Pelvic Pain; PMS or beyond with the blues?

Guest blogger Elizabeth DeLozier SPT from SDSU
March 2016

Pelvic Pain can be due to many causes, with Physical Therapy at CTS treating myofascial, postural, biomechanical, and post injury (trauma, surgery) related pelvic pain. Often times we notice a cyclical nature of pain flares over the course of treatment, and some of our clients have a strong hormonal influence over the pain, related to PMS, or a more intense cyclical pain cycle PMDD.
We did some research this month to assist our clients who are presenting with cyclical pain flares that can be improved with Physical Therapy, Lifestyle and Nutritional interventions. Discuss the items listed below with your health care provider. Let us know if you suffer with PMS or PMDD and what you have found to be helpful.


PMS vs PMDD

What is PMS?
PMS, or pre-menstrual syndrome, is a broad term referring to physical, emotional, and psychological changes which affect women 1-2 weeks before their menstrual cycle and ease when they begin their period. Approximately 30-80% of women of reproductive age experience PMS. Symptoms include abdominal bloating, headaches, increased or decreased appetite, muscle aches or joint pain, fatigue, depression, and irritability.

What is PMDD?
PMDD, or pre-menstrual dysmorphic disorder, is a more severe form of PMS that affects approximately 3-8% of reproductive-age women. PMDD is characterized by significant mood disturbances and irritability which impair occupational and social interactions. The major risk factors of PMDD include a history of mood or anxiety disorders, familial menstrual or pre-menstrual disorder, and age in the 20’s or 30’s.

What causes PMS and PMDD?
Although researchers are unsure of exactly what causes PMS and PMDD, many women suffering from these disorders may have underlying anxiety or depression. Some researchers believe that the hormonal changes that trigger the menstrual cycle may worsen the symptoms of mood disorders. A recent study found that many women who exhibit signs of PMDD have low serotonin levels. Serotonin is a neurotransmitter involved in controlling mood, attention level, pain, and sleep. Women who believe they may have a mood disorder should talk to their doctor about treatment options.

Diagnosing PMDD
The best way to confirm a diagnosis of PMDD is charting daily symptoms. Women suffering from PMDD will experience a symptom-free phase between menses and ovulation. Well-validated studies on using symptom charting for the diagnosis of PMDD can be found below.
http://www.ncbi.nlm.nih.gov/pubmed/12012879
http://www.ncbi.nlm.nih.gov/pubmed/17470584

Non-pharmacologic treatments for PMS and PMDD can include:

• Lifestyle changes and nutritional supplements:
• Decrease nicotine, tobacco, and alcohol use in the 2 weeks prior to menstruation
• Decrease sugar, caffeine, and sodium intake in the 2 weeks prior to menstruation
• Ensure adequate rest: at lease 6-8 hours a night
• Regular aerobic exercise has been shown to be beneficial for women suffering from PMS or PMDD.

A large, multicenter study found that 1200 mg of calcium per day significantly decreased emotional and physical symptoms of PMS and PMDD.

Studies have found that vitamin B6 in doses of 50-100 mg/day are beneficial for women suffering from PMS and PMDD

Herbal supplements:
There is some evidence that 200 mg of magnesium and 400 IU of Vitamin E per day can decrease symptoms.

A recent double-blind, placebo-controlled study found that 1 tablet of chasteberry extract, also known as agnus castus fruit, significantly decreased PMS and PMDD symptoms of irritability, headache, anger, and breast fullness.

Gingko Biloba has been found to decrease fluid retention and breast fullness associated with PMS and PMDD.

