Marathoning with Molly: Training Update

Molly Caughlan, PT DPT

Hello blog readers! I am writing this blog a good three or so months into my marathon training and wanted to give an update on how it has been going. Things started off rough: when just two weeks in, I rolled my ankle. Unfortunately, this story is not one of cool athletic prowess where I rolled it sprinting to save a child from a burning building. Rather, I was doing an silly move of “texting while walking the dog” maneuver that lead to a mis-step off the curb. I did a full tuck-and-roll, landed on the ground covered in dirt, and very much freaked out my doggo. I wish someone had caught this trip on camera, because I’m sure it was amazing. I took a minute to sit on a bench and assess the damage. Luckily, the grand theatrics of my trip did not equate to the severity of my injury and I was still able to put weight on it enough to walk home.

Two days later, I had a PT session with Tina Cardenia, where she worked to reduce the swelling and improve the mobility in my ankle. This helped tremendously to accelerate my healing and allowed me to return quickly to my running program. I was back on the pavement in under two weeks! Even though the sprain itself has fully healed, it continues to occasionally feel stiff during and after runs along with a little bit of swelling. Tina continues to focus on my right ankle mobility and stability to prevent future sprains. Pictured in this video below, Tina is performing what’s called a “thrust manipulation” that gives a quick stretch to my ankle joint to help it move more freely.

Disclaimer: This technique should be performed by a licensed professional and is not intended to be reproduced at home.

In addition to my right ankle, I will occasionally have left sided hip crease/groin pain and discomfort. This has come and gone even before marathon training. Based on Tina’s assessment, my left pelvic bone does not move well into extension and this causes some pinching in that area. Treatments have focused on releasing tight muscles and connective tissue in the front of my hip as well as building stability by strengthening my glutes and core.

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Another challenge with training is trying to beat out this summer heat! Compared to Atlanta’s summers (where I trained for my first marathon), this season started out pretty mild. I had been doing well and progressing mileage, but once the end of June hit I knew things needed to change. I remember the tipping point when I set out on a 12 mile run and my poor little leggies could only carry me 10. I recognized afterward my mistakes in that I woke up too late, chose a trail with little shade, and that I wasn’t properly supplementing myself in restoring electrolytes. Since this weekend, I’ve added SaltStick Chews to my regimen and they have really made a big difference. I’ve also been more diligent about really planning ahead when I can get in my long runs.

I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Scelrosis, understand disease mechanisms, optimize therapies, and repair the damage caused by MS, as well as offering patient access to the best and most advanced treatment possible. So far I’ve raised $555 and I’m only 11% towards my $5000 goal with just 3 and a half months left to go. Support Team Tisch MS by donating to my fundraiser here.

 

Beyond Basics will be offering matching donations throughout the marathon, so keep your eyes peeled on social media to see how you can make your donation go TWICE as far!

What is Neater than your Peter? A Guide to Penile Health and Function Part 1: Premature Ejaculation

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Fiona McMahon PT, DPT

Ladies and Gentlemen, it is finally time to go for this blog and go on a deep dive to discuss at length (pun not intended), the physiology, health, and function of an amazing organ, the penis! A couple years ago we talked about testicles in our blog, All About Testicles, which remains one of our most popular blogs. Now it is time to travel north and talk about how people with penises can best care for them and how to address things that may go wrong from time to time. This blog will periodically cover different issues that can (ahem) arise with penises. Today we will go over premature ejaculation. But before we can do all that, lets review how the penis works.

As an organ, a healthy penis is an amazingly complex organ despite it’s seemingly simple exterior. It is the tail end of the urinary system, provides amazing sensation, carries sperm to the outside world, delivers a substance that can neutralize the acidity of the vagina in order to make it more hospitable to sperm, and is able to use the muscles around it to raise the blood pressure in the penis higher than that of the outside body, in order to maintain erection.

