In my practice, I see many people with back and neck pain. When I assess the spine, I often find that the thoracic spine and ribs are frozen stiff. When the thoracic spine is not mobile, the low back and neck may compensate for this lack of motion, which can lead to overuse, tension and dysfunction.
Last weekend I purchased a lecture on the Thoracic Spine by Sue Falsone, PT, ATC
from the website Movement Lectures. I was impressed with the material, and was inspired to include some of the exercises that she recommended to regain thoracic mobility into my Restorative Exercise™ class last week.
I have also been loving my new Yoga Tune Up®
self massage therapy balls, so I added some myofascial release into the class as well.
Below I share with you 3 movements to free your thoracic spine.
Thoracic rotation assessment
Breathing Exercise: Enhance Rib mobility, improve rotation
Get into child's pose with arms down by sides. This position will limit your ability to breathe into your belly and will encourage you to expand your breath into the back ribs. Take 5 good long breaths. Try to expand the ribs on the inhale, and on the exhale, close the ribs.
Reassess thoracic rotation: More motion
thoracic extension and myofascial release with ball
Place two tennis balls in a sock. A sock will keep the balls from rolling all over the place. Lie down on your back with the balls underneath you just below your shoulder blades. Your spinous processes should be between the two balls.
Notice how much the ribs lift up when you lay down over the balls. You will need to prop up your upper back and neck to make sure you stay in alignment.
The balls are placed at the bottom of the shoulder blades and the upper back is propped up so the ribs relax down against the body wall.
Lift the arms overhead. Make sure to only lift as far as you can before the ribs start lifting up. Complete 3-5 times and then move the ball up your spine.
As you move higher up your spine, you will not need a prop under your shoulders.
Flexion and extension of both of the shoulders creates a flexion/extension moment at the thoracic spine. The ball helps to decrease the tension on the paraspinals.
I would love to know how great you feel after practicing this for one week!
pic taken from wikipedia
Not quite a month ago I wrote a post
about raking leaves and waking up the next day with pain at my shoulder blade. I was able to relieve it after a few minutes of exercise. Well.... it came back after a weekend of hovering over my computer.
This time I had a different strategy: address the tension in my neck and pectoralis minor.
Due to the attachment on the coracoid process of the scapula
, tension in the pec can pull the scapula forward lifting the bottom edge away from the body
, potentially creating dysfunction for the entire shoulder girdle.
I was inspired by Jill Miller's YogaTune Up® Blog
on the pec minor. So I share with you pics from my 2 minutes of myofascial work with a tennis ball, and "bam" no more pain! I used a tennis ball for this, but I recommend the high grip rubber of the Yoga Tune Up massage balls.
Find the deltopectoral groove at the front of your shoulder.
Place the ball at the groove, just under the clavicle.
Find a corner and lean into the wall.
You can add more pressure by shifting your weight forward into a lunge. Find a tender spot and allow your muscles to release. Come down farther onto the ribs and find another spot. Work 2-3 minutes.
I felt good all day! Until I woke up the next morning and there it was again: pain in my left shoulder blade! This time I released my pec minor AND added the ball release to the muscles at my neck just above my clavicle. Five minutes later, no pain! Check out how I did it by watching this video:
Recently I had the opportunity to work with a woman 7 weeks postpartum. She had been experiencing heaviness and pressure in her vaginal area with walking, lifting, and prolonged standing. At her 6 week check in with her midwife, the midwife said she had a mild prolapse. Concerned about the discomfort and the inability to perform daily activities: lifting her 5 yr old and newborn, walking, standing...etc., and the potential further descent of her organs, she made an appointment with me (smart woman).
My evaluation confirmed her midwife's diagnosis of prolapse: a mild rectocele
and urethrocele (see pic above).
