Neutral Spine Posture Is Not Easy…It’s Dynamic!

Neutral spine posture is a key piece of the puzzle when working to rehabilitate pelvic floor dysfunction. It is one of the three key components of a successful rehabilitation program and probably the hardest to comply with. Why is it so hard to follow through on neutral spine posture? For those of you who work hard to find and hold optimal posture throughout your day, you are well aware that neutral spine posture is a dynamic position. It is a position of free movement and balance between full extension and flexion of all of our joints. It requires muscular control versus the locking of joints or the tension of ligaments or tendons. This begins at our knees where we don’t want our femoral condyles locked in full extension on our tibial plateau, but rather just out of full extension in a position of free movement. This dynamic position requires coordinated firing of our quadriceps, hamstrings, and calves, to provide stability to our knee joints. This position is not as easy as locking our knees, but it is so much better for the health of our knee joints as well as our posture up the chain.

Next, we can look at our pelvis. It is easiest to either allow our pelvis and lumbar spine to lock back in full extension (anterior pelvic tilt) or to rock forward, resting on the tension of our hip flexors and ligaments (posterior pelvic tilt). Either of these two positions will set us up for injury through excessive compression of our lumbar vertebrae or pelvic/hip dysfunction. Rather than locking joints, positioning of the pelvis just out of the fully extended position allows free movement of the multiple joints of our pelvis, hips, and spine. Finding your neutral spine is key to maximizing blood flow and muscular control, setting the base for your thoracic and cervical spinal building blocks. This position of free movement of your pelvis and lumbar spine is not easy. Just like our knees, it requires a coordinated effort of muscles on the front and back side to hold this dynamic position. It is the co-contraction of our multifidi muscles, our transversus abdominus, and our pelvic floor muscles that help to stabilize our lumbo-pelvic girdle, setting the base upon which the rest of our spine is stacked.

Much like everything in life – if it seems too easy, it’s probably not right. Posture certainly follows this rule. It takes an awareness of your body and consistent reminders to hold neutral spine posture. You can refer to to see and hear the cues that will help you find your own neutral spine. Let your posture be a focus by keeping your muscles “on,” and your body in a position of free movement. It’s not easy but the benefits are worth it!

Perhaps Under-Appreciated, But Really Key: Multifidi Muscles

The multifidi muscles are some of the most underused muscles in our body. This is the reality for many of us, but the problem is that they should be engaged throughout all of our daily activities. They lie very close to our spine and work to extend each individual vertebrae. This extension is especially important in our lower spine that is built to have a gentle lordotic (concave) curve.

Maintaining this gentle curve is important for our lower back health and more. If we lose the extension of our lumbar spine, then we change the building blocks upon which our thoracic and cervical vertebrae are stacked. Physical therapists assess this lumbar curve in patients with neck pain, shoulder pain, lower back pain, pelvic pain, hip pain and more because it is often the root of the cause of chronic pain and dysfunction. Your lumbar curve provides the central shape from which the rest of your skeleton is affected, setting your posture when sitting and standing. Your posture in turn, affects the tension of muscles, tendons, and ligaments, putting them in perfect position to react and contract, or in many cases of poor posture, to not react or contract at all.

Our multifidi muscles play an important role in holding us in optimal (neutral spine) posture. Their action is to extend the spine, so keeping them active prevents the flattening out of our lumbar curve. Our multifidi work together with our transversus abdominus (TA), pulling against one another, to give stability and strength to our lumbar spine as we lift, twist, and reach. Both of these muscles, are key components of our pelvic basket that coordinate along with our pelvic floor muscles, our inner thighs, and our deep hip rotators to prevent pelvic floor dysfunction.

Finding your multifidi and the extension of your lumbar spine is key to resolving/controlling your pelvic floor symptoms. I have included two of my favorite multifidi activation exercises below. Remember, it is important to keep your multifidi activated throughout your daily activities to hold your natural lordotic curve in sitting and standing positions. So a step beyond completing one of the workouts from the Hab It DVD daily, is to check your multifidi and lumbar posture at different times throughout your day!