The penis is not one tissue all the way through. It has what’s called the tunica albuginea which is the wrapping for the erectile parts of the penis. This guy is really important because it closes off the vein returning blood flow from the penis to keep the penis erect during arousal. Inside the tunica albuginea is the corpus carvernosum and corpus spongiosum. No, these two tissues are not Harry Potter spells, but critical parts of penile infrastructure. The corpus cavernosum fills with blood during erection and helps make the penis hard. The corpus spongiosum keeps the urethra from getting clamped shut during erection so the sperm can get out.

How Does The Penis Get Hard?

Usually, in response to sexual stimulation, the smooth muscles (the involuntary ones, not the pelvic floor) will relax allowing the small blood vessels within the penis to fill with blood, the result is the tunica albuginea ( the wrapping of the erectile parts of the penis) will compress on the veins of the penis, thus preventing the blood returning back to the body. The trapped blood in the penis will cause the penis to get hard and stand up. The lovely muscles of the pelvic floor, specifically the ischiocavernosus will contract to further increase the blood pressure within the penis and keep the penis erect.

What Happens with Ejaculation?

Ejaculation occurs with orgasm. It is possible to have an orgasm without ejaculation if you have had a procedure like a prostatectomy. For a normally functioning penis, ejaculation occurs with orgasm and is what carries the sperm and other fluids to the outside world. The contractions felt in orgasm are what propel the sperm through the penis and to the outside world. The bulbospongiosus is responsible for these contractions and is part of the pelvic floor.

Premature Ejaculation

Here is where I would normally supply you a pithy little statistic like “ 1 in 4 men will experience premature ejaculation in their lifetime”. Unfortunately, I cannot provide any such statistic for this subject because so few people talk about this problem. The clinical definition of premature ejaculation is a little wonky too, and has not consistently been used in research, therefore prevalence data are likely inaccurate. The International Society for Sexual Medicine (ISSM) , in an attempt to improve the medical definition of premature ejaculation defines it as:

  • Ejaculation that always or nearly always occurs within about 1 minute of vaginal penetration from the first sexual experience (Defined as lifelong premature ejaculation)
    • OR
  • A clinically significant reduction in latency time, often to about 3 minutes or less (defined as acquired premature ejaculation)
  • Inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • Negative personal consequences, such as distress, bother, frustration, and/or avoidance of sexual intimacy (Althof 2014)

If you are a gay or bi-man, or a man who does not have vaginal intercourse you are probably well aware how problematic this definition is. Currently, it is the ISSM’s stance that there is insufficient evidence to draw up criteria for men who have sex in ways other than vaginal intercourse.

As you can tell by the definition, premature ejaculation is divided up into 2 subgroups, lifelong and acquired. The distinction is relatively new in the research and can help patients find better ways to treat their premature ejaculation.

Potential causes of premature ejaculation include:

  • Hypersensitivity of the glans( head) of the penis
  • Issues with serotonin
  • Erectile dysfunction*
  • Either stopping or starting drugs
  • Chronic pelvic pain syndrome*
  • History of rushing early sexual encounters
  • Prostatitis*

*These are conditions treated at Beyond Basics Physical Therapy

What to do about premature ejaculation?

Don’t ignore it. Performance anxiety and premature ejaculation can often become a vicious cycle, where one will promote the other. Regardless of how your symptoms started, there is a lot that can be done to improve your sex life.

If you have prostatitis or chronic pelvic pain come to physical therapy. Did you know 90-95 percent of cases of “prostatitis”/chronic pelvic pain are musculoskeletal in nature… ahem… this is one of the most common conditions we treat at Beyond Basics. Overactive muscles, those in the abdomen, legs and pelvis can contribute to symptoms of prostatitis/chronic pelvic pain, (i.e. burning urination, painful ejaculation, sitting pain, genital pain, defecatory pain, urinary or bowel frequency, urgency, retention, incomplete emptying, etc.,.). Physical therapy can go a long way to treating and curing these symptoms by relaxing and lengthening your overactive muscles and strengthening weaker muscles. Prostatitis is a vast subject that requires its own blog. Luckily for you, I already wrote one. Check it out here.

