Pilates: Spinal Extension

By Denise Vidal

Continuing with our prone series, we’ll now focus on extending the spine while in the prone position.

With so much of our lives spent focused on computer screens, our postures have taken on a sort of rounded forward position. Our spinal extensor muscles are continually overstretched, and over time lose their ability to shorten. As I have mentioned before, healthy posture comes from healthy muscular support, which requires the muscles to both shorten and lengthen to their fullest ability. The following exercise focuses on shortening the muscles of the spine, specifically the muscles of the cervical and thoracic parts of the spine.

Lie in the prone position that we discussed in the previous two blogs, your head will be resting on the backs of your hands. This time, however, you can eliminate the use of the pillow.

To start, take a deep breath into your back ribs. As you exhale engage your abdominals. Feel the front, back, and sides of your waist hug towards the imaginary sphere in your abdomen. Try to keep that tone as you feel the muscles on either side of your spine narrow inwards. I like to use the image of a little baby fist wrapping it’s hand around my spine. The tone of the muscles should be supportive, not tense. Slowly float your forehead off your hands. Keep your focus downward, and only lift your head about an inch off your hands. Just like we did with the legs, the head should feel a sense of lengthening as it lifts. Also, the height which you lift depends on your ability to maintain support in your lower back and pelvis. As soon as you feel tension in your spine and your abdominals disengage, know that you have lifted too high.

When you have reached your maximum height, lower your head as you feel your upper back muscles lengthen.

Lift and lower your head five times, each time getting longer as you go higher.

Give it a try and let me know how it goes. It you have any questions leave a comment below. If you are experiencing any pelvic or back pain, you should consult with your physical therapist before attempting this exercise. In the meantime, work on the breathing exercises discussed in the previous blogs until your pain lessens.


By Riva Preil

Before vulvodynia was referred to by the title of this blog in an episode of Sex in the City, vulvodynia, a vulvar condition associated with chronic stinging, burning, irritation, and diffuse pain, received its name from doctors in 1983.  Many believe that the pain and symptoms are due to irritation or injury to the pudendal nerve, the primary nerve supplier to the vulva, or any of its three branches.  Injury to this nerve creates pain at rest, even without an additional trigger (ex. prolonged sitting, tight pants, cycling).  The pudendal nerve can be damaged in many ways, several of which include a herniated disc, trauma related to pelvic surgery (ex. prolapse repairs that involve attaching the vagina to the sacrospinous ligament), orthopedic injury (ex. fracturing the coccyx, i.e. tailbone), stretching of the nerve during childbirth, or nerve damage due to the herpes zoster or simplex virus.  Often, women who present with vulvodynia-like symptoms also reports increased vaginal discharge or vulvar secretions.  This may be related to altered nerve mechanisms which cause the vulvar glands to produce abnormally high amounts of secretions.

Treatment of vulvodynia includes replacing vulvar irritants with vulvar friendly substitutes (ex. soft, white unscented toilet paper instead of products containing fragrance, sodium lauryl sulfate, or propylene glycol).   Some doctors also recommend using a topical anesthetic, such as Xylocaine, to help relieve pain.  In addition, doctors often recommend tricyclic antidepressants or anticonvulsant drugs to help control the pain symptoms.  Any activity that aggravates the pain such as horseback riding, tight clothing, or working out should be avoided until the symptoms are controlled.  Nerve blocks have helped relieve pain in some patients, and pelvic floor physical therapy is beneficial to help treat muscle tightness that may have resulted due to the pain and which may be continuing to contribute to it.  Physical therapists can also help correct and musculoskeletal misalignment which may be further compressing and irritating the pudendal nerve, and they can perform nerve glides to mobilize the nervous system and decrease restrictions on the pudendal nerve.

Holiday Traveling? Pain-Free’s the Way to Be!

