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

How to Improve Bladder Health

bladder-cherry-chinese-lanterns-ornamental-plant-433076

Fiona McMahon, DPT

The bladder, not super complex right? Just a tupperware for pee, holding your urine until an opportune time to go. The bladder is so much more than that, integrating information from the brain, muscles of the pelvic floor, and responding to stretch to efficiently serve its purpose. We never think of the bladder until something goes wrong with it.

In this blog, we will be exploring the anatomy of the bladder, what is normal for the bladder, what can go wrong with the bladder, and how to best take care of your precious and hard working bladder.

Bladder Anatomy/ Physiology

 

Male or female, we all have the same basic structure of the bladder, with a few exceptions. Here’s what everyone has in their lower urinary tract.

  • Detrusor Muscle: Forms the body of the bladder and is responsible for squeezing the bladder to empty its contents. It spends most of its time relaxed in order to allow for bladder filling.
  • Trigone Muscle: Forms the neck of the bladder, and is a powerful sensory organ. When the trigone stretches in response to the filling of the bladder, it sends a message to the brain that it’s time to pee.
  • Internal Urethral Sphincter: Smooth muscle (involuntary) which seals off the exit of the bladder and allows for continence.
  • External Urethral Sphincter: Striated or voluntary muscles which also seals the exit of the bladder.
  • Urethra: This is the tube that leads out of the bladder and is the pathway for urine into the outside world.

Sex differences:

People with male anatomy have a prostate. The prostate is a sex organ and is responsible for keeping the semen at the right pH to fertilize a waiting egg. It wraps around the urethra and lives just under the bladder. It also provides a mechanical buttress or support for the bladder, lessening the load on the pelvic floor.  Because of its proximity to the urethra, problems with the prostate can cause problems with the bladder.  An enlarged prostate, which can be a benign part of aging, cancer, or infection, will restrict the flow of urine out of the urethra, resulting in weak stream, painful, burning urination, and difficulty urinating (the same thing happens with tight pelvic floor muscles). A prostate that has been surgically removed, most often has occurred for treatment of prostate cancer can reduce support for the bladder and lead to leaking. For more information on prostate cancer click here  and for more info on prostatitis, click here!

Another important difference between people with female and male anatomy are the respective length of their urethras. Male urethras are a lot longer than female urethras. This is one of the reasons people with female anatomy are more prone to bladder infections. In a female, bacteria have a lot easier time making the trek to the bladder because of the shorter urethra.

Conditions of the Bladder

Incontinence

Incontinence is the involuntary leakage of urine. There are many causes of incontinence. It’s important to know why you are leaking in order to know how to appropriately remedy it. It is possible to have more than one type of incontinence, and when that occurs we call it mixed incontinence.  Let’s go through the types together.

  • Urge incontinence occurs when you leak urine  after a sudden urge to urinate. We call it, lock in key syndrome, because certain events like unlocking the door to your home can cause urge incontinence.  This is the type of incontinence, which should be treated first in cases of mixed urge/stress incontinence.
  • Stress incontinence is the result of pelvic floor weakness that prevents the closure of the external urethral sphincter with activities that increase the pressure on the bladder, like coughing, laughing, lifting or sneezing. Pelvic floor weakness can occur if the muscles and or connective tissues are too loose to create an efficient contraction and more commonly, especially with athletes, too tight or imbalanced, to fully close the external urethral sphincter. Read more about incontinence in athletes here.
  • Functional incontinence occurs when you physically can not get to the bathroom in time to urinate. This is common in the elderly or disabled, who may have trouble ambulating to the bathroom, removing clothing, or transferring from a chair into standing. It is imperative that this type of incontinence is treated aggressively by a physical therapist or occupational therapist as it increases the risk of potentially fatal or disabling falls.

Incomplete voiding

Incomplete voiding is when the bladder does not fully empty.

In a normally functioning patient, volitional effort should not be required to empty the bladder.  A pelvic floor that is unable to relax, will have a smaller opening for urine to pass through or the voluntary muscles involuntarily contract because of muscle spasming, resulting in hesitancy, or incomplete bladder emptying.