If you are experiencing erectile dysfunction along with premature ejaculation, get thee to a doctor. I already explained to you how amazing the penis is as an organ. Its function is reliant on blood flow, thus problems with erection, especially in younger people may be an early sign that something may be up with your vascular system. Once systemic causes have been ruled out, get thee to physical therapy. We spoke earlier about how the penis requires blood flow and muscles to work properly; pelvic floor physical therapy can restore the function and improve the vascular health of the muscles vital to erection. Erectile dysfunction is yet another subject that could use its own blog. Again, luckily for you, I already wrote one. Check it out here.

If you don’t think erectile dysfunction, prostatitis, or chronic pelvic pain is causing your premature ejaculation, there is still a lot you and your urologist can do. There is new work revealing that certain medications and psychotherapy can really help reduce premature ejaculation. You are not alone in this and you deserve to start feeling better.

Thank you so much for reading our blog, if you think physical therapy can help you. Please give us a call at either our midtown location 212-354-2622 or our downtown location 212-267-0240. We are offering free phone consultations at both offices for a short period!

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Fiona McMahon PT, DPT is currently practicing from our midtown location

Check out our other Neater Than Your Peter Blog:

What’s Neater Than Your Peter (a series on male sexual dysfunction): A Bend in the Road: Peyronie’s Disease

 

 

Althof S, McMahon C, Waldinger M, et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2014; 2(2) 60-90

Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome). Harvard Health Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Dean R, Lue T. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urpl Clin North Am. 2005; 32(4): 379-v

Herman H. “Male and Female Health Wellness and Sexual Function”. New York. 19-20 May 2018

Quinn P. A Multinational Population Survey of Intravaginal Ejaculation Latency Time. J Sex Med. 2005; 2(4) 492-497

Check out Corey’s Interview with Mongoose Bodyworks!

Below is a repost of an interview that Corey Hazama did with Moongoose Bodyworks. Corey is a physical therapist and the co-owner of our Beyond Basics Physical Therapy downtown location.

Pelvic Floor Health in NYC

COREY HAZAMA IS A PHYSICAL THERAPIST AND CO-OWNER OF “BEYOND BASICS PHYSICAL THERAPY”, A CLINIC THAT SPECIALIZES IN ALL CONDITIONS AFFECTING THE PELVIC FLOOR IN MEN, WOMEN AND CHILDREN. WE LOVE THIS AT MONGOOSE BODYWORKS, AS SO MUCH OF OUR PILATES CORE WORK IS RELATED TO THE PELVIC FLOOR.

HALLE: Tell me a bit about your practice .

COREY: We specialize in treating all conditions affecting the pelvic floor in men, women and children. We are a manually based orthopedic clinic and treat patients one-on-one for an hour.

HALLE: How did you come to focus on women’s health and pelvic floor issues ?

COREY: I had been treating orthopedic injuries for some time and was seeing more and more complex cases of back, hip and tailbone pain, etc that didn’t resolve with traditional PT. In treating these patients I started to feel that the source of their pain was coming from something else, something I didn’t understand completely, the pelvic floor. I had the opportunity in 2015 to work and train with Amy Stein who has revolutionized the pelvic floor field in New York City. I decided that I really needed to train more and understand this region of the body better so that I could help these patients.

HALLE: Who can benefit from this type of therapy?

COREY: Any individual who is having pain or discomfort in their pelvic region, which is the area from the top of your pelvis to your sit bones. This includes the Sacroiliac [low back] region as well as the groin. We can help patients who are having genital pain, or pain with intercourse. We also treat issues with bladder which can be incontinence after a vaginal delivery, or increased urgency and frequency, incomplete emptying which can affect women and men. We also see a lot of patients who are having pain with bowel movements or constipation, bloating, and pain. We also have pretty much seen it all, so we can offer insight if PT has not worked in the past, or a patient wants to know if their complaints are muscle/joint related. We treat the hard cases, the people who tried traditional PT for their hip or groin pain and the exercises either made them worse or didn’t help.

