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Getting Out Of Back Pain

11/18/2022

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Tension in the back is all too common! A high percentage of my clients are coming to see me because of it.

Many people who also see me for pelvic issues such as urinary leakage, pelvic organ prolapse, pelvic pain or healing abdominal separation postpartum say that they have a history of back pain that comes and goes, or experiences persistent chronic back pain.

Understanding some of the contributing factors to excessive tension in the muscles of the back can be key to decreasing or eliminating  pain, and improving function.
  • Breathing Patterns
  • Postural Patterns
  • Movement Patterns
  • Stress, Nervous System Regulation & Lifestyle Habits

Breathing Patterns

Because breathing is automatic, we don't always notice HOW we breathe.  Becoming a better breather is key to oxygen delivery, nervous system regulation, core movement and stability.  If the diaphragm is not moving well neither is the ribcage or the core canister.  You have got to move it to use it!​
  • Core Breathing
  • Oxygen Advantage
  • Buteyko Breathing

Postural Patterns

Our posture is created by our emotional states and how we move and present ourselves in the world.  Become more aware of unnecessary tensions that are affecting our postural state.
  • ​Feldenkrais Lessons: Posture for Life
  • Alexander Technique: 5 tips for standing posture
  • Katy Bowman of Nutritious Movement: Lower your risk of injury with proper alignment

Movement Patterns

I am sharing a home program circuit of some of my favorite moves to decrease tension in the back.  The emphasis here is to release the back extensors through breath, positioning and recriprocal inhibition (contracting  the abdominal flexors to relax the back extensors).

Stress Patterns

We live our lives in automatic.  How can we bring more presence to our lives in order to optimize nervous system signaling and therefore appropriate cues for the health of each system of the body.  
  • Understand and tend to the nervous system: Predictive Processing -Why expectation matters for movement and pain, Befriending your nervous system (50% off right now!),  Learn to repair your nervous system.
  • Mindfulness and Stress Reduction: Online programs with Tara Brach, Mindfulness Based Stress Reduction
  • Lifestyle Habits: Be True- Discover your core values and live your life on purpose (if you go to SoulSalt's IG page you can find the Black Friday/Cyber Monday code for 50% off),  Hire a Wellness Coach
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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Healing Your Abs Postpartum

5/16/2022

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Healing the Abdominal Wall Postpartum
Postpartum Body
Of course, I am biased, but I believe that every person that gets pregnant and gestates a baby for 9 months and then goes through the intense experience of delivery, should go see a Pelvic Health Physical Therapist (or Occupational Therapist) in the postpartum period (even if it has been many years since the last delivery).

At the Postpartum evaluation I can assess the integrity of the pelvic floor and the abdominal wall.  When I assess the abdominal wall, besides checking for diastasis recti,  I like to observe posture, breathing patterns and recruitment patterns of the core with different loads:
  • standing:  resisting the arms to movement in flexion, extension and rotation, forced expiration
  • lying on the back: lifting a straight leg, lifting both straight legs, resistance to the arms, forced expiration

A Common Core Pattern: Overactive upper abs and rib gripping

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!

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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Quadruped Rocking: Happy Hips and Spine

1/7/2019

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Neutral Spine has spinal curves.  A healthy spine moves!
Neutral Spine has Spinal Curves
Neuromuscular re-education plays a major role to getting out of pain and improving function.  Our body is very intelligent; the nervous system is prepped and primed for movements, actions and behaviors that are similar to what has happened in the past.  This is useful because it frees up our system's energy for more important metabolic tasks.  Unfortunately over time, the way we have done something in the past is not always helpful for the longevity of the tissues involved in the present movement.
Neuromuscular re-education drills help to create new neural circuitry to enhance proprioception, balance, motor control and coordination, which will have carry over to lasting healthy loads to the muscle and skeletal system.