Are you constantly on the road, or traveling a lot this holiday season? Whether you know it or not, your body  is talking to you and it may not be super psyched to see yet another seatback in the upright position. Take a look at these tips from About.com to make sure your travel this holiday season (and your travel from now on!) is pain-free.

Prone Hip Extension

By Denise Vidal

A few blogs ago we talked about the pelvic clock and the importance of pelvic stabilization. In this blog we are going to continue our work in the prone (lying on your abdomen) position while reviewing the pelvic stability exercise. By challenging our pelvic stability in the prone position, we can better access our posterior muscles, that is our spinal muscles, our gluteal muscles, and our hamstrings.

For this exercise, you can use the same pillow as you used for the prone breathing exercise, except this time lay with the pillow under your pelvis horizontally.

To start, observe your pelvic positioning. In previous blogs, we have discussed finding a “neutral pelvis”, that is the place where your “hip bones” are on the same plane as your pubic bone. As I have said before, depending on your individual structure this may not happen. If you feel like your forcing a position that is tense or uncomfortable, just focus on keeping the spine long and the pelvis stable.

Take a deep breath. When you exhale engage your abdominals by feeling your navel, your spine and the sides of your waist hugging the imaginary sphere in your pelvis. Keep this tone around your abdomen as you float your right leg off the floor. Think more about maintaining a neutral pelvis than about the height of the leg. The goal is not to lift the leg high, but to use the muscles in the back of the leg to lift the leg without destabilizing the pelvis. Try lifting each leg ten times while keeping your pelvis in neutral. You should feel the work in your core as well as the back of your leg.

Leave me a comment to let me know how it goes.

If you are experiencing any pelvic or back pain, you should consult with your physical therapist before attempting this exercise. In the meantime, work on the breathing exercises discussed in the previous blogs until your pain lessens.

Whatever the Weather…

By Riva Preil

Is totally going to be hot? Cold? Sunny? Stormy? Great question- these days, who knows! Considering the recent weather fluctuations, now is a good time to review the physiologic effects of hot temperature extremes on our bodies.

Moist hot packs and cold packs are two of the most commonly utilized modalities by physical therapists to treat pain. Heat is often used to treat chronic pain as well as muscle stiffness and discomfort. Heat is a vasodilator (expands blood vessels to allow for improved circulation), and this brings oxygen and nutrients to the cells. In addition, increased blood flow allows toxic waste products and carbon dioxide to be removed from the cells. The recommended temperature for optimal most heat treatment is 104-113 degrees Fahrenheit for five to thirty minutes. However, heat should not be used over sprained or strained ankles or on body parts with decreased sensation for fear of inadvertent burning.

Cryotherapy (cold therapy) is the other common modality often used for pain relief, especially for acute injuries. Cold has the opposite effect of heat- it is a vasoconstrictor (creates narrowing of blood vessels thereby decreasing the local blood flow). Cold decreases edema (swelling), pain, and inflammation, and it should be applied indirectly to the skin for less than fifteen minutes. The order of sensation when using cold are as follows: Cold, burning, aching, numb- so even if the initial cold, burn, and ache feel uncomfortable, the desired eventual numbness is worth the wait!  The effects of cold therapy are longer lasting than heat therapy.

Learning about Diabetes, Part II

by Riva Preil

If too much glucose builds up in the bloodstream, a very dangerous condition known as ketoacidosis may develop. The symptoms of this condition include breath that smells like acetone, fast and heavy Kussmaul breathing pattern, vomiting, nausea, abdominal pain, and possibly even altered states of consciousness (ex. coma). Glucose accumulation in the eye lens can also create vision difficulty due to altered lens shape. Diabetic dermadromes are a specific type of rash that may develop with DM. Furthermore, some individuals with DM develop peripheral neuropathy, dysfunction of the nerves that send messages to the extremities (especially the lower extremities). This may result in decreased sensation to the feet and decreased strength in the leg muscles.