Bladder Pain

Pain is our body’s way of telling us there is something wrong. With a new onset of bladder pain, it is important to rule out infection or an organic condition. Often times musculoskeletal conditions or general bladder irritation can mimic bladder infections.  In our practice, we often see patients who had been convinced they had an infection only to find out all of their tests for infection, where in fact, negative and the source of their pain was a tight or shortened pelvic floor.

It is important to understand the character of your bladder pain. Does your bladder hurt as it fills with urine and then feels better only shortly after voiding? If your answer is yes, you may have bladder irritation from urine that isn’t dilute enough (you are not drinking enough water), or you are consuming something irritating like spicy food, caffeine or alcohol. You may also have a condition known as painful bladder syndrome/interstitial cystitis which is contributing to your symptoms. It is important to get a handle on bladder filling pain right away, because it is the first step in treating other conditions such as frequency, urgency, incomplete emptying and retention.

If you have pain and burning during urination with no infection, it is likely the pelvic floor muscles and tissues cannot relax enough to allow urine to flow out without burning, (the pelvic floor also plays a role in bladder filling pain as well). Burning with urination that is not caused by an infection, is treatable with pelvic floor PT.

Frequency:

Everytime I hear someone say “I have a small bladder”, I have the uncontrollable urge to say, “No, you have a sensitive bladder, which can be trained to be better”. Saying you have a small bladder is 95% of the time fatalistic and just untrue. Most bladders, with few exceptions can hold 400-600 mL. Holding capacity can be diminished in cases of constipation, pregnancy and some neurological conditions, but most everyone is working with similarly sized equipment (the exception, being growing children).

Average intervoid interval, aka times between pees, is 2-3 hours, unless you chug a liter of fluid or cups of caffeine in one sitting. An example is being able to make it through James Cameron’s, Titanic, without having to excuse yourself. The trick with the bladder is it’s antsy. It informs you with the first urge to urinate when it is approximately 40% full. Over time, if you listen at that first urge, the bladder will begin to inform you earlier and earlier until you are going once every 20 minutes. Training your bladder to hold more is achieved with ignoring the urge or practicing various behavioral strategies, like deep diaphragmatic breathing with pelvic floor drops, to allow for longer intervals until your bladder capacity is within normal limits. This can be a longer process for those with a more sensitive bladder.

Bladder training is complicated by pain. Pain usually must be treated simultaneously in order to truly get the most benefit from bladder retraining. It is also important to realize that substances like caffeine and alcohol increase urgency and make bladder training more difficult.

How to Manage Bladder Issues:

Fortunately, there is a lot you can do, RIGHT now to manage your bladder symptoms. I find that in my practice and everyday life, there is a certain fatalism about bladder conditions. I can’t count how many times I’ve heard phrases like, “ I just have a small bladder”, “People my age after babies just leak”, “I am older so I pee more at night” and “it’s always been like this”. The bladder is a trainable organ and the muscles influencing it can be stretched and strengthened like any other muscle in the body. The best part is there is so much you can do for yourself at home. It’s totally worth trying and in many cases is a life changer.

Diet and fluid intake:

It may sound counter intuitive, but drinking plenty of water is good for almost all bladder conditions. Yes I am talking about leaking, urgency, incomplete emptying and frequency. Drinking lots of water keeps your urine nice and dilute, minimizing the irritation of the bladder wall as well as the reactive spasm of the detrusor muscle. You should drink approximately half your bodyweight in ounces of water a day. For example: a 150 lbs person should consume 75 ounces of water a day. You should increase this amount if you are exercising, or experience a lot of sweating or drink a lot of caffeine and or alcohol, which are both dehydrating. It is also important to be mindful of bladder irritants which can worsen bladder issues. Big irritant culprits are alcohol, caffeine, citrus, and spicy food. In children, dairy milk is a common bladder irritant.  Keep in mind that one person’s bladder irritant may not be your bladder irritant. It’s easy to look at lists of bladder irritants and get overwhelmed. Try eliminating a suspected offender for two to three days. If you feel better when you aren’t consuming that item and worse when you add it back in, consider eliminating that item from your diet.  It is also important to eat in a way that prevents constipation, as this worsens bladder symptoms and puts extra pressure on the bladder.

Posture

If you are having problems fully emptying your bladder or you have post void leakage (dribbles following going to the bathroom) consider your toileting posture. People with bladder issues should sit on the toilet ( even dudes), to allow the pelvic floor muscles to relax and allow the bladder to fully empty.

