Is Exercise the Fountain of Youth (Part II)

So, is exercise the fountain of youth??? It may be the closest thing we have to it. Lots of things change throughout our lives including our cars, jobs, and houses, but our bodies are the one constant that is with us for the long haul. We can’t trade it in or upgrade it so taking the time to learn about how we can keep our engine running smoothly with appropriate nutrition and exercise is worth it. I don’t plan on going in depth on nutrition, but anyone with direct questions is more than welcome to ask by posting a comment on the blog, and I will be happy to answer your questions. No one can deny that our food choice has a profound effect on our energy levels and overall health as we age.

Physical activity also has a profound effect on our engine, so much so that it can help to maintain our cardiovascular system, our mental health, and it can prevent or control symptoms like osteoporosis, arthritis, prolapse, and incontinence. Why are we all so willing to take multiple pills to control all or some of these symptoms when we can simply learn specific exercises to control them?

Let’s start with osteoporosis which is defined as “the reduction in mass of bone per unit of volume, interfering with the mechanical support function of bone.” It is said that this bone loss begins after the age of 25 and speeds up after menopause. How do we prevent it? With resistance exercise! Find a physical therapist near you who can teach you appropriate strengthening exercises for your legs, arms, back, and appropriate postural strengthening exercises. Some of these exercises can be as simple as squats at the kitchen sink, shoulder blades squeezes “down and in,” as well as resistance training for your upper and lower body using your own body weight, tubing, or hand weights. Bottom line: Resistance exercise can help prevent osteoporosis.

Arthritis is defined as “inflammation of a joint.” Arthritis can cause significant stiffness and pain, but don’t let it scare you. The best way to fight arthritis is to move the joint to flush out the inflammation and increase circulation. Out with the old, in with the new! Arthritis will cause you to be stiff and sore in the morning or after prolonged sitting but you have got to keep working the joint to prevent the inflammation from just sitting there. Warm showers in the morning improve circulation and blood flow, and exercising throughout the day to move the joint is important. A physical therapist can show you how to strengthen the muscles that support the joint to prevent excessive wear and tear. One the most common mistakes I see among patients with arthritic knee(s) is stopping squatting down or avoiding stairs because it hurts. The avoidance will only serve to further weaken the knee joint as the muscles supporting the knee are no longer worked. Rather, performing controlled squats with weight on your heels, not going past a 90 degree knee bend may control, if not improve your knee pain.

The next two conditions of incontinence and prolapse can also be controlled with an appropriate exercise program. Specific exercises are presented clearly on our Hab It: Pelvic Floor DVD which provides physical therapy guidance through four separate workouts aimed at helping strengthen pelvic floor and support muscles. Let’s talk about prolapse and incontinence, two very common conditions experienced with increased age.

Prolapse, “the falling or dropping down of an organ,” is often described as a heaviness within one’s vaginal opening or a feeling of “lack of support”. The prevalence of prolapse symptoms in women post partum and perimenopause is staggering. The numbers seem to be increasing as women are talking more openly about their symptoms and looking to do something about it. Can you believe exercise can control this as well? Picture our organs – your bowel, bladder, and uterus – suspended by ligaments and cradled by our pelvic floor muscles. The organs are being pulled down by gravity our whole lives and then hormone changes that occur with pregnancy and menopause, as well as the trauma of childbirth, can change the ligamentous support for these organs. That leaves our muscles to hold everything in place. A physical therapist or the Hab It: Pelvic Floor DVD can show you several exercises and appropriate postural alignment to help support your pelvic organs to prevent or improve your prolapse symptoms.

Incontinence is “the involuntary loss of bowel or bladder control.” Did you know that an estimated 20 million women experience involuntary urine leakage? This is no small problem. A few simple exercises every day could resolve a great number of these cases and could improve many others. A women’s health physical therapist in your area or the Hab It: Pelvic Floor DVD can coach you through a specific exercise routine to strengthen the appropriate muscles. Exercises will include drawing your pelvic floor up into your pelvic outlet and holding it for endurance as well as short, quick contractions; strengthening your lower abdominals (transversus abdominus) while drawing your pelvic floor up toward your belly button; and also strengthening the support muscles of your deep hip rotators, your lower back and your inner thighs.

Specific exercise programs for all of these symptoms (osteoporosis, arthritis, prolapse, and incontinence) are like regular tune ups for your body. I don’t want to pretend that the solution to any of these problems is simple. You have to be a student of your own body and commit to regular exercise routines to reap the benefits. No one can do it for you. The reality is that you are the driver and you want your body’s engine to run as smoothly as possible for as long as possible. To do this, tune ups are required along the way!
(All definitions taken from Taber’s Medical Dictionary)

Is Exercise the Fountain of Youth? (Part I)

What happens to our bodies as we age? Can we stop or slow the effects of aging? Does menopause signal the beginning of a slippery slope? Well…let’s talk about it.

As we age we may notice decreased endurance, decreased balance, decreased flexibility, decreased strength, or decreased agility. You may begin to experience hot flashes, mood swings, or symptoms such as incontinence, prolapse, arthritis, osteoporosis, and others.