Our Pelvis, Spine And Head Are Mobile... or I should say, We Want Them To Be Mobile

Many of the clients who walk into my office with hip, back or pelvic pain share some common features:
  • Inability to isolate pelvic motion and/or rigid spinal motion
  • Limited hip mobility in all ranges, especially hip flexion, adduction (moving toward midline) and internal rotation
  • Hypertonic spinal muscles (increased mass and tone in the lower thoracic or lumbar area).  

Movement drills to bring in neuromuscular re-education to these areas:

1.  Get the spine moving; Get the pelvis moving.  A great drill for this is pelvic tilts (click on link for a video of pelvic tilts on the floor).  The video here demonstrates the pelvic tilts in sitting.
2.  Get the hips moving.  Explore hip flexion and extension in quadruped (hands and knees or forearms and knees).  Make sure that the spine is neutral (refer to the spine pic above for a visual of our spinal curves) so you can make sure to get into the hips.  If the lumbar spine moves into flexion as you rock back, this means that you are not accessing the tissues of the hip joint.  
3.  Teach the erector spinae muscles that they don't have to 'HOLD TIGHT' all the time.  This requires patience and lots of neuromuscular re-education time (maybe I can do some videos for the next blog).  I like the client to connect to this in quadruped  and then bring to standing with hip hinge and bending/ lifting drills.  A good test to reveal the state of the muscles is to get into quadruped and see how the muscles respond (in this position they should soften and drop into extension).  For many people who overuse their back muscles, the erectors will be hard and pronounced like a steel rod.  The goal of rehab is to teach the muscle to let go and move into shortening (extending) and lengthening (flexing), which when held, doesn't perform either action very well.
Erector Spinae tension and hip/back pain
Notice the two mounds on each side of the spine just below the shoulder blades. You can see that the left side is just a bit more pronounced than the right.
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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Breathing Circuit

12/4/2018

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As a pelvic health specialist and a general orthopedic physical therapist, addressing the health of the "core" is essential to every client walking into my office.
What is the first and foremost requirement for healthy tissue?
MOVEMENT: 
  • Muscles can fully lengthen and shorten
  • Joints have the space, glide and spin for full active and passive range of motion
  • 3D Movement is available in all planes: rotation, sidebending and forward/backward bending

A healthy core is a core that moves.

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.
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Heal Your Core: Trunk Rotation

11/1/2018

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Heal Your Core: Trunk rotation movement sequence
When I am working with clients who present with pelvic organ prolapse, urinary leakage, back pain or abdominal wall separation, there tends to be a few common patterns:
  • Breathing pattern issues
  • Misuse of the pressure system
  • Excessive tone/tension in one or more muscle groups: neck & jaw, upper abdominals & ribcage, paraspinals, pelvic floor.
Breathing is the first skill to reeducate.  I have written about this here and here and here.  Once the breathing pattern is reestablished in sitting or lying down, it is time to practice adding an additional skill on top of the breathing pattern.  Many times when we workout and even throughout the day as we do certain moves, we tend to hold our breath.  The key to a healthy core is to maintain the flow of breath throughout all movements.

Maintain steady breathing during each movement drill

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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Healing the core: Are you tensing up just a little too much?

6/13/2018

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Healing abdominal wall separation (diastasis recti), urinary incontinence and pelvic organ prolapse
Many clients that I work with are coming in to see me in order to heal from abdominal wall separation (diastasis recti), urinary incontinence and pelvic organ prolapse.  Our culture admires the look of rock hard bodies, and we are taught at a very young age to "hold it in", to look toned and fit.

Unfortunately, down the road, this holding and tensing interferes with our functional mobility, and the full range of motion of lengthening and shortening of muscle fibers.
What will it take for our muscle system to be at rest when we are at rest, and to be able to move through full range of motion when we are ready to move?

Rather than DO such and such exercise to strengthen this and that, we need to UNDO!

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.  

Core integration sequence: UNDOING tension in the neck and ribcage

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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Healing Abdominal Wall, Urinary Leakage or Prolapse

2/28/2018

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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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    Susan McLaughlin,
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Contact:  Susan McLaughlin, PT 801.859.4142
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