Category: PT Corner with Friends

by Ashley Newton PT, DPT

 

Intra-abdominal pressure is the pressure within the abdominal cavity created by the interaction between the abdominal wall and organs. This pressure changes with breathing and the resistance from the abdominal wall. When we are lifting an object or even lifting a limb, we increase intra-abdominal pressure. The coordination of the diaphragm, abdominals, and pelvic floor musculature works to support the pelvic contents during changes in intra-abdominal pressure. However, suppose the synergy between these muscles is compromised. In that case, they are unable to optimally support the abdominal organs, which results in excessive pressure placed on the back, pelvic organs, and pelvic floor. As a result, issues can arise that include but are not limited to: urinary incontinence, pelvic organ prolapse, back pain, and diastasis recti. So how do we begin to understand if our bodies are managing pressure properly and not putting undue pressure on our abdominal organs and pelvic floor? 

 

It all begins with breathing. Our abdominal cavity is capped at the top by the thoracic diaphragm and capped at the bottom by the pelvic floor musculature. This creates the ‘core canister’. When we breathe, the pelvic floor and thoracic diaphragm move down and up together like a piston. If, however, this movement is restricted by fascial tightness, weakened, and/or paradoxical movement (the opposite movement occurs), they are compromised in their ability to support the abdominal contents. So let’s do a breathing exercise to check in on our coordination:

 

1. In seated, align skull, scapula, and sacrum.
2. Make sure you are sitting evenly on your SIT bones.
3. Bring the tongue to the back of the top teeth and imagine you are pressing a small raspberry up to the top of the mouth.
4. Place your hands on the sides of your ribs.
5. Inhale through the nose and think about widening the ribs into your hands. Imagine an umbrella opening.
6. Exhale through the mouth and imagine “fogging a glass” as you exhale.
7. Keep your belly soft as you exhale!! (Squeezing the belly can create excess pressure on the pelvic floor and abdominal organs!) 
8. Repeat 5 times. 

 

Breathing is core work and the foundation of better management of intra-abdominal pressure. For this reason, it is also imperative that whenever lifting objects, you do not hold your breath! This creates increased pressure on the abdominal contents, pelvic floor, and the heart which can be dangerous! Always keep breathing while you are lifting in order to prevent an increase in pressure on your musculature and organs. 

 

Good lifting mechanics and upright postural alignment optimize the functioning of our core canister and our ability to manage changes in pressure in our body. In this way, our body is able to stabilize the spine and better prevent injuries!

by Thalia Wynne, PT, DPT, AT

@thalialovee

 

Why do we care about balance? Physically, balance can be defined as stability. It’s a useful area of focus, especially in yoga, but there is far more to this concept than avoiding injury and managing not to fall over. The more you learn about physiological balance, the more you’ll learn about another, more important kind of balance.

 

Balance is an intricate dance of three different physiological systems: The vestibular, somatosensory, and visual systems. The vestibular system uses signals from the inner ear, position sensations known as “proprioception,” and intended movements or “motor commands” to analyze motion. The somatosensory system is governed by your senses of touch, pain, pressure, and temperature. The visual system communicates your physical orientation to your brain via eyesight, such as a view of upside-down objects signaling that your body is upside-down.

 

If one of these three systems is inhibited, it will impact your ability to find and maintain balance. One way to develop a strong sense of balance is to make sure that you are not over-relying on one of these three systems for information. Often, we over-rely on vision to tell us where we are in space. 

 

Here are some simple things you can do during yoga to reduce an over-reliance on vision:

 

1. During your yoga practice, close your eyes while moving on the mat. Remove all stimuli that provide visual information. Pay attention to other signals to tell you where you are in space, such as sounds and feelings. 
2. Train your vestibular system by finding a target to focus on with your eyes. Move your head side-to-side for 15 to 30 seconds. This may make you feel dizzy so try it while sitting down first. Rest and repeat 2-3 times. 
3. During your yoga practice, confuse your visual system. Try looking up and down or side to side while holding a pose. This forces you to rely on other systems to find your balance. You’ll learn how to engage your muscles and other senses more effectively.
4. Lastly, train for optimal posture every day. Read this article by Lara Heimann to learn more about training your body’s posture to find your balance. (link)

 

One of the many wonders of yoga is that the principles of physical balance can translate into another, far more important kind of balance: Life balance. To get an idea of what we’re talking about, ask yourself these questions: 

 

1. Do I feel satisfied with my life as it is? Why or why not? 
2. What does it mean to me to have a work-life balance? 
3. Do I feel I am doing my best? How could I do better? 

 

These are not easy questions to answer. To help you, we’d like to introduce the 8 dimensions of wellness:

 

1. Physical: Your energy, gut health, sleep, hydration levels, hormonal health, absence of injury/illness, dietary habits, exercise habits, etc. 
2. Emotional: How well you know and embody your authentic being, self-worth, and emotional regulation; experiencing the full spectrum of your emotions without judgment; how well you resource yourself with grounding tools; how well you trust without co-dependency, etc.
3. Spiritual: Connection with a greater meaning or a higher power in life, a sense of and pursuit of purpose, actions aligned with your authentic code and beliefs, co-creating with the universe, implementation of practices to connect to God, a Source, a Higher-self, etc. 
4. Social: Sense of belonging, community, connection with others; quality time with loved ones; awareness of others and your social determinants of health and how they impact interaction; awareness of your implicit biases and using strategies to mitigate them; actively participating in groups; recognizing and mitigating people-pleasing behavior; ability to set boundaries, etc.
5. Environmental: Curation of a safe space for you and your family, acting in ways that honor and respect your physical world, cleanliness and order of your home and workspaces, access to resources, etc.
6. Vocational: Meaningful work that aligns with your authentic values and beliefs, recognizing tendencies to overwork or underwork, satisfaction with performance, etc.
7. Intellectual: Fueling your mind with brain-healthy activities, consuming uplifting content, learning, thinking critically, engaging in self-analysis and self-reflection, doing creative activities that bring you joy, trying new things, etc.
8. Financial: Healthy money mindset, financial literacy, goal setting and planning, debt management, allocation of resources, etc.

 

Below is an exercise that will help you analyze your overall balance in these areas. You will rank each of these dimensions from 0 to 5. 

 

0 = unsatisfied/unhappy 

5 = most satisfied/happy.

 

It is normal to score less than a 5 in multiple areas—if not all of them! Your scores will also constantly shift through your week, month, and lifetime because your priorities shift all the time. The good news is that these scores can indicate important areas of focus, areas where you can set personal goals for improvement. 

 

You will likely need to get out of your comfort zone in order to grow in these areas, much like forcing your body to rely on other senses and queues to develop a stronger sense of balance. Similar to the way that your three physiological systems of balance can work together, these eight areas of life balance can and should work together in promoting your overall wellness. Your mind, body, and spirit will begin learning how to rely on one another for strength. The key is being okay with being off-balance. 

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!