More info about PMS and PMDD can be found at:
http://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd
http://www.webmd.com/women/pms/premenstrual-dysphoric-disorder
https://womensmentalhealth.org/specialty-clinics/pms-and-pmdd/

The Happy Heart, The Healthy Heart

Maureen Mason, MSPT, WCS, CCI, PYT-C

February is heart health month, and I am writing this in honor of a dear friend who confided in me she discovered during a recent medical procedure that she has significant heart disease. She is now intent on, and practicing, heart health in mind, body and spirit. She may use medication and /or surgery, as needed, yet in her post op lifestyle she is on a health quest incorporating mindfulness, walking, and healthy eating daily. I want her to live long and prosper!

Sages throughout the ages offer strategies and methods for peace, enlightenment, and wisdom. Certain habits and practices help mind, body and spirit to thrive. Here are a few habits that can improve your health,and can specifically help your heart health.

Exercise regularly, 12 x per month or more.
Regular exercise may include the practice of yoga, either solo, or in a class that is safe and sound. A study published in research gate identified significant reductions in anxiety, depression, worry, and reduced salivary cortisol in women practicing Iyengar yoga for 3 months, compared to controls. Walking is also a wonderful form of exercise.Recent research is noting health benefits of yoga as similar to that of traditional cardiac training.

Maintain a good weight, BMI range 18.5 to 29.9
Calories count: Eat a diverse, Mediterranean diet. Eating a lot of vegetables, nuts, and good fats and proteins helps fill you up and nourish your body.

Practice meditation*: clear your mind
"Being", sitting or reclining, breathing, and cycling a mantra or prayer can calm and control the wandering mind. Use free guides, friends, or links in prior yoga posts here to develop a meditation practice. Research is showing improved mental and physical health in individuals who meditate regularly.

Alcohol: moderation
Women may benefit from one drink per day, men, 2 drinks. But alcohol use can cause impaired health by adding extra calories, upsetting blood sugar, irritating the throat, stomach lining, pancreas and liver, so if used, only in moderation.

Engage the positive with Spirituality, or Religious affiliation.
Reading uplifting literature or prose regularly, or having spiritual or religious devotions can enhance your life, and your health. Individuals that have spiritual or religious devotions as part of their life rate higher on compassion, forgiveness, and on heart health standards.

Comprehensive Therapy Services has resources to help improve your health, including free handouts on Mind Body health strategies, Meditation*, “Medicine Mind” mindfulness training, Doterra essential oils, pilates and other fitness classes, acupuncture and massage. Ask your therapist for resources to improve your heart health and self care. One on one private training is available for health and wellness in professional yoga therapy.

Ginger Garner is a a preventative health care leader with free mediation* podcasts and a gentle yoga DVD you can practice.She founded the Institute for Professional Yoga Therapy. The PYT-C after my name denotes my Professional Yoga Therapy affiliation and training, which has helped me practice self care and expand my integrative health care offerings to clients. She created PYT to offer medically based, safe, sound yoga programs. Here is her link: http://www.gingergarner.com

Research based articles on heart health:
Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program.
"Women suffering from mental distress participating in a 3-month Iyengar yoga class show significant improvements on measures of stress and psychological outcomes. Further investigation of yoga with respect to prevention and treatment of stress-related disease and of underlying mechanism is warranted."

Measurement of the effect of Isha Yoga on cardiac autonomic nervous system using short-term heart rate variability
During both supine rest and deep breathing, Isha Yoga practitioners showed well-balanced activity of vagal efferents, overall increased HRV, and sympathovagal balance, compared to non-Yoga practitioners. Hence, it may be postulated that Isha Yoga practitioners: have better exercise tolerance, their cardiac response to adverse conditions like day-to-day stress is improved following Isha Yoga practices the probability of them experiencing hypertension and other premature cardiac events like ischemia or infarction is decreased after the practice of Isha Yoga. However more studies should be conducted to explore these areas further.

Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women
Cardiovascular disease mortality was significantly lower among women in the top quintile of the Alternate Mediterranean Diet Score (RR, 0.61; 95% CI, 0.49 to 0.76; P for trend less than 0.0001).