Multifidi extensions (3 sets x 10 repetitions) – Position yourself on your stomach with your forehead on a towel roll to avoid having to turn your head to the side. In this position, perform 10 contractions of our multifidi muscles. These are very small muscles in between each segment of our spine that holds our natural curve or neutral spine. So, in this lying position, simply rotate your pelvis, lifting our tail bone up toward the ceiling. The movement is very subtle so you shouldn’t see a big rotation of your pelvis. Remember to SLOW DOWN holding each lift for a count before relaxing and repeating. (This exercise can also be completed in standing position)

Standing Hamstring Extensions (3 sets x 10 repetitions) – To begin, stand with your feet approximately 6 inches apart with a slight bend in your knees. From this position, hinge at the hips tilting your upper body forward. Take care to keep the arch or lordosis in your lower back as you hinge your upper body forward. It may help to think of sticking your buns out. When you reach a point of hamstring tension, stop your forward hinge and begin a set of 10 knee extensions, straightening your knees followed by small knee bends. 3 sets of 10 repetitions will produce good passive tension in your pelvic floor as well as a good hamstring stretch. Note that your mulitifidi have to work throughout this exercise to keep the arch or lordosis in your lower back.

Such a BIG Difference!

So many women have been told to “do your Kegels.” They may do hundreds each day with no results. Talk about frustration! What they need to recognize is the importance and key role of their transversus abdominus (TA) muscle in relieving symptoms of pelvic floor dysfunction (including both prolapse and incontinence). This isn’t so much the fault of the women receiving the message but, rather, the fault of the health care provider giving this incomplete instruction.

Activating your TA muscle is a step beyond a simple Kegel, and will actually lift your pelvic floor. It will draw the muscles and the connective tissue of your entire pelvis to a higher, tighter position. To give you a clear visual of your TA muscle, you can simply place your hands on your hips, then slide your hands forward until your fingers touch. Your fingers from your thumbs down to your pinkies are the fibers of your TA muscle. They enclose the front of your pelvic cavity and encircle the soft tissue within your pelvis, attaching to the fascia of your spine in back. In order to engage or activate your TA muscle, you can focus on drawing your belly button “up and in.”

Engaging the co-contraction of your TA muscle and your pelvic floor muscles is the deepest contraction that offers stability to you lower lumbar spine, hips, and pelvis. Get to know these muscles. They are the root of your core! Stopping short and only contracting your pelvic floor leaves your spine, hips, and pelvis very vulnerable to dysfunction. We see evidence of this in the frustration so many women experience with “doing their Kegels.”

Learning the coordinated effort of the TA and pelvic floor is such an important lesson that we have made that the focus within the Hab It: Pelvic Floor DVD. The two 2-step Kegel contraction taught on our DVD will begin to re-train your body how to activate your deepest core muscles, setting you down the path to improved symptoms of pelvic floor dysfunction.

Questions from You to Me: Cystocele and Pilates

I was recently diagnosed with a cystocele. Do you feel that if I continue to work out with your DVD exercises that I will recover? I’m in good health, not heavy, I work hard at home. I had 3 children with vaginal births. I am 65 and work full time sitting, and walking throughout the day. I love your DVD. Thrilled to find this on the market and have used this for one week now. I do feel better. I do reformer Pilate’s for 30 minutes a week. I’ve asked the trainer to only work on pelvic floor. Is this okay?

So glad you found the DVD, and I have every confidence with your activity level that you will be just fine. That doesn’t mean that after a hard day working in the yard, you won’t feel an increase in symptoms, but it does mean that you will know exactly what to do to recover just fine by the next day.

I want to encourage you to read through my blogs. There are a lot of great topics in there that will help you. I am a yard work lady too, and just this year I still noticed my symptoms increasing with snow shoveling. I gave the tips that I worked with, being sure to breathe out and keep my TA engaged, that helped me…and this is 7 years after I first discovered my prolapse. So take comfort that, in years to come, you will continue to find different things that will help your symptoms.

