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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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How to sit with a neutral pelvis and spine

11/9/2016

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Decrease back and neck pain by sitting with a neutral pelvis and spine.
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.

Neutral Pelvis

Neutral Pelvis with Prop

Neutral Pelvis & 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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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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Skinny Jeans and Your Pelvis

7/20/2015

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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

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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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Breathing and Core Stability

2/16/2015

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Core stability
I just did a search on the internet for the best exercises for core stability.
Here are the top exercises that came up in the search:
  • Modified plank on knees
  • Plank
  • Side plank
  • Bridges
  • Bird-dog on hands and knees
  • Crunches
  • Obliques crunches
  • V sits
  • Plank with an exercise ball
  • Dying Bug
These exercises are great for building the global muscles of the core: abs and back muscles, but what about the intrinsic muscles of the core? In my practice, many people have come to me who have already been doing their "core exercises" and yet they still suffer from back pain, SI dysfunction and pelvic floor disorders, etc.  The key to true core stability is to develop motor control, timing and coordination of the intrinsic muscles first, and then develop the abs, obliques and back muscles once the inner stabilization system is firing and wiring together.

Intrinsic Core Muscles

Breathing and Core Stability
Burrell Education has incredible courses. Check them out!

Diaphragmatic breathing is a great way to reconnect the inner core muscles

The Rhythm of the Respiratory Cycle:

  • During inhalation, the diaphragm contracts while the pelvic floor and the deep abdominal muscles relax.
  • During exhalation, the diaphragm relaxes while the pelvic floor and deep abdominal muscles contract.

Establishing Core Stability Through Diaphragmatic 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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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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Refining the Quad Stretch

8/14/2014

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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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How to Strengthen Your Gluteus Maximus

5/19/2014

13 Comments

 
How to strengthen your gluteus maximus
I have been working with a client for a few visits.  His main complaint: L low back pain and L hip pain.  He has made some good progress and will feel good for about a week or so and then the discomfort will come back.  In our last session we found that he couldn't lift his left thigh off of the table when he was on his stomach, and it really hurt his back.  I could see that his back muscles on his left side were really working hard.  I released the back muscles and his discomfort went away, but he still couldn't lift his leg.  His left gluteus maximus was not responding what so ever!
This last weekend I attended a training called  "Finding Center"  by Gary Ward of Anatomy in Motion.  The first day of training we spent 4 hours exploring the 3D movement of 6 key muscles in the body. One of these muscles was the gluteus maximus.  Many of us know the glute max actions: hip extension, hip external rotation and hip abduction.  Typical ways to strengthen this muscle is through concentric contractions as in clam shells, fire hydrants, bridges, lunges and squats.  
According to Gary Ward, the first rule of movement is: "Muscles lengthen before they contract."  His theory is that you want to lengthen the muscle as far as it can go, and it has nothing to do but contract.  I applied this concept when I returned from my training. 
My client came in this week with his left back and hip a little aggravated.  I tested my client again on his stomach.  He could not lift his thigh off of the table, and he had incredible pain in his back.  I had him stand up onto his left leg and move through the single leg squat and 3D reach.  I had him allow his hip and knee to move into flexion, adduction and internal rotation (prior to this training, I would have controlled for knee adduction and internal rotation).  After completing about 10 repetitions he says, "I don't have the pain in my glute anymore."  We moved through a few more patterns, got him back on the table and retested his ability to lift his thigh off the table:  Full lift without any pain!  He was completely amazed, and quite honestly so was I!  He got off of the table, took a walk and didn't have any pain.  Next time you feel like you are stuck in your training, or you have a case of "dead butt", remember: muscles lengthen before they contract.
I have included one of the movement patterns I went over with my client in the video below.  Rather than tapping down with the foot, you can also try reaching your arm out to touch the floor in a clockwise fashion.

3D Glute Max

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

76 Comments

 
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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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Contact:  Susan McLaughlin, PT 801.859.4142
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