Yoga for Pelvic Floor

I’ve noticed a problem in the yoga world ever since I’ve joined it, and I’m thinking it’s time to talk about it.

Have you ever been to a yoga class before and heard a teacher say “engage your mula bandha”??

Maybe your teacher explained it as an energy lock or seal that you should learn to activate for better body-mind connection and focus. The mula bandha correlates to the root energy lock, which is your pelvic floor, a group of muscles that actually create the base of your core that sits at the bottom of your pelvis.

If you think about the core as a house, your diaphragm is the roof; your transverse, oblique and rectus abdominals are the walls; your pelvic floor is the foundation. You cannot have a resilient core without resilient pelvic floor muscles (PFM).

The reason I say resilient, and not STRONG, is because there is such thing as being so strong that you get too TIGHT. This happened to my pelvic floor. Being a yoga practitioner and teacher, I heard and used to say “engage your pelvic floor or mulabandha” and would myself contract and lift so much, that I got way too tight. I created a situation where I actually aggravated my pudendal nerve, the nerve that innervates the PFM, and gave myself a form of urinary incontinence (UI) called urge incontinence. I felt like I had to urinate every 5 minutes, and when working as a physical therapist with patients at the time, going to the bathroom to try to find relief was not ideal. It was actually painful and felt like what would have been a urinary tract infection (UTI).

So I called a friend, a pelvic floor PT, and asked her what to do. She advised me to relax, breathe, and work on releasing my pelvic floor through some self manual work. I did it and it worked!

So why should you be concerned with having a relaxed- or better yet, resilient- pelvic floor? From what I’ve read and heard from fellow yoga teachers is that yoginis (female yoga practitioners) tend to have the worst and longest child-birthing experiences. This is in part because of the great emphasis on Kegels aka engagement of the mula bandha during class, but none for the relaxation. That is huge and needs to change. Luckily, here are a handful of amazing yoga postures that help facilitate relaxation as well as activation, so that you are working on the FULLEST range of motion of your pelvic floor. If you practice moving through the contraction, relaxation, and the lengthening, these postures could help the tightest PFM relax when paired with the right breath cues.


CHILD’S POSE // BALASANA

Spread your knees apart, big toes together. Sit your hips back on your heels and reach long through your arms. Imagine your pelvic floor muscles lengthening and relaxing as you breathe in. On exhalation, imagine them drawing your tailbone to your pubic bone.

YOGI SQUAT // MALASANA

Start with feet wider than hip width distance apart with your toes turned out for more accessibility. Sit your pelvis low and maintain a neutral spine. Hands can remain at heart’s center while you close your eyes. Inhale and imagine your pelvic floor lengthening down towards the floor without straining or bearing down. Exhale and feel your navel gently engage towards your spine while you imagine drawing your sits bones (ischial tuberosities) together. Maintain that connection to your pelvic floor as you breathe. Sit on blocks (as many as you need!) if you’re working with tighter ankles, knees, or hips.

HALF WIND RELIEVING POSE // ARDHA PAVANAMUKTASANA

Begin lying on your back. Draw your right knee in towards your right shoulder. Inhale and think about relaxing your PFM towards your left heel. Exhale and imagine picking a grape off of a vine with your PFM. Hold at the top and release the muscles again as you breathe in. Repeat on the left side. If you’re pregnant, this supine posture might not feel as accessible. Go back to the yogi squat, or try this posture reclined on a bolster.

HAPPY BABY POSE // ANANDA BALASANA

Begin on your back, hug your shins to your outer rib cage. Compress downward while lengthening your tailbone and sacrum to the ground for a more neutral versus rounded spine. Guide your shoulder blades down your back and draw elbows wide to feel your hips and inner thighs opening. Breathe in, relax your PFM to their lowest resting tone fully. Breathe out, imagine closing curtains and then lifting your PFM gently towards your head.

There you have it. Sounds counterintuitive to sync your inhalation to relaxing/lengthening and exhalation on contracting, but when you think about how the diaphragm works in sync with your pelvic floor (remember roof and foundation?) it makes sense to create as much room in your lungs with the intra-abdominal cavity pressure. As you inhale, your diaphragm contracts and pulls down so your lungs can inflate, pushing the pressure downward. This allows you to relax and lengthen the PFM. As you exhale, your diaphragm relaxes and rises to expel air out of your lungs. This makes it easier to contract the PFM “shut” and gently lift up.

