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.

• 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).

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.

• 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.   ​

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.

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.

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.

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.

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.

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!