HALLE: Do you think people are ever embarrassed to contact you?

CORY\: I hope not. We are all very approachable and we offer phone consults if a person wants to know if PT can help or if they are a candidate for Pelvic Physical Therapy.

HALLE: Why do you love this work?

COREY: I feel I have a special skill set and knowledge where I can help a lot of people where their symptoms are scary and distressing and they have not been able to get the answers or treatment they need. The symptoms of pelvic floor dysfunction can be scary and these patients get bounced around from doctor to doctor without getting answers. I also feel like I have a lot of tools at this point, I have spent a lot of time taking continuing education classes to learn new ways that I can help.

HALLE: What gets you out of bed in the morning?

COREY: My brain is always going, I have always wanted to understand how things work. I used to take apart VCRs and radios when I was a kid because I wanted to see how it worked. I feel the same way about the body. I want to understand how everything works together and is related to the whole so that we are pain free and functional.

HALLE: Do you have a favorite exercise?

COREY: I really like to roll my arches on a pinky ball. I have really tight feet and calves and I am on my feet all day so it feels really good to do that at night when I get home.

HALLE: What’s your experience with Pilates? Do you have a favorite Pilates exercise?

CORY: I have been doing private pilates now for a little over a year. It has really changed how I move and my posture. I feel stronger through my core and better grounded when I am working. I don’t know if I have a favorite exercise, but I do know which one kicks my butt the most! I have never been able to do a complete curl up/roll up. Using the arc and roll down bar I can finally do it (with a little help from the bar). I also found out that my whole life I was doing the ab curl wrong and it has been very enlightening to learn how to do it correctly and also to work through my own limitations that prevented me from being able to do it correctly.

HALLE: How does Pilates relate to your work?

COREY: In doing Pilates myself, I have learned so much about the benefits of working with a skilled Pilates instructor to identify my own limitations and also learn how to correctly activate the correct muscles. In the work I do I find that eventually all my patients get to a point where I have been able to restore normal muscle tension through their pelvic floor muscles, abdomen, hips, and spine, and now they need to start to learn how to use these muscles in an optimal alignment and what better to do that than pilates! The men and women who teach Pilates are masters of observation and I trust them entirely to make sure my patients are not compensating with the exercises. It is the compensations that occur, when we don’t even realize it, that get us into trouble in the long run.

HALLE: What do you do when you are not being a PT?

COREY: I am a knitter and a foodie!

HALLE: Anything you’d like to share about home life?

COREY: I have a wonderful husband, who is also a PT, he is an amazing teacher in regards to PT, but it is more his teaching me to not be a PT all the time that has really done so much for my work life balance.

THANKS COREY!!!

Not From NYC?! Come see us as an “Out of Town Patient”

high rise building
Photo by Nicolas Poupart on Pexels.com

Fiona McMahon PT, DPT

So you’re reading the blog, you’ve seen us on Instagram and you keep thinking “ ughhh if only I could get to Beyond Basics Physical Therapy”. Well, if you have the ability to get to NYC, Beyond Basics Physical Therapy (BBPT) offers an intensive and comprehensive physical therapy program to help our patients living out of state or even out of the country to get started on their own individual path to healing.

Why make the Trip to BBPT?

Beyond Basics Physical Therapy has been pioneering pelvic floor physical therapy for the last 16 years. Founder Amy Stein has worked throughout her career to educate clinicians and patients alike about pelvic pain. She is the author of Heal Pelvic Pain and the co-author of Beating Endo with co- author, Dr. Iris Orbuch and creator of the video: Healing Pelvic and Abdominal Pain. The staff physical therapists have extensive training in the treatment of pelvic floor disorders in men and women. Many of the therapists at BBPT have contributed to medical textbooks on treatment of the pelvic floor and do educational seminars and talks on the subject. All of this is to say, we feel very passionately about pelvic floor treatment and education. What makes Beyond Basics stand out is that pelvic floor treatment is a high percentage of each physical therapists’ (PTs’) caseload. All of our therapists see men and women for pelvic floor treatment on a daily basis, which is an advantage over a clinic that may only see a few pelvic floor cases a week.

