Category: Blog Posts

by ashley newton, pt, dpt

 

The pelvic floor is known to hold onto stress. The body has nerves that go to the pelvic floor that are intimately connected with our sense of fight or flight. This area of our body is responsible for supporting our organs, so it makes sense that when the body and brain are stressed, we tighten these muscles as a method of protection. This guarding can become maladaptive when the brain and body get stuck in fight or flight mode. In pelvic PT, we refer to this state as ‘up-regulated’, a state where the nervous system is in an excitatory state and our body is focused on survival. In survival mode, the pelvic floor’s adaptability can become compromised and result in some of the following issues:

 

1. Pelvic Pain: The pelvic floor muscles contract and guard in response to pain but sometimes, they get stuck in guarding mode. When the muscles undergo stretching during things like sexual activity, the experience can be painful! 
2. Changes in Voiding: If the pelvic floor gets stuck in ‘on’ mode, it can be difficult to relax after. With both urination and defecation, the pelvic floor needs to relax and lengthen in order to completely void. If the muscles are having trouble lengthening because they are gripping/contracting, voids may feel incomplete or difficult to pass. 
3. Leakage: If the pelvic floor muscles are gripping, guarding, and staying in fight or flight mode, they can have trouble doing their job of closing around the urethra and rectum to maintain continence. 
4. Weakness: If the pelvic floor is constantly tightening, it becomes weak. This prevents us from being able to recruit these muscles readily to do their job of stabilizing the pelvis when we move. As a result, other tissues may become overloaded trying to do the job of the pelvic floor. 

 

Ways to Get Out of Fight or Flight Mode

To get the body and brain unstuck and move into a more relaxed, down-regulated state, we recommend trying the following exercises:

 

1. Legs Up Wall: Place a pillow under the pelvis and bring the legs to a wall so they are supported. Allow the legs to relax and practice diaphragmatic breathing. 
2. Child’s Pose: Begin on hands and knees and sit the pelvis back to the heels with the knees apart. Begin breathing into the back and direct the breath down to the SIT bones, sensing that they move apart as you inhale and draw back toward your midline as you exhale
3. Mindful Walking: Get out in nature and practice relaxing the arms and unclenching the jaw as you walk. 
4. Daily Yoga: You can practice yoga as a way to stretch your pelvic floor muscles. With simple exercises, your pelvic floor will begin to relax and experience healthy contracting. Online yoga classes are a great way to start your stretching right from your home.

by Thalia Wynne, PT, DPT, AT

 

Having poor foot intrinsic muscle activation can be an unknown cause of foot and ankle pain. Your foot intrinsic muscles are small muscles in the feet that help control your foot mechanics, provide balance and stability, and help with proprioception (your ability to sense the environment). When people come in with physical therapy with foot, ankle, knee, hip, and even back issues, we often check their foot mechanics by analyzing their gait and using the exercises listed below to see how well they can control their feet. Yoga classes can help with strengthening the foot muscles. You can get the best of both worlds by combining intrinsic foot exercises with daily yoga classes.

 

By keeping your foot intrinsic muscles active and healthy, you are setting yourself up for success every time your foot hits the ground. In other words, happy feet equals a happy life! Give these moves a try to see how well you can activate your foot. If these exercises are hard or you physically can’t do them, don’t worry. Our brains are smart and the more you practice, the easier these will become. We often tell patients, “just keep staring at your foot and thinking about moving it. It’ll eventually happen.” This is because of the ‘use it or lose it’ principle in neuroanatomy. If we do not use a muscle, our brain shuts down that neural pathway in favor of saving energy for the systems we do use more often. This is problematic if you are not using the appropriate muscles to carry out your activities of daily living. If we strengthen that neural pathway with concentrated attention and repetition through yoga classes, we can get control back. Pay special attention to these little muscles of the foot to improve your arch support, and foot mobility, and ultimately move better! 

 

1. TOE YOGA

Figure 1.

Figure 2.

