In today’s Pilates blog, we are going to discuss the basic principle of Centering. Pilates used the word centering to refer to the “core” musculature. He believed that all movements should radiate out of the core for maximum stability. There is a lot of use of the word “core” in exercise literature. However, no one ever discusses what that actual means. In the Pilates method, the “core” refers to the diaphragm, the pelvic floor, the deep spinal muscles, and the transverse abdominus. The transverse abdominus is a deep abdominal muscle that is attached to our pelvic bones in a horizontal fashion, from one hip bone to the other. One way to find these muscles is by breathing, as all the core muscles are attached to the diaphragm and ribs via fascial connections.
Try this exercise to find your “core.” Lie on your back with your knees bent. If you need, you can have a small pillow under your head for support. Now, imagine that you have a small, helium filled balloon in your abdomen behind your navel. As you inhale see the balloon expand. As you exhale, imagine the balloon being hugged by your navel and your spine, simultaneously. On your next exhale keep that image of hugging the balloon as it floats up into your ribcage. This image incorporates the three dimensions of our torso, aka the “core” of our body.
There is no need to think of contracting individual muscles. Just keep this vision in mind and you will have a wonderfully functional core. Go over this exercise with your PT in your next session, or come see me for a private session at Beyond Basics. Your body, and your core, will thank you!
Denise has not 1 but 2 hats here at Beyond Basics Physical Therapy. Not only is she a Doctor of Physical Therapy, specializing in functional manual therapy, orthopedics and pelvic floor conditions, she is also a certified Pilates instructor. Through the years she has worked to combine her passions to produce an outstanding Pilates program tailor made for individuals suffering from any pain condition and to help them become more functional and back to their exercise routine.
On July 6th at 7pm, Denise will be sharing her expertise with the public by offering a FREE gentle pilates class here at Beyond Basics. In this class participants will “ examine the interconnectedness of [their] own functional anatomy to move through and around [their] current fitness barriers”
To get a flavor of what Denise has to offer check out her blog posts bellow. If you are interested in attending the class, please RSVP here. Learn more about the Pilates program and the physical therapy program by clicking here.
March is Endometriosis Awareness Month. Endometriosis is a condition that is near and dear to our hearts at Beyond Basics Physical therapy. Endometriosis is a gynecological disease that occurs when a tissue similar to the lining of the uterus implants itself outside of the uterus in the abdominal and pelvic cavity. It is an inflammatory condition, whose symptoms can vary from mild to severe. Most commonly endo is seen as causing painful periods, but it can also cause bowel and bladder symptoms, issues with fertility, pain with sexual activities and general pain. For the past two years we have done a post about endometriosis during endometriosis awareness month on how musculoskeletal pain can be a contributor or the primary cause of abdomino-pelvic pain condition. To learn more about how the disease affects the body and its symptoms as well as how we treat the condition at BBPT click here:
The article by Fabio Parazzini and his colleagues is a literature review. The point of a literature review is to aggregate many studies on one topic and determine a general trend in the data in one place. A literature review is not as powerful as its cousin a meta-analysis, in which more powerful statistical tools can be applied to interpret the data. Nonetheless, literature reviews can provide us with a general sense of what is going on in a certain field of research.
First things first, let’s talk about the limitations of this review. Designing a single study on endo and diet can be rather difficult. First of all, not all endo is the same. Women with endo can experience vastly different symptoms that don’t always correspond to the amount of endometrial deposits seen on laparoscopy. It can be really difficult for researchers to ensure they have a homogeneous (or similar) study population. Secondly, studying something like diet it usually correlational and not causal. Diet can reflect a lot of other components besides the nutrients going into one’s body. Diet may reflect factors such as culture, wealth, education, geographic region, which all may play independent roles in the diagnosis and progression of endo. Most of the studies examined were based on self-report, which also may not be entirely accurate.
Now that we have the caveats out in the open, let’s talk about why a study like this is useful. Like I said before, this article is an aggregation of multiple other publications. When we see similar results produced by different authors in different groups of people, it lends a little more weight to the individual study’s findings. Most importantly Parazzini is also careful to include information on why a particular food group may be more beneficial or even harmful in the progression of endometriosis.
What the Article Found
Green Vegetables and Fruit
The authors found two studies that show that a higher intake of green fruits and vegetables reduce the risk of endometriosis. They found that the higher the intake of green fruits, specifically (think okra, etc) caused the decreased risk of endometriosis and did not find the same relationship with green vegetables (think kale, spinach, and lettuce). Parazzini notes that green vegetables and particularly fruit are high in a compound called organochlorine, which has been shown in other studies to reduce the risk of endometriosis. Organochlorines are a particularly broad class of molecules and can be found in healthy things but also make up compounds used in industrial purposes. This study is referring to those occurring naturally in vegetables and fruits.
Vitamin A is found in animal products like fatty fish, dairy, and animal kidneys and livers. Its building blocks are found in green and orange vegetables and fruits and can be manufactured into vitamin A in the body. Parazzini and colleagues found mixed results some with no benefit for development of endo and some that did show benefit. No studies showed harm.
