Pilates with Kierstin: The Plank

Kierstin Elliott, Pilates Rehab Specialist

Exercise: Plank

Set Up: Start on all fours with the shoulders stacked on top of wrists, lats engaged, collar bones broad, and chin slightly tucked to create length through the back of the neck.

Execution: Inhale to prep, exhale to extend one leg at a time back into a full plank position. Abs and glutes engage while nothing in the upper body shifts. Create a sense of length from the crown of the head through the heels. Hold anywhere from 10 seconds to a minute maintaining proper form.

Focus: Three key focal points when performing a plank: 1. Be sure to not sink into the shoulders. Push away from the mat, broaden collar bones, engage lats and serratus (your side body), and keep the back of the neck lengthened. The upper back should be flat, not rounded. 2. Support the lower back. Abdominal engagement is critical in this exercise and includes knitting ribs together, drawing navel to spine, and creating a hollowed out feeling in the lower abdomen in order to achieve optimum support for the lower back. 3. Create a sense of length. Constant energy reaching through the crown of the head to the heels will give you a sense of lift making the plank feel lighter. P.S. Don’t grip the glutes, but engage them slightly for more support.

Importance: Planks are a killer full body exercise. Everything has to be on, including the brain, in order to execute this exercise correctly. Planks allow you to target shoulder stability, core strength in its entirety, and mental/physical endurance.

Modifications: To modify, keep knees under the hips, tuck the toes and hover knees off the mat. Focus on the same cues for full plank. To add a challenge, well… the options are endless! Try adding alternating leg lifts, mountain climbers, or walk down to forearms and back up to hands without shifting hips side to side.

Pilates with Kiertsin! The Saw

Kierstin Elliott, Pilates Rehab Specialist

Exercise: Saw

Set Up: Seated with legs extended mat distance apart and arms extended out to the side.

Execution: Inhale to prep, exhale to rotate torso right as you flex forward (nose toward knee) reaching your left hand toward the outside of the right foot. Reach the pinky finger to the pinky toe a little further 3 times (creating a saw like action) before rolling up through the spine. Inhale as you pass through center and rotate left as you repeat the same actions on the left side. Complete 3 rounds.

Focus: Focus on anchoring the opposite hip to the mat while reaching toward the foot. Be sure to keep a flexed spine versus an extended spine while folding forward over the leg. Lastly, keep shoulders out of the ears (IE. Relax your shoulders) while reaching toward foot.

Importance: Spinal rotation and hamstring length! It’s so easy to track improvement with this one 🙂

Modifications: For extra tight hamstrings or hip flexors, sit on a bolster or a couple yoga blocks to elevate the pelvis.

Molly completes the NYC Marathon!

On November 3rd 2019, Molly Caughlan completed the New York City Marathon for the very first time! We at Beyond Basics are so proud and overjoyed for her! She ran to raise money for multiple sclerosis research. Read her last update before the big race, here!

I sit here writing this blog with just 6 days left to go before the big race. I’ve been tapering down milage, taking time to rest, stretch, and strengthen. The forecast, fingers crossed, is looking very ideal with highs in the mid 50s and looking like sunshine all day. I’m nervous, excited, and feeling confident that I’m going to cross that finish line.

Since my last blog, I’ve hit just a few bumps in the road with my training. In September right before a critical long run (my first 18 mile run), I had an acute onset of posterior tibialis tendonitis that made it difficult to even walk on. I was devastated and had to hold on running any distance all together. I was feeling incredibly anxious because of how close I was getting to the big day and at the thought of skipping such an important training notch. While I was healing, I did a Hot Vinyasa class that I hadn’t done in a while that help me hit a reset button and set up a strategy to manage these symptoms. I took a whole week off from running and had two sessions with Tina as well as doing some self treatment with modalities (ice/heat). I also had an acupuncture treatment with something called dry needling to my calves with a treatment for chi energy deficiency. With ALL of these treatments combined, the first run I did I was FLYING! I had so much energy and was going at such a fast pace that I shaved a few minutes off of my traditional 5 mile run. Things have been looking up since that week in September and looking back now, resting was the most important treatment I could have done.

As part of my training, I ran the New York Road Runner’s Brooklyn Half Marathon October 19 and had such an amazing time. The end of the race was in Prospect Park, which is essentially my back yard and where I’ve been doing a lot of my training. This helped me to finish strong and break my own personal record for a half marathon with a time of 2:07.

As the days wind down, I’m looking forward to having some of my family members come visit just so they can support me on Sunday. I’ll have support from my local friends on the sidelines and, with the help of modern technology, will have the spiritual support from friends across the country. I’m eager to see all of the other anonymous supporters with their signs and I’m excited to have all of this energy boost me across the finish line.

Last but not least, I must say that I am still working on my $5000 fundraising goal and I’m 71% of the way there. I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Sclerosis, 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. Support Team Tisch MS by donating to my fundraiser!