As of 2012, an estimated 346 million people worldwide had Type 2 DM. It is the predominant form of DM, and it is associated with obesity. Insulin treatment became available in 1921, and this can help facilitate glucose absorption in Type 1 DM. However, pumping more insulin into an individual with Type 2 DM does not correct the issue, because their bodies no longer respond to insulin. Therefore, it is important for individuals with any type of DM, especially Type 2, to make lifestyle changes that will promote health and prevent further medical complications. For example, exercise has been shown to facilitate glucose transport into the cell (similar to insulin)! Appropriate management of the disease (which to date cannot be cured) includes maintaining healthy blood pressure, exercising regularly, maintaining a healthy body weight, terminating smoking, and regular foot inspection to assure skin integrity. Furthermore, as a general rule, individuals with DM should not cut their own toenails due to the sensory changes they may experience and to prevent inadvertent injury.

November is American Diabetes Month

By Riva Preil

November marks American Diabetes Month, and is therefore an appropriate time to discuss Diabetes Mellitus (DM).  DM was first described in an Egyptian manuscript in 1500 BCE as a disease associated with increased urination (polyuria), and in fact the very name “diabetes,” which means “to pass through” was first used by the Greek Appollonius of Memphis in 230 BCE due to this trademark of the disease.  The other two primary symptoms of DM are increased thirst (polydipsia) and increased hunger (polyphagia).

Normally, when a person eats carbohydrates, complex sugars are consumed, digested, and broken down into simple sugars (ex. glucose) which are sent to the bloodstream.  Glucose is transported to the body cells where it is absorbed and metabolically broken down through cellular respiration in the mitochondria of the cell.  This process produces ATP, or energy, and enables us to function.  Insulin, produced in the pancreas, is vital in this process- it allows for normal transport of glucose into the cell.  However, with DM, a person experiences hyperglycemia, increased blood sugar levels due to interference of glucose transport into the cells (to be discussed further- stay tuned for next blog).

There are generally two reasons for this abnormality: either the beta cells of the islets of Langerhans in the pancreas are not properly producing insulin (Type 1 or Insulin Dependent DM) OR the insulin is being produced, however the person has developed an insulin resistance (Type 2 or Non-Insulin Dependent DM), thus preventing glucose from entering the cells.  In addition, a third type of diabetes known as gestational diabetes may develop in some pregnant women. It is associated with decreased insulin secretion thereby interrupting with glucose transport into the cells.  The prevalence of gestational diabetes is 2-5% of all pregnancies, and it usually spontaneously resolves after childbirth.  There is a correlation between gestational diabetes and future development of Type 2 DM.  In fact, approximately 20-50% of women who experienced gestational diabetes while pregnant eventually develop Type 2 DM.

Physical Therapy: a Primary Intervention for Pelvic Floor Dysfunction and Urinary Incontinence

By Amy Stein and Mary Hughes

Physical therapy is almost always the first line of defense with any orthopedic injury, in order to prevent possible invasive surgical procedures.  The pelvic floor musculature maybe the most overlooked group of muscles in the body.   The American Physical Therapy Association stated proper preventative measures by a physical therapist can help manage, if not alleviate, urinary incontinence.  In a study by Hung et. al they were able to improve symptoms of incontinence by “retraining diaphragmatic, deep abdominal and Pelvic floor muscle coordinated function.”

Over 25 million Americans suffer from urinary incontinence alone or involuntary loss of urine. And, it is not just a “women’s disorder;” men and children can have pelvic floor dysfunction as well. Physical therapy for pelvic floor muscle training is a great, less invasive option to help, reduce and/or stabilize pelvic organ prolapse, increase strength, improve sexual function and decrease leakage/incontinence.

American Physical Therapy Association. (2008, March 20). “Urinary Incontinence In Women Alleviated With Physical Therapy Treatment, New Study Reveals.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/101112.php, on October 29, 2012.

Hung, H. C., Hsiao, S. M., Chih, S. Y., Lin, H. H., & Tsauo, J. Y. (2010). An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Manual therapy, 15(3), 273-279.

