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.

Endo Awareness Month: How Endo can Affect your Tummy

Amy Stein

Beating Endo Cover

March Is Endometriosis Awareness Month. Treating endometriosis and improving the lives of people with endometriosis has long been a passion of Dr. Amy Stein, founder of Beyond Basics Physical Therapy, so much so, that she teamed up with Dr. Iris Orbuch and wrote a book about it! This month we are reviewing some of the major talking points in their book, Beating Endo . For more on endometriosis, check out our past blogs as well as Beating Endo.

Endo Awareness Month: Understanding Endo

Endo Awareness Month ( Part 2 of 4) : How Endo can Affect your Bladder

Endo Awareness Month: Sleep, The Ultimate Self-Care (Part 3 of 4)

This week we are continuing our series on endometriosis. We are highlighting how endo can affect your gastrointestinal system (your tummy) and what you can do about it. As you may recall from our previous blog posts, endo occurs when endometrial like cells occur outside the uterus. These cells can implant themselves within the abdomino-pelvic cavities and its organs causing inflammation and reducing the movement of the organs therein. The symptoms caused by endo in the gut are myriad. These symptoms can often be unpredictable and incredibly frustrating to those experiencing them. These symptoms may also occur regularly or at various points during one’s cycle and can be just as frustrating.

GI symptoms commonly associated with endo include:

  • Bloating
  • Diarrhea
  • Constipation
  • Painful bowel movements
  • Abdominal pain

With all this going on in the gut, there are still some things you can do. The pelvic floor is the “governor” of bowel function. When it contracts, it holds bowel movements in, and when it relaxes, it allows bowel movements out. With endometriosis, and the inflammation and pain it can cause, the pelvic floor muscles often get very tight, which worsens the problems outlined above. Pelvic floor PT can help reteach those muscles to relax and let go, thereby improving your GI symptoms!

How to help your tummy at home:

The I Love You Massage

How to do it:

Flatten your palm, make a fist, or use your fingers, first to trace the letter I in a descending movement from just under your left rib cage to your pelvic bone. Do this ten to fifteen times. Then place your palm, fist, or fingers under the right rib cage and draw the L— right to left horizontally, then straight down to the pubic bone. Again, do this ten to fifteen times. Finally, the U: Start on the right, at the top edge of the pelvic bone, and massage up toward the rib cage, then left across the body, then down to the top of the pelvic bone. Do this ten to fifteen times as well. What you have done is massage the descending colon, the transverse colon, and the as­cending colon, thus stimulating the involuntary contractions that actually move the stool. Use moderate pressure; if it hurts, lighten the pressure. If it still hurts, stop—although even a light massage may cause some soreness at first.

For more, check out Beating Endo!

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! Standing Side Splits

StandingSideSplits

Kierstin Elliot

Exercise: Standing Side Splits

Set Up: Stand with one foot on the carriage and one foot on the platform with weight distributed evenly between both legs. Slightly turn out your legs to help engage outer rotators and glutes. Lighter spring setting will focus on adductors (insides of legs) while a heavier spring setting focuses on abductors (outsides of legs).

Execution: The breath for this exercise changes based on adductor or abductor focus. For adductors- inhale to push carriage away from the platform and exhale to pull carriage back in. For abductors- exhale to push carriage away and inhale to control the carriage back in. Move the carriage out only as far as you can go while maintaining good form, as soon as neutral pelvis shifts to a tilt or a tuck, you’ve gone too far.

Focus: Be sure to keep the integrity of your form throughout the entire exercise. Keep a tall, stacked spine with ribcage over hips, neutral pelvis, and lifted arches. Think of a string lifting you up from the crown of your head. It’s common for the arches of your feet to drop, causing pronation. Keep that pinky toe connected to the machine. This will also keep the knees in correct alignment.

Importance: Great postural exercise. It’s meant to focus on either adductor or abductor strengthening depending on desired resistance. As a whole, it draws attention to weight placement and how that affects your alignment while standing.

Modifications: If you are apprehensive about balance, grab a pole or a long dowel and place that on the floor right in front of you while standing on the machine. If this exercise bothers your knees, keep a slight bend in them the whole time.

Pilates with Kierstin! Bridges with Stability Ball

Kierstin Elliot

Exercise: Bridges with Stability Ball

Set Up: Lie on your back with knees bent, with left foot flat on the mat, and stability ball under the right foot. Arms resting by your sides. Neutral pelvis.