This is not just about having a tight vagina or pelvic floor. It’s about resiliency. The ability for your body, pelvic floor included, to support you in life when there is impact, be it a jump squat, or a baby that makes its way through you to come into this world. Strengthening is important, but so is lengthening and relaxation. Next time your yoga teacher instructs on the mula bandha energy lock, remember the way to release it.

Disclaimer: This is not medical advice. If you have any pain, bowel, bladder, or sexual dysfunction, please see your medical provider or closest pelvic floor physical therapist.

Written by: Brittney Ellers, PT, DPT, RYT

5 reasons why resistance training is important

Why is resistance training so important? Resistance training is not just about improving muscle size and tone but also benefits your bones, muscle mass, heart, body composition, posture, and body awareness. Resistance training can include free weights, machines, resistance bands, and even your own body weight.

1. Resistance training has been shown to improve bone density. Our bones positively respond to resistance and weight bearing exercises by improving our overall bone minimal density and decreasing the risk for osteoporosis.

2. Resistance training has been shown to improve muscle mass. If we don’t use and strengthen our muscles properly then the decline in muscle mass increases even more with age.

3. Resistance training has been shown to improve cardiovascular health. Studies have shown improvements with blood pressure and cholesterol. The American Heart Association recommends weight training at least twice per week to improve heart health.

4. Resistance training has been shown to improve your overall weight and body composition. Studies have shown that as your lean muscle mass increases, your metabolism also increases and your body fat decreases.

5. Resistance training has been shown to improve posture and body mechanics with exercise and functional activities. Posture limitations and poor body mechanics are often caused by muscle strength imbalances throughout the body. Improving your body awareness and posture will help to prevent injury with exercise and when performing daily tasks.

Written by: Madison Goldin, PT, DPT, RYT

Knee pain when squatting

Being able to squat correctly is important in our daily lives as we perform a squat to do many functional tasks such as getting into/out of a car, sitting down, going to the toilet and picking things up. One of the first things to look at if you are experiencing knee pain when squatting is alignment on your lower extremities during the motion. Often times the knees will drop inward (valgus motion) or move to far forward past your toes which can create excess stress on the medial and/or anterior knee.

This can happen due to the positioning/anatomy of your foot, a lack of mobility at the ankle and hip and/or weakness in glutes and quadriceps. If you have a flat (pronated) foot this can cause an inward motion (adduction and internal rotation) of the lower leg causing the knee to drop inwards as you squat. This can put stress on the soft tissues on the medial aspect of the knee and cause altered tracking of the patella. Another cause of this inward motion can be a lack of functional strength at the glutes. When there is a lack of strength in the lateral glutes the thigh can drop inward which will cause similar medial stress on the knee. Focussing on lifting slightly through the arch of the foot when squatting and working on functional glute strengthening will help improve alignment.

Another common thing we note that causes knee pain when squatting is the knee moving too far past the toes. This can occur due to altered motor control and biomechanics or due to a lack of mobility at the ankle and hip and poor proximal strength. Decreased ankle dorsiflexion and hip flexion can limit the depth of the squat and it is common to compensate with driving the knee’s further forward. This causes increased compression forces on the patellofemoral joint. Focus on sitting the hips back (like your sitting back into a chair) and flexibility of the foot and hip to help improve alignment.


Correct alignment when squatting:
Knee is in line with the 2nd/3rd toes and hip. Knee stacks over the ankle joint. Even weight between both feet.

Written By: Paula Lamont, PT, DPT, CAFS, RYT

Hip mobility for a healthy low back

Low back pain is a common injury amongst the population. One of the things that continues to come up in a lot of patients suffering from low back pain is poor hip mobility. Why do we get so tight and immobile through our hips!? Think about how much time you spend sitting each day either at your work desk, driving, watching TV in the evening. When we sit for long periods we are positioning a few of our hip muscles in a shortened position. When we then stand up, these shortened muscles can pull on the pelvis creating altered alignment and increasing stress on the low back when we move.

