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

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

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).

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

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!

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.

There are so many different ways to sit yet most of us spend time sitting in chairs at work, at school, at the movies, etc. And yes, there a lot of different ways to sit in a chair, but mostly when we sit we are leaning back into the chair, allowing our spine and pelvis to collapse. Over time, this constant load onto the flexed spine, the sacrum and supporting ligaments can create muscular and connective tissue adaptations. If we can make some simple changes in our sitting habits, we can change the loads and environment within the tissues to improve blood flow, cellular remodeling to potentially get us out of a back ache or even a pelvic floor issue.

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. 

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
 

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.  

If I said that I was going to run a marathon in 9 months, it is common knowledge that I would need to get ready for it.  I would have to set a training schedule to prepare my body for the long distance: 26.2 miles, average completion time 4 hours.

What if I said that I was pregnant, and I was going to give birth in 9 months.  Would the expectation be that I would train for this?  Probably not.  Why is that?  For many first time mothers, labor can last for hours, with the average length of active labor being 12 hours give or take.  Preparing the body to sustain increasing mass during pregnancy and preparing the hips and the pelvis for vaginal delivery should be part of the “mother to be” training.

In order to have a pain free pregnancy and complication free vaginal delivery here are some requirements:

• Strong thigh muscles to support the weight of the torso
• Hip mobility
• Moveable sacrum
• Strong deep abdominal muscles
• Pelvic floor muscles that will yield

Your training program should include:

Walking 
Walking with a reciprocal arm swing incorporates whole body movement which enhances circulation, strengthens the legs, and frees the pelvis.  Work up to walking 5 miles a day (this does not have to be done all at once).

Optimal postural alignment
We tend to carry our pelvis out in front of our ankles. 
 A forward pelvis affects: 

• the stability of the pelvic girdle which can create pubic pain or sacroiliac dysfunction
  

• the function of the pelvic floor which can cause the muscles to become shortened and unyielding 
• the position of the sacrum relative to the pubis which decreases the distance of the pelvic inlet.

Ideally we want to have the skeleton stacked so that we have the line of gravity going through the ear lobe, midpoint of shoulder, hip, knee and ankle.

Footwear choices affect alignment.  Any shoe with a heel will angle the body forward. The body compensates for this by tucking the pelvis under, bending the hips and knees.  Over time this can shorten the muscles on the back of the leg which can pull the pelvis out of alignment creating back pain and pelvic floor dysfunction.  Choose shoes that are flat and allow your toes to wiggle.

Hip mobility and leg strengthening
Squatting improves the mobility in the hips, strengthens the glutes and legs, promotes a wider pelvic outlet and allows the pelvic muscles to yield.
Exercises to address lateral glute strength will prevent the pregnancy waddle and decrease the instability and excessive motion at the pelvis.

Deep abdominal and pelvic floor training
Learn how do activate your deep abdominal muscle transverus abdominus without holding your breath.  Learn how to utilize this muscle for the pushing stage of labor.  The TRA is best activated during the exhale of the breath cycle: draw your belly button to your spine.

Learn how to let the pelvic floor relax in order to allow the baby to pass through without tearing (yes, this takes practice). The pelvic floor should relax/yield on the inhale of the breath cycle.  Imagine the ischial tuberosities (SITS bones) widening as the pelvic floor relaxes.