Stein, A. (2009). Heal Pelvic Pain: A Proven Stretching, Strengthening, and Nutrition Program for Relieving Pain, Incontinence, IBS, and other Symptoms Without Surgery. New York: McGraw Hill.

Lying Prone

By Denise Vidal

In these Pilates blogs we have explored our breath and its relationship to our posture, core, and the movement in our joints.  We have explored the difference of breathing into our abdominal cavity as well as into our chest cavity. We have also explored breathing into the sides of the ribs as well as the front and back. However, the front and the sides of the ribs can be much easier to access, given that we can both see and touch those areas. In today’s blog we are going to talk about finding more breath in the back part of the rib cage. One way in which we can explore this is lying prone, or lying on your abdomen.

To start, take a pillow from your bed and lie on it lengthwise on your abdomen; that is, put the pillow under your torso from your shoulders to the top of your pelvis.

Put your hands under your forehead for support.

Feel how your front ribs sink into the pillow, allowing your back ribs to have room to spread and open. As we have done before, focus on the back part of your ribcage expanding with each inhale and softening back down with each exhale. See each section of your back ribs expanding separately, starting with the low ribs, the middle ribs, and then your upper ribs (under the shoulder girdle).

Once you feel like you have made a connection with the breath in your back ribs, try to engage your abdominals. Using to cues that we have used before, as you exhale feel your waist hug the imaginary sphere inside your belly. See if you can do this while keeping the pelvis in neutral. Remember, in neutral pelvis we are attempting to keep the pubic bone level with the hip bones. Depending on our individual structure this may not happen; however, the point is to keep the spine long and the pelvis heavy. When we engage our abdomen, there is no need to squeeze your butt or tuck your pelvis.

Practice this and let me know how it goes.

In the next few blogs we will begin to add movement of the limbs in this position.

Conquering Lymphedema

by Roseanne Cruz

According to recent studies, the incidence of breast cancer-related edema can range from 6-70%. Lymphedema, which can affect both men and women, is a persistent swelling of a body part due to a blockage in lymphatic flow when nodes or vessels are damaged or abnormal, such as post-radiation or chemotherapy treatment. Individuals who have lymphedema may complain of discomfort or pain in the affected limb, feeling of fullness in the limb, fatigue, or decreased flexibility. They may also complain of breast or pelvic pain, tight-feeling skin, difficulty fitting into clothes, or tightness when wearing rings, bracelets, watches, socks, or shoes.

Lymph drainage therapy (LDT) consists of a gentle massage technique that is said to aid in the circulation of body fluids, drain toxins from the body, stimulate the immune system and the parasympathetic system, reduce pain and/or muscle spasms, increase ROM, and decrease swelling.  LDT can be used to treat conditions such as post-surgery and scars, fibromyalgia, chronic fatigue syndrome, infertility, painful periods, constipation, and irritable bowel syndrome. In conjunction, it is important to have an exercise program of stretching and strengthening to get the maximum benefits of LDT.  After treatment, the patient may experience increased urinary frequency or increased amount of urine, increased sleep time or better quality of sleep, tension release and/or emotional release, or improved senses.

If you are seeking treatment, you need to see a licensed healthcare provider that is trained in Lymphedema Drainage Therapy.  To find a specialist in your area, go to www.apta.org and click on “Find a PT,” or do a search through the National Lymphedema Network.

Roseanne Cruz, PT, DPT, LLCC, is certified in lymphedema management through the Upledger Institute.  Roseanne received her B.S. and doctoral (DPT) degree from New York University.  Roseanne has been interested in working with patients with pelvic pain, pelvic floor dysfunction in adults and children, and lymphedema for many years and has spoken in the Greater New York area on these topics. Roseanne is a member of the APTA (Women’s Health and Oncology sections), National Vulvodynia Association, International Pelvic Pain Society, and the National Lymphedema Network.