Eat More! Optimal Nutrition for Health

Eat More! Eat Less! Optimize Your Nutrition for Health

Maureen Mason, MS PT, WCS, CCI, PYT-C   January 2016

   Choosing specific foods can reduce inflammation and pain, so here are medical guidelines recommended by the experts. Check with your health care professional for any questions or concerns. Add one new item per week to your current routine. 

Eat more for specific anti –inflammatory* effects:

Nuts such as Walnuts, Almonds, Flaxseed

Avocados   Mushrooms

Salmon, Sardines, Herring

Green Tea, Tart cherry juice, Red wine, 5 oz., and Soy

Spices Turmeric, Ginger, Cinnamon

Eat more for overall health: fresh fruits and vegetables, seeds and nuts and beans, low glycemic foods, “whole food” with no chemical additives, lean poultry, fish, and omega 3 enriched eggs. Balance good fat and protein and carbs to equalize blood sugar response after eating.

Eat Less

Processed food, fried food, meat, and dairy. Seafood such as shrimp and lobster can be pro-inflammatory. Gluten is in any wheat product and also used as an additive in many products, consider limiting if your provider advises. Dairy is associated with indigestion and IBS and many health care providers advise limiting to reduce indigestion. Alcohol and soda are big calorie items and associated with negative health indices. Overall portion size of items from this list can be reduced with benefit, such as having ½ of a donut vs. 3 donuts.

Notice how your stomach and digestive system react for hours after you eat. Notice energy levels, mental focus and clarity, and ease of sleep and waking.

*Anti-inflammatory effects occur on a cellular level with an optimal nutritional intake. Protein molecules called cytokines that are produced with injury act as part of the immune system. Cytokines circulate and sensitize nerves to pain and increase pain sensations. Omega 3 healthy fats and other items listed in the anti inflammatory list help dampen the cytokines and reduce pain signal production. Effects of food are cumulative, so choosing a regular grazing habit from the best items can help you feel better in the long term.

Nutrition Websites and Resources to help optimize eating habits

1.     1..Dr Ski Chilton advises we reduce our overall calorie consumption 20% -30% if overweight or obese; here is a link to his advised anti-inflammatory nutrition program, with a free information guide on healthy eating and suggested good fats: www.genesmart.com/pages/meet_dr__chilton/10.php

2. Here is a tremendous link Dr Michael Lara, a holistic psychiatrist, with his outline of slides explaining the inflammatory process and the role of nutrition, supplements, and exercise in health and disease: http://www.slideshare.net/mlaramd

3. Do you have “brain fog” after eating, or feel tired? Perhaps you are eating meals that have too high of a glycemic index. Check out this link for excellent detail as to why you may be on a glycemic roller coaster: https://www.raystrand.com/glycemic-index.asp Foods that are high on the glycemic index include: white bread, cereal, rice, white flour, potatoes, beer, fruit drinks, and processed foods.

4. Are you on the paleo trend? What’s the buzz? If you are a high level athlete you may need more protein to support your training, and some MD's are leaning towards plaeo, Here is a link to the Mayo clinics explanation and medical advice on the topic: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/paleo-diet/art-20111182

5. Do you really understand what the Mediterranean diet is? Here is the Mayo clinics profile and medical advice: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

6. Fact: Physical therapists treating pelvic pain, bowel and bladder problems, sexual medicine, and any musculoskeletal pain problem are directing clients towards self care and healing with optimal nutrition. Here are links to women’s resources for optimizing nutrition in relation to health concerns: http://integrativewomenshealthinstitute.com/blog/

Additional: Fluid and Fiber Management

Optimal fluid intake can be considered an intake of ½ of the body weight in ounces of water per day. A 150# individual may need 75 ounces of water per day.  Food and other fluid intake, temperature, age, and activity level all influence hydration need. Increased temperature and increased activity level both will increase the need for hydration. Signs of dehydration include fatigue, fainting, low blood pressure, falls, constipation, and dry, itchy, wrinkled skin.

