Category: Blog Posts

by Sarah Kingsley

Lately, I have seen an increase in those suffering from symptoms of vertigo or dizziness. Many have noticed vertigo and other neurological side effects post COVID vaccine or infection. There is a difference between “dizziness,” more of a lightheaded feeling which can be solely from dehydration, hunger, or change in blood pressure when changing positions too quickly, and “vertigo,” a sensation of the room spinning around you, which has more to do with your vestibular system.

The more commonly known and treatable form of vertigo is “BPPV” Benign Peripheral Paroxysmal Vertigo which is experienced after a car accident or trauma involving an impact such as a fall, however, it can also come on for no reason at all, and some suffer from chronic recurrences of this type. This is the most treatable type of vertigo and can usually be cured from a maneuver or series of movements performed by a practitioner, or even by yourself. The trick is which ear canal is affected. Most often, the posterior canal is the culprit and the Epley’s or Canalith repositioning technique is used. You can figure out which side is affected by coming to a long sitting position on a bed (torso upright and legs extended in front of you), turning your head to the right, and abruptly throwing yourself onto your back. Whichever side symptoms occur, stay in this position for 30 seconds or until symptoms subside. Next, turn your head to the opposite side for another 30-45 seconds. Keeping your head turned in that direction, roll onto that side with your nose down towards the pillow for another 30-45 seconds. Bring your legs off the edge of the bed and press yourself up to a seated position. Stay there for 1-2 minutes. This can be repeated as needed and symptoms should decrease each time if this is your issue.

The horizontal canal calls for “The BBQ Roll.” Deciding which ear is affected is the first step, and begin lying on that side for 30 seconds, then roll onto your back for another 30 seconds, then roll onto your opposite side for 30 seconds. Next, tuck your chin down slightly as you roll onto your belly and prop yourself up onto your elbows for 30 seconds. Finally, roll back onto the side you started for 30 seconds, and return to an upright sitting position. Some suggest trying to keep your neck and head neutral for 15 minutes following.

Other forms of vertigo include a peripheral hypofunction – when one side is not working properly leading to symptoms due to overexcitement of the nonaffected side typically. For this type, and most other forms or reasons for symptoms of vertigo, 3 types of exercises are recommended. 

Adaptation – Attempts to retrain and reconfigure your vestibular system. 

Exercises include: holding a target about 6 inches in front of you as you try to keep your gaze on the target and turn your head from left to right or up and down. You can also take two targets arms length ahead beginning with your gaze in the center. Look with just your eyes to the right target, then keeping your gaze there, turn your head to face that target, then look with just your eyes to the left target, then turn your head to face the left target. Repeat left and right until dizziness occurs or you are unable to maintain the gaze on the targets. It is important for these eye exercises to be followed by an eyes-closed-and-covered 30-second rest to allow your system to rest and reset before trying another set or the next exercise.

Substitution exercises attempt to substitute for the loss or malfunctioning side. 

Begin with one target arms length ahead. Lock your gaze, then close your eyes and turn your head to the left, attempting to maintain your gaze on the target. Open your eyes to check, then close them again and turn your head to the right and open for your check. Repeat again for 1-2 minutes or until symptoms occur.

Habituation – Repetitive exposure to a noxious stimulus or one that triggers symptoms, overtime promotes decreased symptoms. 

Exercises include: turning your head left/right, up/down, laterally up/down to each side 10 or more times each with your eyes open and with your eyes closed. Movement in concurrence with these exercises works well. Walking while turning the head left/right, up/down, possibly adding eyes closed, or keeping a gaze on a target, or a patterned surface that can often trigger symptoms. These exercises when coupled with balance training such as bringing feet together, tandem stance, or standing on a foam/pillow surface or rocker board also further stimulate the vestibular system. Again, it is important to wean into these exercises and not progress too much too fast, thus overloading the system.

by Michelle F. Onion, PT, MSPT

Why is talking about the pelvis so important? Because it is our base, our center. Our trunk “rests” on it and our legs come out from it. When it is not in an ideal position it can impact how we move and the ease with which we move. 

Let’s first talk about the bones of the pelvis. The largest bones are the ilium. There are two, one on each side. In the back, the ilium attaches to the sacrum. As the pelvis comes around you have the pubis bones on the top and they attach at the front at the pubic symphysis. At the bottom, the ischium attaches to the pubis and creates the obturator foramen (the large hole that sits between the bones). The ischium is angled lateral and anterior. It, in conjunction with the ilium and pubis, forms the acetabulum (hip joint). The inferior or posterior position of this acetabulum is determined by a posterior or anterior pelvic tilt, but there is a slight inferior orientation to it in neutral. The ilium, ischium, and pubis move as one but remember there are two sides. They can move in and out relative to neutral, rotate forward and backward, and slide up or down. This is a slight movement but movement nonetheless, that can impact muscular function altering both ease of motion and which muscles do the primary work. 

There are multiple ligaments in the pelvis, spine, and hips that help to control and support. They are our enforcers. Bones are not stable in and of themselves but work in conjunction with muscles and ligaments to create stability. 