Instructions: 

1. Start position: seated or standing with foot flat on the floor.
2. Lift big toe without lifting the other four toes. Focus on pressing the balls of your little toes down to stabilize, but don’t grip the floor with your toes. Lower down. 
3. Lift the little toes without lifting the big toe. Focus on driving the ball of the big toe down to lift the little toes up. Again, don’t grip the floor by curling the toes. Lower. 
4. Keep alternating between the two (Figures 1 & 2).

Parameters: 2 sets of 15-20x.

 

2. BIG TOE ABDUCTION

Figure 3.

Figure 4.

Instructions:

1. Start position: seated or standing with both feet side by side but without touching. (Figure 3.)
2. Slide big toes together without lifting your foot off the floor. (Figure 4.) Return to neutral.
3. Repeat.

Parameters: 2 sets of 15-20x.

 

3. ARCH DOMING PROGRESSION

Figure 5.

Figure 6.

Progression #1 

1. Start position: seated or standing with foot flat on the floor. 
2. Pick up all the toes but keep the balls of the feet connected to the floor. Feel how this raises your arch? (Figure 5.)
3. Keep your arch height as you slowly let the toes come down. (Figure 6.) Hold for 5 seconds. Release the arch and relax. 
4. Repeat. 

Parameters: 2 sets of 15-20x.

Figure 7.

Figure 8.

Progression #2

1. Start position: seated or standing, with foot flat on the floor. (Figure 7.)
2. Raise the arch of your foot without curling the toes. (Figure 8.) Hold for 5 seconds. 
3. Relax. Repeat. 

Parameters: 2 sets of 15-20x.

 

Progression #3

1. Start position: standing with feet flat on floor. (Figure 7.)
2. Hold your arch up – we call this “doming”. (Figure 8.)
3. Dome the arch while performing different movements. Try a squat, lunge, and side lunge. See how well you can maintain good arch support with these movement patterns. Repeat. 

Parameters: 2 sets of 15-20x. 

 

4. BIG TOE EXTENSION STRETCH

Figure 9.

Instructions 

1. Start position:  sitting, foot flat on the floor.
2. Lift the heel off the floor, like a heel raise. (Figure 9.)
3. Slide your foot back until you feel a stretch on your big toe. Keep your foot from turning in or out as you do this. 
4. Hold for 5 breaths. 
5. Repeat. 

Parameters: Perform 2 sets. 

 

Shoot me a video to show off your foot skills and have a healthy, happy, barefoot summer! 

 

XO, 

Thalia Wynne, PT, DPT, AT

@thalialovee

by Sarah Apple

 

June is skin health month and also my personal favorite month as my birthday is in June! 🙂 What better way to celebrate than to discuss my newfound favorite topic FASCIA! So what is this new buzzword?

 

As John Barnes explains, “The fascial system surrounds, infuses with, and has the potential to profoundly influence every muscle, bone, nerve, blood vessel, organ, and cell of the body. Fascia also separates, supports, connects, and protects everything. This three-dimensional web of connective tissue is alive and ever-changing as the body demands. Thus it is a network for information exchange, influencing and influenced by every structure, system, and cell in the organism. Like air and gravity, its influence is so all-pervasive that we have tended to take it for granted.” 

 

WOW! What a powerful statement. We often move through life and our busy schedules abusing our bodies without even knowing it until something breaks down and we experience pain, dysfunction, fatigue, etc. Deep inside, however, our bodies are holding onto this trauma, whether it be from day-to-day experiences, repressed memories from your childhood and distant past, or some might even argue from a previous life. All of these emotions and behaviors get trapped inside our bodies, and we continually move into positions of tension and stress, habitually creating more fascial crosslinks or intertwining of tissues. The longer we go without addressing this deeper layer, the longer it will take to truly unwind these structures and return the body to a resting or parasympathetic state. 