In the image below you can see how the pelvis is tilted forward which creates a reverse ‘C’ shape in the low back (lumbar extensions or lordosis). This can be caused by tightness through the muscles attaching to the front of the pelvis (the hip flexors). When we walk, the amount of functional hip extension that can be achieved will be limited. When we get to our limit in hip extension, the body will find an alternative way to move to get the desired outcome (walking) and will extend into the low back, rotate outward at the hip and lower leg, causing shearing stress on the low back. Over time this can cause degeneration in the lumbar and sacral-iliac joints. To help prevent tightness in the front of the hips, try the stretches below 1-2 times a day to open up the front line of the body (especially after sitting for any length of time). 

Stretches                                                                                                                                                                                                      1. Kneeling hip flexor                                                                                                                                                                                    2.Standing hip flexor                                                                                                                                                                            3.Runners lunge                                                                                                                                                                            4.Runners lunge with quadricep stretch 

Written By: Paula Lamont, PT, DPT, CAFS, RYT

fix-anterior-pelvic-tilt-poor-posture.jpg
Kneeling hip flexor stretch 

Kneeling hip flexor stretch 

Runners lunge

Runners lunge

Runners lunge with quadricep stretch 

Runners lunge with quadricep stretch 

Exercises for Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction is a common injury which is often misdiagnosed. The sacroiliac joints are formed in the posterior (back) of the pelvis between the sacrum and the ilium (your hip bones). It is a very small joint with very little movement, but when you have either excessive or lack of mobility in this joint it can lead to a lot of pain and discomfort. The pain is usually localized to one side of the sacrum (but can also be both) and may also cause alignment issues and discomfort at the pubic symphysis. The pain is usually aggravated by unilateral activities which increase load through the hip/pelvic region such as running, walking and climbing stairs.

Altered alignment at the sacroiliac joints leads to a functional leg length discrepancy where one leg will appear longer due to a rotation at the pelvis. It is often the result of asymmetries in muscle length and strength in the muscles surrounding the pelvis. This can occur from a number of things that alter your biomechanics when walking and running. Alignment at the pelvis can be corrected by a Physical Therapist and maintained with rehabilitation exercises addressing flexibility and strength.

Here are some basic alignment and strengthening exercises I use to help maintain and address issues in my sacroiliac joint and pubic symphysis so i can keep running!

1. For pubic symphysis alignment:
a. Lie on your back with your knees bent and soles of the feet pressing firmly into the ground. Place a yoga block (or foam roller, folded towel etc) between the knees. As you exhale, squeeze your thighs and knees into the block as you draw your navel in and up to activate your pelvic floor. Hold for 5-10 seconds and release. Repeat 3-5 times.

2. Pelvic floor and transverse abdominis activation:
a. In a kneeling position (option to also sit on a yoga block), sit up tall with hands placed on your knees. Draw the shoulder blades down and back and relax the shoulders. On your inhale relax the abdomen and muscles around the pelvis. As you exhale contract your transverse abdominis and pelvic floor by drawing the navel inward and upward (think about that motion of your navel to help activate the muscles). Continue relaxing and contracting as you breathe. Start out by trying to perform for 1 minute.

3. Bridging:
a. Lying on your back, bent both knees and walk the feet towards the glutes. Arms are by your sides. Knees are inline with 2nd/3rd toes. Knee stacked over ankle. Even weight through the toes and heel of each foot. Exhale as you engage the abdominals and lift the hips by pushing through the heels of the feet. Aim to feel this primarily in the gluteals. You will also feel some engagement through the quadriceps and abdominals and a slight stretch through the front of the hips.

4. Static lunges:
a. Sagittal plane (Anterior lunge): Start in a split stance 3-4 feet apart with the feet hip distance and pointing straight ahead. High on the ball mound of the back foot, front knee is bent. Bend into the front knee so it stacks the ankle ensuring hips stay aligned to the front. As you exhale, engage the abdominals and hold this alignment as you bend the back knee and sink the hips towards the ground. Push through the heel of the front foot to rise back up. Feel activation of your front glute and back quadricep.
b. Frontal/transverse plane (Curtsy lunge): Step your left foot back and behind the right (almost at a 45 degree angle). High on the ball of the left foot, right foot is pointing straight forward, hips are square to the front of the room. Slowly sink the hips towards the ground while maintaining hip alignment and abdominal engagement. The front knee should stay stacked above the ankle in line with the 2nd/3rd toes. Feel engagement of the front glute muscles.

