifting. She possessed the education to continue her home program from the initial visit and we added gluteal strengthening to her program.  

Two weeks later she returned to clinic reporting continued improvement.  She was able to walk and perform yard work without any discomfort!  She had a follow up visit with her midwife who reported upon exam significant reduction of prolapse!  She was given additional functional movement reeducation for her home program.  I will follow up with her in a month and more than likely discharge treatment.   

Moral of the story is this:  if you feel pressure or heaviness in your vaginal area postpartum (or at any time),  get it taken care of, go see a pelvic health physical therapist.  Or contact me for more information!

The first movement is called the Rhomboid Pushup.  Complete 5-10 repetitions.  Make sure that your fingers and elbow creases face forward, and keep your elbows straight.

We had a good storm this week to blow off all of the leaves of the frontyard tree.
I spent two hours raking and bagging.  The next morning I woke up with pain and pulling at my left shoulder blade.
I am sure that many of you can relate.
So, instead of waiting it out and griping about it all day, I took 15 minutes to work with the muscles and set freedom to my scapular sling muscles. Post session, no pain!
Below I have pics and video of the simple movements and stretches I went through to decrease the pain in my shoulder girdle.  
These are also great exercises to perform daily to combat shoulder blade, arm, and neck tension from computing, driving, hair styling, pushing strollers, carrying babies, etc.

After the rhomboid pushup, perform a shoulder stretch as shown here.

Repeat the rhomboid pushup 10 more times and then go into this next stretch, Quadruped Rib Twist.

Complete another cycle through of each, the rhomboid pushup, the shoulder stretch and the rib twist.  Finish up with some wrist stretches shown below.

Hip mobility is key to the health of the spine.  When we lack the motion at our hip joints, the spine will take up the slack by moving into flexion or extension. Here I am trying to lift my leg backward.  Compare the two pictures.  You can see the increase of the lumbar curve on the left, this is called extension.  This creates compression and degeneration of the tissues and tension in the back muscles. This picture on the right shows my true hip motion without compensating by getting more motion through my spine.

Now, here I am lying on my back with my knees bent.  On the pic on the top, the dots demonstrate having a level pelvis.  As I bring my knee toward my chest, I moved past my actual motion at my hip joint and my pelvis tilts posterior or toward the floor.  This action creates flexion at my spine and places more stress on the lumbar discs making me more susceptible to a disc herniation or degeneration.

Restore mobility to your hips, and save your spine from wear and tear from all that extra motion! Below are 10 of my favorite Restorative Exercises™ to free up the hips and the spine!  Unless stated otherwise, hold the stretch for one minute each side.

This Saturday, September 22 marks the beginning of Fall.  The change of seasons here in Salt Lake City is invigorating: brisk mornings and evenings require putting on layers, and the leaves are turning orange, yellow and red.  This change feels so synchronized, steady and effortless.

If only changing habits and behaviours could be so elegant...  

A transition of seasons may appear effortless, because of the consistency in change month after month.  We can apply this concept of change to our own habits and behaviours: big changes most often happen from a sequence of small solutions strung together.

Using research from business, psychology, sociology and neuroscience, brothers Chip and Dan Heath have written a book called Switch: How to change things when change is hard.  This is a “how to” book that begins with a premise:

All change efforts have certain patterns that are similar

• You must start acting differently
  
• You must change your situation
• You must change how you feel and what you think
• You must get the emotional brain and the thinking brain to integrate

This Fall, ALIGN has teamed up with SoulSalt coaching to create a program for change.  We call our program Ultimate Freedom:  Finding your way out of pain.  We are seeking individuals who are in pain, and who are ready to move through it!  Ultimate Freedom is a 5 week intensive, that is offered in either a group or an individual format.

Utilizing principles of coaching, neuroscience, movement and neuromuscular education,  Ultimate Freedom will assist to restore you through a season of change, and a future of no pain!

If I said that I was going to run a marathon in 9 months, it is common knowledge that I would need to get ready for it.  I would have to set a training schedule to prepare my body for the long distance: 26.2 miles, average completion time 4 hours.