 

So what does this have to do with skin? As mentioned above, fascia has connections to everything – including the skin – and it uses the skin to help send the body (and myofascial release therapists) a message. When we begin to dive deeper into the fascial layer and release restrictions, the body enters a parasympathetic state and increases blood circulation creating a redness response in the skin. Sometimes this response happens in the actual area of the body being addressed, but more often it appears somewhere else in the body entirely! This reveals fascia’s connections throughout the body and also guides us on where we should address next. Our subconscious minds are incredibly smart, telling our bodies to constantly adapt and change to support our needs. Although you might be experiencing pain or sensation in one area of the body, it could be related to somewhere else. Think of wearing a tight sweater. When you pull it from the top it often gets stuck elsewhere. Fascia works in a similar way, with symptoms often appearing in a different area than the actual issue.

 

Like our skin, fascia is composed of collagen and elastin fibers that help absorb tensile forces in the body. Then there is a polysaccharide gel complex that fills the spaces between fibers. This complex allows the muscle fibers to slide over each other with minimal friction as well as to absorb the compressive forces of movement. As long as the forces are not too great, the gel is designed to absorb the shock of tensile forces and disperse them throughout the body. If fascia is restricted at the time of trauma, they are unable to perform their job and often result in injury. The same result can take place over time through microtrauma, such as having leg length discrepancies due to a rotated pelvis. Every step further imbalances the body, forcing the body to compensate through muscular spasm, fascial restriction, and PAIN.

 

Myofascial release techniques can be performed to help reduce these symptoms. With these techniques, the enormous pressure of the fascial restrictions are eliminated from pain-sensitive structures, producing increased range of motion, alleviating symptoms, and restoring the normal quality of motion and the body’s ability to absorb shock. When having these techniques performed it is important to rehydrate the tissues because, as described above, this gel-like matrix is composed of mostly WATER. Releasing the toxins and restrictions and refueling the body with hydration allows for deep tissue healing, as well as superficial skin results, and even emotional releases! Find a myofascial therapist near you to experience the results for yourself! 

 

Search for a therapist near you: http://mfrtherapists.com/

 

Happy Skin Health month y’all!

by Ashley Newton, PT, DPT

 

If your family was anything like mine, before a car trip, my mom would always ask if everyone made sure they had gone to the bathroom. And even if you didn’t have to go at that moment you would make a trip to the bathroom to try to avoid any stops on your car trip. Fast forward to today when lots of adults urinate ‘just in case’ before they go out to the store, feel like they are constantly going to the bathroom, and wait in ridiculous lines to use the toilet. What is going on? Why do people feel the almost constant urge to urinate? The answer is multi-layered, but I will discuss causes that fall into the following categories: neuromuscular, musculoskeletal, and dietary.

 

The first thing that you need to know is that as the bladder fills, we get our first experience of urinary urgency at 50% full. The amount of time it takes a bladder to fill is 2-4 hours! However, the connection between the bladder and the brain is very smart and if someone starts to urinate more frequently, the body starts to experience urinary urgency earlier and earlier. As a result, people feel like they have to go to the bathroom more frequently even though their bladder is not full. The behavior ultimately trains the brain and bladder! 

 

The bladder is surrounded by a muscle called the detrusor. When the detrusor contracts, it pushes urine out of the bladder. If the detrusor is contracting too much, it gives the sensation of urinary urgency. We also know that fascia suspends the bladder and that the pelvic floor muscles support it. If there are issues with pelvic floor coordination and/or strength, the muscles are not doing their job of supporting the bladder. Dysfunction in the muscles of the pelvic floor can cause urinary urgency as well.

 

Lastly, there are known foods and drinks that cause bladder irritation. Bubbles from seltzer, citrus, coffee, and chocolate, just to name a few. These foods irritate the bladder lining and can cause the sensation of urgency. Now it is important to note that since the urine inside the bladder plays a role in urgency, restricting water in an attempt to not go to the bathroom actually worsens irritation! This actually makes the urine more concentrated and thus more irritating to the bladder wall. 

 

If you feel like you are going to the bathroom ‘all the time’, it may be helpful to consult your local pelvic health physical therapist to retrain the brain and body so that life is not so interrupted by trips to the bathroom.

