Since 2018 I have been studying  osteopathic manual techniques developed by Jean Pierre Barral, DO.  Through his Institute I have learned how to engage with the body more as an integrated whole, by working with the organ system (called visceral manipulation), the spine and joint system, the vascular system, and the neural system.
The common denominator in all of these systems of the body is fascia.  Fascia is our connective tissue that wraps around every organ, nerve and vessel.  Fascia is the wrapping or container of structures and it is also in the spaces, like the extracellular matrix (ECM).  The ECM is the structural framework of the body, providing support and organization for cells.  It's made up of fibers such as collagen, hyaluronic acid and gel-like ground substance.
Fascia has a role in maintaining structural integrity, support, protection, shock absorption, defense, communication and exchange processes, biochemical processes and hemodynamic responses.  Fascia is directly in concert with the autonomic nervous system. For healthy bodies, we want our fascia to be mobile and hydrated.  In dysfunction, the fascia becomes bound and held which affects the health of the organs, the nervous system transmission, cell communication and movement.  Manual based fascial work can optimize function and decrease pain.
Recently I took a Fascial Decoding course through the Barral Institute taught by Serge Paoletti, DO.  In this course we learned how to test the fascial chains, and to work with the fascia in 3D.  
I now have more tools to effectively treat:

• Bunions
• Plantar Fasciitis
• Morton's neuroma
• Achilles Tendonitis
• Knee Pain
• Hip Pain
• Sciatica
• Back Pain
• Tennis Elbow/Golfer's Elbow
• Carpal Tunnel
• Shoulder Pain

If you are curious and want to get out of pain, reach out and schedule a session.  I would love to see you!

Because breathing is automatic, we don't always notice HOW we breathe.  Becoming a better breather is key to oxygen delivery, nervous system regulation, core movement and stability.  If the diaphragm is not moving well neither is the ribcage or the core canister.  You have got to move it to use it!​

• Core Breathing
• Oxygen Advantage
• Buteyko Breathing

Our posture is created by our emotional states and how we move and present ourselves in the world.  Become more aware of unnecessary tensions that are affecting our postural state.

• ​Feldenkrais Lessons: Posture for Life
• Alexander Technique: 5 tips for standing posture
• Katy Bowman of Nutritious Movement: Lower your risk of injury with proper alignment

I am sharing a home program circuit of some of my favorite moves to decrease tension in the back.  The emphasis here is to release the back extensors through breath, positioning and recriprocal inhibition (contracting  the abdominal flexors to relax the back extensors).

We live our lives in automatic.  How can we bring more presence to our lives in order to optimize nervous system signaling and therefore appropriate cues for the health of each system of the body.  

• Understand and tend to the nervous system: Predictive Processing -Why expectation matters for movement and pain, Befriending your nervous system (50% off right now!),  Learn to repair your nervous system.
• Mindfulness and Stress Reduction: Online programs with Tara Brach, Mindfulness Based Stress Reduction
• Lifestyle Habits: Be True- Discover your core values and live your life on purpose (if you go to SoulSalt's IG page you can find the Black Friday/Cyber Monday code for 50% off),  Hire a Wellness Coach

I have been reading the book, My Grandmother's Hands by Resmaa Menakem.  This book "is a call to action for Americans to recognize that racism is not only about the head, but also about the body.  Menakem introduces an alternative view of what we can do to grow beyond our entrenched racialized divide and takes readers through a step-by-step healing process based on the latest neuroscience and somatic healing methods." Quote from the back cover of the book.

​I have been taking time with the second part of Menakem's book, which is titled "Remembering Ourselves".  He says, "The place to begin the all-important healing of trauma is with the body.  Your body.  Each of our bodies."  He provides body and breathing practices to get to know, experience and understand the body.  I have been enjoying these practices and have incorporated some of the ways to settle into a movement practice.  The movement sequences shared below bring in novel ways to move the spinal chain and mobilize the joints.  "Sometimes trauma energy can get stuck in the joints," Manakem states.  The momentum and rotations can help to release the energy and reduce the tension along the kinetic chain. 

We take breathing for granted: I am alive, therefore I am breathing well.  Unfortunately, this is just not true.  Almost everyone could benefit from breathing better.  When it comes to getting out of pain, or healing the core from abdominal wall separation to leaking urine, the first step to improved function is to learn how to breathe better.  Breathing better doesn't mean taking big breaths, in fact, breathing better means breathing slow, low & less.  If you want to dive into the depths of why its important to breathe slow and less check out these books:

• Oxygen Advantage
• Breath: The New Science of a Lost Art

In my practice, I like to work with the body wholistically.  From this wholistic lens, how we move and use our body in the day to day affects the health of our tissues and systems. Habits that are repeated day in and day out can become a "tax" on the tissues and systems.  A VERY common habit that I see in our bodies is breath holding.  Chronic breath holding increases internal pressure and stresses the nervous, hormonal and immune systems.  Over time, this can impair physical and psychological (our brains consume 20 % of the body's oxygen supply) function.  