Bladder Training

If you have bladder frequency or leakage  now is the time to try and train your bladder to hold more urine. Keep in mind you should start treatment to address pain with physical therapy and in certain cases, with medication, to allow you to be successful with bladder training. I always tell my patients to start their bladder retraining at home, where a bathroom is available to take the stress out of possible leaks or not being able to find a bathroom. Start by simply waiting to go to the bathroom 5-10 minutes past your first urge to urinate. Use behavioral strategies, such as deep breathing and pelvic floor drops, mindfulness, distraction and others.  If you don’t have to go after 5-10 minutes, Great! If you do, go to the bathroom. As waiting 10 minutes becomes easy, stretch your time to 20 minutes and so on until you are able to go 2-3 hours in between urination.

Physical Therapy

Physical therapy is considered a mainstay and top treatment for musculoskeletal causes of bladder disorders and bladder pain.  Expert pelvic floor physical therapists are clinicians who can find the cause of your bladder issues and provide you with a customized plan that will provide you with the best results possible. PT’s can work to relax spasmed muscles, treat constipation contributing to bladder issues, improve your toilet posture, reduce tightness around the bladder, abdominal and thigh region that can contribute to bladder dysfunction, as well as strengthen weak muscles. If you are experiencing bladder issues, please come see us.  There is so much we can do to help!

Sources:

Berghmans L, Hendriks H, Van Waalwijk, et al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000; 85: 254-63

Chancellor, M, Yoshimura N. Neurophysiology of stress incontinence. Rev Urol. 2004; 6(Suppl3)S19-S28

Chang H, Lynm C, Glass R, et al. Urinary incontinence in older women. JAMA, 2010; 303(21): 2208

FitzGerald M, Brensinger C, Brubaker L, et al. What is the pain of interstitial cystitis like?. International Urogynecology Journal Including Pelvic Floor Dysfunction. 2005

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epib. Apr 4

Pilates, Moving from Injury Back to Peak performance

Julia Rosenthal PT, DPT

Julia Pilates

As an avid high intensity exerciser, I am always looking to push myself in my workouts. When pain gets in the way of my progress, it can be extremely frustrating. For years, I have been struggling with chronic hip and sacroiliac joint (low back) pain. These symptoms intensified about two and a half years ago when I fractured a lumbar vertebra weight lifting. Recovery was hard, and during that time I was told by doctors, friends, and family that I could not or should not return to the things I loved: lifting heavy weights and running outside. I was devastated. I tried swimming, biking, the crazy looking stair treadmill at the gym, and while I was able to get some exercise in, I still felt like I had lost one of the things that brought me the most joy.

Months after my injury, I finally started listening to my body and my physical therapist friends rather than the limiting and negative advice I had gotten. I started returning to weight lifting and running and began trying not to judge myself for the strength I had lost. The more I did, the better I felt. I was scared, but I felt liberated at the same time. But despite making some initial progress, I started to hit a wall. I couldn’t deadlift as much as I could before, I couldn’t lift as much overhead, and I was too afraid to run on concrete or to get in a squat rack, which was where I had hurt myself all those months ago. I started to feel that hip and sacroiliac (SIJ) pain again after every workout, and I knew I had to change something about what I was doing.

Enter: Pilates. Pilates and weight lifting are both forms of resistance training, but there are key differences between them that make Pilates an effective form of cross training for a weightlifter. When you do any singular form of exercise, your body is learning how to complete a task one way. Introducing a different form of exercises gives you variability, and teaches your body to work under lots of different conditions using different muscle groups. The more options our bodies have for how to complete a task (like a deadlift), the stronger we become.

Here at Beyond Basics Physical Therapy, I had the opportunity to work with Kierstin Elliot,a certified Pilates instructor with a wealth of experience working with clients who struggle with orthopedic issues, including pelvic floor dysfunction. “In Pilates,” Kierstin explained, “subtle nuances matter and you have to be a stickler for form and alignment.” Weightlifting athletes, on the other hand, generally focus more on larger, more powerful movements. Because of these differences, Pilates can make a big difference when it comes to increasing strength and decreasing injury in people who typically exercise with high resistance. In the months that I spent working one on one with Kierstin, I achieved personal bests in my squat and my deadlift and could feel that I was much more steady in any single leg weight lifting activity.