Execution: Inhale to prep. Exhale to lift pelvis off the mat into bridge position while pressing left foot firmly into the mat and right foot firmly into the stability ball. Hold bridge for one breath, then lower with control maintaining a neutral pelvis. Repeat 5-10 times on this side and then switch to the other leg.

Focus: Keep pelvis completely level throughout the entire exercise. Be sure to not overuse or arch the lower back. Ribs should be flush with abdomen and the knees should be reaching over the toes.

Importance: Key muscles targeted in this exercise are the glutes and hamstrings! Pelvic and core stability are also challenged due to the stability ball. If you feel only your hamstrings engaging as you bridge, move heels closer to sits bones. This should help the glutes turn on.

Modifications: If you find adding the stability ball too challenging, don’t continue using it with faulty form. Try marching slowly in a bridge position- hold the right leg up for 5 counts, then slowly transfer to left leg lifting for five counts. Keep alternating legs being sure the pelvis stays level and glutes and hamstrings are engaged. If you find you pelvis dropping on one side as you do this, then do fewer repetitions to start.

Marathon Training: Two Perspectives

sneaker.pngAs we creep closer and closer towards marathon weekend, our very own Tina Cardenia PT, DPT, CFMT and Victoria LaManna (Vicky) PT, DPT, CLT, PRPC were kind enough to share their stories about preparing for the 2018 New York City Marathon. Vicky will be running her first marathon on November 4th, 2018 in order to raise money for Multiple Sclerosis Research. Tina was gracious enough to volunteer her expertise in orthopedic physical therapy to help Vicky have the best run possible for a great cause. If you are interested in donating to support MS research, please donate here and read more about their stories below. If you are interested in hearing more about our orthopedic and sports program here at Beyond Basics Physical Therapy, give us a call at 212-354-2622.

From the Runner’s Perspective

victoria2016

Victoria LaManna (Vicky) PT, DPT, CLT, PRPC

This year I am participating in my first ever marathon in the NYC Marathon for Team TischMS. Truly, this is my first ever 5k, Half Marathon, or Full Marathon. I am traditionally an anaerobic, (short bursts energy) exerciser. I have played soccer, dabbled in Muay Thai kickboxing, yoga, and weight lifting for exercise. The mind-body challenge of running a marathon (and doing it all for a great cause!) appealed to me. But where to start?

Luckily, I am in a profession that specializes in exercise, injury screening, and prevention, as well as injury rehabilitation. One of my co-workers has also run a few marathons and pointed me in the right direction for a training schedule. To further help ensure success in my training process, I also started physical therapy and made sure I got on my co-worker Tina’s super busy schedule.

vicky.pngShe first tested my core strength, checked hip mobility and strength, as well as spine and rib cage mobility. All areas that are important for efficient running. Tina found that I had poor core-first responses to outside forces, meaning that every time my foot hit the ground while running, my core was not firing to connect my lower extremities to my trunk. This could definitely be why I was experiencing right low back pain with running, and it could actually lead to further injury and result in not being able to RUN at all! Tina also found limitations in my breathing, rib cage, and thoracic mobility. Other than back pain, my first main complaint a few weeks into training was that I could not breathe. While you could chalk that up to poor conditioning, it was something that was felt immediately in runs – as if I just did not have the capacity to take a breath in. This is where we started our treatment – rib cage and thoracic spine mobility.

From there, Tina continued treating based on observation of my running pattern. She continued to work on hip, spine mobility and core control based on what she saw was insufficient in my running. My breathing improved greatly, as well as my mobility. I began to run completely pain-free with ease.

About 2 months away from Marathon Day, I injured my right foot trying to complete a 16-mile training run. I was unable to walk without pain and was limping around the office. Tina quickly observed that I had a bone in my foot and ankle that were compressed and out of alignment. Her work to align my foot and ankle, working all the way up again through my hip and trunk helped me to get back to pain-free running.

I am all set to run the NYC Marathon Sunday, November 4th! I am incredibly thankful to Tina for helping me to get through my training pain-free, manage an injury along the way, and quickly get me back on track for race day. And I am thankful for Team TISCH for allowing me the opportunity to join their team and support a great cause that affects many men and women.