Optimal fiber intake is 20-30 grams per day, ideally from consuming excellent nutrition with fiber rich foods.  Fiber supplements are extensive, but the easiest fibers to consume include prunes, plenty of fruits and vegetables, beans, nuts and seeds. Constipating, binding foods include toast, bananas, and applesauce.

Discuss these topics with your health care provider, and enjoy your food, with gratitude,

In health,

Maureen

Medical Yoga for Centering, Energizing.

Medical Yoga for Centering, and Energizing              

Maureen Mason, MSPT, WCS, CCI, PYT-C

Celebrate PT month with yoga! October 22

Warrior Series

  What is your mood as you approach exercise?  With a yoga repertoire, you can choose and adapt your own home program to meet your needs. Start an energizing session with mountain pose. Stand tall, and notice all the textures around your feet, from heels to toes, and the inner and outer pressures on the soles.

Taking a few slow breaths here and sensing feet, ankles, knees, hips and pelvis-can help your nervous system to steady and “ground” into appreciation for any aspect of your life. You can practice outdoors, or indoors, and a yoga mat on top of a padded rug is soft and easy.

Getting your feet NAKED is important, our feet get numbed from our footwear and the level surfaces we often walk upon. You can thank your feet for getting you around all your life. 

                                        MOUNTAIN:

A yoga colleague Dina Chalom, PT,  cued me to not quickly blast out of this mountain pose into the warrior series, but to really make this a focal point to a start of a session. Sense yourself with stability, being alive, energizing with rhythmic inhalation, exhalation. Grounded feet. Diaphragm breaths are utilized, and the transverse abdominus is engaged to stabilize the trunk, as well as a slight engagement of the shoulder blades, meeting each other, while in front holding the shoulders open. The hand position of prayer pose reminds me to engage both front and back shoulder muscles.

 Mountain pose:feet may be slightly apart as well.

Thank your muscles and bones for holding you steadily in position.

WARRIOR I:

Ginger Garner, of Professional Yoga Therapy, advises hands held together

in mountain and balancing as you step back into Warrior I. Pulling this off 

smoothly requires dynamic stability, holding steady in one part while moving

another.

 Warrior I is a great pose to open up the hips, and focus on stability at the feet and up to the trunk stacked above. Breathing and holding the spine neutral and pain-free, I no longer throw my leg back far and wobble-I lift the leg back into place, pressing down into the back and front foot with equal pressure, and hold and breathe, and allow the small muscles around my joints to work with the larger sling-muscles. This is a therapeutic exercise concept of generating biomechanical stability and co-contraction of muscles around joints.

In  Warrior I, above, I am checking that both hips are in the same plane, not tipped down on one side, and also that the entire pelvis is aligned towards the front. This allows me to really stretch my quad and hip flexor, vs rotating my spine and pelvis back. After I warm up with this series and few other Asanas, I am able to open up the pose more…but this is it for me in an early am photo shoot. Add Arms up for more of a workout with Warrior I.

Thank your digestion for energizing you. Look forward to your next meal.

WARRIOR II

Warrior II is a great pose to further open up the hips. You can step back into the pose from mountain, and allow your pelvis and body to turn to the side. Check if your hips are level, and your body is stacked comfortably above your pelvis. Look down to your forward knee, as it moves into a lunge it should optimally align in line over the foot, not be diving in towards the ground. I align by consciously activating the deep hip muscles that turn the femur bone outward. 

Warrior II with arms lifted, shoulder blades can lightly meet each other, then palms can turn down to the floor.While here, sense the back ribs lifting a little as you inhale, while at the same time hold the navel in for stability. Keep shoulders soft and easy.

I like to look out over my forward facing fingertips and consider what I want to focus on for the day, to accomplish.Or if this is a sunset workout for me,  I consider a positive emotion to focus upon. When outdoors, I let the natural beauty of the environs refresh me in my own little yoga bubble.