If you like to lift weights and you want to see your performance improve, here are 5 specific ways that Pilates can up your weight lifting game:

  1. Eccentric Strengthening
    1. While weight lifting certainly helps to develop core strength, Pilates does so using lighter weights and more eccentric contractions. Eccentric contractions require muscles to work and lengthen at the same time. Typically, weightlifting and other forms of exercise will strengthen the core in a concentric way, meaning the muscles are asked to shorten and tighten in order to build strength. While both are effective, the best option is a combination – variability is key. Eccentric contractions are also a great way to increase mobility.
  2. Increasing Mobility in the Spine and Extremities
    1. The demands on the spine are very different in weight lifting versus Pilates. Lifting heavier weights requires you to maintain a certain amount of stiffness in the spine to protect it against a heavier load. While that is an important skill (think about how hard it can be to lift a heavy suitcase, stroller, car seat, etc.), it is also important to be able to manage resistance at times when our back can’t be in a “neutral” position, like when you’re putting a baby in a crib or digging things out of your storage unit. Pilates exercises are done at lower resistance and in various different spinal positions: flexion, extension, side-bending, and rotation. This allows you to learn to move well under tension in lots of different positions.
    2. Pilates is also a great way to increase your hip and shoulder mobility, both of which are important for weight lifting. Squatting, deadlifting, and overhead movements were the things I was having the hardest time progressing back to, and these all require good shoulder and hip mobility. Pilates exercises are often done with the trunk supported, and with resistance applied to the limbs by springs. This means that there are more eccentric contractions involved (working and lengthening at the same time), which can be a great way to improve strength and mobility at the same time.
  3. Increasing Stability
    1. Weightlifting focuses on powerful movements. These types of movements will require increased work from our larger “global” muscles which tend to be longer and move lots of joints at the same time. While strengthening these muscles is important, using Pilates to strengthen the smaller “stabilizing” muscles is a great way to enhance the strength of the global musculature. When we do a big, powerful movement, we need the smaller stabilizing muscles to automatically fire too – this enhances our overall strength, improves our balance, and makes us less prone to injury.
  4. Increasing Endurance
    1. Training for increased endurance means training at a lower weight and performing more repetitions. In weightlifting, the goal is to work at a higher percentage of your 1 rep maximum, meaning the greatest amount of weight that you would be able to lift once. In Pilates, on the other hand, lighter resistance is used for more repetitions.
  5. Increasing Body Awareness
    1. Proprioception is the sense that allows us to know where our bodies are in space. Exercises that are done in a closed chain – meaning one of your body parts is in contact with a fixed surface – enhance this sense. Because reformer Pilates includes spring tension with your feet or hands in contact with a surface, almost all exercises are done in a closed chain. This can be a really great way to ease into a movement after an injury. The support of a closed chain exercise allows you to tailor the movement to your current level as you progress back towards more traditional open chain (no contact with a surface) weightlifting movements.

Thanks for reading! I hope this blog post helped you understand how you can take your training to the next level. If you are interested in experiencing what Pilates can offer or how physical therapy can maximize your athletic potential, please call our midtown (212-354-2622) or downtown office (212-267-0240) today!

 

Check out what Kierstin has to say about Pilates here!

The Benefits of Pilates While Healing Diastasis Recti

Pilates with Kierstin! Standing Side Splits

Pilates with Kierstin! Bridges with Stability Ball

References:

  1. Ahearn EL, Greene A, Lasner A. Some Effects of Supplemental Pilates Training on the Posture, Strength, and Flexibility of Dancers 17 to 22 Years of Age. Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science. 2018;22(4):192-202.
  2. Di Lorenzo CE. Pilates: what is it? Should it be used in rehabilitation? Sports health. 2011;3(4):352-361.
  3. Phrompaet S, Paungmali A, Pirunsan U, Sitilertpisan P. Effects of pilates training on lumbo-pelvic stability and flexibility. Asian journal of sports medicine. 2011;2(1):16-22.
  4. Queiroz BC, Cagliari MF, Amorim CF, Sacco IC. Muscle activation during four Pilates core stability exercises in quadruped position. Arch Phys Med Rehabil. 2010;91(1):86-92.
  5. Valenza MC, Rodriguez-Torres J, Cabrera-Martos I, Diaz-Pelegrina A, Aguilar-Ferrandiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clinical rehabilitation. 2017;31(6):753-760.
  6. Why Pilates and Lifting Weights Aren’t Mutually Exclusive – Girls Gone Strong. Girls Gone Strong. https://www.girlsgonestrong.com/blog/strength-training/why-pilates-and-lifting-weights-arent-mutually-exclusive/. Published 2019. Accessed May 26, 2019.

