Below is a video sequence to address spinal mobility and upper back tension. Before you begin, lie on your back with your legs out straight. Notice the contact of the back of your legs, your low back, lower ribs and shoulder blades to the floor. After you complete the sequence, lie on the floor again and notice the change of your muscles and your connection with the floor. Enjoy!
Recently I had a conversation with a doula about fetal positioning. She and many of her doula colleagues have noticed an increase in clients that struggle during labor due to posterior positioning of the fetus. Posterior occiput position is when the baby's head is down and facing mom's belly. A normal presentation is when the head is down and the baby's head is facing the mom's sacrum as in the picture to the left. I would like to share some information from the workshop I presented to our Salt Lake Birth Circle group.
Incidence and consequences of Occiput Posterior (OP):
Why are babies malpositioned?
Penny Simkin, PT and author of The Labor Progress Handbook attributes fetal malposition to cultural habits and trauma.
What can we do about it?
Stand and Sit Alignment
Release Tension in your Hip Flexors and Pelvic Floor
If you are in the Salt Lake area you can learn about the topics introduced in this blog and more, in my prenatal workshop, Birth Mechanics: Get Your Body Tuned up for Delivery. The next workshop is coming up February 15, 9:30-noon. Find out more here!
Hands down, one of my favorite muscles in the body is the psoas major. Mostly because I have had personal experience in "rehabing" my own psoas strain (took me 2 years for it to get back to "normal"), and chronic back and SI pain. As you can see from the picture, this muscle covers some real estate: Attaching superiorly at the spine (to the transverse processes and lateral surface of thoracic vertebra 12 to the last lumbar vertebra and corresponding discs) and traversing down and forward through the pelvis to attach to the inside of the upper leg (lesser trochanter). Understanding and visualizing the position of this muscle should help you appreciate the relationship of the psoas to the function of the trunk/spine, pelvis, and extremities. It is involved in everything! As soon as I began to respect the stress and excessive loads that I was placing on my psoas (there are two, one on each side), my groin strain went away and so did my back and SI pain. As I work with clients with back, pelvic, hip and SI pain, a psoas release is one of the first steps toward decreasing tension and moving toward healthy tissues!
Below is a video demonstration of how to get into my most favorite psoas release position. I have shared this release in other posts, and received feedback that it would be helpful to do a "how to" video. So, here it is! Enjoy!
I have written about the psoas before in other posts, please take a look:
A Song To My Psoas: Please Release Me Let Me Go....
Ten Exercises For A Healthy Psoas
Pain In The Hip And What To Do About It
Top 10 Exercises For Hip And Spine Health
Results from a systematic literature review suggest that women experience foot pain more than men, and that the most common site of pain are the toes and the forefoot, AND that two-thirds of the population studied described moderate disability for daily living. You can't walk very far if you feel like you have a pebble in your shoe, or every time you take a step you feel burning pain or tingling at the base of your toes.
A bunion occurs from pressure at the side of the big toe (hallux). This pressure shifts the big toe toward the others and the joint can become swollen, sore and enlarged.
A neuroma occurs at the bottom of the foot typically under the 3rd and 4th toes. The pressure at the forefoot irritates the plantar nerve and the tissue around the nerve can become dense and hard. Because the nerve is irritated, people may experience burning, tingling, or numbness between the toes and foot.
What contributes to bunions and neuromas?
Simple Steps to Eliminate Foot Pain
1. Take a piece of blank paper. Stand barefoot on the paper and outline your foot with a pen. Take this paper to your closet and compare the width of your shoes to the outline. Don't wear the shoes where you can't fit your toes in the toe box, and the outline extends beyond the shoe. Notice that the shoe sits inside of the outline in some places; don't wear these shoes! Find shoes that do not have a heel. If you are used to wearing a higher heel you will need to gradually transition to lower heels so your tissues have time to adapt (give yourself 4-6 wks before you transition for each .5 to 1 inch).
2. Learn how to stand in alignment. See pic above. Or read this blog.
3. Wear toe spacers. Yes, you should be able to see space between your toes! There are many products on the market. These are my favorite: Correct Toes. Cool thing about these is that you can wear them in your shoes! Very comfortable (but you have to have a wide enough toe box in your shoe). If you have a bunion you may want to test to see if this will be comfortable for you before purchase: take your big toe and pull it away from your other toes as far as you can, and then lift it up. If there is discomfort in the joint then your toe is probably compressed, and it would be good for you to see me, or your local PT (or chiro, osteo, etc) to work with you.
Exercise your feet
Almost a year ago I wrote about the pectoralis minor's referral pattern into the shoulder blade and shared a lovely release using a tennis ball (you can read about that here). I am back at it again with another post highlighting the pectoralis minor and pectoralis major. Due to the location of their attachment sites on the skeleton, they can affect the function of the head, neck, shoulder and arm.
Pectoralis Minor attaches to the coracoid process of the scapula and to the outer surfaces of the third, fourth and fifth ribs. Restriction here can pull the shoulder blade forward (you will see the bottom/inferior portion of your shoulder blade lift away from your body wall), potentially bringing the entire arm with it).
Pectoralis Major is a big fan shaped muscle that is attached to the chest at the sternum (breast bone) and clavicle (collar bone) . The fan shaped fibers coverge at the arm and attach into the bicipital groove of the humerus. Restriction in this muscle will pull the arm in front of the body and rotate your arm into internal rotation (with your arms at rest at your sides, look in the mirror: where are your elbow creases facing? If they are turned toward your body, that is called internal rotation. In neutral, the arms should rest at the sides of the body with the elbow creases facing forward).