Here, you can thank your lungs for oxygenating all your tissues 

Move into the poses from the prior post for more power, Chair, Plank, Side Plank, and Hip Bridge. 

These Asana poses may be used prior to meditation practice, or to simply be a self care and refreshment time in your day. In yoga philosophy, the poses are part of a lifestyle for wellness; see the 8 limbs of yoga reference. 

After I perform these postures (Asanas) my body feels lighter and my hips move more fluidly as I walk. A great feeling, older, stronger! Look at the link below on yoga for healthy aging. 

 Next up: Warrior III, and the Hip and Yoga

Resources 

Medical Therapeutic Yoga Definition: Medical Therapeutic Yoga is the practice of yoga in medicine, rehabilitation, and wellness settings by a licensed health care professional who is completing or has graduated from the Professional Yoga Therapy Studies program and has been credentialed as a Professional Yoga Therapist-Candidate or Professional Yoga Therapist.  http://proyogatherapy.org

http://yogateachercentral.com/free-teaching-tools/blog/class-theme-grounding/

I share this link for the option for you to read more about how one may “ground” or feel connected to the earth, and your feet, during yoga exercise. However specifics on foot and knee alignment as given here may not pertain to you, in other words you may need to have feet slightly turned in or out depending on your ankles, knees, hips and pelvic structure.

http://yogaforhealthyaging.blogspot.com/2015/10/proof-of-effectiveness-of-reducing.html Look at all the medical benefits of regular yoga exercise

http://www.yogajournal.com/article/beginners/the-eight-limbs/

The Core, week 4: Pelvic Floor Muscles

The Core, week 4: Pelvic Floor Muscles

“Because you know I’m all about that bass, ‘bout that bass, no treble” 

(Meghan Trainor's fantastic lyrics from “All about that Bass”)

Abdominal core stabilization is not complete without activating the muscles at your base--a group of muscles located at the bottom of your core. You may know them as “Kegel” muscles. They are your pelvic floor muscles (PFM). They play a role not only in core stability, but also in urinary  function, fecal function, and sexual health.

If you don’t want any “trouble” (such as leaking urine, prolapse, or ineffective core activation) then it's time to learn to use your “base”.

How do they (PFM) make my core stronger?

A strong core gives your spine stability when you move or lift something. The core muscles work together to add pressure inside of your abdomen so your spine is stable. If the rest of your core (diaphragm, abs, and back muscles) are all contracting and adding pressure, but you have no “floor” to resist that pressure, then you get a leak of pressure. This leak at best means you don’t build enough pressure to stabilize your spine. For some, it means you leak urine.

How do I strengthen them?

This is the question we are asked at CTS all the time. The answer seems backwards. Most women I see are not weak because they haven’t done enough Kegels, but because they are Kegeling too much, making their muscles short and tight. Or they are long and weak because they bare down often-straining to poo or pee. Or they have scarring from childbirth that keeps the muscles short. And for both men and women I see pelvic floor muscles that are confused or de-activated after a surgery. So here are my best generalized tips on how to strengthen your pelvic floor muscles.

So where are these muscles anyway!?! This is a front view of a model of a female pelvis with bones and muscles showing. The white represents the bones of the pelvis. The brown is the pelvic floor muscles (PFM). They span from the pubic bone to tailbone. 

Here is a sideview.

1.Relax. Do a diaphragmatic breath that you learned last week. Can you feel your pelvic floor muscles stretch when you inhale? If so, you are doing a good job relaxing.

-Are you someone who holds stress in your pelvic floor? Many people do!  Throughout the day, think about tension levels in your pelvic floor and do a diaphragmatic breath to relax if you feel tension.

-Relax when you defecate and urinate! No straining!!

2. Try a basic Kegel, it works for many people. For women it feels like a closure and lift of the vaginal opening. For men it feels like a slight lift of the scrotum. This is the same contraction you do to stop the flow of urine.