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Body, Baby, and Breastfeeding: the effects of exercise on milk supply

Joanna Hess PT, DPT, PRC, WCS

tilt shift lens photo of infant s hand holding index finger of adult
Photo by Dominika Roseclay on Pexels.com

Breastfeeding, for all its two-way benefits, requires the mother to share her body and she often ends up feeling like the health of the baby comes at the cost of her well-being—physical, mental, and social. Physical activity improves all three realms for the mother but activity may be postponed because of the assumption that it will negatively affect the baby’s growth. Can a mother have it all–breastfeed a growing baby and get return to pre-baby weight? Multiple studies and reviews show that moderate physical activity and weight loss does not negatively impact milk supply or infant growth.

Should intentional weight loss be considered during the postpartum period?

Yes, for most mothers. At one year postpartum, about one in six women retains 10 pounds or more of weight gained during pregnancy. The weight gain during and after pregnancy often stays with the mother into post-childbearing years setting up for metabolic diseases and orthopedic complications (10). While moderate physical activity itself is not sufficient for postpartum weight loss (6), physical activity remains an integral part of restoring the body’s set point in conjunction with dietary modifications. Moderate physical activity influences maternal health not only through weight control but also mental wellbeing, bone health (9), functional tolerance, sleep quality, and establishing family patterns of recreation. Breastfeeding itself requires high levels of energy, 300-600 kcal/day (5), and is associated with improved postpartum weight management long-term over 24 months (2), but not short term within 3 months (4).

Does exercise for intentional weight loss affect milk supply?

No, for most mothers. However, when breastmilk is the sole source of nutrition, a fussy baby protesting or rejecting a feed can be worrisome. Multiple studies have shown that exercise is not related to decreased milk supply, milk quality, or infant growth (1, 3, 6). Some studies show that over time, moderate exercise is related to increased milk supply (7). Some babies show a distaste for post-exercise breast milk. Lactic acid produced in vigorous levels of exercise may be associated with a decreased acceptance of breastmilk (8), but it resolves within 30-60 minutes of exercise (1, 13). Weight loss in most situations, but particularly while breastfeeding, should not exceed 0.75-1 pound/week (6, 9, 12). Wait until milk supply is established for more aggressive caloric restriction.

  • Intensity: Most studies evaluate moderate exercise intensity, roughly measured as the ability to talk, but not sing during the activity. Depending on the mother’s fitness level, the activity varies from walking to jogging. Vigorous activity is cautioned mainly because of the lactic acid buildup that is associated with poorer baby nursing.
  • Duration and frequency: 45 minutes, 5 days/week for cardiovascular. 30 minutes, 3-4 day/s week for resistance training (6).

If not exercise, what else affects milk supply?

Despite the normalcy and frequency of breastfeeding, we have yet to fully understand the complexity of the mechanism to regulate calories and nutrition, to replenish based on need, and what can increase or decrease milk supply. While baby’s quantity and quality of nursing most directly affects supply, more subtle influences like maternal food and liquid intake, exercise, sleep quantity and quality, cortisol slopes (11) also contribute to short term milk supply fluctuations.

Anything else before squeezing into the WunderUnders?

  • Fatigue. At 6 weeks postpartum, the majority of mothers do not yet have their normal level of energy (9) making additional activity difficult and almost incomprehensible to include into long days. Physical activity is only one part of wellness in the postpartum period.
  • Fussy baby. Full breasts contribute to uncomfortable and leaky exercise. If possible, feed your baby before heading off to exercise. Clean off the sweat after exercise, wait for 30 minutes if your baby seems fussy after exercise.
  • Good fitting bra. The balance of support for comfort and managing compression to protect milk ducts is the goal for your sports bra. Take off your bra when feeding to allow for complete emptying of the breasts and maintaining supply.
  • Hydration. Although hydration is more important for mother thirst than milk supply, increase fluid intake during and after exercise by about 1 liter (5). Attend to the thirst signal.
  • Baby and mother health. Although studies show that physical exercise does not detrimentally affect infant growth nor maternal health, consult with your healthcare practitioner if baby or mother aren’t following expected patterns.

A postpartum exercise plan should be a gradual and systematic return to previous level of activity. The physical therapists at Beyond Basics Physical Therapy safely guide women through this postpartum period to address multiple factors in recovery and return to fitness.

REFERENCES

1 Carey GB, Quinn TJ. Exercise and lactation: are they compatible?. Canadian journal of applied physiology. 2001 Feb 1;26(1):55-74.

2 da Silva MD, Oliveira Assis AM, Pinheiro SM, de Oliveira LP, da Cruz TR. Breastfeeding and maternal weight changes during 24 months post‐partum: a cohort study. Maternal & child nutrition. 2015 Oct;11(4):780-91.

3 Daley AJ, Thomas A, Cooper H, Fitzpatrick H, McDonald C, Moore H, Rooney R, Deeks JJ. Maternal exercise and growth in breastfed infants: a meta-analysis of randomized controlled trials. Pediatrics. 2012 Jul 1;130(1):108-14.

4 Elliott SA, Pereira LC, Guigard E, McCargar LJ, Prado CC, Bell RC. Association between breastfeeding, maternal weight loss and body composition at 3 months postpartum. The FASEB Journal. 2016 Apr;30(1_supplement):45-.