Are you training for a marathon? Looking to improve your running form? OR even improve your golf swing? I would highly recommend seeing a physical therapist for an injury prevention screen for any and all sports, recreation or exercise. Setting yourself up for optimal movement and mechanics will enhance your activity, as well as reduce the risk of injury. It worked for me!!

 

From the Therapist’s Perspective:

Tina Cardenia PT, DPT, CFMT

Tina head shot

Victoria LaManna is such an inspiration. She volunteered to run the NYC marathon this year with little to no running experience and I was lucky enough to help prepare her! I have been working with Victoria for the past 6 months and I am amazed by how far she has come and how much she has already accomplished. Each week during our PT sessions there were a couple of things that I would look at to monitor her progress. I would observe her running, assess her core with tests called the Lumbar Protective Mechanism* and the Elbow Flexion Test*, her standing posture, her single leg stance, double leg squat, single leg squat, her glut and hamstring strength and how it connects to her trunk, and trunk rotation range of motion.

I saw that Vicky’s main limitations when I was observing her run were her limited trunk rotation towards the right, poor landing control on both of her legs especially her right one, and running with her feet turned out. One of the main things I looked for when observing Vicky run is the force transfer through her body from her feet to her trunk, and how the force translates through the rest of her body. It looked as though the force transfer wasn’t as efficient as I would have liked and this repetitive stress through her back and legs could potentially lead to injury.

tina and vickyVicky’s limitation with trunk rotation correlated to one of her complaints of having difficulty breathing during her runs. It seemed as though she was only able to get a good breath through only one side of her body. Upon examination, I found that she was limited into rib cage expansion especially on the right side. After some rib mobilization and breathing inhalation retraining and working thoracic spine rotation Victoria was able to rotate more symmetrically and reported an increased ease of breath with running.

Vicky’s lack of control with landing while running meant that she had a lack of eccentric (the motion of an active muscle while it is lengthening) control through her pelvis, causing compression through her back every time she lands. This could explain the low back pain Vicky has been experiencing. To address this, I worked on increasing the mobility and range of motion through her hips, pelvis, and back. I then worked on retraining her body with specific neuromuscular techniques called Proprioceptive Neuromuscular Facilitation (PNF) and specific exercises to help Vicky create a core first strategy with her running. This means, with every step and every movement Vicky is able to initiate with her core muscles first, which prevented her from overusing her bigger muscles which tend to fatigue quickly and can lead to injury and pain.

Vicky was running with her feet turned out causing poor force absorption from her feet up to her body. This style of running can also result in muscle overuse injuries and pain over time. This could have also been contributing to her complaints of shin splints while running. To work on this, I evaluated Vicky’s foot and ankle mobility, her knee tracking with squats, and single leg squats. With knee tracking, I noticed that she went into valgus with both of her knees, but it was worse on her right. Valgus means that her knees were “knocking in” which was an issue of having weak hip strength as well as lack of mobility and flexibility through some of her leg muscles and joints.  I did a lot of manual work to restore good range of motion and mobility and a lot of muscle retraining and drills to train Vicky to use those muscles appropriately and to be able to carry it over into her running.

After all this training and all the hard work that Vicky has been putting into running, Vicky’s running form now looks great! She has much more mobility through her trunk, is able to control her landing much more efficiently and is able to connect her feet for a better push off during running! Even as Vicky increased her mileage, she kept reporting to me how much easier her runs have been feeling, how much easier it was to breathe and how much more ease of motion she had through each run, and I couldn’t be more proud of her hard work!

*The Lumbar Protective Mechanism and the Elbow Flexion Test are special tests that come from the Institute of Physical Art. If you would like to learn more about their approach to PT, click here.

Life After Giving Birth: Trying to Get Back to Competing After Pelvic Girdle Pain (PGP)

Note from Fiona McMahon PT, DPT

In this blog, our guest writer is talking about pelvic girdle pain (PGP), which can often get confused with pelvic floor dysfunction (PFD), although they are related, they are different conditions. For pelvic floor dysfunction, we often caution against just strengthening the pelvic floor. Often times the pelvic floor muscles are over tightened and tense and strengthening often can worsen the situation. Pelvic girdle pain refers to issues around the pelvic bones and sacrum. Both can occur during pregnancy but often require different treatment approaches. If you have pain, come see us at BBPT.

ball court design game
Photo by Pixabay on Pexels.com

 

Exclusively written for BeyondBasicsPTBlog.com

By: AvaFreya

Back in college, I used to be an avid tennis player and even had the chance of representing my school in intercollegiate tournaments. I would wake up at 5 am for three-hour training sessions all the while trying to balance my studies. But after college, the corporate life sucked me in, and I was lucky if I got to play for an hour every other week.

