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Healing Abdominal Wall, Urinary Leakage or Prolapse

2/28/2018

1 Comment

 
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

3 Comments

 

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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Know Your Core

6/21/2016

1 Comment

 
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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.

The Core

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The core is the area where your head and extremities attach. We have an inner core: throat, diaphragm, deep abdominal (transversus abdominis), pelvic floor, deep back (multifidus) AND I personally like to include the psoas. The outer core is all of the other muscles.

Understanding how the core works

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). 
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I love this gif from Burrell Education. If you are interested in living your most healthy self, check out her programs: prenatal, postpartum and peri-menopause. Click on the pic to take you to her website.

The First Step to Strengthening Core:

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. 
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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Improve Breathing & Decrease Tension

1/13/2016

0 Comments

 
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I know that you have heard it before: "Breath is life". Tuning into the breath is my top strategy for change in the musculoskeletal and nervous systems. Focused breathing creates movement in the body: movement of organs, fascia, muscles and ribs.  Optimal breathing allows for the vital chemistry exchange to deliver nutrition to all of our cells for health and vitality.
Let's face it, life happens, and it's not always full of breath....  We hold, we limit and we restrict.
This movement sequence below is a great way to release the muscles surrounding the chest and to improve the expansion of the ribcage for better breathing.
Breathing better allows the oxygen to flow to our muscles and nervous system which can decrease tension and bring the body into ease.

Soft Tissue Release & Ribcage Mobility 

This movement sequence was inspired by my exploration with Jill Miller's Yoga Tune Up™/Roll Model and Yamuna Body Rolling.
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.
0 Comments

Breathing and Core Stability

2/16/2015

7 Comments

 
Core stability
I just did a search on the internet for the best exercises for core stability.
Here are the top exercises that came up in the search:
  • Modified plank on knees
  • Plank
  • Side plank
  • Bridges
  • Bird-dog on hands and knees
  • Crunches
  • Obliques crunches
  • V sits
  • Plank with an exercise ball
  • Dying Bug
These exercises are great for building the global muscles of the core: abs and back muscles, but what about the intrinsic muscles of the core? In my practice, many people have come to me who have already been doing their "core exercises" and yet they still suffer from back pain, SI dysfunction and pelvic floor disorders, etc.  The key to true core stability is to develop motor control, timing and coordination of the intrinsic muscles first, and then develop the abs, obliques and back muscles once the inner stabilization system is firing and wiring together.

Intrinsic Core Muscles

Breathing and Core Stability
Burrell Education has incredible courses. Check them out!

Diaphragmatic breathing is a great way to reconnect the inner core muscles

The Rhythm of the Respiratory Cycle:

  • During inhalation, the diaphragm contracts while the pelvic floor and the deep abdominal muscles relax.
  • During exhalation, the diaphragm relaxes while the pelvic floor and deep abdominal muscles contract.

Establishing Core Stability Through Diaphragmatic 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.
7 Comments

Thoracic Mobility

12/10/2012

13 Comments

 

Thoracic rotation assessment

Mobilize the ribcage to decrease neck pain
In my practice, I see many people with back and neck pain.  When I assess the spine, I often find that the thoracic spine and ribs are frozen stiff.  When the thoracic spine is not mobile, the low back and neck may compensate for this lack of motion, which can lead to overuse, tension and dysfunction.
Last weekend I purchased a lecture on the Thoracic Spine by Sue Falsone, PT, ATC from the website Movement Lectures. I was impressed with the material, and was inspired to include some of the exercises that she recommended to regain thoracic mobility into my Restorative Exercise™ class last week.  
I have also been loving my new Yoga Tune Up® self massage therapy balls, so I added some myofascial release into the class as well.
Below I share with you 3 movements to free your thoracic spine.

Breathing Exercise:  Enhance Rib mobility, improve rotation

Child's Pose breathing into the posterior ribcage
Get into child's pose with arms down by sides. This position will limit your ability to breathe into your belly and will encourage you to expand your breath into the back ribs. Take 5 good long breaths. Try to expand the ribs on the inhale, and on the exhale, close the ribs.

Reassess thoracic rotation:  More motion


thoracic extension and myofascial release with ball

Using Yoga Tune Up balls to release tension between the shoulder blades
Place two tennis balls in a sock. A sock will keep the balls from rolling all over the place. Lie down on your back with the balls underneath you just below your shoulder blades. Your spinous processes should be between the two balls.
Assess the spine: how much arch in your back?
Notice how much the ribs lift up when you lay down over the balls. You will need to prop up your upper back and neck to make sure you stay in alignment.
Thoracic Mobility: Flexion and Extension over tennis balls
The balls are placed at the bottom of the shoulder blades and the upper back is propped up so the ribs relax down against the body wall.
Self Mobilization for the thoracic spine
Lift the arms overhead. Make sure to only lift as far as you can before the ribs start lifting up. Complete 3-5 times and then move the ball up your spine.
 thoracic spine release
As you move higher up your spine, you will not need a prop under your shoulders.
Mobilization of the thoracic spine
Flexion and extension of both of the shoulders creates a flexion/extension moment at the thoracic spine. The ball helps to decrease the tension on the paraspinals.

I would love to know how great you feel after practicing this for one week!
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.
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Contact:  Susan McLaughlin, PT 801.859.4142
susan@alignforhealth.com