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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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Hip Mobility

6/19/2015

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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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Self Care for Hip, Groin, and Back Pain

10/1/2014

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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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How alignment can affect fetal positioning

2/9/2014

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Daily habits can affect position of babe in womb
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) 

Why are babies malpositioned?

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                                                                           

What can we do about it?

  • Stand & Sit in alignment
  • Release tension in your hip flexors and pelvic floor
  • Walk 3-5 miles a day

Stand and Sit Alignment

Good Standing Posture during pregnancy
Stand in alignment.
If we had a plumb line coming down from her shoulder, you can see that her shoulder, hip, knee and ankle are stacked up in a line.
The pelvis is neutral in this position and the load is transmitted through the legs. The ribcage is stacked over the pelvis, so the core is able to engage and support.  The muscles of the pelvic floor are in a more optimal position to generate force.

Optimal sitting alignment
Sit in alignment.
Sit on your ischial tuberosities, not your sacrum.
Avoid sitting slumped on cozy couches, and driving in bucket seats. For a demonstration see video to the right.

Anterior pelvis sway in pregnancy
Poor standing alignment.
If we had a plumb line coming down from her shoulder, there wouldn't be any joint stacked underneath.
The load is being transmitted to the front of her abdominal wall (which can create abdominal separation), to the front of her pelvis (which can create pubic symphysis pain) and to her low back and SI joints.
The ribcage is not stacked over the pelvis which interferes with the optimal function of the core: diaphragm, pelvic floor and deep abdominal muscles.

Release Tension in your Hip Flexors and Pelvic Floor

Psoas muscle tension can affect engagement into pelvic inlet
 Attaching superiorly at the spine (to the transverse processes and lateral surface of thoracic vertebra 12 to the last lumbar vertebra and corresponding discs) and traversing down and forward through the pelvis to attach to the inside of the upper leg (lesser trochanter).  Tension in the psoas can limit the fetal space as the baby descends into the pelvic inlet.

Psoas Release on the floorPsoas release
Place the bolster near the bottom of the shoulder blades.    Make sure that the ribs remain relaxed and flush with your abdominal wall.  Extend the legs. Make sure that the back of your thighs fully touch the floor. If they don’t, you need to bolster up higher.  Relax here for 5-10 min.  Allow your legs and torso to relax.  Practice breathing.  Focus on allowing the pelvic floor muscles to relax on the inhale. Tension in the pelvic floor can pull on the sacrum, limiting sacral mobility that is necessary to widen the pelvic outlet.


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.  
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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Ten Exercises for a Healthy Psoas

10/5/2013

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We have two psoas muscles on each side of our body: psoas major and psoas minor.  This blog is specific to our psoas major.  
This summer I took a very cool tele-class from Liz Koch, of Core Awareness.  In this 5 week series we explored the location and function of the psoas and its relationship to the nervous system and our "fight/flight/freeze" response,  to our emotional well-being and to our skeletal support.
The psoas is centrally located: emerging from the midline at thoracic level 12, attaching to every lumbar vertebra and inserting into the inner thigh at the lesser trochanter.  
The psoas allows the lower limb to move and swing a as a pendulum: multidirectional/orbital.  
As a physical therapist I see many people with SI dysfunction, hip and back pain.  In almost all cases, the psoas is the top priority to rehabilitate.   On muscle testing the psoas is usually weak, and the flexibility test is usually tight.  What I have come to understand through this tele-class, through my training as a Restorative Exercise Specialist™ and as an NKT™ practitioner, is that rather than manipulate the psoas through deep tissue work and stretching, the psoas needs to rehydrate and recover from over-exhaustion.
I have compiled my favorite top 10 ways to release, rehydrate and restore the psoas.  It is helpful to perform a release before going onto the movement sequences.  Some of these are from Liz Koch's book, "The Psoas Book" and some are from the Whole Body Alignment Program.

Releases

Constructive rest position for psoas release
Position yourself on your back as shown. You can use a pillow for your head if you notice that your chin lifts to the ceiling. Begin to focus on your breathing. Tune your awareness to your hip sockets. Imagine that the head of your femur bone is centered in the socket of your pelvis. Breathe here for 5 minutes.
Psoas release with a bolster
Postion yourself on a bolster or rolled up exercise mat as shown in the picture. You want to find a bolster that is high enough so that the back of your thighs touch the floor. When you lie on the bolster, you want to make sure that your lower ribs are flush with your abdomen. Breathe here for 2-5 minutes.
Hip flexor release with block under the pelvis
Position a yoga block, rolled up yoga mat or thick book under your sacrum. You want to make sure that the block does not go higher than your pelvis (it should not be blocking your low back). Breathe here for 2-5 minutes.

