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.

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). 

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. 

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.

I have been working with a client for a few visits.  His main complaint: L low back pain and L hip pain.  He has made some good progress and will feel good for about a week or so and then the discomfort will come back.  In our last session we found that he couldn't lift his left thigh off of the table when he was on his stomach, and it really hurt his back.  I could see that his back muscles on his left side were really working hard.  I released the back muscles and his discomfort went away, but he still couldn't lift his leg.  His left gluteus maximus was not responding what so ever!
This last weekend I attended a training called  "Finding Center"  by Gary Ward of Anatomy in Motion.  The first day of training we spent 4 hours exploring the 3D movement of 6 key muscles in the body. One of these muscles was the gluteus maximus.  Many of us know the glute max actions: hip extension, hip external rotation and hip abduction.  Typical ways to strengthen this muscle is through concentric contractions as in clam shells, fire hydrants, bridges, lunges and squats.  
According to Gary Ward, the first rule of movement is: "Muscles lengthen before they contract."  His theory is that you want to lengthen the muscle as far as it can go, and it has nothing to do but contract.  I applied this concept when I returned from my training. 
My client came in this week with his left back and hip a little aggravated.  I tested my client again on his stomach.  He could not lift his thigh off of the table, and he had incredible pain in his back.  I had him stand up onto his left leg and move through the single leg squat and 3D reach.  I had him allow his hip and knee to move into flexion, adduction and internal rotation (prior to this training, I would have controlled for knee adduction and internal rotation).  After completing about 10 repetitions he says, "I don't have the pain in my glute anymore."  We moved through a few more patterns, got him back on the table and retested his ability to lift his thigh off the table:  Full lift without any pain!  He was completely amazed, and quite honestly so was I!  He got off of the table, took a walk and didn't have any pain.  Next time you feel like you are stuck in your training, or you have a case of "dead butt", remember: muscles lengthen before they contract.
I have included one of the movement patterns I went over with my client in the video below.  Rather than tapping down with the foot, you can also try reaching your arm out to touch the floor in a clockwise fashion.

If you didn't know already, the squat is hot. Everybody is doing it..... The squat is one of the most effective ways to strengthen your glutes.  But.... not every body is ready to bust the move and go deep into the squat position without losing their balance or hurting their knees.  
This post demonstrates how to perform a double leg squat and a single leg squat with a vertical shin.  A vertical shin helps take the load from the knees and puts the weight back into the posterior chain: hamstrings and glute max.  The single leg squat also engages the gluteus medius, which is important for stabilizing the pelvis.

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!

Last week on Align’s Facebook page I posted a picture to promote my Postpartum workshop. This picture showed an example of the abdominal “bread loaf” that can occur if the Transversus Abdominus muscle is not activated correctly during daily activities such as bending or lifting and abdominal workouts.   The increased pressure is going down into your pelvic floor and out into your abdomen.  Over time, supportive tissues can fail, and the results are abdominal/inguinal hernias, organ prolapse (uterus, bladder, rectum) or disc herniations (just to name a few).

In a previous post, I reviewed how to contract the deep abdominal muscle correctly.  This is an important skill to master before increasing the demands on the body such as carrying more weight, or moving the limbs.  Once the contraction can be performed without holding the breath, it is good to challenge the core by moving the legs.  Here is a lower leg progression to advance core control.

Habits die hard... with mindfulness and awareness.  When it comes to pelvic health, learning to tune into those automatic circuits will allow the body and mind to stop the dysfunction cycle and create healthy patterns.
 
Take for instance sucking in the stomach.  Many people that I see in my clinic with pelvic floor dysfunction also have a habit of sucking in their tummy.

Sucking in may be sexy in a swim suit, but this upward force of the diaphragm opposes our natural downward necessary functions like: digestion, elimination, menstruation, circulation and birth.

Not too sexy when you bloat, can’t poop, have menstrual cramps, and need to have a c-section.

So, let’s do a habit check: are you sucking in right now?

Many of us have been sucking in so long that we don’t even realize it.  So, check again.  Go to the mirror and lift up your shirt.  If your are sucking in, you will see an upward pull of your abdominals at the bottom of the ribs.

Many people mistake sucking in for contracting their “core”. A contraction of the deep abdominal muscle, the transversus abdominus, is inward toward the spine, not upward.

In order to regain the optimal function of our “core”, sucking in needs to stop.  Practice an abdominal release on your hands and knees. Feel the tummy relax and drop toward the floor.  It may feel uncomfortable at first as the diaphragm relaxes back to its natural position. Start to become aware of how often you suck in during the day, and let it go. You can break the habit!