That being said, we also treat orthopedic conditions like hip, back, and neck pain and often times, treatment of these areas are regularly addressed in pelvic floor dysfunction because it is all connected. Many of our clinicians also have additional certifications and training in the treatment of non pelvic conditions and they are experts in this field as well.

What to Expect

Every body is different and everybody is different. But that said, there are a few things that are consistent across patients. For our out of towners, we usually schedule 2 hour appointment blocks multiple times a week while our you are in the city. What these long blocks do is allow us time to really get to know you and your history so we can really delve into making you feel better.

During your exam, your physical therapist will address things like your strength, core stability and mobility, posture, and range of motion of the muscles, tissues and joints, much as you might experience in a typical physical therapy session. If you have pelvic floor complaints, with your permission, your therapist will examine your pelvic floor. She may do this by looking at the pelvic floor externally and asking you to contract and relax your pelvic floor. With your permission, she may place a gloved and lubricated finger in the vagina or rectum to assess for pain, mobility, and strength.

Once your PT has completed her exam she will sit down with you and detail your findings to help you better understand why you may not be feeling so well. She then will go to work in session by performing a variety of techniques typically consisting of manual therapy, nervous system downtraining, exercise, behavioral and postural modifications and more. Every single treatment at BBPT is individualized to your needs, so there is no one uniform treatment across patients. Read more about a typical pelvic appointment here.

Another super important element of our treatment is the home program. Your physical therapist will curate an individualized home plan to help you maintain what you have gained with us and continue to improve once you return to your home. It is super important that you try out you home program while you are in NYC so we know if we need to modify anything before you leave.

During your course of treatment, we may find that additional help may be needed to jump start your healing. We may suggest you see our colleagues in medicine, mental health, or nutrition to help you improve faster and more completely. Beyond Basics has close relationships with top pelvic floor specialists in other disciplines and can facilitate connections between you and these experts.

As PT winds down we will try our best to find some way for you to continue your care back home, whether that be helping you to find a qualified PT or other movement practitioner to help you continue healing.

How to Set Up Your Visit

Obviously, getting into NYC needs some pre-planning, on both our ends! Given the intensive nature of our program, we need to find time on our PT’s schedules to get you in, so the earlier you know you’ll be in NYC and schedule, the better. This will also give you more access to appointment times that will allow you to take some time to explore the Big Apple! When you call we will send you forms that will allow you to detail what you are experiencing so your PT can hit the ground running. You also will get a chance to speak to our billing manager who can help you figure out the ins and outs of insurance coverage.

If you have been suffering, come visit us. We would love to meet you and help jump start your healing journey.

For more information on becoming an out of town patient, click here.

If you are ready to learn more about our out of town program, give the front desk a call at 212-354-2622

Pilates with Kierstin! Bird Dog Balance

Kierstin Elliott, Pilates Instructor at Beyond Basics

Exercise: Bird Dog Balance

Set Up: Start by getting into all fours, with hands under shoulders and knees under hips. Establish a neutral spine with a slightly tucked chin and a slightly extended tailbone. Abs engaged, ribs knit gently together.

Execution: Inhale to prep, exhale to extend right arm forward and left leg back. Inhale to place both hand and knee back on the mat, exhale and extend left arm forward and right leg back. Keep alternating sides without losing neutral spine while maintaining a level pelvis.

Focus: Maintain a neutral spine! Avoid hiking the shoulder up towards the ear when extending arm forward. Engage lats and broaden collar bones to prevent this. Avoid shifting or dipping the pelvis when extending the leg back.

Importance: Fabulous exercise for balance, stability, coordination, and core strength.

Modifications: For people with wrist sensitivities, keep reps to a minimum. For an added challenge, raise knees 2 inches off the mat while performing the exercise.

