Office Location: 1817 S Main Street, Suite 10 SLC, UT 84115 | Phone 801 . 859 . 4142
Align Integration & Movement
  • Home
  • Work with Me
    • Request an Appointment
    • Rates & Insurance
    • Orthopedic & Pelvic Health Physical Therapy
    • Visceral Manipulation
    • Biofield Tuning®
    • Restore Room: Enhance your healing with Whole Body Vibration & The Vitalizer Chi Machine
    • NeuroKinetic Therapy™
    • Nutritious Movement™
    • Workshops
    • Testimonials
    • Resources
  • Blog
  • About Me
    • About Me
    • My Philosophy
  • Store
  • Podcast

Breathing Circuit

12/4/2018

0 Comments

 
Picture
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.
0 Comments

Heal Your Core: Trunk Rotation

11/1/2018

0 Comments

 
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.
0 Comments

Healing Abdominal Wall, Urinary Leakage or Prolapse

2/28/2018

1 Comment

 
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.
1 Comment

How Do You Breathe?

1/13/2018

3 Comments

 

Breathing is the key to life. If we can't breathe, we die within minutes.  Breathing is so essential to the health of our systems, yet rarely do people understand the connection and importance of HOW TO breathe effectively for the support of our core and the health of the shoulder girdle, hip complex, and lumbar spine.
Poor stability strategies and unconscious habits interfere with the proper movement of the muscles of the ribcage, diaphragm, abdominals and pelvic floor.  In order to have good stability to support the spine, we need to generate appropriate intra-abdominal pressure.  What I see over and over again with my clients is the inability to access the core muscles mentioned above during the breath cycle, as well as in functional activities.  A typical compensation pattern that people use is a pushing strategy to create strength, rather than allowing the muscles to activate and generate the intra-abdominal pressure.  This pushing strategy creates excessive outward and downward strain onto the pelvic organs and abdominal wall (think pelvic organ prolapse, urinary leakage, diastasis recti and hernias).  Not to mention over activation of the neck, shoulder girdle and paraspinals which impact neck/back/hip pain and function.

​Try this right now:

  • Lie down on the floor with your legs out straight
  • Bring your legs together
  • Keep your knees straight and lift both legs off of the floor about thirty degrees.
  • Notice: what happens to your abs?  Did they bulge outward?  What does your back do?  Does it arch?  What does your neck do?  Does it tense?
​How did you do?  In my experience, 95% of my clients use a pushing strategy: holding breath, pushing out into abdominal wall and pelvis, arching back and tensing or lifting the neck. Outside of pilates, or working out, this strategy gets carried over into daily tasks such as: getting out of bed, bending and lifting tasks, pushing open a heavy door, etc.   ​

So, what is optimal breathing for core function?

The first step is to become aware of the day to day habits that interfere with optimal breathing:
  • shallow breathing into chest and neck
  • holding breath
  • holding abs
  • locking down ribcage or gripping shoulder blades back and down
  • lifting shoulders to breathe (over activation of the scalenes, upper trapezius, levator scapulae)
  • squeezing butt cheeks (tightens the pelvic floor muscles)
  • ribcage and pelvic positions
The second step is to practice breathing.  During quiet respiration there should be movement in the intercostals (the muscles between the ribs), the diaphragm, the abdominals and the pelvic floor.  In order to have strength in the muscles, they need to move through full range of motion: lengthening and shortening. In this video, I talk about diaphragmatic breathing and core function.  Practice lying down, sitting and standing.  Each position places a different demand on the body. 
​Have fun and explore!

The third step is to begin to challenge the system.  Can you maintain the breath as you add a new skill or a new load?  Are you able to get movement into all areas of the thoracolumbar pelvic canister?  Quite often I observe tension and stiffness surrounding the ribcage.  Below I share a breathing drill to get mobility at the lower ribcage and diaphragm and a link from Dr Evan Osar on Three Dimensional 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.
3 Comments

Breathing and Core Stability

2/16/2015

7 Comments

 
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.
7 Comments

Pregnancy:  How to get your body ready for birth

9/7/2012

6 Comments

 
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.
Optimal Standing Alignment for Pregnancy
Optimal standing alignment
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 Squatting during pregnancy
Maintain a vertical shin as you lead with your butt to come down into a squat. This protects the knees and engages the glutes. Go down into a deep squat to improve hip mobility.
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.