In our session we worked on making her aware of habits that increase downward pressures which can contribute to prolapse, with the ultimate goal of reducing or eliminating such patterns.Automatic habits addressed in the first session
My client stood as most of us do, with her pelvis out in front of her. She also lifted her ribcage to bring her shoulders back. Ideally we should stand with our pelvis stacked over our ankles and our ribcage stacked over our pelvis; think about our functional core connection here: diaphragm, transversus abdominis, pelvic floor and deep back muscles. (For an educational read, get the book, The Pelvic Girdle by Diane Lee.) When the pelvis is out in front, we no longer have a neutral pelvis, which is important for the position of the pelvic organs (bladder, uterus) to have support of the pelvic ring below (notice in the pic above on the left, the bladder and uterus rest on the pubic bone). This means more grativational load on the fascia and ligaments leading to tissue failure (and descent of the organs). So my client learned how to stand.
Poor alignment: anterior pelvic sway. Notice the hips in front of the ankles. The ribcage is lifted up and in front of the pelvis.
Improved alignment: pelvis is stacked over the ankles and the ribcage is stacked over the pelvis.
Sucking in the stomach
Pulling in the gut to “look” slimmer freezes and shuts down the diaphragm, not to mention increases pressure in the cavities above and below. Read more about sucking in here
: So my client learned how to breathe.Tension in the pelvic floor
All muscles need to be able to contract and relax optimally. When the pelvis is out in front, the muscles in the pelvic floor are held in a shortened position. When there is increased pressure in the abdomen and pelvic cavities from sucking in, the pelvic floor muscles try to create balance by increasing contraction to maintain continence. Chronic tension means decreased blood flow, decreased oxygen, decreased waste removal = potential for pain signals. So, my client learned how to relax her pelvic floor
Very shortly my client returned to the clinic with noticeable improvements
Within a week she felt less heaviness and pressure in her vaginal area. She felt pressure only with heavy lifting. She possessed the education to continue her home program from the initial visit and we added gluteal strengthening to her program.
Two weeks later she returned to clinic reporting continued improvement. She was able to walk and perform yard work without any discomfort! She had a follow up visit with her midwife who reported upon exam significant reduction of prolapse! She was given additional functional movement reeducation for her home program. I will follow up with her in a month and more than likely discharge treatment.
Moral of the story is this: if you feel pressure or heaviness in your vaginal area pospartum (or at any time), get it taken care of, go see a pelvic health physical therapist. Or contact me for more information!
If you are in the Salt Lake City area, I am offering a Postpartum Workshop
December 8, 2012 where we will address these issues and more. The workshop will be held at Vitalize Studio in Sugarhouse, 2154 S. Highland Drive from 9:30 to noon.
We had a good storm this week to blow off all of the leaves of the frontyard tree.
I spent two hours raking and bagging. The next morning I woke up with pain and pulling at my left shoulder blade.
I am sure that many of you can relate.
So, instead of waiting it out and griping about it all day, I took 15 minutes to work with the muscles and set freedom to my scapular sling muscles. Post session, no pain!
Below I have pics and video of the simple movements and stretches I went through to decrease the pain in my shoulder girdle.
These are also great exercises to perform daily to combat shoulder blade, arm, and neck tension from computing, driving, hair styling, pushing strollers, carrying babies, etc.
The first movement is called the Rhomboid Pushup. Complete 5-10 repetitions. Make sure that your fingers and elbow creases face forward, and keep your elbows straight.
After the rhomboid pushup, perform a shoulder stretch as shown here.
Repeat the rhomboid pushup 10 more times and then go into this next stretch, Quadruped Rib Twist.
Complete another cycle through of each, the rhomboid pushup, the shoulder stretch and the rib twist. Finish up with some wrist stretches shown below.
Place forearm vertically, flex wrist and pull fingers down and toward your forearm. Hold for 30 secs.
Now pull each finger individually, hold 10-20 secs.
Bend elbow to 90 degrees. Extend wrist and pull all fingers down and back, keeping fingers straight. Hold 30 secs.
Now pull each finger back individually and hold 10-20 secs.
Hip mobility is key to the health of the spine. When we lack the motion at our hip joints, the spine will take up the slack by moving into flexion or extension. Here I am trying to lift my leg backward. Compare the two pictures. You can see the increase of the lumbar curve on the left, this is called extension. This creates compression and degeneration of the tissues and tension in the back muscles. This picture on the right shows my true hip motion without compensating by getting more motion through my spine.
