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Getting Out Of Back Pain

11/18/2022

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Tension in the back is all too common! A high percentage of my clients are coming to see me because of it.

Many people who also see me for pelvic issues such as urinary leakage, pelvic organ prolapse, pelvic pain or healing abdominal separation postpartum say that they have a history of back pain that comes and goes, or experiences persistent chronic back pain.

Understanding some of the contributing factors to excessive tension in the muscles of the back can be key to decreasing or eliminating  pain, and improving function.
  • Breathing Patterns
  • Postural Patterns
  • Movement Patterns
  • Stress, Nervous System Regulation & Lifestyle Habits

Breathing Patterns

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

Postural Patterns

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

Movement Patterns

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).

Stress Patterns

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
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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Movement Practices to Settle Your Body

9/29/2020

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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.

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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. 
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.
​
Disclosure: I only recommend programs and products that I would use myself.  If you use these links to purchase something, I may earn a small commission at no additional cost to you.
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Breathing for a Healthy Core

7/29/2020

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Exhalation activates the parasympathetic system and increases vagal tone
Exhalation stimulates the parasympathetic nervous system and increases vagal tone.
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.  

Break the habit of breath holding

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!

Suggestions for breaking the habit 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.
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Spinal Mobility Drill in Sitting

2/3/2020

 
Spinal Mobility: movement
Improve spinal motion and decrease pain
Healthy spines need movement; healthy bodies need movement!  Every spinal segment is like a cog in a wheel, when one section or vertebrae moves, the other follows suit, just like the chain moving around the crank shaft.  Over the course of our lifetimes we get bogged down by tensions, holding patterns and loads that limit the mobility of the spine.  Our nerves that travel to our organs, muscles, and skin exit the spine and span outward to their destination. For the health of your nerves, your lower extremities, core, organs, upper extremities and head, get a move on!  

Explore your spinal movement

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

Understanding our Nervous System

3/19/2019

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The key to health: regulation of the autonomic nervous system
Traffic light analogy of the Autonomic Nervous System

​Understanding and tapping into our innate healing capacity and regulation of the nervous system is key for getting out of pain and improving function.  Many people have learned in school that the brain and the spinal cord are the central processing and relay centers, and the peripheral nerves take off from the spinal cord to drive the movement of our muscles.  More elusive in understanding is the part of our peripheral nervous system that goes to our smooth muscle and organs: the autonomic nervous system.  The autonomic nervous system keeps us alive.  It is important for basic metabolic functions such a breathing, heart rate, digestion, hormone regulation, sleep/wake cycles, sexual response, immunity, repair & regeneration, etc.

The Autonomic Nervous System: Polyvagal Theory

In 1994, Professor Stephen Porges proposed the Polyvagal Theory.  In this seminal work he describes the autonomic nervous system in more detail.  Rather than a 2 part system balance of sympathetic "fight or flight" and parasympathetic "rest or digest", he acknowledges the evolutionary nervous system development that brings the humaneness into being human such as connection, social engagement, relationship,  and the ability to have team work and community.  One of the best explanations of the Polyvagal Theory that I have heard is by Stephen's son, Seth.  I have posted the video below.  Please watch, and then watch again.
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.  

Nervous System Regulation: The Still Face Experiment

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.

Now what?  How does this apply to me?

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
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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Quadruped Rocking: Happy Hips and Spine

1/7/2019

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Neutral Spine has spinal curves.  A healthy spine moves!
Neutral Spine has Spinal Curves
Neuromuscular re-education plays a major role to getting out of pain and improving function.  Our body is very intelligent; the nervous system is prepped and primed for movements, actions and behaviors that are similar to what has happened in the past.  This is useful because it frees up our system's energy for more important metabolic tasks.  Unfortunately over time, the way we have done something in the past is not always helpful for the longevity of the tissues involved in the present movement.
Neuromuscular re-education drills help to create new neural circuitry to enhance proprioception, balance, motor control and coordination, which will have carry over to lasting healthy loads to the muscle and skeletal system.

Our Pelvis, Spine And Head Are Mobile... or I should say, We Want Them To Be Mobile

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).  