Breathing techniques for labor


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.
6 Comments

Engage Your Core: Lower Body Progression

7/4/2012

14 Comments

 
Last week on Align’s Facebook page I posted a picture to promote my Postpartum workshop. This picture showed an example of the abdominal “bread loaf” that can occur if the Transversus Abdominus muscle is not activated correctly during daily activities such as bending or lifting and abdominal workouts.   The increased pressure is going down into your pelvic floor and out into your abdomen.  Over time, supportive tissues can fail, and the results are abdominal/inguinal hernias, organ prolapse (uterus, bladder, rectum) or disc herniations (just to name a few).

In a previous post, I reviewed how to contract the deep abdominal muscle correctly.  This is an important skill to master before increasing the demands on the body such as carrying more weight, or moving the limbs.  Once the contraction can be performed without holding the breath, it is good to challenge the core by moving the legs.  Here is a lower leg progression to advance core control.
Picture
Lie on your back with your knees bent, and feet flat on floor. Make sure that your pelvic triangle (see dots) is level. Notice your ribs. Can you see in this pic that the ribs are lifted? If your ribs lift like this, you may want to prop something under your shoulders and head so they can come down.
Picture
The head and shoulders have been propped up with a half cylinder under the shoulders and a yoga block under the head. Now the ribs are in alignment and the transversus can have a more effective contraction. The pelvic triangle remains level.
Core Lower Body Progression
Activate your Transversus by drawing your belly button toward your spine as you exhale. Lift one leg to ninety degrees as shown, and hold for 1-2 sec. Then lower down. Contract your transversus again and lift the other leg. As you gain more control, contract the transversus, lift one leg to ninety degrees and then alternate legs without having to reset the contraction. Complete 10 repetitions and then rest.
Core Progression: Double leg lift
When you are able to complete alternate legs without difficulty. Perform transversus activation by drawing belly button toward the spine on the exhale, lift both legs at the same time as shown. There should be no bread loaf. If there is, you are not contracting transversus correctly. Go back to the last step before advancing to this progression. Hold for a few seconds and then lower down slowly on your exhale. You should never hold your breath! Repeat.
Picture
Next progression: From the initial position, place a pillow or yoga block between your knees. Contract your transversus and lift legs to ninety degrees. Gently squeeze into the block. Maintain transversus contraction as you begin to rotate your hips.
Core Progression: Active Hip Internal Rotation
Gently squeeze block as you rotate your hips by moving your feet away from each other, and then return to start position as in prior picture. Perform 10 repetitions and then bring both legs down on your exhale. Repeat 2-3 times.
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.
14 Comments

How to contract your deep abdominal muscle: The Transversus Abdominis

4/30/2012

93 Comments

 
In a recent post on “Habits and Sucking In”, I talked about becoming aware of how often we hold our stomach in to not look fat.  In the fitness world we are told to “suck it in” or “hold the abdominals tight” to help protect the spine.  This language can get really confusing: suck it in, contract your core, hold it up, use your abs...
 

What does this mean?  For many people when they are told to contract the abdominals, what they really are doing is sucking in, pulling up their diaphragm and bringing the abdominal contents with it.  This is not muscle work.
Picture
Tranversus Abdominis Muscle.
The muscle that should be contracting is called the transversus abdominus.  It is the deepest of our 3 muscles in the side body wall.  In order to engage the entire muscle and to perform a correct contraction, the ribs should be flush with the body wall and the spine and pelvis should be in neutral (when lying on your back your pubis and pelvic bone are all even). The cue that I like to give is to "use your muscles to pull your belly button back to your spine." I find it helpful to have people perform the contraction on the exhale phase of the breath.  Make sure to keep the pelvis level during the contraction.
Picture
My client at rest, her pelvis is level.
When performing a lower abdominal exercise such as the leg lift, you can tell if you are not using the transversus abdominis if your rectus abdominis (your six pack muscle) pokes out and looks like a bread loaf.  Try contracting the muscle before you lift the legs and see if the “loaf” stays flat and engaged.
Picture
When she starts to lift her legs, her rectus abdominis pops up like a "loaf".
Picture
Here she is able to lift her legs by performing a transversus abdominal contraction prior to the lift. Look, no "bread loaf"!
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.
93 Comments

Habits... and sucking in.

