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Glute Strengthening

12/9/2016

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Glut Max strengthening
This October I attended a continuing education course: Functional Biomechanics of the Lower Quarter taught by Christopher Powers, PT, PhD, FACSM, FAPTA.
I walked away from the weekend with much more appreciation for the gluteus maximus.  The glute max works in 3 planes at the hip: extension (moving leg back behind the body), abduction (moving the leg away from the body out to the side), and external rotation (rotating the thigh so the knee moves outward).
The glute max is key to controlling the trunk over the pelvis, to the stability of the pelvis and to the lower quarter.  When the glutes are weak, you will see increased leaning of the trunk, excessive pelvic drop on non-weightbearing leg, and poor femur control (medial collapse of the knee & internal rotation of the femur).  Dr. Powers says, "If something isn't being used, something else is being overused."  If you have pain in your back, your hip, your knee, or your foot, stop right now and do this self assessment of your glut max.  Video yourself and observe your trunk, your pelvis and your knee as you step down and back up from an 8 inch step.

Step Down Test

My glutes need some work on both sides, but notice that I have less control with my right leg in this test.  I have a harder time keeping my trunk upright, my pelvis drops, and my knee collapses in and is wobbly.  What I really like about Dr. Powers program is that he provides a systematic 8 level training program for the glut max.  You cannot go to the next level until you are able to pass the lowest one with ease and control.  I have provided the first level of glute training here. Have fun, and may you be blessed with buns of steel!

Glute Max Activation

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

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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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Getting Deep into the Hips

4/11/2016

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Can you go deep?  This is me in my workout days a few years ago, getting my serious face on to flip that heavy tire.
There are multiple factors that can limit the ability to go deep into a squat:
  • decreased mobility in ankles, knees, hips and spine
  • tight calves, quads, hamstrings, hip flexors
  • poor motor control
  • non-optimal core stability
This post addresses the first 2 bullet points and provides a quick mobility sequence to get into the hip, knee and ankle.  


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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Chair Busting

2/8/2016

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For many of us, our day is spent sitting at work, sitting at school and then we come home, maybe exercise and then sit and watch TV.
How can we minimize the deleterious effects of sitting? Stand more, walk more, and move more throughout the day.  In this post I have included 3 chair busting strategies that emphasize strengthening the posterior oblique sling: gluteus maximus, thoracolumbar fascia and the opposite latissimus dorsi.  This muscular sling is very important for lumbo-pelvic-hip stability during our gait and rotation patterns.

Get Moving!

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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Get up and down from the floor with ease

10/19/2015

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Can you get up and down from the floor without using something sturdy for support like the coffee table or your knee?  A few years back there was a Longevity Test hot in the news that predicted mortality risk.  The test participants were told:  "Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed.”
The study found that those who needed to use their hands and their knees to get up and down were almost seven times more likely to die within six years, compared with those who could get up and down without support.
This study tested 2000 subjects ranging from ages 51 to 80.  Now I don't know about you, but I know a lot of 20-30 year olds who need to use their hands and knees for assistance!
Lack of joint mobility and decreased strength plague our ability to move well.  In order to get up/down from the floor easily we need toe extension, ankle dorsiflexion, knee and hip flexion and leg strength. Below I share with you two movements that are great for your lower extremity mobility and strength.

Split Lunge

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Step into a stride position. Allow your back heel to be off of the floor. Make sure your feet face forward (think railroad tracks).
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Drop straight down so your front knee bends at a 90 degree, and your back knee is bent at a 90 degrees. Hover just above the ground and then come back up. Repeat 5 times each leg.

Kneeling Toe Extension

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Come down into a crouch position with your weight into your foot pads.
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Begin to move your knees toward the floor taking your toes into an extension stretch. Moving nice and slow. Shift your weight down and back up 5-10 times. Stand back up and repeat the split lunges. Repeat the sequence at least 3 times.
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If it is too intense to come all the way down to the floor you can use a prop to bolster with.
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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Skinny Jeans and Your Pelvis

7/20/2015

6 Comments

 
Tight jeans decrease blood flow in the pelvis.
If you follow the news or stay updated with current events via Facebook or Twitter, you probably read the story about a woman who sustained nerve damage in both of her legs after helping her friend move.  This woman wore skinny jeans and spent most of her day in a squat position cleaning out cupboards. By the end of the day her feet felt tight and numb and she couldn't walk, she kept losing her balance and falling.  Apparently the jeans had to be cut off of her due to the swelling, and it took her 4 days in the hospital to recover.  