 

Written By: Paula Lamont, PT, DPT, CAFS, RYT

Pubic Symphysis Alignment

Pubic Symphysis Alignment

Pubic Symphysis Alignment 

Pubic Symphysis Alignment 

Bridge

Bridge

Frontal/Transverse Plane (Curtsy Lunge)

Frontal/Transverse Plane (Curtsy Lunge)

Sagitall Plane (Anterior Lunge) 

Sagitall Plane (Anterior Lunge) 

Apple Watch Series 3: Worth It?

What’s so special about this smart watch, and how can it be better used to redefine your health and fitness? I purchased my watch with the cellular option a little over one month ago, and these are just some of my favorite features that help me feel more effective and efficient not only in my personal workout routines, but in my job helping others achieve their health and
fitness goals.


1) Phone calls and texts - My cellular network is synced with my watch, and it allows me to stay connected and in touch with important people in my life, even while I am squeezing in a workout on land or in water. I love the idea of being able to reach family, friends, and clients without having to carry my phone with me. But of course, the yogi in me does not like to be distracted during my practice, so I always slide my watch on “do not disturb” before I step on my mat.
2) Activity rings - Apple’s version of their fitness tracker allows me to visualize my activeness with three rings - move, exercise, and stand - which are all customizable to meeting my fitness goals and standards on a daily basis. It holds me accountable for these short term fitness goals, which end up making me feel accomplished at the end of the day. They even go as far as congratulating me with fireworks when I “close a ring” or all three rings! I am able to track all of this on my phone as well to get the bigger picture of my fitness progress, which motivates me to keep it up throughout my week.
3) Waterproof workout tracker - If I open up one of the workouts I like to do, my watch will track my heart rate range, calories burned, and time that I spent doing that workout. And say I did that workout in the pool doing laps or out in the open sea for a surf session- this watch will vibrate/pulse to get excess water out once I am done!
4) Seconds/timer - My personal favorite as a physical therapist. I get to focus on my client’s body, form and alignment rather than figuring out what number exercise they are on. It counts down for me, as well as offer a tabata option where I don’t have to keep track using a silly stopwatch. The watch automatically tells me when to switch exercises according to the time I’ve allotted.

So is this watch worth it? In short, my answer is yes. At Redefine Health and Fitness, accountability for your health matters. If you have a hard time making or keeping realistic fitness goals, this watch could help, giving you frequent reminders and encouraging alerts to keep your body moving (especially when a therapist or trainer isn’t there to tell you what to do).

Written by: Brittney Ellers PT, DPT, RYT

The Go-Giver Book Review

Our company has experienced a significant growth over the past 4 months, particularly over the past 8 weeks. It was perfect timing that a client gifted me this book a few weeks ago. As we grow in size and success, I feel that it is important to remember the purpose of why Redefine Health and Fitness was started. This book does an excellent job of guiding how a business can grow in success and influence while remaining generous and giving in nature. I read this book twice the week it was gifted to me. Even if you are not a business owner, the principles that are described can be applied to interactions in everyday life. It's a quick read, enjoy! 

Written by: Carla Pryor CEO, PT, DPT, OCS, CSCS, RYT 

Glute activation and ankle mobility exercises for running

Running is a great cardiovascular exercise that is convenient, time efficient and easy to do anytime, anywhere. For those of you that have ran a lot, you know how prone runners can be to injuries, especially overuse injuries (for example; achilles tendinitis, ITB syndrome, plantar fasciitis). When we are running, we are repetitively switching between a mini single leg squat on each leg, with flight time in between. In order to allow for the right muscles to ‘turn on’ and support our hips, knees and back when running, we need to ensure good mobility at the ankle joint. As the ankle is the first point of contact with the ground it is important to have good ankle dorsiflexion and eversion to allow our body to absorb shock and activate the correct muscle groups up the kinetic chain. Just as important as preparing our ankles for the impact of running is activating our glute muscles. These muscles are some of the string power muscles in our body that act to maintain correct alignment at the ankle, hip and spine when running to prevent injury. Some of the key exercises I do before I run each morning are ankle mobility and glute activation exercises. This prepares my body for the activity it is about to perform, helping reduce the risk of injury. See below for a couple of my go to exercises!