What if I said that I was pregnant, and I was going to give birth in 9 months.  Would the expectation be that I would train for this?  Probably not.  Why is that?  For many first time mothers, labor can last for hours, with the average length of active labor being 12 hours give or take.  Preparing the body to sustain increasing mass during pregnancy and preparing the hips and the pelvis for vaginal delivery should be part of the “mother to be” training.

In order to have a pain free pregnancy and complication free vaginal delivery here are some requirements:

• Strong thigh muscles to support the weight of the torso
• Hip mobility
• Moveable sacrum
• Strong deep abdominal muscles
• Pelvic floor muscles that will yield

Your training program should include:

Walking 
Walking with a reciprocal arm swing incorporates whole body movement which enhances circulation, strengthens the legs, and frees the pelvis.  Work up to walking 5 miles a day (this does not have to be done all at once).

Optimal postural alignment
We tend to carry our pelvis out in front of our ankles. 
 A forward pelvis affects: 

• the stability of the pelvic girdle which can create pubic pain or sacroiliac dysfunction
  

• the function of the pelvic floor which can cause the muscles to become shortened and unyielding 
• the position of the sacrum relative to the pubis which decreases the distance of the pelvic inlet.

Ideally we want to have the skeleton stacked so that we have the line of gravity going through the ear lobe, midpoint of shoulder, hip, knee and ankle.

Footwear choices affect alignment.  Any shoe with a heel will angle the body forward. The body compensates for this by tucking the pelvis under, bending the hips and knees.  Over time this can shorten the muscles on the back of the leg which can pull the pelvis out of alignment creating back pain and pelvic floor dysfunction.  Choose shoes that are flat and allow your toes to wiggle.

Hip mobility and leg strengthening
Squatting improves the mobility in the hips, strengthens the glutes and legs, promotes a wider pelvic outlet and allows the pelvic muscles to yield.
Exercises to address lateral glute strength will prevent the pregnancy waddle and decrease the instability and excessive motion at the pelvis.

Deep abdominal and pelvic floor training
Learn how do activate your deep abdominal muscle transverus abdominus without holding your breath.  Learn how to utilize this muscle for the pushing stage of labor.  The TRA is best activated during the exhale of the breath cycle: draw your belly button to your spine.

Learn how to let the pelvic floor relax in order to allow the baby to pass through without tearing (yes, this takes practice). The pelvic floor should relax/yield on the inhale of the breath cycle.  Imagine the ischial tuberosities (SITS bones) widening as the pelvic floor relaxes.

Have you ever checked into your body to notice how much tension you carry in your muscles?  Constant muscle contraction reduces the amount of blood flow in and out of the area, as well as compresses the joints that the muscles cross.  Compression of the joint causes decreased mobility, friction, misuse of the limb, and potentially arthritis. 

We tend to carry a lot of tension in many of our muscles, but many of us are more aware of our neck and shoulders.  Feel your neck and shoulders now, are they tense? Look in the mirror, and see if your shoulders are elevated. Notice if your collar bones are angled up at a diagnal to your shoulder.  Let your neck and shoulders relax.  Take a breath in, and on your exhale allow the shoulders to relax and come back down.

Now let’s check the tension in your legs.  We should be able to stand without clenching our butt cheeks together, or gripping our quadricep muscles in the front of the thigh.

In order to check the tension in the legs, we need to have a straight leg.    When I teach this in my classes many people get confused because they have been told, “don’t lock your knees!”  The leg isn’t locked if it is straight.  It is “locked” when the quad muscles are contracted.

If the quads are relaxed, you should be able to contract your quads (notice your knee cap lift up) and return to the relaxed state.  If you can’t tell if your knee caps are lifting, more than likely your quads are already in a contracted state (this means that your patella is compressed against your femur, creating decreased mobility and friction which can lead to arthritis). Check out the videos below:  On the left she is able to lift and lower her knee caps, so her quads are relaxed.  If you weren't able to release your quads, go lean against the wall for support with your feet about 2-3 feet from the wall.  Notice the knee caps in the video on the right.  As you are able to contract and relax the quads, move closer to the wall until you are 3 inches away. If you are still able to relax, then move away from the wall and check again.  This is a big deal!  Chronic contraction decreases blood flow, compresses the joint, decreases mobility, increases friction and can lead to arthritis. Practice this a few times a day until you can stand 100% of the time with your quads relaxed.