                -How long you hold depends on how strong you are. Start with just 2 seconds and build up to 10 seconds. More importantly, rest completely for 20 seconds.   So, if you are new to Kegels, then hold for 2 sec, rest for 20 sec. Only do 10 reps. Three times a day. These are teeny tiny muscles you are strengthening, so they will fatigue quickly and you won’t be doing good if you try to do all 30 in one set.

                -Don’t hold your breath while contracting. No need to use full force effort to contract, a gentle contraction is all you need. Also, keep your hips, buttocks, and legs still. If you do the contraction right, no one should be able to see that you are contracting :)

Do I contract all of my abdominal core muscles together, or is there a better order?

There is a better order! Stay tuned until next week to learn how to activate the final two muscles of your abdominal core and most importantly, how to coordinate them. For now, get really good at both contracting and relaxing your pelvic floor muscles in isolation so you can use them when needed, and give them the break they deserve when not needed.

Week 1: Let’s get acquainted, Core.

Week 2: Alignment - build the scaffolding to support your weak spots while they heal and repair

Week 3: Diaphragm and what Queen Elsa got right

Week 4: Pelvic floor muscles

Week 5: Transverse abdominis and multifidus muscles

Week 6: Shoulder girdle and hip

Week 7: Functional core exercises

Week 8: Round robin demonstration of CTS Physical Therapists’ favorite core exercises.

Happy Moving!

Crystal Hazelton, PT, MPT, OCS

This article is not medical advice. If you have pain or concerns, consult your physical therapist or physician.

The Core: Week 3. Diaphragmatic breathing and Letting Go

The Core: Week 3. Diaphragmatic breathing and what Queen Elsa got right

Take a really nice deep breath…ahhhh

Not only does a deep belly breath slow your heart rate and calm your nervous system, it is also a key component of your core. Why is the diaphragm important? It is one of 4 sides of a canister. When all 4 sides of the canister contract, pressure builds up and stabilizes the spine. If you only do crunches, you build up only one of the 4 sides.

 If you tried several core “exercises” and still are not getting results, first check your alignment, then check your diaphragm function. Correcting faulty diaphragm function has improved problems ranging from back pain to leaking urine while running.

How does it work? 
The diaphragm is a muscle and fibrous tissue that separates the thoracic cavity (heart and lungs) from the abdominal cavity. It is an upside down muscle that is shaped like a dome located at the bottom of your ribs. When it contracts, it moves down towards your abdomen and becomes flat.

The diaphragm is at rest on the left. This is what it looks like when you exhale. Your abdomen will feel hollow. The diaphragm is contracted on the right. This is what it looks like when you inhale, feel your lower ribs open like an umbrella, feel your abdomen rise, and feel your pelvic floor drop.  The red arrows show where pressure is moving.

This downward motion of the diaphragm increases pressure inside of the abdomen. But you still need activation of the other core muscles to maintain pressure for spinal stability. And preferably the diaphragm and pelvic floor muscles need to activate first.

How to breathe with your diaphragm, the basics:

1.     Lie down and relax. Place one hand on your chest and one hand on your stomach just under your ribs.

2.     Inhale through your nose slowly and feel your abdomen rise and the lower part of your ribs slightly expand like an umbrella. Now repeat this and feel the rise all the way to your lower abdomen and even down into your pelvic floor muscles. You should feel them stretch or expand slightly just like your stomach does. (more on the pelvic floor next week)

3.     Exhale slowly and observe the return of your stomach and pelvic floor like a balloon that has deflated

Use the hand on your chest to make sure you aren't breathing with the top of your ribs. You should have twice as much abdominal movement as upper chest movement. 

*Always check alignment first. Are your ribs lifted up, causing chest breath? Are they facing down,  causing an exclusive belly breath?