Notice how the muscles and ligaments fill in the foramen (holes) of the pelvis. They act as a sling to support all that sits in the pelvic and abdominal cavities. They are a support system and they are crucial in keeping everything contained. This is our pelvic floor. 

What I want you to notice from these two pictures of the muscles is how the pelvis connects the lower body, trunk and ultimately the upper body. Here you have the muscular connections. You can start to get an appreciation of how movement in the legs impacts what happens in the abdominals, glutes and vice versa. Small movements within the pelvis can allow the muscles in each of these regions to operate optimally or suboptimally.

And then we have the addition of fascia. Fascia is the support structure that has just recently been given more attention. Think of fascia like plastic wrap. There is a strength and pliability to it. If you take a piece of plastic wrap and pull at one end of it, there is a far-reaching ripple effect impacting the entire piece of wrap. And fascia is everywhere and a big connecter of the lower and upper body. Small nuances in the pelvis can impact how the fascia moves. If it pulls or if it is more fluid, if it allows or prohibits movement.

Let’s think about how this applies to yoga and our daily lives. If the pelvis lives in an anterior or posterior pelvic tilt, muscles will be at a disadvantage and unable to work as well for you or for your clients. Our core will not be able to engage fully. Our glutes will snooze even more. Our pelvic floor will have difficulty supporting all that depends on it for structure. And this has a huge impact on our movement and functional capabilities.

If you look at the lower body. Our femurs will not be able to move well in the acetabulum (hip joint) and we will potentially have impingement and pain changing our movement patterns even more. As our hips move in this altered manner it impacts the ability for our knees to function which, in turn, impacts what our feet do. It is a complementary system. You lose optimal movement in one area and the other areas are impacted. We will lose the possibility of overall optimal movement. 

Looking at the upper body. The structure and position of the trunk impacts the pull on the scapula impacting the stability and mobility of how the scapula move with shoulder motion. The scapula and humerus have a rhythm that allows for or takes away from good movement patterning. The difference with the upper extremity and lower extremity is that the upper extremity is not fixed to the ground so the impact on the elbow, wrist and hand may not be as noticeable, but there is still an impact. 

And this all comes from our center, our pelvis. It is why LYT focuses on a neutral pelvis, not to make things difficult, but to allow our body to have access to optimal movement patterns. To be dynamic in our everyday. If your clients have difficulty with finding neutral, think about the other ways a pelvis may move: in/out; up or down. There might be a dysfunction there and physical therapy may address this. Perhaps helped with a joint mobilization or muscle energy technique that a PT can perform. And then the neutrality can be supported through our practice of LYT. 

As you take time to consider the pelvis, think about how this impacts your individual function. Get to know its impact on your own movement, on your own function, and take this exploration to your clients and to others around you. We have the gift of guiding others through their own exploration of their individual movement. Helping others find their center, their base. Creating structure to allow for more optimal, dynamic movement. Enjoy the exploration! 

by Magdalen Link

I remember in college when I was competitively cheerleading it was a joke among my friends that sometimes we peed a little when we tumbled. A roundoff backhandspring on a hard basketball court puts a lot of pressure on the pelvic floor–but little did I know back then. I have seen this same joke play out in different ways–moms crossing their legs when they sneeze, looking at their kids saying “you did this to me!” And clinically I see it time and time again. “Do you leak when you cough sneeze or jump” I ask. “Oh yes, but I’ve had 3 kids so…

Stress urinary incontinence is leaking (a little or a lot) of urine with any activity that increases the pressure in your abdominal cavity such as sneezing, coughing, laughing, jumping, running ect. It is very common–up to 30% of women experience stress urinary incontinence–but it is not normal. There are many factors that can contribute to the development of symptoms. Some include poor coordination, strength or relaxation of pelvic floor muscles, damage to the pubocervical connective tissue, urethral hypermobility, ect. During pregnancy your pelvic floor has not only the job of holding all your internal organs but also holding a baby. This is hard work and can lead to stretching of pelvic fascia and weakness of the pelvic floor muscles. Childbirth, particularly where forceps are needed can lead to stress urinary incontinence from damage to the pelvic floor. Chronic coughing, straining when having a bowel movement, or excessive weight gain can also lead to SUI. 

What to do about it?

The good news is–most of the time it is treatable! First line of treatment is conservative management which includes lifestyle changes, pelvic floor physical therapy and/or pessaries. In pelvic floor physical therapy, treatment may include pelvic floor muscle strengthening, relaxation, coordination training, optimizing your body’s ability to manage pressure, and strengthening surrounding musculature. Sometimes the pelvic floor needs a bit of internal support in the form of a pessary. A pessary is a small device that fits into the vagina to help support a prolapse of the uterus, bladder and/or rectum. If all else fails, surgery may be an option for you. 

It is important to normalize talking about pelvic floor health so the high percentage of people who have pelvic floor dysfunction can get the treatment they deserve. So the next time you hear someone joking about their stress urinary incontinence tell them a pelvic PT can help! 

If you want to learn more about your pelvic floor follow me on:

Instagram & TikTok @Magdalenlink_dpt 

Xoxo-

Magdalen