Your job is sitting, so I encourage you to extend your spine on breaks throughout the day. Lie on your stomach if you can, if not stand up and do some multifidi extensions intermittently throughout your day. Also, think about using a stability ball for a chair that will hold you in better posture by sitting on your “tripod.”

Regarding the pilates – way to go! That is a great workout, but I caution you on doing any exercise that makes you feel pressure bearing DOWN on your pelvic floor. When the work load moves beyond the capacity of our transversus abdominus, we recruit our rectus abdominus (RA), which automatically forces pressure onto our pelvic floor (whereas the TA cinches up our midsection and forces the pressure up under our ribs). The RA is easily recruited on the reformer so be careful.

Finally, work your way through the DVD AND read through my blogs to arm yourself with as much info as possible! Then, look for an advanced workout that we are uploading on our site soon…just as soon as our web designer gets everything set. If you are doing pilates, this advanced workout may be perfect for you. I will also be uploading an intermediate workout soon, as some woman would like something in between the Hab t DVD and the advanced workout.

Glad you found us Donna. Now work on finding your TA and that connection to your pelvic floor and you will be fine!

Questions from You to Me: Can I Cycle and Swim?

What activities can I still do while I strengthen up my pelvic area? Are swimming and OK to do?

Cycling and swimming are absolutely perfect! I like cycling because it forces you to hinge at the hips and extend/lift your chest, which draws all of your fascia and connective tissue up (this brings our pelvic organs to an elevated position as well). And swimming is a great exercise because it is non-impact and emphasizes extension (I have a blog entry specifically on swimming!).

So go for it! Your desire to be more active will only help your pelvic floor strength as long as you are conscious of your posture and are consistent with doing core stabilization exercises that are found on the Hab It DVD. One more note – if you like to walk or run, it is okay to work these activities into your week as well. Build your time/distance slowly and your body will adapt to the stresses that you place on it.

How to Best Handle a Cough or a Sneeze

I have been asked some great questions regarding sneezing and coughing and the pressure these sometimes violent actions can put on our pelvic floor. I don’t pretend to have all the answers, but our bodies usually do. Pay attention to what your body does when you sneeze.

When we sneeze, many of us squeeze our knees together or even cross our legs. If you think about it, by doing this we are recruiting our adductors (one of the muscles we need to strengthen as part of our pelvic basket). We often unconsciously fire these muscles because our bodies know that by engaging our adductors, we can assist our pelvic floor muscles.

Some others may sit down quickly if they feel a sneeze or cough coming on. This is usually done with a forward lean which extends our spine and lifts our tail bone putting a passive tension on our pelvic floor. Once again, our bodies will lead us into a position that will better support our pelvic floor.

If we pay attention to our body it will show us, in these subtle ways, how we can help ourselves. To take this knowledge and help ourselves further, we need to allow ourselves to use all the muscles of our pelvic basket to help work against the force of a sneeze or cough.

Here are some helpful tips that you can try:
• Draw your transversus abdominus (TA) muscle in and elevate your pelvic floor as you feel the sneeze or cough coming on.
• Resist the urge to crunch your body forward since this will recruit your rectus abdominus (RA) and draw your ribs down, allowing no expansion of your chest and forcing the pressure downward. Make a conscious effort to stay extended whether sitting or standing.
• Follow your body’s urge to squeeze your knees together. This will assist your pelvic floor. To take it a step further, turn your toes out to recruit your external hip rotators further assisting your pelvic floor.

So go ahead and sneeze…you can handle it!