*When you get good at this, progress to sitting or standing

*Take about 5 min a day for practice with breath work. Get really good at this so that in a few weeks when it’s time to tie this all together you have a diaphragm that is ready to pull it’s weight!

Tips

-You’ll learn how to coordinate the diaphragm with the rest of the core muscles in a future post. For now, just learn how to do a diaphragmatic breath

-No need to hyperventilate, breathe slowly, and take some regular breaths in between the deep ones.

-Postpartum ladies may need some extra time or assistance getting their diaphragm back into shape thanks to a wiggly little human squishing the diaphragm for many months of the pregnancy. This squishing often also causes the ribcage to expand resulting in an overstretched and therefore weak diaphragm.

-Please stop sucking in your stomach all day! Go ahead and pull it in for that summer vacation photo, but like Queen Elsa said, “Let it GO,” the rest of the time! Where do your guts go when you suck in? They can go up into the diaphragm stopping it from dropping and therefore making it unable to help out with correct pressures. Or, they can go down into your pelvic floor contributing to pelvic organ prolapse for women and hernias for men. This constant pressure on your guts can also add to GI dysfunction such as irritable bowel syndrome, constipation, bladder pain, and bladder urgency. So, give your abdomen a break. Relax your belly more than you contract it. And when it is time to correctly activate your core, make sure all parts of the abdominal core are simultaneously contracted.

---And while we are on topic, sucking in makes your muscles tight and short. Remember last week when I said a short and tight muscle is a weak muscle? So, walking around “activating your core” all day long can actually make it weaker.

A quote from Katy Bowman, one of my favorite biomechanical authors, in her recent book, Move Your DNA:

            “Rather than stretching or adding exercises to address our chronic stress, we will focus on releasing areas of the body most prone to hypertonicity.”

Your homework this week:

Spend time learning how to breathe with your diaphragm.

Use your core when you need it.

Relax your core when you don’t need it. 

Still have no clue how to do a diaphragmatic breath? Never fear, your anatomy loving PTs are here! We can assess your breathing and all the muscular, bony, and neural structures that can possibly affect that breathing. Then, most importantly show you exercises and movement patterns that can help your “core” function as a useful unit.

Happy Moving!

Crystal Hazelton, PT, MPT, OCS

This article is not medical advice. If you have pain or concerns, consult your physical therapist or physician.

Week 1: Let’s get acquainted, Core.

Week 2: Alignment - build the scaffolding to support your weak spots while they heal and repair

Week 3: Diaphragm and what Queen Elsa got right

Week 4: Pelvic floor muscles

Week 5: Transverse abdominis and multifidus muscles

Week 6: Shoulder girdle and hip

Week 7: Functional core exercises

Week 8: Round robin demonstration of CTS Physical Therapists’ favorite core exercises. 

The Core, week 2: Alignment matters

The Core, week 2: Alignment matters

Last week we labeled the muscles that make up your abdominal core. I have two amazing kiddos. Since carrying them in my once toned tummy, my stomach muscles became pretty unrecognizable to me--overstretched, widened, and very very weak. This is common for women postpartum and men with a split in their abdomen (diastasis recti) from heavy weight lifting or a sudden gain in weight.  When something important on a building is broken or weak, the repair guys build a scaffolding system to hold the structure of the building while they fix the weak spot. We need to do the same when fixing our weak and overstretched core. Good alignment is your scaffolding. 

These abdominal core muscles are both strained and weaker when your alignment is off. Another way to say this is good alignment of your bones maximizes muscle function. Why? Muscles stretch, relax, and contract. Their maximum force occurs when they are on a slight stretch. If they are already short, then there is not much room for the muscle to contract.

So, what does good alignment look like? Here are some do's and don'ts:

DON'T! This is my lazy posture. Look at my stomach and compare it to the better posture below. I am not sucking in my stomach in any pic, promise! You can actually make your stomach look smaller just by standing with good alignment (and if vanity isn't enough to convince you, you are helping your stomach heal and make it easier to activate your abs when you stand the right way!)