How to Travel with Pelvic Floor Dysfunction

Fiona McMahon PT, DPT (She, her, hers)

airplane-backlit-clouds-1262304

It’s that magical time of year in New York City, that I call “Goldie Locks Time”. It is that brief stretch of one to two weeks right after the cold of winter has left us and right before the sweltering hot gritty city summer descends upon us. It is the time of year that the weather is so supremely pleasant, that the hustle and bustle of the city slows and usually frenetic New Yorkers actually take time to stop and smell the roses, literally. My pediatric patients begin to grow giddy as school is wrapping up in a couple weeks. It is a time when many New Yorkers start looking forward to their summer escapes back to their home towns across the country or vacations to new and familiar locales alike. Having the time and resources to travel is a luxury, but for those with chronic pelvic pain, it can seem like a really daunting task. People often wonder, “how can I fly across the country if sitting for more than 20 minutes causes my pain?”, “how will I keep from flaring?”, “How do I negotiate the demands of travel so I can actually enjoy my time away?”. Although travel can be really daunting, there are steps that you can take to ease your journey and help you enjoy your time at your destination. Below are some considerations for travel I hope that you will find helpful.

Hydrate- Even if You Have Bladder Problems

Recirculated air is the worst and is inevitable when flying, but is also something you should consider with bus, car, and train trips. Long and even short haul flights can leave you feeling parched and dry which can cause issues with many pelvic floor symptoms. It is really important to not get on the plane dehydrated. In the week or so preceding your trip, be extra mindful of trying to get enough water. A popular guideline we use at BBPT with to try and consume at least one half your body weight in water in ounces. For example, if you weigh 150 pounds, drink 75 ounces of water. Being properly hydrated will decrease irritation within the bladder and can even reduce frequency, reduce your chances of constipation, and ensure the tissues of your body have good mobility. Also be sure to hydrate on the plane and in the airport. Water sold at airports is usually overpriced and has the downside of being packaged in environmentally unfriendly plastic. To save money and the planet, I suggest bringing an empty reusable water bottle through security. Once you are through security you can fill it up and keep on your hydration game. One thing to remember is to take your water bottle out of your bag and place it in the screening bin, so you won’t lose time having security check inside your bag to verify that your bottle is indeed empty.

Prioritize Pooping

In my world, it’s all about poop. Traveling can lead to some gnarly cases of constipation, which makes virtually every pelvic floor complaint worse. We talked about keeping up with your hydration, which is a really good first step. Making sure that you have a enough time to eat, chill, and have a solid BM before rushing off to the airport is really important. So when possible, Try and carve out at least an hour of pre-travel chill time before heading out the door.

Food

Eating well is so important. Many of our patients have diets that make them feel better. When travelling, food can be a wild card. With the change in routine associated with travel, it can be all too easy to throw a diet that is working to the wind. A huge change in dietary routines is one of the top reasons I see people flare. Although indulging in margaritas and other treats can be so much fun, be aware of how it will affect your symptoms and overall enjoyment of your trip. It is good to come prepared if possible. Packing snacks that you know don’t make you feel like garbage if you are going to place where you are unsure of what the food situation will be like, will help.

Choose your Seat

The idea of sitting on a long haul flight is daunting especially for those who have pelvic and or sitting pain or bladder issues. There are travel cushions you can bring with you to ease your symptoms. If you don’t typically use a travel cushion, check out my cushion hack bellow using a jacket.

seat.jpg
The cushion hack: If you find you have sitting pain but no cushion, use your coat or sweatshirt to fashion a cushion

Choosing seats next to the bathroom when possible can go a long way towards reducing stress for folks with bladder issues. Additionally ,opting for an aisle seat can also be helpful. To the extent possible, try to get up and move to reduce the pressure on your pelvic area.