Then after childbirth, my life consisted of trying to raise a beautiful baby boy. I haven’t picked up my racket in months. It’s not because I don’t have time for things other than raising my child – I’ve been blessed with a husband who assumes his fair share of the responsibility. What’s holding me back is my physical state. The pelvic girdle pain (PGP) I experienced during pregnancy never really went away postpartum. In truth though, it is not uncommon. The American Physical Therapy Association notes that many women continue to have the symptoms of PGP after birth.

It’s a scary thought not to be able to do something you used to love so much. Compared to other stories I’ve heard, my case can be considered mild, but I had to seek help if I wanted to play again. Beyond Basics Physical Therapy led me to Pilates and I learned to channel my breathing in a way that it gently engages my pelvic floor [ remember this may be appropriate for PGP but not necessarily PFD]. It has been a great way to reintroduce strength to my core, considering that pregnancy has changed my body in more ways than one. When I get nostalgic and look at pictures from my glory days, I barely recognize myself. Where are the muscular legs, rock hard abs, and enviable arms? Not in this 34-year-old body of mine, that’s for sure. But I’m committed to gaining control over my body and getting back to the court.

But in the five months that I’ve been doing painstaking therapy, my sacroiliac joint feels a lot better, and I no longer feel stiff. During my recovery, Serena Williams was a great inspiration to me. For one, she’s a fantastic player, and Coral identified her as the highest paid female tennis player. More importantly, though, she’s a mom who never used her pregnancy as an excuse not to get a hold of her life. She probably even went through the same pain many other women, and I did. When I was bed-bound during my pregnancy, my idol was playing in the Australian Open while she was 8 weeks pregnant and even won the final.

Not all women’s bodies are the same or even experience pain similar to mine, but Williams continues to be my inspiration on and off the court. I have been playing tennis with my trainer—sometimes with my husband—and we sometimes play for as long as my stamina allows it. Torquing my hips doesn’t worry me anymore, in fear of a sudden crack of my bones anymore. On excellent days, I think that my backhand is even returning. Although I suspect that it will be a long time before I regain the level, I was playing at during college

Note from Fiona McMahon, PT, DPT at Beyond Basics Physical Therapy

We are so grateful to have AvaFreya share her experience of returning to tear up the court post baby! Everyone’s story evolves so differently with pregnancy and childbirth, which is what makes it both terrifying, exciting, and momentous, all the same time. The truth is some women bounce back on their own, (lucky duckies), others find it to be much more complicated. We recommend coming to visit a Pelvic Floor Physical Therapist during pregnancy and after you give birth to guide you to a program that is right for you. We often run into women, who with the very best of intentions, started down a path that actually made them worse! Often times we see this with women doing excessive Kegels when their pelvic floor is already too active secondary to weakness somewhere else in the body. Frankly, it’s a total bummer and delays getting back to the things you love. If you have recently had a baby or are currently preggers, you owe it to yourself to see a pelvic floor physical therapist who can advise you on exercises to do on your own or treat you more intensively if you need it. Your time and your health are way too precious.

 

For more reading on pregnancy and pregnancy-related conditions, please check out these blogs:

 

Stop Doing Kegels: Real Pelvic Floor Advice For Women (and Men)

Sacroiliac Joint Dysfunction

Lace up or Feet up? Running During Pregnancy

Why Do I Still Look Pregnant?!: Diastasis Recti, Part I

Why Do I Still Look Pregnant: Part II

Mind the Gap: Diastasis Recti Abdominis and What We Don’t Know: Part I

Mind the Gap Part II: Improving the Look and Function of the Mommy Tummy (Diastasis Recti)

 

 

 

We have offices in both midtown and downtown locations. If you recently have had a baby or are pregnant, please give us a call at

 

212-354-2622 (Midtown)

 

212-267-0240 (Downtown)

 

We are offering free phone consultations in both locations for a limited time!