Nutrition Tips

In my last blog, I mentioned how we have choices as they relate to our nutrition, activity, level and posture, etc. To get you thinking about what sorts of choices you might make about nutrition, I thought I would give some tips on good nutrition for a healthy body. So here we go:

Nutrition Tips
Your Goal is to EAT CLEAN – think foods from our earth, limiting foods with added sugar and other ingredients that you don’t recognize. This leaves no room for chips (baked chips are the exception), mac & cheese, crackers, most cereals…basically anything packaged.
• Let Breakfast and Lunch be your bigger meals and your dinner should be a lighter meal compared to the previous two. Think like this…Breakfast= Protein+Carb+Fruit, Lunch= Protein+Carb+Fruit, and Dinner=Protein+Carb+Vegetable
Snacks are good around 10 and around 2:30 (give or take) IF you are not cheating with high calorie and processed foods. If you cheat, skip the snack!
Always have fresh fruit in the house: have ½ cup with every breakfast and every lunch! Oh, and don’t forget that fruit with a little protein via nuts or cheese or a nut spread is a perfect snack.
Decide what veggies you will eat and plan at least ½ cup of veggies every night with dinner.
Allow yourself one dose of chocolate (preferably dark chocolate) per day.
Do NOT drink your calories. No soda – choose tea, coffee, or water.
Never stuff yourself – eat as if you are going to workout in about an hour.
Recognize Food as Fuel – eat to fuel yourself for the day ahead, to fortify your body to help fight off illness, and to supply your body with the nutrients to replenish the water loss and muscle breakdown from the day.
Good Protein choices – chicken, pork, lean turkey, fish, egg whites, and beans.
Good Carbohydrates – potatoes, multi-grain toast/bread, brown rice, whole wheat noodles.
Good Fats – avocados, olive oil, nuts – fats help to keep you feeling full longer!
No room – eating all the fruit and veggies you should eat, leaves no room for cookies, cakes, etc.

Breakfast: Protein+Carb+Fruit+Milk or OJ
• Toast with natural peanut butter, almond butter, or Nutella + ½ cup fruit + glass of milk or OJ
• Toast with scrambled egg whites (2) + slice cheese or 1 cup yogurt + ½ cup fruit + milk or OJ
• Can substitute a low fat Nutrigrain Eggo Waffle for toast above. Good with honey.
• 1 cup yogurt with granola or some other carb + ½ cup fruit + milk or OJ
• Fruit Smoothie – Good with frozen fruit + 1 cup yogurt + 1 cup pineapple or OJ + 1 banana
• Oatmeal with brown sugar + ½ cup fruit + milk or OJ

Snack options: Focus on light carb with protein at both 10am and 2:30pm.
• Smoothie – frozen fruit, yogurt, juice and banana
• Carrots or any veggie with balsamic vinaigrette dip, hummus spread, or nut spread
• Apple with almond butter or Nutella dip (limit to 2 tablespoons)
• Celery with natural peanut butter or almond butter
• Hand full of pretzels with tablespoon of natural peanut or almond butter
• Hand full of almonds or walnuts – can mix with a few cranberries for added taste

Lunch: Protein+Carb+Fruit
• Turkey or Ham or Tuna Sandwich (1/2 or full depending on sides – for instance if you have a couple of red potatoes with your sandwich, then you would go with ½ a sandwich because the potatoes would be extra carbs) + fruit or veggie
o Can have handful of baked chips with sandwich…or
o Can have 1 cup yogurt…or
o Can have any of the snacks listed above with your sandwich
• Salad – a salad anytime with balsamic vinaigrette is a good choice. Need to have protein with this – good source is avocado, tuna, turkey, ham, beans, or hardboiled egg minus the yoke. Easy to add veggie to this with cucumber, carrots, red bell pepper, tomato etc.
• Fish of any kind with sides including a veggie and a carb

Afternoon Snack: Many options of light protein and carb listed above.

Dinner: Protein+Carb+Vegetable
• Soup – with side of toast or another light carb. If there is no vegetable in your soup, then have ½ cup on side.
• Turkey or chicken or bean taco – serving size would be one soft shell tortilla or if you want a hard shell, you could have 2. Easy to include veggie in this.
• Whole wheat noodles with chicken or turkey and sauce. Serving size should be one cup of cooked noodles. Don’t forget your veggie.
• 5 oz. Ahi tuna steak or salmon filet that cooks easily. With veggie & carb (toast, potato, rice)
• Chicken breast or Pork chop with veggie and carb
• Could make your own mini pizza. You can eat ¾ of this and save other ¼ for lunch the next day with apple slices 🙂
• Turkey, chicken, pork, fish – make them any way you like and add a carb and veggie
• Salad with added veggies and an added protein
• Many, many options as long as it is a lean protein, a whole wheat carb, and a vegetable

Do Our Bodies Have a Chance to Remodel?