Movements

Modified Thomas Stretch
After the block release, bring one leg toward your shoulder as shown in the picture. Let the other leg go out straight and begin to lower the leg down to the floor. Make sure to keep the knee straight. Hold for 3-5 breath cycles and then repeat on other side.
Quadruped hip extension
Come on to your hands and knees (or onto your forearms as shown in the picture). Kick one leg back with a straight leg. Make sure to keep your pelvis level. Move your leg toward the floor keeping your leg straight and then extend your hip back as far as you can go without moving or rotating your pelvis. Repeat 10 times, then switch sides.
Supine straight leg raises
Lie on your back as shown. In this movement you will keep your leg straight as you lift your leg up and down 10 times, then place your leg on the floor and slide your foot toward midline and then outwards 10 times. Repeat on other side.
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Bend your knees and reach your arms toward the ceiling.
Psoas stretch with arm movement
Begin to move your arms overhead as far as you can go without arching your back or lifting your ribcage, and then return to starting position. Repeat 10 times.
Knee to chest stretch with bent knee
With your knees bent, bring one knee toward your chest. Take 3-5 breath cycles and then switch sides. Repeat 3 times each side.
Single leg hip stretch with leg straight
With your opposite leg straight, bring one knee toward your chest. Take 3-5 breath cycles and then switch sides. Repeat 3 times each side.
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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Pain in the hip, and what to do about it

1/2/2013

11 Comments

 
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Tensor Fascia Lata (TFL) attaches to the iliac crest/ASIS and into the fascia lata that terminates at the lateral knee.  The primary functional movement of this muscle is to stabilize the pelvis and the knee.  Its action is hip abduction, flexion and medial rotation. Trigger points related to the TFL refer to the outside of the thigh.
Iliacus & Psoas = Iliopsoas The Iliacus attaches to the iliac fossa and the Psoas attaches to the transverse processes of L1-L5 and the lateral aspect of T12-L5.  They share a common attachment point on the lesser trochanter of the femur.  The iliopsoas flexes the hip and trunk.  
Trigger points in the iliopsoas refer to the anterior thigh and low back.
Sartorious attaches to the ASIS on the pelvic crest and to the medial aspect of the tibia. Its action is hip flexion, external rotation, abduction and knee flexion. Trigger points in the sartorious refer to the anterior and medial thigh.
Trigger points in a muscle can be the culprit in many pain disorders.  In this post, I provide a self care technique to assist with these potentially troublesome trigger points. The muscles that can refer pain into the hip area are the tensor fascia lata, iliacus, psoas and sartorious.  If you are interested in learning more about what causes trigger points and how to treat them, I have listed some websites dedicated to trigger points and myofascial pain syndromes at the end of the blog.   Click on the pictures below to enlarge the picture and to link you to triggerpoints.net, an amazing resource for trigger points and referred pain.

If you are experiencing any of these pain patterns , try this:

How to release the psoas
Release tension in the psoas,  and the surrounding hip musculature by performing a constructive rest position with a bolster.  Allow yourself to breathe and relax for 5 minutes.  For instructions on how to do this click here.

How to release tight hip flexors with a ball
Perform a release technique utilizing myofascial release balls such as Yoga Tune Up Therapy Balls for Self Massage (that's what I have and I love them),  Melt Method Products, or good old tennis balls.  There are a lot of different ways to get into the muscles.  For this technique you will take two balls held together in a sock or bag.  My finger is pointing to my ASIS on the iliac crest.  Place the balls horizontally just below the ASIS.

Femoral Triangle
You will be working near a tender area due to the superficial exposure of the femoral vein, artery and nerve at the femoral triangle.  If you start to feel tingling and nerve sensations, move to a different area.  Just underneath the vessels and nerve lies the iliopsoas.  The next muscle laterally (to the right in this pic) is the sartorious, and the muscle in red is the tensor fascia lata.  Sandwiched in between the two is one of the quadricep muscles, the rectus femoris.  This will get released as well.

myofascial release to hip flexors with tennis balls
The balls are placed as above on the left side here.  With the right leg you can adjust how much body weight you put down into the balls.  If it is more comfortable, you can prop up onto your elbows.  If you are not able to get down onto the floor, you can place the balls at your hip, and lean into the wall or a door jam. Try to allow your muscles to relax and mold over the balls.  If you find that the balls are too intense to start with, place a folded hand towel over them to disperse the pressure.  If you are holding your breath and tensing your muscles to deal with the pain, this defeats the purpose.  You should be able to feel the sensation and breathe into the area as the muscles release.   Once you feel that the muscle has let go, move the balls into a new area.  Spend 5 minutes on each side.  Enjoy how you feel when you get up to walk.  Feel the freedom in your hips!


Resources:
 http://www.triggerpoints.net/, http://saveyourself.ca/tutorials/trigger-points.php, http://www.myofascialtherapy.org/
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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    Susan McLaughlin,
    Physical Therapist

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Contact:  Susan McLaughlin, PT 801.859.4142
susan@alignforhealth.com