3/6/2012

42 Comments

 
Habits die hard... with mindfulness and awareness.  When it comes to pelvic health, learning to tune into those automatic circuits will allow the body and mind to stop the dysfunction cycle and create healthy patterns.
 
Take for instance sucking in the stomach.  Many people that I see in my clinic with pelvic floor dysfunction also have a habit of sucking in their tummy.

Sucking in may be sexy in a swim suit, but this upward force of the diaphragm opposes our natural downward necessary functions like: digestion, elimination, menstruation, circulation and birth.

Not too sexy when you bloat, can’t poop, have menstrual cramps, and need to have a c-section.

So, let’s do a habit check: are you sucking in right now?

Many of us have been sucking in so long that we don’t even realize it.  So, check again.  Go to the mirror and lift up your shirt.  If your are sucking in, you will see an upward pull of your abdominals at the bottom of the ribs.
Sucking in the stomach
This is sucking in. See how there is an upward pull and the ribs stick out.
Picture
This is the abdomen relaxed. Notice no upward pull.
Many people mistake sucking in for contracting their “core”. A contraction of the deep abdominal muscle, the transversus abdominus, is inward toward the spine, not upward.

In order to regain the optimal function of our “core”, sucking in needs to stop.  Practice an abdominal release on your hands and knees. Feel the tummy relax and drop toward the floor.  It may feel uncomfortable at first as the diaphragm relaxes back to its natural position. Start to become aware of how often you suck in during the day, and let it go. You can break the habit!
Picture
Starting position on hands and knees.
Abdominal Release
Allow the abdomen to relax. Feel the tummy drop to the floor.
42 Comments

    Author

    Susan McLaughlin,
    Physical Therapist

    Picture
    Picture
    Picture
    Picture
    Picture

    FEEL GOOD SERIES:
    Movement videos for download

    Picture

    Products I love:

    Picture
    Picture
    Picture

    Props for home:

    Disclosure: I only recommend programs and products that I would use myself.  If you use these links to purchase something, I may earn a small commission at no additional cost to you.  Thank you.  

    Categories

    All
    Alignment
    Back Pain
    Breathing
    Chronic Pain
    Core Stabilization
    Fascial Health
    Foot Health
    Healing The Nervous System
    Hip Pain
    Knee Pain
    Lower Extremity
    Neck And Upper Extremity
    Pelvic Health
    Postpartum Healing
    Pregnancy
    Psoas Release
    Self Care
    Shoulder Girdle
    Shoulder Pain
    Si Joint Pain
    Spine
    Thoracic Mobility
    Transversus Abdominis
    Treatment For Si Dysfunction
    Walking
    Wrist

    RSS Feed

    Archives

    November 2022
    May 2022
    November 2021
    April 2021
    December 2020
    September 2020
    July 2020
    June 2020
    May 2020
    April 2020
    February 2020
    October 2019
    September 2019
    August 2019
    July 2019
    March 2019
    January 2019
    December 2018
    November 2018
    September 2018
    August 2018
    June 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    August 2017
    July 2017
    May 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    August 2014
    June 2014
    May 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    August 2013
    July 2013
    June 2013
    May 2013
    March 2013
    January 2013
    December 2012
    November 2012
    October 2012
    September 2012
    August 2012
    July 2012
    June 2012
    May 2012
    April 2012
    March 2012
    February 2012
    January 2012

Office:  1817 S Main Street, Suite 10 | SLC, UT 84115
Located in the Forrester Office Complex


ALIGN integration | movement, PLLC.  All rights reserved.
@2012-2023
​Medical Disclaimer        Privacy Policy & Terms of Use
Good Faith Estimate
​

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