What may cause these changes? It may be decreased activity level as we age, less variety of activities, or natural hormone changes that contribute to some or all of these symptoms. As a physical therapist, my specialty is exercise and I want to highlight the direct link exercise has with our physical, mental, and emotional health. I want to talk about both the type of exercise and the intensity at which you challenge yourself and how this can affect some of the symptoms listed above.

For example, when we are younger we may play organized sports, dance more often, or chase our kids around, all activities that require more side to side movement and more change of direction which helps maintain our agility and balance. We may challenge ourselves more with cardiovascular exercise, working out at a higher intensity or competing in races. This requires our lungs take in maximum amounts of oxygen and our hearts to pump more efficiently to adapt to our work load. The loss of flexibility as we age may be the result of prolonged poor posture or simply that we have stopped moving all of our joints to end range.

In fact, these are all normal changes associated with aging. However, we have the ability to slow these effects by staying active and challenging our bodies with a variety of activities. By staying active, we can slow the decline in performance of our heart, lungs, and neuromuscular system. In other words, the old saying that “if you don’t use it, you lose it” is very true. If you never exercise to the point where you are breathing heavily, you will see a rapid decline in max cardiac output and max O2 uptake. If you never work activities that move your body side to side, front to back, or up and down, you will lose agility. If you don’t work single leg balance or walk on uneven terrain, your body will lose this ability as well. And if you don’t move or stretch all of your joints to end range, you will gradually lose mobility of your joints and flexibility of your muscles.

So what do I recommend? Get out and move! Climb the stairs – don’t avoid them. Take a dance class, work single leg balance every day, begin to increase your intensity level during workouts two times per week to raise your heart rate and breathing rate to an effort level where it would be difficult to hold a conversation. Don’t be afraid to try something new. A variety of activities will challenge your neuromuscular system in new ways, keeping all of your muscles, nerves, and joints active and healthy.

In the next blog, I will go into more detail about the various things we can all do to help slow the effects of osteoporosis, arthritis, prolapse and incontinence.

General Health September 25, 2009

Getting Back into Daily Activities and Exercise

I just finished a morning run and I was thinking about how running has helped to strengthen my pelvic floor. These were thoughts I needed and wanted to share with those of you who have avoided whatever activities you used to do, including regular fitness like walking, running, hiking and aerobics, because of incontinence or prolapse issues. The truth is, that just like my legs and arms are stronger and more toned because of my running and stabilization exercises… so is my pelvic floor.

I certainly wasn’t symptom-free when I started. I had done all the exercises included in the Hab It: Pelvic Floor DVD, consistently, for 8 weeks and was symptom-free with my daily activities. But, now I wanted to get back to my regular cardio workouts. I remember when I first started running after delivering each of my babies (which was well after my OB gave me clearance at 6 weeks, because I felt such a heaviness in my vaginal opening). I felt like I had to suck my stomach in and keep all my air up in my chest to help pull my pelvic floor (PF) up. It wasn’t a comfortable feeling, but I knew through experience that if I pushed my body to a new level, it would adapt and strengthen to accommodate the new challenges. I also knew that if I avoided all the activities that caused my prolapse or incontinence to increase, my body would never strengthen to the degree that I needed it to, to maximize my activity level and feel like my old self again.

So I ran. I worked my way into it slowly, alternating running and biking days and building my time and intensity gradually. What happened over the next 4 weeks was a decrease in that heaviness I felt within my vaginal opening while running and I also noticed that I never thought about it during my daily activities any more, including yard work, vacuuming, and carrying one or two of my children at any given moment.

I did, however notice that I could still feel my prolapse when I would sprint. So that was my next challenge. I began tossing in ten 50-100 yard sprints twice a week. My body once again got stronger. I have heard the same stories from hikers who would continue to experience symptoms as they would descend from their hike, or women who avoided jumping jacks, etc. My advice has always been the same: Gradually increase the load and intensity of exercise and your body will respond with appropriate strength and endurance gains. Remember this is true when rehabilitating any muscle group in your bodies, including a leg muscle, a shoulder muscle, your back muscles, or your pelvic floor muscles.

My rehabilitation recommendation for advanced PF strengthening is to perform 6 core and PF stabilization exercises each day, including your Kegel exercise (both quick flicks and long holds) and exercises aimed at strengthening inner thighs, low back, transversus abdominus, and hip rotators (you can find four physical therapist-guided workouts on the Hab It: Pelvic Floor DVD). Also, learn to find neutral spine and be aware of your posture and hold it there with contractions of your transversus abdominus and multifidi muscles (also on the Hab It DVD).

And the bonus on the days where you can squeeze it in is 20 minutes or more of a cardio workout to challenge your weak PF muscles. The next question may be, “How do I fit that in to my already crazy schedule?” The answer will vary for each of you. It may be in the morning or during nap time or maybe at night. A 20-minute workout is easier to shoe horn in than an hour-long workout so I have included an example of one of my running workouts below. Usually I can get this one in before my kids wake up in the morning or during nap time because, let’s face it – I, like many of you, have 3 little ones right beside me most of my day.