Just get it off your chest and feel more free!
Before you begin with the exercises, do a motion assessment first. Stand with your elbow creases and palms facing forward. Lift your arms up and see how far you can lift without arching your back or letting your lower ribs lift away from your body wall. Complete the movements as show below and then repeat the assessment. For the first exercise you can use a tennis ball, but I prefer the high grip rubber of the Yoga Tune Up massage balls.
Reassess your arm motion: Hopefully you have more freedom in your movement!
We have two psoas muscles on each side of our body: psoas major and psoas minor. This blog is specific to our psoas major.
This summer I took a very cool tele-class from Liz Koch, of Core Awareness. In this 5 week series we explored the location and function of the psoas and its relationship to the nervous system and our "fight/flight/freeze" response, to our emotional well-being and to our skeletal support.
The psoas is centrally located: emerging from the midline at thoracic level 12, attaching to every lumbar vertebra and inserting into the inner thigh at the lesser trochanter.
The psoas allows the lower limb to move and swing a as a pendulum: multidirectional/orbital.
As a physical therapist I see many people with SI dysfunction, hip and back pain. In almost all cases, the psoas is the top priority to rehabilitate. On muscle testing the psoas is usually weak, and the flexibility test is usually tight. What I have come to understand through this tele-class, through my training as a Restorative Exercise Specialist™ and as an NKT™ practitioner, is that rather than manipulate the psoas through deep tissue work and stretching, the psoas needs to rehydrate and recover from over-exhaustion.
I have compiled my favorite top 10 ways to release, rehydrate and restore the psoas. It is helpful to perform a release before going onto the movement sequences. Some of these are from Liz Koch's book, "The Psoas Book" and some are from the Whole Body Alignment Program.
The inner thigh (adductor group) is made up of five muscles:
When the foot is not planted on the ground, the adductors will bring the leg toward the midline, and flex the hip when the thigh is in an extended position as in the swing phase of the gait (walking) cycle.
The adductors play a significant role during walking and are active in all phases of the gait cycle. The adductors are a part of two important functional kinetic chains:
Dysfunction within the slings can result in overuse of the adductor group leading to over facilitation, increased tension and bound up connective tissue, and potentially pain. Here is a videoblog demonstrating how to release the adductors using a foam roller.
Tension in the piriformis muscle can be a trigger for irritation of local surrounding tissues. The sciatic nerve exits the pelvis just below the piriformis. When there is dysfunction in the lumbo/pelvic/hip complex, the piriformis often gets overworked, creating compression and friction in the small area which can wreak havoc on the sciatic nerve. Sciatica is defined as aching/burning/stinging pain along the distribution of the sciatic nerve: buttock, back of the thigh, lower leg and foot.
Stretching the piriformis can be a very effective way of diminishing the compression, and therefore irritation of the nerve. Pictured to the left is a very common stretch given as treatment to relieve sciatica.
Piriformis Stretch Refined
Using the wall and props can be an effective way of maintaining a neutral spine and pelvis. A traditional piriformis stretch, like the one shown above, is often done with a tucked pelvis and can irritate the nerve if pulled too aggressively. By staying in alignment, and by being able to adjust the load by gradually bending the knee to 90 degrees, the tissues will begin to yield and let go, rather than work to hold the body in position. Picture on the left: The half cylinder and block supports my shoulders and head to allow me to rest into neutral with my ribs down and in line with the level pelvis. Due to my tension, I also have to support my lumbar area with a rolled yoga mat so I can comfortably attain neutral pelvis (pubis and ASIS level). Middle picture: I place my left leg straight on the wall and cross my right leg over the left, making sure not to tilt the pelvis. Picture on the right: I begin to slide my heel down the wall and stop when I feel that I am at my resistance barrier, or my pelvis begins to shift. Hold at least one minute and repeat on the other side. If you can tolerate the stretch stay longer, up to 5 minutes each side.
Some people will try to get a deeper stretch by pressing the right knee down. Make sure that you don't drag your whole pelvis when you do that (as shown in the pic on the left). The purpose of this refinement is to maintain neutral, and that means a level pelvis (as shown on the right).
Even if you don't have sciatica, this is a wonderful stretch to open the hips, and allow more freedom to your pelvis! Enjoy!
The dot and arrow show pelvic posterior rotation.
Legs on the wall pose is a restorative position that should be a staple for every person that has a pelvis! Traditionally, the pose is taught by placing the butt close to the wall, and then bringing the legs up against the wall so the back of the legs touch, and the soles of the feet are facing the ceiling. A variation to the pose is to widen the legs into a "V" position to stretch the inner thighs and groin.
Recently I have rediscovered the beauty of this pose by modifying the position to be able to maintain neutral pelvis (pubis and ASIS in line) and rib alignment. The benefit of maintaining the alignment markers during this pose allows the connective tissue and muscles to fully release. When the alignment markers are not in place, there is more load to the tissues which can potentially maintain tension, and prevent a full yield ("letting go") of the muscles and fascia.
In order to do this pose in alignment, you may need to get out props. Due to the tightness of my psoas muscles and the increased kyphosis of my thoracic spine, I have used a thin yoga mat rolled up to maintain neutral pelvis: pubis and ASIS level, and a half cylinder & block to prop up my upper back to get my lower ribs down and flush with my abdomen. In order to get my pelvis level, I needed to scoot away from the wall, get the props set up, and then place my legs on the wall (see pics below).
Benefits to Legs on the Wall Pose:
Legs on the Wall Pose in Alignment
Hand Behind the Back Stretch