Movement drills to bring in neuromuscular re-education to these areas:

1.  Get the spine moving; Get the pelvis moving.  A great drill for this is pelvic tilts (click on link for a video of pelvic tilts on the floor).  The video here demonstrates the pelvic tilts in sitting.
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.  
3.  Teach the erector spinae muscles that they don't have to 'HOLD TIGHT' all the time.  This requires patience and lots of neuromuscular re-education time (maybe I can do some videos for the next blog).  I like the client to connect to this in quadruped  and then bring to standing with hip hinge and bending/ lifting drills.  A good test to reveal the state of the muscles is to get into quadruped and see how the muscles respond (in this position they should soften and drop into extension).  For many people who overuse their back muscles, the erectors will be hard and pronounced like a steel rod.  The goal of rehab is to teach the muscle to let go and move into shortening (extending) and lengthening (flexing), which when held, doesn't perform either action very well.
Erector Spinae tension and hip/back pain
Notice the two mounds on each side of the spine just below the shoulder blades. You can see that the left side is just a bit more pronounced than the right.
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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Breathing Circuit

12/4/2018

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As a pelvic health specialist and a general orthopedic physical therapist, addressing the health of the "core" is essential to every client walking into my office.
What is the first and foremost requirement for healthy tissue?
MOVEMENT: 
  • Muscles can fully lengthen and shorten
  • Joints have the space, glide and spin for full active and passive range of motion
  • 3D Movement is available in all planes: rotation, sidebending and forward/backward bending

A healthy core is a core that moves.

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.
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Healing Abdominal Wall, Urinary Leakage or Prolapse

2/28/2018

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Healing Postpartum: prolapse, abdominal wall separation or urinary leakage
Has Dr. Google left you confused as to how to heal your diastasis recti (abdominal wall separation) or prolapse?
In my last post about breathing I talked about how optimal breathing is key to creating core strength.  The muscles of the core: the glottis (voicebox), the diaphragm, the abdominals and the pelvic floor all need to move in coordination for effective generation of force.  These muscles need to respond reflexively for whatever task is at hand, whether that be loading the dishwasher, working out at the gym, or chasing after your kids.
Healing from diastasis recti, pelvic organ prolapse and urinary leakage is not going to happen with 100s of kegels and abdominal bracing contractions.   Healing happens when we look at the whole system working together as a team.

Integrate the team for a Healthy Core

  • 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).

Let's look at a common muscle strategy that I see in women who present with DR, prolapse and urinary leakage: Overactive Upper Abdominals

Tension in the upper abdominals at rest
At rest you can slightly see the crease above the belly button. From the side view the crease is more evident.
rib gripping: overactive upper abs
Can you see the crease just above the belly button? During the "Draw the belly button to the spine" cue, the "hour-glass" is created by over recruitment of the upper abdominals.
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.
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 Do You Breathe?

1/13/2018

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Breathing is the key to life. If we can't breathe, we die within minutes.  Breathing is so essential to the health of our systems, yet rarely do people understand the connection and importance of HOW TO breathe effectively for the support of our core and the health of the shoulder girdle, hip complex, and lumbar spine.
Poor stability strategies and unconscious habits interfere with the proper movement of the muscles of the ribcage, diaphragm, abdominals and pelvic floor.  In order to have good stability to support the spine, we need to generate appropriate intra-abdominal pressure.  What I see over and over again with my clients is the inability to access the core muscles mentioned above during the breath cycle, as well as in functional activities.  A typical compensation pattern that people use is a pushing strategy to create strength, rather than allowing the muscles to activate and generate the intra-abdominal pressure.  This pushing strategy creates excessive outward and downward strain onto the pelvic organs and abdominal wall (think pelvic organ prolapse, urinary leakage, diastasis recti and hernias).  Not to mention over activation of the neck, shoulder girdle and paraspinals which impact neck/back/hip pain and function.

​Try this right now:

  • 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.   ​

So, what is optimal breathing for core function?

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.
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Movement Time Out

12/19/2017

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Decreasing tension is essential to get out of back and hip pain
Time Out
I grew up playing sports, so I understand the importance of a  time out.  In sport we use a time out to take a rest, make substitutions, communicate with the team to re-strategize or to inspire.  Part of the work that I do with clients is to help support people to get out of pain.  Often I suggest time outs to check in with the body and make the changes as needed: how am I sitting or standing, am I breathing, am I holding tension?  These time outs are a great way to break the stagnation of the day, to connect with the body, and to come back into the present.  Way too often our day gets caught up into automatic drive.  So stop right now, get on the floor and try out these moves!

Your body will love you with these quick movement time outs:

  • Spinal Rotation: trunk and head
  • Flexion & Extension: Feet to head
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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Contact:  Susan McLaughlin, PT 801.859.4142
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