Observe yourself over the next few days to notice if you breath hold.  If you do, when does it happen?  Typically people breath hold with transitions such as getting out of bed/chair, bending, lifting & reaching.  People also tend to hold with multi-tasking such as cooking, gardening, house cleaning.  Breath holds happen when thinking, or concentrating such as writing a letter, putting on make up, or learning a new skill.  We want to be able to experience every moment of our daily life with our breath steady and paced to meet the task at hand.  Breath holding is a sign of stress and living life on automatic!
Being in the present moment is the way out of breath holding!

• You can't talk and hold your breath at the same time (really, you can't) so sing or hum while cooking dinner or cleaning, etc.
•  To prevent the tendency to breath hold with transitions such as getting out of bed/chair, bending, lifting & reaching: count out loud to 10 throughout the task, or you could just exhale on the effort phase of the movement.
• Pair a task that you do often throughout the day with breathing "low, slow and less": while you wash your hands, paused at a stop light, picking up the kids toys from the floor, etc.
• Simply just notice.  When you are  _______  can you find your breath and let that be your anchor to whatever you are doing.

Below I share 2 drills to connect you to your core.  The silent breathing is great to find the slow, low and less.  The Exhalation drill is a great way to bring in the expansion and contraction of your abdomino-thoracic cylinder!

​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.

Link to Anatomy in Motion's, Wake your body up!

Polyvagal analogy of the traffic light:

• Green is the safety zone: our social engagement system.  our heart rate slows, digestion activates, facial muscles are responsive,  eyes are soft and able to make contact, hearing is turned on.
• Yellow is the danger zone:  our heart rate increases, pain increases, muscles are mobilized for movement, flat facial affect, the middle ear is turned off in order to hear lower threat tones.
• Red is the life threat zone: our system goes into freeze/immobilization.  This zone leads to metabolic shut down.

A healthy autonomic nervous system is fluid, bouncing between the green and yellow zone.  

As humans we are wired to connect.  We need to have connection and safety to build a healthy nervous system. If you watched Seth's video above, you now have a deeper understanding of this.  Because the nervous system is so subtle, and because many of us have had "bad stuff/trauma" happen to us, (we can be stuck in a freeze state or amped up into hyperarousal, or stuck in both states) we don't always "get" this understanding of how important it is to heal at a nervous system level.  The still face experiment exemplifies what happens to the nervous system and subsequent behavior when connection and safety is withheld.  

The above video can be hard to watch.  In just 3 minutes of non responsiveness from the mother, the child turns her head and body away; she withdraws with a hopeless expression on her face.  To use the traffic light example, in the beginning we see activation of the green light, then mom becomes non responsive, the child escalates to the yellow light and when mom continues not to respond, the child collapses into the red light.  Fortunately, this was an experiment, and mom comes back to engage and repair to green light.

Our nervous system impacts our entire well being: emotionally, relationally, mentally and physically.  Common signs of dysregulation: depression, anxiety, numbed out, brain fog/can't concentrate, procrastination/resistance, chronic pain, gut issues, headaches, severe PMS, autoimmune disorders, hormone issues, pain, etc.  You may also find yourself continually getting injured or wanting to take your exercise to the next level and you end up hurting your back (knee, shoulder, foot, etc), or you keep going to the chiropractor and they tell you that you aren't holding your adjustments or you look in the mirror and notice that your body rests in rotation (one shoulder is higher or your head slightly tilts, etc).   We all have layers and layers of "stuff" that has happened to us over the years, some more than others.  By acknowledging that this "stuff" is held in our nervous system (and thus, our organs and connective tissues) we can start to become more vital by reconnecting & regulating our nervous system.  As Seth mentions in the video above, breath is key to mediating the autonomic nervous system.  In my next blog I will explore some breathing options to facilitate a relaxation response. 
If you are interested in learning how to be more ALIVE in your body, there are some great books and online programs available to get started:

• Somatopia: this program is super affordable. It is a good place to start if you are completely new to the mind- body connection.  It goes over some of the foundational concepts and beginning techniques.
• 21 Day Nervous System Tune Up: this is a more thorough self study program that offers a great Facebook support group.  It has explanations of the neuroscience and plenty of neurosensory exercises to keep you busy.
• Crappy Childhood Fairy: to be honest, I haven't taken this course, but I am impressed by what I see on her videos.  She is not a therapist, or a health care provider, she is someone who had a "crappy childhood" and spent years in therapy.  It wasn't until she started working with the nervous system dysregulation that she started to heal.  Her program is based on the tools that she used to heal.
• "The Body Keeps the Score", Bessel Van Der Kolk
• "Healing Trauma: A Pioneering Program for Restoring the Wisdom in Your Body", Peter Levine

Many of the clients who walk into my office with hip, back or pelvic pain share some common features:

• Inability to isolate pelvic motion and/or rigid spinal motion
• Limited hip mobility in all ranges, especially hip flexion, adduction (moving toward midline) and internal rotation
• Hypertonic spinal muscles (increased mass and tone in the lower thoracic or lumbar area).  

