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?  

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.

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.

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.

This month I was interviewed by a colleague of mine from the Neurokinetic Therapy™ Community, Eric Nelson.  Eric Nelson is a chiropractor and owner of Nelson Chiropractic and Pilates Center.
Not many people specialize in pelvic health, so he wanted to pick my brain about pelvic health. He asked me some great questions about pelvic health so I thought that it would be a good idea to share the interview on my blog.
Some of the topics discussed:

• Pain during pregnancy and how to prepare for delivery
• Why are episiotomies common and how to heal from them?
• Why is pelvic organ prolapse so common and what can be done to prevent prolapse?
• Is the Kegel an appropriate exercise for training the pelvic floor?
• How does the pelvic floor relate to the core?
• Do you work with men with pelvic floor issues?

Here is the link to the interview.  Eric talks for the first 10 minutes about NKT, so if you want to get to the interview, fast forward.
Inside the Brain Of:  Susan McLaughlin, PT
 

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.

Recently I had a conversation with a doula about fetal positioning.  She and many of her doula colleagues have noticed an increase in clients that struggle during labor due to posterior positioning of the fetus.  Posterior occiput position is when the baby's head is down and facing mom's belly.  A normal presentation is when the head is down and the baby's head is facing the mom's sacrum as in the picture to the left.   I would like to share some information from the workshop I presented to our Salt Lake Birth Circle group.
Incidence and consequences of Occiput Posterior (OP):

• 15-30% present posterior at onset of labor  
• 5% presentation at delivery
• 5.5% of OP accounts for 12% of all cesarean deliveries for lack of progress or dystocia
• 7 fold increase in the incidence of 3-4th degree perineal tears (into anal sphincter) 

Penny Simkin, PT and author of  The Labor Progress Handbook attributes fetal malposition to cultural habits and trauma.
Cultural Habits:

• Slouching
• Crossing legs
• Sitting too much, driving
• Standing with pelvis imbalanced
• Too little or too much exercise

Traumas:

• Sport injuries/falls
• Motor vehicle accidents
• Assault
• Fears                                                                           

If you are in the Salt Lake area you can learn about the topics introduced in this blog and more, in my prenatal workshop, Birth Mechanics: Get Your Body Tuned up for Delivery.  

1.  Take a piece of blank paper.  Stand barefoot on the paper and outline your foot with a pen.  Take this paper to your closet and compare the width of your shoes to the outline.  Don't wear the shoes where you can't fit your toes in the toe box, and the outline extends beyond the shoe.  Notice that the shoe sits inside of the outline in some places; don't wear these shoes!  Find shoes that do not have a heel.  If you are used to wearing a higher heel you will need to gradually transition to lower heels so your tissues have time to adapt (give yourself 4-6 wks before you transition for each .5 to 1 inch).
2.   Learn how to stand in alignment.  See pic above. Or read this blog.
3.   Wear toe spacers.  Yes, you should be able to see space between your toes!  There are many products on the market. These are my favorite: Correct Toes.  Cool thing about these is that you can wear them in your shoes!  Very comfortable (but you have to have a wide enough toe box in your shoe). If you have a bunion you may want to test to see if this will be comfortable for you before purchase: take your big toe and pull it away from your other toes as far as you can, and then lift it up.  If there is discomfort in the joint then your toe is probably compressed, and it would be good for you to see me, or your local PT (or chiro, osteo, etc) to work with you.

The inner thigh (adductor group) is made up of five muscles:

1. Pectineus
2. Adductor brevis
3. Adductor longus
4. Adductor magnus
5. Gracilis

When the foot is not planted on the ground, the adductors will bring the leg toward the midline, and flex the hip when the thigh is in an extended position as in the swing phase of the gait (walking) cycle.
The adductors play a significant role during walking and are active in all phases of the gait cycle. The adductors are a part of two important functional kinetic chains:

1. Lateral Sling: comprised of the adductors, same side gluteus medius/minimus, opposite side quadratus lumborum.  This chain is responsible for frontal plane stabilization of the lumbo/pelvic/hip complex during single leg stance (stance phase of gait), squatting and lunging.
2. Anterior Oblique Sling: comprised of the adductors, same side internal oblique, opposite side external oblique and hip external rotators.  This chain is responsible for transverse plane stabilization during trunk rotation in gait, throwing, swinging, twisting activities.