DO! Much better! Keeping my ribs down and a slight arch in your low back. My low back still looks flat here, hmm looks like I have some stuff to work on...

DON'T: This posture doesn't help either. Here, my abs are overstretched. Can you see that my ribs are lifted up and low back is over-arched? This posture can happen when you wear high heels.

There are three ways to make your muscle short and weak (don't do these 3 things):

1.     Bad alignment during a task. For example, slouch and try to contract your “abs”. Now sit up tall and try to contract them. Where did you feel stronger? Probably when you were upright. That’s because the abdominal muscles generally span from your ribs to your hip bones. If you bring your ribs close to your waist, you are shortening the muscle. Remember this during daily tasks like lifting your toddler’s stroller into the car. If you use the right posture, your core will actually be stronger!

DON'T! Can't quite activate my core because my ab muscles are already too short in this position. See how close my ribs are to my waist.

DO! Ah, now I can easily contract my abs, protect my back, and get an extra squat in for the day while I lift this cute wiggle worm.

Check out our amazing aide Alliena's demonstration of how to pick something up off the ground correctly.

DON'T! Nope, can't contract abs here. It's hard to see her ribs in this picture, so you can look at her spine. Do you see how curved it looks? Her stomach muscles are shortened in this position. 

DO! Yes! She is not squishing her abs here. It will be easier to activate her core if needed. An added bonus: this position protects your back even if you pick something up that is light, such as a pen!

 2.     Tight muscles.  Muscles are amazing, they adapt to what our posture tells them to do. Bad alignment over time causes the muscles to decrease length. An easy example is if you sit most of your day, the muscles on the front of your hip will get cozy in that position, thereby becoming short. You experience this as feeling tight (psoas anyone!?!).

3.   Overactive muscles. Because muscles adapt, if you keep them contracted (muscle length shortens when it contracts) all the time, they will stay short which makes them weak. Therefore, sucking in your core all day long is NOT a way to strengthen it!

Or, you might be making your muscles long and weak by over stretching them. 

Look what happens to my stomach when I wear 3 inch heels.

DON'T! Sad overstretched abs (I confess, you'll see me wearing cute heels at times. But not when walking or long periods of standing are involved)

My low back arches and and pushes my abs forward.

DO! Happy abs that have no strain or stress

What is your body doing when you put on make-up, brush your teeth, or fix your hair?  Here I am putting on make-up, being lazy as I lean my stomach on the counter. 

DON'T! Stomach is overstretched, back is arched

DO! Standing upright without arching my back or leaning on the counter

Alliena demonstrates the wrong and right way to reach into a cabinet.

DON'T! Her ribs are lifted up, this over-stretches her abs

DO! She correctly keeps her ribs down, this makes it easier for her abs to engage

So, using a bit of logic. To make your core stronger, use good alignment, relax your abs unless you need them (more on this later), and stretch your muscles so they have good length.

If you cannot get into good alignment, you need to spend extra time improving the motion at certain joints. Your physical therapist can help you identify these joints and prescribe specific exercises to improve your alignment.

Hoping this helps you move better! Here is the line up for the rest of this core series.

Week 1: Let’s get acquainted, Core.
Week 2: Alignment - build the scaffolding to support your weak spots while they heal and repair
Week 3: Diaphragm and what Queen Elsa got right
Week 4: Pelvic floor muscles
Week 5: Transverse abdominis and multifidus muscles
Week 6: Shoulder girdle and hip
Week 7: Functional core exercises
Week 8: Round robin demonstration of CTS Physical Therapists’ favorite core exercises.

Happy Moving!

Crystal

Crystal Hazelton, PT, MPT, OCS

This is not medical advice. If you have pain, contact your physical therapist or doctor.
For more great pics and specific information on diastasis recti, checkout the blog at Diastasisrectified.com