Saggy Jeans and Tailfeathers: How Your Pelvic Positioning Affects Your Body

animal bird blue bright
Photo by Pixabay on Pexels.com

Joanna Hess PT, DPT, PRC, WCS

Wait! Marie Kondo has you throwing out your favorite jeans because the joyless saggy bottoms that your tushy cannot manage to fill out? We are seeing an epidemic flat butt among mamas, plumbers, barre fanatics, and office workers—all with strangely similar symptoms—pelvic floor dysfunction, low back and sacroiliac pain, and a tucked under pelvis. In this blog we will explore why the position of the pelvis, the maker of flat butts and the maker of less flat booties, is important and how to more easily move out of this position for benefit beyond your behind.

Besides needing a new wardrobe, why should I care about my flat bum?

The flat bum or preference towards posterior pelvic tilting shrinks the distance between the front and back of pelvic outlet which changes pelvic floor muscle tension. The body needs access to the full range of the pelvis and pelvic floor muscles. Over time, this position could cause excessive pelvic floor activity to compensate for the loss of resting tension. Think of the pelvic floor muscles simplified as a rubber band between two points, the pubic bone and tailbone. When the distance between the two points decreases, the rubber band loses its stability from resting tension. Changes in pelvic position alters stability from the pelvic floor muscles. This posterior pelvic tilt position also decreases the accessibility for hip extension and therefore the upper glute muscles get sleepy. As the top of the pelvis moves back, the sacroiliac joint in the low back opens and decreases its bony stability. Translated into everyday life, the flat butt position increases the potential for incontinence, pelvic floor muscle tension, sacroiliac pain, and decreased efficiency in movement.

The Flat Bottom. Only in the eye of the beholder?

Pelvic floor and tilt

The disagreement of the “neutral pelvis” or zero-point causes confusion when describing pelvic tilt—anterior pelvic tilt, posterior pelvic tilt, and neutral pelvis. Some argue that the neutral pelvis is when the ASIS’s (front hip bones) are level to the PSIS (back butt dimples). Others say that the pelvis is neutral when ASIS’s are in the same plane as the pubic bone. Or for those with X-ray vision, pelvic tilt is the vector of the sacral angle at S2 in relation to the vertical axis. But often, neutral pelvic position is subjective to the observer and relative to other parts of the body—namely the spine/rib cage and thigh bone. Clinically, this “neutral pelvis” is hard to find because 1) pelvis’ are shaped very differently, 2) left and right pelvis on the same person can also be quite different, 3) feeling these bony landmarks have been shown to be remarkably unreliable, 4) the neutral pelvis should be on top of vertical thigh bones. See how the eyes can be tricked confusing spinal curve focusing on pelvic tilt without also including rib position.

Rib pelvic alignmentThe inability to move in and out of posterior pelvic tilt and anterior pelvic tilt decreases efficiency and possibly results in pain and instability. Anterior pelvic tilt is when the front part of the pelvis moves forward/down. Posterior pelvic tilt is when the front part of the pelvis moves back/up. A neutral pelvis on top of vertical femurs and happy rib cage should correlate with better muscle performance.

Do I have a flat butt?

Aside from the saggy jeans, the flat butts of the world have a few other correlations.

1. The Tailfeather Test: Stand comfortably and squeeze the gluts.

a. Neutral pelvis: Thigh bones rotate.

b. Posterior tilt-ing pelvis: The butt will further tuck under and mainly access the lower glutes.

c. Anterior tilt-ing pelvis: The pelvic floor muscles will do most of the work.

2. You bear weight more in the heels

3. Back of your rib cage is behind your pelvis

4. Your Thigh bones are angled so that your pelvis is front of your knees

5. Your lower belly pooch

6. You Sit with pressure more on the sacrum/tailbone vs. sit bone

7. You have Overactive and possibly overworking pelvic floor muscles—the front to back pelvic distance decreases with your posterior tilted pelvis and loses the resting tension from length. As described earlier, this is similar to tensile strength of a slightly stretched rubber band vs. rubber band without pull/tension. Therefore, your pelvic floor muscles have to work harder to keep some type of tension for purposes like continence, stability, etc. The inability for the pelvic floor muscles to work optimally can lead to incontinence, pain, and constipation.

