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Heal Your Core: Trunk Rotation

11/1/2018

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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.
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Healing Abdominal Wall, Urinary Leakage or Prolapse

2/28/2018

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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.
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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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Decrease Knee Pain

12/13/2014

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Decrease knee pain with therapy balls
I love using Yoga Tune Up® therapy balls!
Knee pain affects 25% of the adult population.  Most knee pain is blamed on arthritis.  Arthritis is joint pain, stiffness, inflammation. But what causes that?  How you move and use your body every day can increase joint loads, friction, and compression at the knee, and can eventually lead to pain, stiffness and inflammation.  So, below is a series of movements to decrease the tension in the muscles surrounding the knee. This sequence is designed to improve blood flow and connective tissue hydration which can help decrease the tension in the muscles surrounding the knee and help to decompress the knee joint.
Save your joints and give yourself some quality ball time!

4 movements to release the muscles around the knee:

The last two videos don't show it, but you will want to continue to move the ball down the calf.  Repeat on both sides, or just on your side of pain.  If your knees are too stiff and painful to bend as shown in the last two videos, roll up a towel and place it on top of the balls and then sit back.
You can by the Yoga Tune Up® Balls and DVDs if you want to explore the amazing products from Jill Miller and Yoga Tune Up®.
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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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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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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Simple Steps to Eliminate SI pain

3/5/2013

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In healthy movement, the sacrum moves relative to the inominate bones.  When the sacral promontory moves forward into the pelvic bowl, the motion is called nutation; counternutation is the opposite motion.  The optimal position for the sacrum in standing and sitting is slightly nutated between the inominates.  This is the goldilocks position: not too tight and not too loose. 

During sitting and standing, you can diminish stress on the SI joints by maintaining a neutral pelvis.   
In my practice I work with a lot of people who have low back pain, and sacroiliac (SI) pain.  How we stand, how we sit, and how we move in our bodies over time, contributes to our dysfunctions and potential pain syndromes.

Being mindful of HOW we stand and sit are simple steps to begin to unravel the increased loading and compression on the spine and SI joints, as well as the tension and pull on corresponding ligaments and muscles. 

Before going over standing and sitting, let’s look at the anatomy:  The pelvic girdle is comprised of the 2 pelvic (inominate) bones and the sacrum.  The inominate bones join in the front by a thick fibrocartilage disc similar to that of the vertebral discs.  This area is called the pubis or pubic symphysis.  In the back, the inominate bones attach to the sacrum, creating the sacroiliac joints.  

The function of the pelvic girdle is to transfer the loads between the trunk and the lower extremities via the spine and hips (lumbopelvic-hip complex).  There are 35 muscles that attach directly to the pelvic girdle.  Therefore, the mobility and stability of the SI joints depends on the interaction of these muscles, ligaments, fascia and nerves that surround the pelvic girdle.

Learning how to stand

Look around you, most people stand with their pelvis out in front and their shoulder’s and ribcage back (as in the pic below).  
This posture causes the sacrum to fully nutate, meaning that this is the maximally closed position of the SI joints.  This position can create low back and SI joint aching during prolonged standing.
SI compression with poor standing posture
Incorrect Alignment: Anterior Pelvic Sway
Correct your alignment by shifting your hips back, allowing your trunk to move forward so the line of gravity travels through your joints: shoulder, hip, knee and ankle.  Now the pelvis is in neutral: the pubic bone and ASIS line up vertically, and the SI joints are in optimal position.
Improve SI pain by standing better
Joints are in a plumb line.

Learning how to sit

Many people slump their spine and pelvis while sitting watching TV, or sitting slumped at the computer.  In this posture, the weight of the body is positioned behind the SI joints.  This places the SI ligaments under load, the sacrum is tucked (counternutated), and pressure is at the tailbone (coccyx).  
Eliminate SI pain
Photo by Felipe Dias
The stress of this position will stretch the ligaments of the SI joint, and can also create tailbone pain.  Maybe you can relate to having pain while trying to walk after sitting like this for awhile.  The initial steps are excruciating until you are able to walk it out as the ligaments regain their normal position.

Correct your alignment by sitting on your ischial tuberosities (SITS bones).  The pelvis and spine should be in neutral.
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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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