 

I am excited to share tips and education with you in LYT newsletters to come! Follow me on Instagram @ashleynewton_dpt and @activcoreprinceton_pelvic for weekly content on pelvic floor, the nervous system, yoga, and wellness!

 

Xoxo, 

Ashley

Follow the Rhythm of Your Monthly Cycle and Optimize Your Training

 

Did you know that as females, we run on two different biological clocks? We have a circadian rhythm that runs on a 24-hour cycle and the infradian rhythm that runs on a 28-day cycle. Everyone has a circadian rhythm. It runs many physiological processes such as a cortisol spike in the morning to wake you up and melatonin in the evening to lead you into sleep. It regulates digestion, body temperature, metabolism, sleep, elimination, and more. Your circadian clock is relatively the same day in and day out. From puberty until menopause, females have a second clock that is not often talked about but has tremendous effects on our energy levels, workflow, and you guessed it – our exercise tolerance. So here is everything you didn’t know you needed to know about your infradian clock so you can work smarter, not harder and train like a girl. 

 

The infradian rhythm aligns with your menstrual cycle. The menstrual cycle has four phases – follicular, ovulatory, luteal, and menstrual. Hormones fluctuate in each phase. Disruption of this clock can affect your physical health and lead to a range of problems from poor skin health, gut health, low energy, mental health changes, etc. The first step to training like a girl is to heal any hormonal imbalances to align with your body’s natural monthly rhythm, a topic that deserves more space than this article can provide so please seek out more resources to heal hormone imbalances if this is you. 

 

The follicular phase begins right after your bleed ends, lasting for 7-10 days. All hormones are low and begin to increase in concentration. It’s the phase to prepare and begin again. The ovulatory phase (3-4 days) happens with a stark rise in estrogen and luteinizing hormone to stimulate follicule maturity and egg release. Testosterone rises as well. This is a time to socialize, try new things, and open up. Next is the luteal phase. Lasting 10-14 days, this is where estrogen, progesterone, and testosterone reach their peak concentration and then begin to fall to their lowest levels, right before bleeding begins. PMS is a common (but not necessary) symptom in this phase. It’s a natural time to complete tasks, draw inward, and organize your space. Lastly, the menstrual phase lasts 3-7 days and is categorized by the bleed as the uterus sheds the endometrial lining. Hormones fall to their lowest concentrations. It’s a great phase to rest and reflect. Now that you are familiar with your female biology, let’s see how you can use it to your advantage when training. 

 

• Follicular phase: energy is rising after a time of rest. You are naturally open to new things so shake it up with a new instructor on LYT PRIME. 
• Ovulatory phase: Estrogen and testosterone are peaking meaning you have energy to burn. Turn your training up a notch with more advanced classes or LYT HIIT (high-intensity-interval-training). 
• Luteal phase: In the first 5 days, energy will still be high as estrogen and testosterone have not declined yet. As progesterone rises, calm the cardio and focus on strength training as your hormone levels are prime for maximizing lean muscle gains. During the second half of the luteal phase, all hormones start to decline which will affect your ability to build muscle. Switch your training to focus on mobility and slow flow classes. 
• Menstrual phase: hormones are at their lowest and your energy is low as a result. Avoid high-intensity training and focus on more restorative or stretch classes. 

 

Here is sample chart of how to structure your LYT Daily and LYT PRIME subscriptions to align with your infradian rhythm: 

 

Follicular Phase	Ovulatory Phase	Luteal Phase	Menstrual Phase
Full week of trying      new classes/instructors           on LYT PRIME	LYT HIIT  Workshops  Intermediate & Advanced classes	First half:  Strengthening      Full Body      Second half:  Slow Flow  Posture  Foundational	Meditation      Breath Stretch Bliss

 

Rather than force yourself to train the same every single day and beat yourself up for not being able to “keep up” like you usually can, try training in a more cyclical nature. When I finally let go of needing to be consistent in that way and instead allowed myself more rest in my late luteal and menstrual phases, I was surprised to find I had more energy, better results, and more mental wellbeing. Train like a girl and embrace your feminine rhythm to unlock your yoga practice in a new way. 