Manage Travel Stress

Travel is a stressful thing for most of us. There is so much out of our control and there’s no amount meditation or mindfulness that can change that. That being said, meditation and mindfulness practice can help how you deal with how you react to  cancelled flights, lost baggage, the works. Allowing yourself a quiet moment to breathe before and during your travels can help you re center and get back to enjoying the journey. Both Calm and Headspace make really awesome guided meditation apps that you can use while waiting for your flights.

 

Get out There!

This world is so big and beautiful. It can be really hard if pelvic pain is holding you back. Try these tips out on smaller trips to see if they help you! If you find that you are still having pain that holds you back, see a pelvic floor physical therapist who can help you get out there!

Beyond Basics Physical Therapy offers intensive week or weeks long treatment to those who live out of town and do not have regular access to pelvic floor physical therapy. If you are feeling like taking a trip to the Big Apple, NYC, check out more about our out of town services here.

 

The Special Care Needs of the LGBTQ+ Community

Happy Pride Month!!!!

We are reposting an old post broadly discussing the LGBTQ+ community, with special focus on transgender individuals. Please keep checking back as we continue to discuss specific issues relating to the care of the LGBTQ+ community.  

Amy Stein PT, DPT and Fiona McMahon PT, DPT

rainbow flag

Who are LGBTQ+ individuals?

At Beyond Basics Physical Therapy, we have been meeting and studying with experts about the LGBTQ + community. LGBTQ+ refers to individuals who do not identify as heterosexual or do not identify as cis- gendered (although these two categories are not mutually exclusive). Cis-gender means you identify with the genital anatomy you were born with. People who belong to the LGBTQ+ community can be cis-gendered (meaning they identify with the genital anatomy that they were born with) and be gay/lesbian/ bisexual/ questioning etc.  They can be trans-gender and heterosexual or some combination thereof. Basically LGBTQ+ is a term that includes people who are not both cis-gender and heterosexual. LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, and other individuals.  

Never Assume. Listen, Ask.

We were excited to understand and learn more about how we can help, specifically with patients experiencing pain or weakness in the pelvic floor. We met with an LGBTQ + advocate and he recommended the following when it comes to treating patients both within and outside the LGBTQ+ community.  First rule of thumb:  with all patients, don’t assume and be open to any questions or discussion. Ask if your patient would like you to stay away from certain terms regarding their anatomy, as well as their preferred gender pronoun. Use language that they want us to use.

 As with all patients, we need to use a biopsychosocial approach. With any patient, Richard Green at Bellevue hospital says that we always want to know exactly what is going on with our patient. We must subjectively understand why they are visiting us.  Has there been trauma, surgery, complications, or anything that has worsened their symptoms? What hormones and medications are they on? Don’t single anyone out. These questions are important for every patient.  

We want to get the medical and surgical history during or prior to the visit. There is no standard one surgical procedure or hormonal protocol in trans care. Hormones, either testosterone, estrogen, lupron, puberty blocking, testosterone suppressing can be used in many patients, but are also used specifically to aid in transition in transgender patients. Many hormones have consequences or side effects and our patients need be educated on the various options.  There is research on hormones and bodily changes, however there is no good research on how the hormones affect the pelvic region. Anti-estrogen hormones may result in vaginal drying and atrophy, more tissue tearing, and pain with penetration.  Hormones can be administered via injection, pellets, patches, creams, gels, and pill form.  It’s important to realize side effects and risks of hormones for each patient. Dosage depends on body type, weight, previous surgeries, etc.  Hormone therapy can be given by a primary care provider or endocrinologist; however, many are not familiar with a specific protocol but at the same time each person may have different goals.  Progression of hormones can be monitored for each patient and according to patients wants and needs.  

For those who opt for surgical transition, it can result in pelvic pain and or weakness as organs are moved and or removed. Like we mentioned before, there is no one surgical protocol and it will vary from surgeon to surgeon, from changes in hormones from the removal of certain organs.  Knowing what tissues have been removed or moved and or where scar tissue could have been formed, is important to addressing a patient’s complaints. Also, it’s important to ask if the patient was having these symptoms or pain prior to any of the surgeries or hormonal medications. Surgical transition can take a long time with various surgeries and various symptoms that arise throughout. Some issues that  can occur are fistulas or fissures and when dealing with nerve implants there could be nerve damage and restrictions.

