In a previous post I addressed how increased internal pressure contributes to prolapse and urinary incontinence.  Increased internal pressure can effect the healing of DR and the abdominal wall as well.  In the post mentioned above, I discuss and provide an example of what a non postpartum body looks like with overactive abs.  The tension created by the over activation of the upper abs and gripping with the diaphragm and muscles of the ribcage creates downward pressure into the lower abdomen and the pelvic bowl.  People who have this pattern also tend to over activate their neck, rib, diaphragm, and spinal extensor muscles.  In order to heal the DR and abdominal wall there needs to be better balance with all the muscles of the core.  In this post, I will share some moves to help you connect to your lower abs without recruiting your upper abs first.  

Are you an overactive upper ab and rib gripper?  How can you tell?

• Your lower abs stick out compared to upper abs or despite working out, your lower abs still don't get toned.
• When you engage your core you can see a crease across your ab above your belly button.  You can see a demonstration of this in the blog mentioned above.
• Blow out really hard on your exhale like you are going to blow out 50 candle.  Do your lower abs push out?
• When you lie on your back and lift both straight legs does your back arch, your neck tense, your ribs grip and your abs push out?

Even if you don't grip your upper abs, these moves can still be helpful for you!

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.

Healing the nervous system is a process.  We have many layers to support and unfold.  These five tools above can get you started.  I look forward to support you on your healing journey.

One of the first tools I go over with clients is to reeducate proper breathing mechanics.  Most of the clients that I work with have pain or are wanting assistance to heal from leaking urine, prolapse or abdominal wall separation.  Getting movement in the core system and regulating the nervous system are top priority for healing, therefore, breathing is the bridge between the range of motion of the core team AND the ANS.  For most of us, breathing is unconscious, and we have developed strategies to just get by, such as shallow breathing, open mouth breathing, shoulder and neck breathing, etc.  In order to heal, we need to get out of a habitual pattern, change the loads, get better oxygen and carbon dioxide balance in order for the blood to deliver the oxygen molecule to the tissues.

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

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.

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.  

• 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.