2.  Get the hips moving.  Explore hip flexion and extension in quadruped (hands and knees or forearms and knees).  Make sure that the spine is neutral (refer to the spine pic above for a visual of our spinal curves) so you can make sure to get into the hips.  If the lumbar spine moves into flexion as you rock back, this means that you are not accessing the tissues of the hip joint.  

Breathing brings vital movement to the core: expansion/compression of the ribcage, diaphragm, abdominals and pelvic floor. How do you breathe?  Where do you breathe?  Can you feel your ribs expand on inhale and compress on exhale?  Does your pelvic floor lengthen on inhale and shorten on exhale?  Does your back move with your breath?  For most people, the answer is "I don't know."  I really like to have my clients load the body in different positions in order to explore variations of breathing which can help them connect to their core. 
In the breathing circuit video posted below,  I go through 3 positions plus a typical "core stabilization" exercise: 

• crocodile pose: on inhale, once the abdomen hits the floor (which is right away) take your breath into your back body.
• child's pose: same as above
• sitting: place hands on the side of the ribcage to feel the expansion/compression on inhale and exhale
• bird-dog exercise:  typically when this exercise is taught, people are cued to draw in abs before lifting the arms and legs.  In this drill we want to maintain steady breathing with no holding of the core.  Be mindful as you lift your leg off of the floor.  Do not over extend the hip, as this will compress the spine.

​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.

• Skeletal System

The bones are in a position for appropriate loading to stimulate bone growth, and to position the muscles for optimal resting length tesnion.  From a sideview, the Standing plumbline markers for alignment are the earlobe, midpoint of joints: shoulder, hip, knee and ankle.  The ribcage is stacked over the pelvis, and the pelvis is stacked over the ankles.  

• Muscle System

The muscles are able to shorten and lengthen through full range of motion.   Optimal positioning of the skeletal system allows the muscles to be in a better position to move and generate force.

• ​Pressure System

Ability to generate appropriate intra-abdominal pressure.  Normalize pressures: Increased resting muscle tension can create abnormal pressures.  Pushing type strategies (bearing down) for strength and movement increase downward pressures into the abdominal wall and pelvis.

• Nervous System

Regulation of the peripheral and autonomic nervous systems.  Dysregulated autonomic nervous systems increase resting muscle tension (among other things).

Due to the resting tension in the upper abdominals there is more pressure into the lower abdominals and pelvis.  When the muscles are activated in a shortened contraction, even more pressure is created into the lower abdomen.  This constant downward pressure can have an impact on the health of the pelvic organs, abdominal wall and pelvic floor.  
Changing the pressure and muscle activation pattern is essential to recovery.  Typically, this person has no problem breathing low into the belly, but may have a hard time filling the entire abdomino-pelvic canister evenly on the inhale (generation of appropriate intra-abdominal pressure, evenly distributed 360 degrees). Home practice will require breathing practices to connect with the movement of the lower ribcage, side and back body, and then bring this new awareness and pattern into movement and daily activities.

• Lie down on the floor with your legs out straight
• Bring your legs together
• Keep your knees straight and lift both legs off of the floor about thirty degrees.
• Notice: what happens to your abs?  Did they bulge outward?  What does your back do?  Does it arch?  What does your neck do?  Does it tense?

​How did you do?  In my experience, 95% of my clients use a pushing strategy: holding breath, pushing out into abdominal wall and pelvis, arching back and tensing or lifting the neck. Outside of pilates, or working out, this strategy gets carried over into daily tasks such as: getting out of bed, bending and lifting tasks, pushing open a heavy door, etc.   ​

The first step is to become aware of the day to day habits that interfere with optimal breathing:

• shallow breathing into chest and neck
• holding breath
• holding abs
• locking down ribcage or gripping shoulder blades back and down
• lifting shoulders to breathe (over activation of the scalenes, upper trapezius, levator scapulae)
• squeezing butt cheeks (tightens the pelvic floor muscles)
• ribcage and pelvic positions

The second step is to practice breathing.  During quiet respiration there should be movement in the intercostals (the muscles between the ribs), the diaphragm, the abdominals and the pelvic floor.  In order to have strength in the muscles, they need to move through full range of motion: lengthening and shortening. In this video, I talk about diaphragmatic breathing and core function.  Practice lying down, sitting and standing.  Each position places a different demand on the body. 
​Have fun and explore!

The third step is to begin to challenge the system.  Can you maintain the breath as you add a new skill or a new load?  Are you able to get movement into all areas of the thoracolumbar pelvic canister?  Quite often I observe tension and stiffness surrounding the ribcage.  Below I share a breathing drill to get mobility at the lower ribcage and diaphragm and a link from Dr Evan Osar on Three Dimensional Breathing. 

​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.