Vitamin C and E
These vitamins were not consistently found to be helpful in reducing endometriosis risk. Some studies reported that increased amounts of vitamin C and E intake reduced risk of endometriosis, while other studies failed to yield significant findings. Parazzinni did provide evidence from other studies which demonstrates the antioxidant properties of vitamins C and E. Parazinni purposes that because there may be a link between oxidative stress and disease, vitamin C and E may be helpful in reducing the inflammation associated with endometriosis.
Red Meat and Saturated Fat
Again, results were mixed. Saturated fat mainly occurs in animal products. Some studies found a correlation between red meat and endo risk, but no association with butter. In other the results were flipped.
Other items investigated
Fish and Omega 3
Minimal to no evidence supporting associations between endo and dietary intake for any of these products were found.
What’s it All Mean?
One of my patients once told me she was instructed to finish every study, with the phrase, “more research is needed.” This is certainly the case in the field of endometriosis treatment. There’s a lot about endometriosis that we don’t understand We need well constructed studies that will allow researchers to do more powerful meta-analysis to help guide our treatment. This review was only able to include 11 studies for review out of the 256 initially found.
With all that said, I do think there are some key takeaways from this study. There was a general trend in healthier foods and more promising results. Parazinni was also diligent to include mechanisms by which these healthy foods could be helpful. Secondly, there was no harm found by eating what is considered a healthy diet, (high in greens and vitamins). These findings, although small, in combination with the general benefits of a healthy diet, should encourage patients with endo to explore in more depth how eating certain foods affects their symptoms.
At Beyond Basics we take pride in treating our patients from a holistic perspective and we appreciate that we can collaborate with other healthcare providers in our community, including expert nutritionists, naturopaths, functional medicine doctors and mental health therapists. We find that the combination of diet, specific physical therapy techniques, mental health and self-care, can significantly reduce pain and other symptoms and improve function in many patients. Our clinicians specifically are experts in manual therapy techniques such as visceral and connective tissue mobilization techniques, myofascial release and other soft tissue mobilization techniques discussed in the previously mentioned endometriosis blogs. If you are suffering from endometriosis, come visit us today.
Learn more about what we do at BBPT with our upcoming PH101 classes, which are free to the public. Here are some you may find interesting:
April 6th: Does my diet really matter?
April 13th: Pain & Sexuality: Is it all in my head? No, it is not!
The following series of Pilates blog posts will focus on the principles that define the Pilates method. Joseph Pilates developed his methodology using eight basic movement principles: whole body movement, breathing, balanced muscle development, concentration, control, centering, precision, and rhythm. Today’s blog will focus on the principle of Breathing.
Breathing is a natural phenomenon that is performed thousands of times a day. Our daily intake of oxygen and expulsion of carbon dioxide is needed to cleanse our blood, and maintain the functioning of our body systems. That being said, there are different ways to manipulate one’s breath to help facilitate certain physiological functions. For example, there have been many BBPT blog posts about diaphragmatic breathing, where one breathes into their abdomen to get a stretch of both the diaphragm and the pelvic floor muscles. Well, Pilates had his own approach to breathing, which was a variation on Diaphragmatic breathing. Pilates approach to breathing was aimed at getting maximal air intake and release to give the body, what he called, “an internal shower” to rid the body of “toxins”. Pilates focused specifically on lateral expansion of the diaphragm, whereas traditional diaphragmatic breathing focuses on the vertical expansion of the diaphragm. In order to achieve this, Pilates encouraged maintaining the engaged tone of the abdomen, while breathing into the front, sides, and back of the ribcage. See the image below for further explanation.
Pilates- Ribcage/ Chest breathing versus Belly/Diaphragmatic breathing
This is an overly simplified view of the actual mechanics. However, both versions are very important. With the ability to differentiate between ribcage and diaphragmatic breathing you can offer your diaphragm a 3-dimensional stretch and the ability to work on abdominal contraction as well as endurance. If you have any questions you can ask them in the comments section. Or come visit me at Beyond Basics for a Pilates Private session!
You are what you eat. Trash in equals trash out. You can’t exercise yourself away from an unhealthy diet. These adages are often on my mind as I make my food choices because of the myriad of health professionals who have taken time to come to our practice to tell us how we can improve our own and our patients’ health by taking more time to look at what we are consuming in our diet. Lately many of these clinicians have been focusing on candida overgrowth and diet, which can contribute to pain and inflammation conditions.
What we eat can directly affect the bacterial and fungal make up of the gut, AKA the gut microbiome.The gut requires a certain level of good bacteria to help us digest what we eat. Over time a poor gut microbiome can affect how efficiently the gut works. The function of the gut goes beyond just digesting food, but also is vitally important for the production of neurotransmitters, which help to spread messages within the brain and throughout the whole body. The microbiome also plays an important role in our hormones, and immune system. When the microbiome of the gut is not balanced, it is called dysbiosis.