9. You have Breathing and abdominal pressure problems

10. You have Sacroiliac joint pain. As the pelvis tips back, the sacrum moves away from the ilium decreasing the bony stability. The hip muscles have to work harder, but as felt in the Tailfeather Test, the glut muscles aren’t in a good place to work.

Is there a better fix than butt implants?

Bodies have and love variability for posterior, anterior and “neutral” pelvic positioning. The brain likes positions where muscles and nerves work with ease and stability—life shouldn’t be so difficult—but it needs the chance to choose and learn it. Folks working with bodies have traditionally “corrected” spinal curves by changing pelvic position. From what has already been discussed, spinal and pelvic position can be altered many different ways—from the changing weight-bearing area in the feet, to position of ribs and range of breath, and even head angles with visual and vestibular input. Consider these hacks into pelvic stability until the brain learns how to access this stability in many situations and positions.

1. Standing. Bring your chin down to your neck and keep looking down until you see the front of your ankles. You’ve just untucked your pelvis and brought your ribs over your pelvis. This one is courtesy of my colleague, Stephanie Stamas. Or check in to feel where the weight is going through your feet. The front to middle of the foot is a good place to start and then do the Tailfeather Test. You might have to toggle other parts of the body because of how the body will compensate in the chain.

2. Sitting. Get your hips as far back as possible. Or put a pillow in the back of the chair so that your hips can find the pillow and you are sitting on top of your sit bones. Then, relax the trunk into the seat back/pillow. Again, you’ve untucked your pelvis and brought your ribs over the pelvis.

3. Better squats/lunges/burpees/stairs/ab work. You can do 5 sets of 20 squats, but still no junk? Take care to see if your pelvis is tucking under in the movement. If so, use an inhale to keep the pelvic floor lengthening as your hips bend in movement. Later, the movement should be dissociated with breath pattern (as long as you are breathing.)

4. See a physical therapist. Often times, the habits of pelvic tucking are a little more complicated because it is a protective and compensatory mechanism for stability. A physical therapist can help with seeing the bigger picture and how different parts of the body relate to each other. They can also help facilitate better movement through manual therapy and specialized movement.

Good luck with the joy sparking!

Fight or Flight? Rest and Digest? Optimizing your Life with the Power of your Autonomic Nervous System

Yoga or Pilates

Fiona McMahon PT, DPT, She, her, hers

You aren’t a zebra getting chased down by a lion on the Serengeti. You know that. But your body might not. Our modern day stress usually doesn’t involve us having to defend ourselves against wild animals. It often involves chronic seemingly unrelenting stress of work, relationships, and life. Stress, our perceived threats, chemically elicit the same type of response whether that is fending off a tiger or stressing over trying to care for your child while simultaneously crushing the game at work. These stress responses are governed by the sympathetic autonomic nervous system of the autonomic nervous system (ANS). The ANS is a powerful system that governs virtually every function in our body to help optimize our responses to things we encounter day- to-day. It is essential to our survival. We can get into trouble if our stress response is perpetually turned on. You can’t fight or flight forever, we must transition out of that sympathetic nervous system back into our rest and digest system, the parasympathetic nervous system. In this blog we will go over the different parts of the ANS and how we can optimize it to live our healthiest and happiest lives.