When our body can't move freely and our tissues are compressed, this will lead to decreased blood flow, decreased nerve conduction and decreased tissue hydration.  Over time this can lead to lymphatic congestion, stiff joints, poor circulation and pain. Tight pants also affect how we are able to sit, bend and squat.  Have you noticed how you sit in yoga pants versus jeans or pants?  
sitting in a posterior pelvic tilt
Here I am in tight pants. In the pic on the left I am sitting like I normally want to do: tucked and posteriorly tilted with my pelvis. The red line shows the tilt of my pelvis. On the right, I am trying to sit as best that I can to neutral with my pubis and ASIS vertical. The blue line shows how far I am from neutral.
sitting with a neutral pelvis
Here I am in loose pants. In the pic on the left again I am sitting in a posterior pelvic tilt. In the pic on the right I have positioned my pelvis to neutral (I am a little off on this as shown by the blue line. Don't judge, my mobility is a work in progress).
Chronic positioning of the pelvis into a posterior tilt can lead to all sorts of bad things like:
  • Changes in pelvic organ position.  A tipped uterus can cause painful menstruation, urinary frequency and urgency.  For more info on this click here. 
  • Changes in muscle and connective tissue.  Tissue adapts to how it is used, so habitual chronic positioning sets the stage for potential low back issues, SI pain, decreased hip mobility, tight and weak pelvic floor, hip flexors, hamstrings and calves.
  • Meralgia paraesthetica, pain and numbness on the front of the thigh.
  • Digestive issues: abdominal pain, bloating, heartburn, indigestion.
Please consider how your pants might be affecting your pelvic health.  Even if you wanted to try to sit with a neutral pelvis, your jeans may not allow you to get there.  Sometimes it is the simple changes that get you moving in a healthy direction.

Neutral Pelvis in Sitting

Neutral Sitting

Untuck Your Pelvis

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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Hip Mobility

6/19/2015

3 Comments

 
Improve Hip Mobility with this kneeling lunge stretch
Kneeling Lunge
The hip is simple in it's joint configuration, but very complex in its function.  Like the shoulder, it is a ball and socket joint.  That means that the thigh bone has a spherical head (femoral head) that fits into a cup-like socket (acetabulum) of the pelvis.  This type of joint offers high freedom of motion to allow us to get down into a squat, high kick, dance, karate, etc.  Compared to the shoulder, the hip has a little less motion in order to provide stability, and the femoral head can sit deeper in the socket of the acetabulum in order to prevent dislocation.
Because the hip is ball and socket, the joint is multi-axial, meaning it can move in many many planes of motion. When the foot is not touching ground (open chain) these actions are:
  • Abduction- moving the thigh away from midline
  • Adduction- moving the thigh toward the midline
  • Flexion- moving the thigh toward the chest
  • Extension- moving the thigh toward the back
  • Internal Rotation/External rotation- rotation about the femoral axis
  • Circumduction- moving the joint in a full circle

As I mentioned above, the joint is simple, but the function is complex because the hip joint, like any other joint in the body, does not work/move in isolation.  Lack of hip range of motion can effect the health of the shoulders, spine, pelvis, knees and feet.  Improving hip joint motion is one of the key steps to ensure proper mechanics of the extremities and the spine.  How are your hips?  Try these moves for better movement.
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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Decrease Knee Pain

12/13/2014

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Decrease knee pain with therapy balls
I love using Yoga Tune Up® therapy balls!
Knee pain affects 25% of the adult population.  Most knee pain is blamed on arthritis.  Arthritis is joint pain, stiffness, inflammation. But what causes that?  How you move and use your body every day can increase joint loads, friction, and compression at the knee, and can eventually lead to pain, stiffness and inflammation.  So, below is a series of movements to decrease the tension in the muscles surrounding the knee. This sequence is designed to improve blood flow and connective tissue hydration which can help decrease the tension in the muscles surrounding the knee and help to decompress the knee joint.
Save your joints and give yourself some quality ball time!

4 movements to release the muscles around the knee:

The last two videos don't show it, but you will want to continue to move the ball down the calf.  Repeat on both sides, or just on your side of pain.  If your knees are too stiff and painful to bend as shown in the last two videos, roll up a towel and place it on top of the balls and then sit back.
You can by the Yoga Tune Up® Balls and DVDs if you want to explore the amazing products from Jill Miller and Yoga Tune 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.alignintegrationandmovement.com.
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Self Care for Hip, Groin, and Back Pain

10/1/2014

25 Comments

 

Self Care Steps:

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This blog is for those of you who have hip pain, groin pain, hip impingement, sciatica, SI joint pain, or low back pain. And if you don't have any of these, then you are lucky and prevention is the best medicine!
Hip mobility is paramount for a healthy body and spine. During an evaluation I like to observe a static standing assessment, a functional movement assessment, and then perform a passive mobility assessment.  
People with back/hip/groin pain often have a postural position of "butt gripping" (read a great article about it here Diane Lee).  In this position, the pelvis is thrust forward and the deep hip rotators are contracted. When these muscles are overactive, they push the head of the femur into the front part (anterior) of the hip capsule which can interfere with hip motion: hip flexion (bringing the knee toward the chest) and internal rotation (turning the thigh inward).
On the functional exam I will see an inability to go into a deep squat, or the hips will shift to the opposite side during the squat.  On the passive motion test there will be a limitation in hip flexion, and they may express pain with a combination of movements: hip flexion, adduction and internal rotation.
Standing in alignment and learning how to let go of the grip in the rotator muscles is essential for healing, as well as reprograming the normal glide of the head of the femur.  In normal motion, as the knee moves toward the chest, the head of the femur should glide back and down.  Due to the tightness of the rotators, the back (posterior) hip capsule can be restricted.  Restoring the tissues and the hip motion can be achieved through simple self mobilizations.
Standing alignment for back and hip health
1. Standing Alignment: vertical leg, torso stacked over the legs.  Think about a plumbline going through the midpoints of the shoulder, hip, knee and front of the ankle bone.

2. Release Deep Hip Rotators:  Lie down on your back with your knees bent.  Place a tennis ball under your left butt cheek just to the side of your sacral bone.  Rock your knees to the side and return to start position 3 times.  Find a new spot and repeat.  Complete in 3-5 different areas and then switch sides.
Piriformis Release with tennis balls
3.  Hip Release and Hip Glides:  this is a video demonstrating how to do the self mobilizations to regain normal motion.
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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Refining the Quad Stretch

8/14/2014

15 Comments

 
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The quadricep muscle group is comprised of 4 muscles that all share a similar attachment to the lower leg bone, the tibia. The muscles converge at the knee at the patella (knee cap) and inserts onto the tibial tuberosity.  The muscles are named for their location on the thigh:
  • Vastus Lateralis -spans from the outside of the thigh to the tibial tuberosity
  • Vastus Intermedius -spans from the center of the thigh to the tibial tuberosity
  • Vastus Medialis- spans from the inside of the thigh to the tibial tuberosity
  • Rectus Femoris- spans from the front crest (anterior inferior iliac spine) of the pelvis to the tibial tuberosity

The main action of this group is to extend (straighten) the knee and the rectus femoris will also flex the hip.  Quadricep control is important for walking, running, going up and down stairs, lunging, squatting, basically every move we make.  Having supple quadriceps is key not just for healthy knees, but for healthy feet, hips and spine.  Restrictions in the quads will affect proper loading of the foot and knee during gait.  Tightness in the rectus femoris can pull the pelvis forward into anterior rotation which increases lumbar extension and spinal compression, and can limit hip extension (being able to bring the leg behind you).


How to stretch the quadricep

Let's face it.  Many of us are super tight, and it feels good to pull on the leg as far as you can to get a deep stretch. The stretch always feels good, but the muscles never fully let go and we have to keep stretching forever and ever.  One possible reason why the muscles don't make lasting changes is that we have a stretch reflex within the muscles that serve as a protective mechanism:  if the muscle is stretched too far beyond its limit, it will contract to prevent injury.  During stretch sessions, you may be moving beyond your tissue limit so the muscles never change!  One way to refine and meet your tissues is to scale back and use alignment markers to guide you into your stretch.
Alignment Markers:
  • Maintain level shoulders and pelvis
  • Keep thigh in line with hip: don't let it move out to the side, or out to the front 

Typical quad stretch

Standing Quad Stretch
Notice in the first pic that in order for me to grab my shin I had to move the thigh out to the side, and you can see that as I hold my ankle my right shoulder has totally dropped down. In the pic on the right you can see that due to the tightness I have had to move my thigh in front of me, rather than behind me.

Refined quad stretch

Standing quad stretch refined
Here I am using a strap to help me meet my tissues. On the left you can see that my shoulders have leveled out and my thigh is straight down from my hip. You can see in the pic on the right that I can barely bend my knee as I keep my leg straight down rather than out in front of me.

How to release the rectus femoris (hip flexor and knee extender)

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I am pointing to the ASIS landmarks on the pelvis.
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The half cylinder (rolled yoga mat or towel) will cover the ASIS landmarks. The pubic bone will not touch your prop.
Quadricep release on the floor
Lie on your stomach with the bolster under your pelvis markers. Make sure that it does not touch your pubic bone. Breathe here and relax for 3-5 minutes.
Assessing new motion after quadricep release
After your release remove the bolster and see how far you can bend your knee. Make sure that you keep your pubic bone touching the floor.
quadricep stretch on the floor
See if you can reach for your foot, ankle or shin. Make sure you can keep your pubic bone down. Hold for a stretch. If you can't reach with your arm, grab the strap.
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
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