I believe they do. Our bodies are constantly remodeling throughout our lives for better or for worse. Here are some examples – we have all seen the world class athlete turn into an inactive, sedentary ex-athlete. Their body remodeled by turning their lean muscle tissue into adipose tissue. How about a more positive story of the 40 year old life-long smoker who stops smoking and sees many of the changes in his lungs and body reversed now that he has stopped smoking and began exercising.

Our habits, our posture, our strength, and our activity level all affect how our bodies remodel over time. If we passively stand by and watch changes take place, we are sure to see aging take place at an accelerated rate. But if we set our minds on the goal of remaining active, working a regular strengthening program, holding neutral spine posture, and engaging our pelvic basket, we give our bodies an opportunity to achieve better health. We can make the positive changes to our posture, activity level, strength, and nutrition at any point in our lives and see the benefits. One of these benefits may be reversing or controlling the symptoms of prolapse and/or urine leakage.

There is connective tissue surrounding our pelvic organs that works along with ligaments and tendons to hold our organs in place. The connective tissue throughout our bodies is a living tissue that is constantly either going through a process of regeneration or degradation. This connective tissue is the support structure of our bones, our muscles, and our organs. It is important to understand that with healthy activity, good nutrition, and optimal posture, we can harness this regeneration of tissue and remodel our body in a positive way. This is an important message for any woman experiencing prolapse or incontinence. By consistently holding a more supportive posture for your pelvic organs and engaging the correct muscles to help cradle your organs, you give your body an opportunity to lay down new connective tissue that can help to hold your pelvic organs in an elevated position.

Remodeling our bodies takes consistency and a commitment to positive lifestyle changes. The benefit over the years will be more than providing better support for our pelvic organs. Many will note relief from chronic pain, many will note improved energy and endurance, and so many of us will prevent future dysfunction, all with a consistent focus on posture, nutrition, strength, and increased activity.

Questions from You to Me: Is Doing Pilates OK Given My Symptoms?

I have a rectocele and did pilates yesterday. I noticed that it got worse and was wondering if pilates isn’t a good option for me?

I have cautioned on pilates in the past. It is a great form of exercise as long as you are aware of your limits. Absolutely anything that causes any intra-abdominal pressure to force your pelvic floor down is a NO-NO. For example, any double leg lift or lower is out. All plank exercises are okay, because these recruit your TA and force pressure up under your ribs. Also, as you do the exercises, be sure that you are breathing throughout the exercise and not holding your breath.

Questions from You to Me: How to Progress Through Workouts

Can you clarify how I should progress through the four workouts you have included on the Hab It DVD?

My minimum recommendation is to do a workout three times per week. This means workout #1 on Monday, workout #1 or #2 on Wednesday, and workout #1 or #2 or #3 on Friday. The speed with which you progress through the workouts depends on your fitness level and your core strength as you begin the program.

For example, immediately following giving birth or if you haven’t worked out much in the past 6 months, I recommend that you begin with workout #1 for the first week, completing this same workout Monday, Wednesday, and Friday. Then, if you feel good with that first workout, progress to workout #2 the next week.

Once you have mastered most or all of the workouts, it is a great idea to rotate through the workouts so that you challenge the same muscle groups with a different exercises on different days.

Finally, feel free to complete the workouts more than three times per week. Five times or even seven times per week is fine. However, I do want to caution everyone not to perform more than 8-10 two-step Kegel exercises per day. Doing so can over-fatigue your pelvic floor.

I hope this clarifies workout frequency and progression. Continue to ask questions as they come up so that you can get maximum benefit from our Hab It workout!