Now, here I am lying on my back with my knees bent. On the pic on the top, the dots demonstrate having a level pelvis. As I bring my knee toward my chest, I moved past my actual motion at my hip joint and my pelvis tilts posterior or toward the floor. This action creates flexion at my spine and places more stress on the lumbar discs making me more susceptible to a disc herniation or degeneration.
Restore mobility to your hips, and save your spine from wear and tear from all that extra motion! Below are 10 of my favorite Restorative Exercises™ to free up the hips and the spine! Unless stated otherwise, hold the stretch for one minute each side.
Psoas release: Place a block under your sacrum with your knees bent so your shins are perpendicular to the floor. Relax here for 5 minutes.
After the release, bring one knee toward the chest and hold it at arms length. Kick the other leg out straight and begin to lower slowly keeping the knee straight. This uses the psoas in an eccentric contraction and allows the hip to move into extension. Repeat other side.
Bend your knees and bring the soles of your feet together.
Cross left leg on top of the right. Repeat other side.
Cross left leg over right. Make sure to sit with a neutral pelvis (not to tuck sacrum or round your spine). Repeat other side.
Get into the lunge position. Make sure your spine is neutral (no flat back or increased curve) and your hips are square. Begin to shift weight forward, moving your R hip into hip extension. Keep your front shin perpendicular the the floor. Switch sides.
Lift your left leg in the air so your hip, knee and ankle are at 90 degrees. Keeping your left shoulder down, take your left leg across the body toward the floor. Take it as far as you can and maintain your left shoulder on the floor. Switch sides.
Begin by starting in the same position as previous stretch. This time, take the knee all the way to the floor. You will notice that your shoulder comes up. Relax your torso to allow your shoulder to come down to the floor. Repeat other side.
Start with knees bent. Place a block in between the knees and lift legs to 90 degrees. Begin to rotate your hips by bringing your feet away from each other and then return to start position. Repeat 10 times for 3 sets.
Maintain neutral pelvis. Cross your right leg over left.
Bring your knees toward your left side until your foot hits the floor. Try to make sure the your right shoulder stays on the floor. Repeat sides.
This Saturday, September 22 marks the beginning of Fall. The change of seasons here in Salt Lake City is invigorating: brisk mornings and evenings require putting on layers, and the leaves are turning orange, yellow and red. This change feels so synchronized, steady and effortless.
If only changing habits and behaviours could be so elegant...
A transition of seasons may appear effortless, because of the consistency in change month after month. We can
apply this concept of change to our own habits and behaviours: big changes most often happen from a sequence of small solutions strung together.
Using research from business, psychology, sociology and neuroscience, brothers Chip and Dan Heath have written a book called Switch: How to change things when change is hard.
This is a “how to” book that begins with a premise:
All change efforts have certain patterns that are similar
- You must start acting differently
- You must change your situation
- You must change how you feel and what you think
- You must get the emotional brain and the thinking brain to integrate
This Fall, ALIGN has teamed up with SoulSalt
coaching to create a program for change. We call our program Ultimate Freedom: Finding your way out of pain. We are seeking individuals who are in pain, and who are ready to move through it! Ultimate Freedom is a 5 week intensive, that is offered in either a group or an individual format.
Utilizing principles of coaching, neuroscience, movement and neuromuscular education, Ultimate Freedom will assist to restore you through a season of change, and a future of no pain!
If I said that I was going to run a marathon in 9 months, it is common knowledge that I would need to get ready for it. I would have to set a training schedule to prepare my body for the long distance: 26.2 miles, average completion time 4 hours.
What if I said that I was pregnant, and I was going to give birth in 9 months. Would the expectation be that I would train for this? Probably not. Why is that? For many first time mothers, labor can last for hours, with the average length of active labor being 12 hours give or take. Preparing the body to sustain increasing mass during pregnancy and preparing the hips and the pelvis for vaginal delivery should be part of the “mother to be” training.
In order to have a pain free pregnancy and complication free vaginal delivery here are some requirements:
- Strong thigh muscles to support the weight of the torso
- Hip mobility
- Moveable sacrum
- Strong deep abdominal muscles
- Pelvic floor muscles that will yield
Your training program should include:Walking
Walking with a reciprocal arm swing incorporates whole body movement which enhances circulation, strengthens the legs, and frees the pelvis. Work up to walking 5 miles a day (this does not have to be done all at once). Optimal postural alignment
We tend to carry our pelvis out in front of our ankles.