1. Ankle drives video:
a. Warming up the ankle and calf muscles in three planes of motion help fire
proprioceptors in the ankle joint which helps turn on muscles. By working into the
dorsiflexion motion, we improve our ability to absorb shock and load the glutes
when our foot hits the ground.
2. Band exercises video:
a. Using resistance bands, we can start to fire the glutes by working the legs in
three planes of motion. This will improve muscle recruitment during the single leg
phase of gait to reduce load on the low back and knees.

Written by: Paula Lamont, PT, DPT, CAFS,RYT

Ankle Drives

Ankle Drives

Band Exercise

WHY DOESN'T MY MIDBACK ENGAGE?

Over the past few months, I have evaluated several clients who demonstrate difficulty engaging their middle trapezius, lower trapezius, and rhomboids. Thinking about their movement dysfunctions and how this impairment contributes to their pain and recreational limitations inspired this blog post. The purpose of this post is to explain common postural impairments that lead to weakening of the midback and loss of motor control in the corresponding muscle groups. I will also list tips to help correct the impairments, and provide guidance on steps you can take to seek consult if further assistance is needed. 

We spend a large amount of time sitting, driving, texting, and working at the computer. Most people lack postural strength and knowledge of proper ergonomics and alignment, thus sit incorrectly for hours each day. The above activities draw the shoulders forward, subsequently protracting the scapula. Over time, the pectoralis minor will adaptively shorten, keeping the head of the humeral anterior in the glenoid (the socket of the joint). The scapula will sit in this protracted position and also anteriorly tilt from the tightness at the pectoralis minor. The rhomboids, middle trapezius, and lower trapezius will adaptively lengthen and weaken. The cross bridging action of the muscle contractile unit is inhibited, preventing the midback musculature from engaging. 

As a person continues to sit with rounded shoulders and protracted scapulae, the tightness in the front of the chest and weakness in the midback will begin to flex the thoracic spine. This action with further protract the scapula and further limit the midback to engage. Over time, the mobility of the thoracic spine will decrease, making these impairments more permanent. 

At this point, the structural consequences of prolonged sitting with incorrect posture can be recognized by the uneducated eye. The person is encouraged to sit up straight, pull their shoulders back etc. The trouble is, the person is unable to do it correctly. With attempts to correct posture, the long term shortening of the pectoralis and hypomobility of the thoracic spine will not immediately change. This person will compensate by hinging into their thoracolumbar junction in an attempt to stand up straight. They will  engage the upper trapezius in attempts to engage the mid back that cannot contract due to its lengthened state fighting against tightness at the reciprocal muscle group. Over time, back pain/ neck pain/ radiating arm pain/ and shoulder pain can occur. 

To properly try to resolve the above postural impairments, a person should first begin with a flexibility program to the pectoralis minor. It is essential during stretching to ensure that the person only feel the stretch through the chest and that they are not hinging into the lower back. A joint mobilization program to the thoracic spine should be implemented, again, being sure that the motion is being drawn by the correct joint spaces. Following mobility based exercises, active range of motion exercises (moving with gravity) should be performed to functionally carryover the achieve range. As one gets stronger, these exercises should be progressed to against gravity, then with resistance, then incorporated into static functional movement, then single plane dynamic movement, and eventually multiplane dynamic movement. Training of the transverse abdominus should complement the above exercises as well to help normalize spinal mechanics. 

From the information above, you can see that it is not as simple as instructing a person who is slouched forward to sit up straight. This person is likely unable to perform the instructed task with proper muscle engagement and they may develop injuries from trying improperly. 

For additional questions/ comments: contact Carla@redefinehealthandfitness.com. 
This is a small part of the detriments of improper sitting, future posts will describe how the above postural impairments also link to dysfunction and pain in the lower body. Please consult with a physician, physical therapist, or qualified wellness professional before beginning a new exercise program. 

FUNCTIONAL STRENGTHENING AFTER STRETCHING TO CARRYOVER MUSCLE LENGTH

Have you ever been to a great yoga session and left feeling flexible and well stretched out, only to wake up the next morning feeling the same muscle tightness as before? Or maybe you have experienced going to a massage therapy session or a chiropractic session and left feeling aligned and relaxed, then woke up the next morning feeling back to stiff and sore? These are common reports heard amongst clientele striving to improve their flexibility, muscle length, and biomechanics through passive treatment options.

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