Parasympathetic versus Sympathetic

In a perfect world our sympathetic and parasympathetic operate in concert to provide us with optimal functioning. When we go out for a run we need our sympathetic to quicken our heartbeat, stimulate glucose release from our liver, and allow us to sweat. After we finish our run and settle in for our post run snack, we need our parasympathetic to stimulate some saliva production, and get digestion started for us. See how the sympathetic and the parasympathetic can work perfectly together? Check out all the functions of the ANS below

Sympathetic Nervous System

  • Dilates pupil
  • Inhibits salivation
  • Constricts Blood Vessels
  • Accelerates Heart Rate
  • Stimulates Sweat Production
  • Stimulates Glucose Release
  • Stimulates secretion of norepinephrine and epinephrine
  • Inhibits urination
  • Stimulates orgasm

Parasympathetic Nervous System

  • Constricts pupil
  • Stimulates tear production and salivation
  • Slows Heartbeat
  • Stimulates digestion
  • Stimulates secretion
  • Promotes voiding
  • Stimulates erection

Health effects of stress

As you can see, the sympathetic nervous system provides us with some really important functions. But you can tell by looking at what it does for the body, that living in chronic sympathetic drive would be pretty uncomfortable. No one wants to walk around with their heart pounding and sweat pouring off their forehead. Beyond discomfort, chronic stress can deeply affect our health. Chronic stress can affect your immune system negatively making it harder for you to battle infections. Importantly for our pain patients, chronic stress can increase inflammatory chemicals called cytokines. This is important because that inflammation can actually make your pain worse. Chronic stress can also affect your digestion through a mechanism called the brain-gut-axis, which can affect how you absorb nutrients and the overall level of inflammation in your gut. You can listen to the details of how the autonomic nervous system can effect your gut on our Pelvic Messenger podcast.

Treatment

So you’ve read this far. You may now be feeling stress about being stressed, which definitely was not the intention of this blog post. Stress is part of life. Parents get sick, our kids get into trouble, money gets tight, life can be stressful. We simply cannot control events and the actions of other people that contribute to our stress. I call these things exogenous stressors, or stress that is occuring outside of ourselves. What we can attempt to control is how we react to those exogenous stressors.

That’s where mindfulness can be so helpful. Mindfulness can allow you to look at a problem without spiraling into extra stress. Let me give you an example. Say your boss gives you some negative feedback about a project at work. You can take the feedback at face value and use it as a tool to improve future projects or you can go down the rabbit hole. You can tell yourself that your boss not only didn’t like your performance on your project, but also doesn’t like you. You can create a narrative that you are inherently bad at your job, are on the verge of being fired, will not be able to afford to live in your house and so on and so on. The place you can take yourself in your mind can be so far from what actually happened. Travelling to those places can allow you to stress about things that haven’t happened or may never happen.

A way I personally learned mindfulness was through a smartphone app. I personally used Calm but 10% Happier, Buddify, and Headspace are also great. Getting into the practice of mindfulness takes… well… practice. I suggest giving it a full three weeks before throwing in the towel. There is no one cure for everyone and it is not a reflection on you, yourself personally if mindfulness is not your cup of tea.

Exercise is another great way to blow off some stress. Honestly, any exercise you do is good but throwing in some meditative movement practices to your repertoire can help up the returns you get from exercise. Meditative movement practices like Pilates, Yoga, Qi Gong, and Tai Chi have been shown to offer a host of benefits for the body and soul.

Here’s the thing. Sometimes we can shake the weight of stress ourselves. That’s when having a professional help can be so life changing. Mental health professionals can not only lift the burden of how we react to stress, but by teaching us to manage our stress responses, they can help set the stage for real and profound healing to take place and augment your treatment at someplace like Beyond Basics Physical Therapy.

As I wrap this blog up, I ask you to make time for you. Your health and sense of well-being are one of your life’s most valuable commodities and you are worth it.

Sources

Low P. Overview of the autonomic nervous system. Merk Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/autonomic-nervous-system/overview-of-the-autonomic-nervous-system Accessed May 23, 2019

Mariotti A, . The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future SCI OA. 2015 Nov; 1(3): FSO23

Won E, Kim Y. Stress, the autonomic nervous system, and the immune-kynurenine pathway in the etiology of depression. Current Neuropharmacology, 2016, 14 665-73