 

Reach out and tell me how it feels! I would love to hear from you. 

 

XO, 

Thalia Wynne, PT, DPT, AT

@thalialovee 

 

Source: In the FLO by Alisa Vitti

by Sarah kingsley

 

Plantar Fasciitis is one of the most common causes of heel pain today. Best known for its hallmark sign of a nagging, aching, burning, or stabbing pain in the heel or bottom of the foot, plantar fasciitis is often felt first thing in the morning when you put your feet down on the ground. The thick band of connective tissue on your foot that connects the calcaneus (heel bone) to the toes becomes dense, restricted, and leads to pulling and pain throughout the foot and ankle complex. The reasoning for this is largely unknown, however, it is especially common in runners and those who are overweight. The connection has to do with the major fascial connective system that surrounds every tissue in our body. The positioning of the pelvis plays a major role down the fascial chain, creating 2000lb/square inch of pressure. That’s the equivalent of a steel cable pushing you forward into this anteriorly tipped position! This is evident in runners due to restrictions in their hip flexors and repetitive forward momentum, and those who are overweight due to the abdominal distension pulling them forward. This immense pressure is translated down into the feet, causing pain.

 

Breaking up the fascia is the best way to find immediate symptom relief. This can be done using stainless steel instruments (or a utensil such as a butter knife) to scrape away at the bottom of the foot in various directions, around the heel, and up into the calf region. Standing on a vibration platform is also great for breaking up fascial adhesions and restrictions. You can stand statically, or perform calf raises and toe raises, bending at the base of the ankle and keeping the base of your toes down and spread wide. A third way to break down adhesions is with eccentric exercise – strengthening in the lengthening phase of a contraction. An eccentric calf raise works wonders for the gastroc/soleus complex that connects to the plantar fascia through the Achilles tendon. Stand at the edge of a step (or even better at the edge of your vibration plate!) and quickly press down through the base of your toes to lift your heels, then slowly lower the heels down as far as possible, feeling a stretch in the back of your calves before quickly lifting the heels back up and repeating. Each time you should feel yourself being able to go down a little bit lower. But don’t forget the position of your pelvis! Scoop your low belly up and in and maintain a neutral pelvis as best as possible during the exercise.

 

For long-term symptom relief, we need to address the source of the issue – which is likely the positioning of your pelvis! The two most common populations to experience this type of pain are often known for an anteriorly tipped pelvis (pitched forward in space). Restrictions in the hip flexor muscles coupled with weak gluteals and hip extensors to counteract these forces create a perfect recipe for disaster! Our LYT yoga practice moves us through the perfect exercises to correct these forces. A few to try out:

1. Stretch the hip flexors in the 90/90 lunge position, activating the back gluteal and engaging your abdominals to feel a stretch in the front of the hip and thigh.
2.  When on your back with your knees bent, bring your hands to your thighs and press them away as you pull your belly to your spine and root your tail towards your heels to create a tractioning of the hips and low back biasing posterior pelvic tilt holding for 3 seconds and relaxing.
3. Progress to actively work the gluteals and hip extensors by performing a bridging motion lifting the hips up, and staying low not to overly activate the spinal extensors as a substitution.

 

Stretching the calf muscles can also help relieve symptoms. Begin facing a wall with your hands on the wall and one foot in front of the other in a staggered stance position. Make sure your toes are pointed forwards. Keep your back heel down as you bend into your front knee until you feel a stretch in the back of your calf on the back leg. Hold for 30 seconds and repeat 3 times. Perform this exercise both with your back knee in the straightened/extended and in the bent positions to be sure to get both your gastroc and soleus muscles respectively.

 

Using a brace to keep your ankle in a neutral position or to provide a passive stretch into the dorsiflexed position while sleeping can also provide a passive stretch to the fascial tissues and help prevent pain upon waking in the morning.

 

References:

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846