Dysfunction within the slings can result in overuse of the adductor group leading to over facilitation,  increased tension and bound up connective tissue, and potentially pain.  Here is a videoblog demonstrating how to release the adductors using a foam roller.

Tension in the piriformis muscle can trigger irritation of surrounding tissues.  The sciatic nerve exits the pelvis just below the piriformis.  When there is dysfunction in the lumbo/pelvic/hip complex, the piriformis often gets overworked, creating compression and friction on the sciatic nerve.  Sciatica is defined as aching/burning/stinging pain along the distribution of the sciatic nerve: buttock, back of the thigh, lower leg and foot.
Stretching the piriformis can be a very effective way of diminishing the compression, and therefore irritation of the nerve.  Pictured to the left is a very common stretch given as treatment to relieve sciatica.

A traditional piriformis stretch, is often done with a tucked pelvis (and/or flexed spine) and can irritate the nerve if the leg is pulled  too aggressively.  Instead, using the wall and props can be an effective way of maintaining a neutral spine and pelvis. By staying in alignment, and by being able to adjust the load by gradually bending the knee to 90 degrees, the tissues will begin to yield and let go, rather than work to hold the body in position.  
Picture on the left: The half cylinder and block supports my shoulders and head to allow me to rest with a neutral spine, with my ribs down and a level pelvis.  Due to my current tension patterns, I also have to support my lumbar area with a rolled yoga mat so I can comfortably attain neutral pelvis (pubis and ASIS level).  
Middle picture:  I place my left leg straight on the wall and cross my right leg over the left, making sure not to tilt the pelvis. Picture on the right:  I begin to slide my heel down the wall and stop when I feel that I am at my resistance barrier, or my pelvis begins to shift.  Hold at least one minute and repeat on the other side.  If you can tolerate the stretch stay longer, up to 5 minutes on each side.

Some people will try to get a deeper stretch by pressing the right knee down.  Make sure that you don't drag your whole pelvis when you do that (as shown in the pic on the left).  The purpose of this refinement is to maintain neutral, and that means a level pelvis (as shown on the right).   
Even if you don't have sciatica, this is a wonderful stretch to open the hips, and allow more freedom to your pelvis!  Enjoy!

Legs on the wall pose is a restorative position that should be a staple for every person that has a pelvis! Traditionally, the pose is taught by placing the butt close to the wall, and then bringing the legs up against the wall so the back of the legs touch, and the soles of the feet are facing the ceiling.  A variation to the pose is to widen the legs into a "V" position to stretch the inner thighs and groin.


Recently I have rediscovered the beauty of this pose by modifying the position to be able to maintain neutral pelvis (pubis and ASIS in line) and rib alignment.  The benefit of maintaining the alignment markers during this pose allows the connective tissue and muscles to fully release.  When the alignment markers are not in place, there is more load to the tissues which can potentially maintain tension, and prevent a full yield ("letting go") of the muscles and fascia.

In order to do this pose in alignment, you may need to get out props.  Due to the tightness of my psoas muscles and the increased kyphosis of my thoracic spine, I have used a thin yoga mat rolled up to maintain neutral pelvis: pubis and ASIS level, and a half cylinder & block to prop up my upper back to get my lower ribs down and flush with my abdomen. In order to get my pelvis level, I needed to scoot away from the wall, get the props set up, and then place my legs on the wall (see pics below).  

Benefits to Legs on the Wall Pose:

• Gently stretches the back of the legs, inner thighs and low back to relieve aches and pains
  
• Improves lymphatic/venous return from the feet and legs 
• Eases stress/anxiety
• Alleviates symptoms of menstrual cramps, PMS and menopause 
• Helps testicular and ovarian problems
• Relieves swollen ankles and varicose veins