5 Kolasa KM, Firnhaber G, Haven K. Diet for a healthy lactating woman. Clinical obstetrics and gynecology. 2015 Dec 1;58(4):893-901.

6 Lovelady C. Balancing exercise and food intake with lactation to promote post-partum weight loss. Proceedings of the Nutrition Society. 2011 May;70(2):181-4.

7 Lovelady C, Lonnerdal B, Dewey KG. Lactation performance of exercising women. The American Journal of clinical nutrition. 1990 Jul 1;52(1):103-9.

8 Mortensen K, Kam R. Exercise and breastfeeding. Breastfeeding Review. 2012 Nov;20(3):39.

9 Mottola MF. Exercise in the postpartum period: practical applications. Current sports medicine reports. 2002 Dec 1;1(6):362-8.

10 Nascimento SL, Pudwell J, Surita FG, Adamo KB, Smith GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. International Journal of Obesity. 2014 May;38(5):626.

11 Straub H, Simon C, Plunkett BA, Endres L, Adam EK, Mckinney C, Hobel CJ, Thorp JM, Raju T, Shalowitz M. Evidence for a complex relationship among weight retention, cortisol and breastfeeding in postpartum women. Maternal and child health journal. 2016 Jul 1;20(7):1375-83.

12 Thein-Nissenbaum J. The postpartum triathlete. Physical Therapy in Sport. 2016 Sep 1;21:95-106.

13 Wright KS, Quinn TJ, Carey GB. Infant acceptance of breast milk after maternal exercise. Pediatrics. 2002 Apr 1;109(4):585-9.

How to Start a New Exercise Program When You’re Feeling Intimidated

How to Start a New Exercise Program When You’re Feeling Intimidated

woman stretching on ground
Photo by Jonathan Borba on Pexels.com

Kierstin Elliott

Maybe you were an avid gym-goer, cross fitter, or yogi and then you got injured. Or maybe fitness has never been a part of your life, but now your doctor or PT has told you that a fitness regimen is necessary in order to help you feel like yourself again. Whatever the case may be, you just don’t know where to start, or you feel intimidated to return to what you were doing in the past because that is how you got injured in the first place. My advice is to start slowly. Educate yourself on how and why you got injured and what the next steps are on your road to recovery. Set goals on what you need to accomplish and build a plan to achieve them. Last but not least, train smartly. If you follow this check list, then you should definitely feel more confident moving forward!

It is imperative when you are transitioning from injury rehab to the fitness world, or starting a new exercise program for the first time, that you build a foundation. It is so crucial you stay true to your journey and not compare yourself to others. Trust that progress takes time. Resist the urge to jump right into something new if you’re unsure about form, alignment, and technique.

The first step would be to invest in private sessions. Educate yourself on what you’re getting into and find an expert in what you want to master. Having a coach who devotes the entire hour to your body and your needs will help you garner a deeper understanding of how your breath, body, and mind connect. Learning the proper form with a watchful eye on alignment, will ensure you have a strong foundation to move forward or join group classes.

Once you’ve gained confidence with your new (or old) exercise program, set some fitness goals. You’ve laid a strong foundation and now it’s time to build a skyscraper! Do you want to improve strength, flexibility, endurance? Once you have clear goals set, create a timeline. Establishing a realistic timeline will hold you accountable to sticking with your exercise program and crushing your goals!

The point I’ll end with is to train smartly. No matter what discipline you train in, if you are not focused on form, alignment, and breath control, you are only setting yourself up for future injuries. If you are in a group class, don’t be afraid to ask questions if something is unclear, doesn’t feel quite right, or if you know you need a modification. If you are doing an at home workout on your own, try to do it in front of a mirror to check out your form. If there’s no mirror accessible, simply take it slow and use the knowledge you’ve acquired from a trainer, coach, or PT. Take notes. Practice. Your exercises won’t be perfect the first time you attempt them. Be patient and mindful. It’s all about the journey 🙂

Pilates with Kierstin! Split Lunges

Kierstin Elliott

Exercise: Split Lunges

Set Up: Stand with right foot in front and left in back, hip distance apart. Pelvis should be square to the front. Weight is primarily in the front foot while the back heel is lifted acting as a kickstand. Hinge forward from the hips slightly to maintain neutral pelvis.

Execution: Inhale to bend both knees as you angle the tailbone to the back wall sitting back into a squat-like position- keep lengthening through the spine. Exhale to stand following the same forward angle that keeps the crown of your head in line with the back heel, squeezing gently into your right glute. Repeat 10x and switch to left foot in front.

Focus: Primary focus is the right glute. Keep front knee stacked over ankle the entire time. Be sure to maintain length in lower back while keeping lower abs engaged. Taper ribs toward hip bones while keeping hips square/level.

Importance: Great exercise for glute strengthening, balance, and stability.

Modifications: To make it easier, use a chair, or wall to hold onto until balance improves. To make it harder, add free weights to incorporate some arms simultaneously, or simply transfer weight solely to front leg as you stand floating the back leg off the floor for a little extra balance challenge!

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!