One of the most common culprits in gut microbiota dysbiosis is candida, (Yeast!). Candida is a naturally occurring inhabitant of the body and when it’s at appropriate levels, it doesn’t tend to be noticed, but anyone who has experienced a yeast infection knows that if this little guy is allowed to go unchecked, it can do a lot to make you miserable. Besides plaguing women with itching, burning vulvas, yeast overgrowth may cause many other ailments.
Science has pointed to the role candida can play in contributing to chronic and inflammatory conditions. In one study by Kumamoto in 2011, candida overgrowth was associated with delayed healing of inflammatory lesions and were associated with pro-inflammatory cytokines (chemicals) and increased incidence of inflammatory bowel disease like ulcerative colitis and Crohn’s disease.
Yeast overgrowth can also affect the bladder along with over colonization of saccharomyces (another form of fungus). In fact yeast and saccharomyces was found to be higher in women during a flare of interstitial cystitis than when their symptoms were low.
Yeast is not the only organism that can get out of balance and affect our bodies in harmful ways. There are many other players that can get out of balance. Some signs of an altered gut microbiome is a history of allergies, eczema, or repeated fungal infection.
What to do?
It all seems pretty dire, right. How do you control who is colonizing your gut, when you barely have enough time to make it to the gym after work? There are a few simple steps you can start with.
Avoid antibiotics, unless your doctor thinks you need them.
The medical community has become a lot more aware of the dangers of over prescribing antibiotics from their perspective, but it is important to keep in mind that a powerful antibiotic can wipe out good bacteria and bad bacteria in one fell swoop. If the good guys in your gut are reduced, the bad bacteria have a better chance of taking over. Take antibiotics only when recommended. Keep in mind antibiotics will not help treat viruses like the flu, they can only treat bacterial infections.
Modify your diet
Increase your consumption of good fats (omega 3’s) to help reduce inflammation.
Food high in omega 3’s include flax and hemp seed/oils, fish (the fishier the fish, usually means more omega 3’s, for example herring is higher in omega 3 than a milder fish like snapper). Also reduce your consumption of processed foods which can increase inflammation levels and eliminate simple sugars and fried foods. If this is only minimally successful, try a gluten and dairy free diet.
If simple changes are not helping consider seeing a professional
Find a naturopath, functional or integrated MD, or nutritionist who can investigate more fully whether or not you have SIBO (Small intestinal bacterial overgrowth), candida overgrowth, or other gut microbiome disorder. Or perhaps you are lacking certain ingredients, vitamins or mineral. These professionals can tailor a diet and medication regimen to help return your gut microbiome to tip top shape.
Kamamoto C. Inflammation and gastrointestinal candida colonization. Cur Opin Microbiol. 2011;14(40): 386-391
This blog contains information adapted from Heal Pelvic Pain by Amy Stein. If you are interested in learning more about pelvic floor exercises you can do on your own, please visit http://www.healpelvicpain.com/ , http://amzn.to/2ioSz2J, or visit us at Beyond Basics Physical Therapy in New York City to get your copy today.
In an earlier post we discussed the positive benefits of adding diaphragmatic breathing to your routine to reduce stress. If you missed it, check it out here .
But why not go a step further. Did you know that you can add pelvic floor drops to your breathing routine to help relax a tight and painful pelvic floor.
What is a pelvic floor drop?
A pelvic floor drop is the relaxation of the muscles of the pelvic floor. It is like that feeling you have when you can finally relax the muscle in between your legs after holding urine in for a long time. It’s a great feeling of relaxation and here’s how you can mimic it when you don’t have to go.
But How do I do it?
Step 1: Get comfortable. Sit, stand, lay down, whatever suits you, relax your body and close your eyes
Step 2: Breathe deep. Inhale between 3 and 5 seconds
Step 3: Exhale. Exhale slowly, 5-6 seconds. As you exhale imagine your breath gently placing pressure on your pelvic floor into relaxation. Don’t push or strain.
Like diaphragmatic breathing, you can use this technique throughout the day to help reduce stress and pain in the pelvic floor. Happy breathing!
Hello folks! Beyond Basics Physical Therapy’s latest health tip is the seated hamstrings stretch!
Why seated you ask? In selecting this stretch over other hamstrings stretches, I wanted to pick something that most everyone can be able to do. This stretch is particularly beneficial for those of you who have difficulty getting on and off the floor. Although if you do have difficulty getting off of the floor, it is important to go to physical therapy and get the training to do so, as being able to independently get up off the floor is imperative for maintaining independent function as you age. Another point: if you have any sciatic pain or sitting pain, please seek a physical therapist before attempting this stretch.
Muscles involved: Hamstrings, gastroc soleus complex ( your calf) and to some extent your sciatic nerve
Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold muscle, because unwarned muscle doesn’t stretch as well as warmed up muscles.
Caution: It is possible to overdo it. Stop the stretch or ease up if you feel tingling in your legs or pain in your low back.
As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modifications.
Directions: Sitting in a sturdy chair, ( don’t do this on a rolly stool or office chair, please!). Straighten knee of leg to be stretched and point toes up. Lean forward at the hips until you feel a gentle stretch in the back of your leg. Don’t round your back. Keep in mind, for those of us with tight hamstrings, you will feel the stretch without too much of a forward bend. So take it slow!