How is care for the LGBTQ+ community funded and regulated?

Medical coverage for the LGBTQ + community is non-regulated and different in each state. The Affordable Care Act, (ACA) covers some therapies and surgeries. You can try to appeal with each insurance which have their own policies on gender affirming care.

How can physical therapy help?

At Beyond Basics Physical Therapy, we specialize in abdomino-pelvic disorders, including pain, weakness, bladder, bowel and sexual dysfunction.  We also specialize in orthopedics and functional manual therapy.  We treat the LGBTQ+ community and we welcome any questions at desk@beyondbasicspt.com or call 212-354-2622. We are happy to help and look forward to hearing from you!
Resources: Center of excellence for transgender health.

WPATH center for care Endocrine Society

  • speaks on hormone therapy (however some information may be out of date).

 Adolescent Health Center

The Benefits of Pilates While Healing Diastasis Recti

Ta facilitation pic

Kierstin Elliot

Almost all postpartum women experience some degree of diastasis recti, or separation of the rectus abdominis or 6 pack muscles. Think about it, your abdomen is stretching continuously for a solid nine months! Something’s got to give. The linea alba (line of connective tissue that splits your rectus abdominus right down the middle) separates as a result of a growing baby. On some women, this separation naturally heals itself within the first year postpartum. In other women, the separation is so severe that they need a little extra attention and care to fuse their rectus abdominis back together again.

Once you’ve given yourself enough time to heal the inflamed tissues from giving birth, usually about 6-8 weeks, then you can start implementing some basic Pilates principles into your routine. Drawing attention to the breath, the transversus abdominus (TA), and the pelvic floor without creating excess pressure throughout your system, will be essential while moving towards healing your diastasis.

Connecting to your breath and your TA should be the first step. Deep three-dimensional inhalation to the back of the ribs and mindful exhalation, tapping into the TA will be crucial. During the exhale you should feel as if your abdomen is hugging or wrapping around your waist like a belt. This is TA activation. Once you’ve established the TA activation, focus on drawing your bottom ribs towards your naval and narrowing your ASIS (hip bones) towards each other. Imagine a drawstring; when you pull the drawstring, the opening of whatever object you’re trying to close, draws together from all sides evenly. That is the effect we are trying to create with the abdomen. Visualize your naval as the center of the opening and your exhalation pulling the drawstring closed.

Once you’ve mastered connecting breath to the TA, shift your focus to the pelvic floor. The easiest way to achieve this is by lying on your back with a neutral pelvis with knees bent and feet flat on the floor. Visualize the tailbone unfurling and your sits bones widening as you inhale allowing the pelvic floor to gently stretch and relax. On the exhale, as you engage the TA and obliques, feel the pelvic floor tighten slightly and if appropriate (after a pelvic floor check from your PT) find a kegel. The ultimate goal is to be able to contract and release your pelvic floor without any problems. After practicing this breathing exercise every day for about 8-10 reps, you should start to feel stronger throughout your core and find some closure or firmness in the linea alba.

This first step is HUGE. After 2-3 weeks of consistent breath work and core activation, layering more extensive exercises will become safe and accessible. Keep in mind that it is not wise to go from zero to one hundred, but rather continue to build and progress slowly. It may feel tedious, but I can’t stress enough how imperative it is to lay this foundation and rebuild your core after birth. Once you feel you’ve made considerable progress with breath work, add in marches (leg lifts) targeting lower abdominal stabilizers and add in a side lying series to challenge pelvic and core stability while also strengthening glutes. Try a side plank starting on knees and then progressing to feet. Any exercise in quadruped is a safe bet that targets shoulder stability, core, glutes, and hamstrings!

One thing to note is that women with more severe cases of diastasis should avoid abdominal curls, rollups, or flexion of the rectus abdominis until there’s been a considerable amount of progress with the deeper core muscles. If you fall under this category and constantly wonder if you’ll ever close your diastasis, yes! You can! And you will if you dedicate the attention and mindfulness to connecting to your body. Think you’re doing everything right, but still feel like no progress is being made? Feel free to book a session with me at Beyond Basics Physical Therapy! I’d be more than happy to help you out on closing your diastasis and transitioning you back into the wonderful world of pilates 🙂