A forward pelvis affects:
- the stability of the pelvic girdle which can create pubic pain or sacroiliac dysfunction
- the function of the pelvic floor which can cause the muscles to become shortened and unyielding
- the position of the sacrum relative to the pubis which decreases the distance of the pelvic inlet.
Ideally we want to have the skeleton stacked so that we have the line of gravity going through the ear lobe, midpoint of shoulder, hip, knee and ankle.
Footwear choices affect alignment. Any shoe with a heel will angle the body forward
. The body compensates for this by tucking the pelvis under, bending the hips and knees. Over time this can shorten the muscles on the back of the leg which can pull the pelvis out of alignment creating back pain and pelvic floor dysfunction. Choose shoes that are flat and allow your toes to wiggle.
Optimal standing alignment
Hip mobility and leg strengthening
Squatting improves the mobility in the hips, strengthens the glutes and legs, promotes a wider pelvic outlet and allows the pelvic muscles to yield.
Exercises to address lateral glute strength will prevent the pregnancy waddle and decrease the instability and excessive motion at the pelvis.
Maintain a vertical shin as you lead with your butt to come down into a squat. This protects the knees and engages the glutes. Go down into a deep squat to improve hip mobility.
Deep abdominal and pelvic floor training
Learn how do activate your deep abdominal muscle transverus abdominus without holding your breath. Learn how to utilize this muscle for the pushing stage of labor. The TRA is best activated during the exhale of the breath cycle: draw your belly button to your spine.
Learn how to let the pelvic floor relax in order to allow the baby to pass through without tearing (yes, this takes practice). The pelvic floor should relax/yield on the inhale of the breath cycle. Imagine the ischial tuberosities (SITS bones) widening as the pelvic floor relaxes.
Perineum: Pelvic floor muscles
Have you ever checked into your body to notice how much tension you carry in your muscles? Constant muscle contraction reduces the amount of blood flow in and out of the area, as well as compresses the joints that the muscles cross. Compression of the joint causes decreased mobility, friction, misuse of the limb, and potentially arthritis.
We tend to carry a lot of tension in many of our muscles, but many of us are more aware of our neck and shoulders. Feel your neck and shoulders now, are they tense? Look in the mirror, and see if your shoulders are elevated. Notice if your collar bones are angled up at a diagnal to your shoulder. Let your neck and shoulders relax. Take a breath in, and on your exhale allow the shoulders to relax and come back down.
Now let’s check the tension in your legs. We should be able to stand without clenching our butt cheeks together, or gripping our quadricep muscles in the front of the thigh.
In order to check the tension in the legs, we need to have a straight leg. When I teach this in my classes many people get confused because they have been told, “don’t lock your knees!” The leg isn’t locked if it is straight. It is “locked” when the quad muscles are contracted.
There are people who are able to hyperextend their knees, it looks like this. Photo taken from: www.lifebridge health.org/
There are people who stand with constant knee flexion (bent knees). It looks like this.
To assess the tension in the quad, the leg should be straight like this. A straight leg means that the midpoint of the hip, the midpoint of the knee and ankle bone should line up vertically.
If the quads are relaxed, you should be able to contract your quads (notice your knee cap lift up) and return to the relaxed state. If you can’t tell if your knee caps are lifting, more than likely your quads are already in a contracted state (this means that your patella is compressed against your femur, creating decreased mobility and friction which can lead to arthritis). Check out the videos below: On the left she is able to lift and lower her knee caps, so her quads are relaxed. If you weren't able to release your quads, go lean against the wall for support with your feet about 2-3 feet from the wall. Notice the knee caps in the video on the right. As you are able to contract and relax the quads, move closer to the wall until you are 3 inches away. If you are still able to relax, then move away from the wall and check again. This is a big deal! Chronic contraction decreases blood flow, compresses the joint, decreases mobility, increases friction and can lead to arthritis. Practice this a few times a day until you can stand 100% of the time with your quads relaxed.
Last week on Align’s Facebook page
I posted a picture to promote my Postpartum workshop. This picture showed an example of the abdominal “bread loaf”
that can occur if the Transversus Abdominus muscle
is not activated correctly during daily activities such as bending or lifting and abdominal workouts. The increased pressure is going down into your pelvic floor and out into your abdomen. Over time, supportive tissues can fail, and the results are abdominal/inguinal hernias, organ prolapse (uterus, bladder, rectum) or disc herniations (just to name a few).
In a previous post, I reviewed how to contract the deep abdominal muscle correctly
. This is an important skill to master before increasing the demands on the body such as carrying more weight, or moving the limbs. Once the contraction can be performed without holding the breath, it is good to challenge the core by moving the legs. Here is a lower leg progression to advance core control.
Lie on your back with your knees bent, and feet flat on floor. Make sure that your pelvic triangle (see dots) is level. Notice your ribs. Can you see in this pic that the ribs are lifted? If your ribs lift like this, you may want to prop something under your shoulders and head so they can come down.
The head and shoulders have been propped up with a half cylinder under the shoulders and a yoga block under the head. Now the ribs are in alignment and the transversus can have a more effective contraction. The pelvic triangle remains level.
Activate your Transversus by drawing your belly button toward your spine as you exhale. Lift one leg to ninety degrees as shown, and hold for 1-2 sec. Then lower down. Contract your transversus again and lift the other leg. As you gain more control, contract the transversus, lift one leg to ninety degrees and then alternate legs without having to reset the contraction. Complete 10 repetitions and then rest.
When you are able to complete alternate legs without difficulty. Perform transversus activation by drawing belly button toward the spine on the exhale, lift both legs at the same time as shown. There should be no bread loaf. If there is, you are not contracting transversus correctly. Go back to the last step before advancing to this progression. Hold for a few seconds and then lower down slowly on your exhale. You should never hold your breath! Repeat.
Next progression: From the initial position, place a pillow or yoga block between your knees. Contract your transversus and lift legs to ninety degrees. Gently squeeze into the block. Maintain transversus contraction as you begin to rotate your hips.
Gently squeeze block as you rotate your hips by moving your feet away from each other, and then return to start position as in prior picture. Perform 10 repetitions and then bring both legs down on your exhale. Repeat 2-3 times.
The health and function within our body depends on many factors: adequate sleep, nutrition, emotional/mental/spiritual wellbeing, and exercise/movement.
In order to get the best health experience with our body, we need to be able to maintain a consistent environment where our cells are given the opportunity to thrive and regenerate. How we move (or don’t move) and use are body on a daily basis plays a big role in the maintenance of our physiological systems: cardiovascular, pulmonary, metabolic, reproductive, digestive and nervous. It can also effect our emotional, mental and spiritual states.
Within the body, the musculoskeletal system is the foundation for our other systems to work efficiently. The skeleton provides the frame for our muscles to attach. The muscles activate and provide the stimulus to pump the oxygen rich blood to all of the body for optimal regeneration of new cells, as well as facilitate waste removal into the lymphatic system.
Consistent practice of alignment principles ensures that the body is in position to allow joints to have full range of motion and muscles are at their appropriate length to stabilize the body and optimize metabolic pathways for daily activities. It also provides a means for you to experience a greater range in your emotional, mental and spiritual sense of fulfillment as you begin to discover where your body is and how you are using it.
Many of our ailments are a result of incorrect use of our body. When the “foundation” starts to shift from baseline, we get increased stress risers or breakdown, which leads to tissue degeneration: arthritis, muscle/ligament tears, muscle strains, organ dysfunction, spinal degeneration, disc herniations.
The more we can pay attention to the objective alignment markers on our body, and be true to our natural design, we can be more vital and pain free! For those of you who would like to know more about the Whole Body Alignment training click here
! For those of you who would like to experience an alignment session click here
! For those of you ready to get started with 10 of the 25 Alignment Points to Optimal Health, see below:
Here is a diagram of the 25 points to Optimal Health created by Katy Bowman, copyright Restorative Exercise™.
Feet facing forward with the outside edges straight. Feet hip width apart.
From a side view the vertical line of gravity should be through the ear lobe, the midpoint of the shoulder, hip, knee and ankle.