This is one of my favorites, a quick and a good strength builder. But don’t forget, your stabilization exercises are the priority and the cardio is a bonus right now!

Treadmill Program – 20 minutes

The idea here is to be running at your comfortable 30-minute run pace at the 10-minute mark. This means start wherever you like and increase as fast as you like so that at the 10-minute mark you are at a pre-determined pace. Then the increasing begins. 1 mph every 30 seconds for the next 10 minutes. Challenge yourself!

1. Begin on treadmill, running at a good pace.

2. Build yourself up so that at the 10 minute mark you are at your normal treadmill running pace.

3. At 10 minute mark, increase your pace one tenth mph (i.e. from 7.5 to 7.6 mph)

4. Continue to increase your pace by one tenth every 30 seconds. ( This means that your race pace will go up 2 mph by the end of your run)

5. You are done at the 20 minute mark.

Great Job!!!

Cardio Questions August 24, 2009

Better Sex Too???

Well, I thought I would blog about this topic simply because women want to know! It is not the focus of our DVD, but it certainly is a positive side effect. The question is “Will these exercises improve my sex life or increase my orgasm potential?”

The exercises that women are asking about are the same exercises that help to improve or resolve symptoms or incontinence or prolapse. The reason these two results may overlap is because the focus for both is our pelvic floor. Remember, our pelvic floor is made up of four different muscle layers. They are, from superficial to deep, our anal sphincter, our urogenital triangle, our urovaginal sphnincter, and our levator ani muscles. You can refer to http://en.wikipedia.org/wiki/Urogenital_triangle or

http://www.primalpictures.com/Pelvic-floor-disorders.aspx for a clear anatomical illustration of our pelvic floor for reference.

The urogentital triangle is made up of several muscles including bulbospongiosus, ischiocavernosus and the superficial transverse perineum muscles. These muscles are sexual in function and contract along with other muscles of our pelvic floor during orgasm.

The levator ani muscle group is made up of the pubococcygeus muscle, the illiococcygeus muscle, and the puborectalis muscles.

As you work through exercises to strengthen your pelvic floor, the same exercises found on our Hab It: Pelvic Floor DVD ; ) and some of which are referenced in the article “Sexual Healing” on page 104 of the June/July issue of FitPregnancy, you are contracting, strengthening, and increasing blood flow to all the muscles of your pelvic floor including the muscles that are sexual in function.

As you contract these muscles, you are increasing blood flow to the area. Increased blood flow increases the reactivity and sensitivity of those muscles, which can only be positive for sexual function. In addition to increased sensitivity, as you perform these exercises regularly, you will be strengthening all of these muscle groups as well. As you strengthen the muscles of the urogenital triangle, you are increasing your chances of experiencing longer and stronger orgasms.

These same exercises will give you a stronger abdominal basket with better postural endurance and help to close down the pathway extending from your bladder to your urethral opening. This is the main focus of our Hab It: Pelvic Floor DVD, but who can argue with a few positive side effects!

General Health July 31, 2009

Revisiting the Belly “Pooch”

I decided to revisit the belly pooch topic because I was fielding a lot of questions regarding how to keep the muscles of our midsection engaged while sitting. I made such an effort to describe appropriate standing posture but, given that many of us spend a lot of time throughout the day sitting, it seems I left out some important information – sitting posture.

My comment on the previous “belly pooch” blog was that the posture you hold throughout your 24-hour day plays the biggest role in shaping your midsection. If you sit for the majority of your 8-10 hour work day, you cannot sit back on your buns and tail bone with a rounded back and rounded shoulders and expect to look tight and toned the minute you stand up.

So how exactly do you sit with appropriate posture and engage your core muscles? The first step is to get to the front edge of your chair. If you have ever been coached to scoot your buns back in your chair and then work to press your back against the seat back, “sitting up straight”, please forget everything you have been taught. The problem with this is that it is far too much work and you will fatigue and go back to a slouched/slumped posture because it “feels better”. The reason why this is too much work is because your hips are at the same level as your knees. When your hips and knees are at the same level or if your hips happen to be lower than your knees – such as in a car – you have to work to overcome your hamstring tension that rounds out your lower back. Remember, a healthy low back is a back in neutral spine with the natural lordotic curve, not a flat back or rounded back. So the key is getting your hips higher than your knees when you are sitting. Most office chairs are adjustable, so simply sit to the front edge of your chair with your feet on the ground and pay attention to your hip height vs. the height of your knees.

The second step is to roll forward onto your “tripod.” Your tripod is made up of your 2 sit bones and your pubic bone. If you roll forward on your tripod, your tail bone is actually lifted as it is supposed to be and free from contact on the chair. If you are rolled back on your buns or feel any pressure on your tail bone, you are not in good sitting posture. You will know that you have found your sitting tripod as long as you feel pressure up front on your pubic bone.

Once you find your tripod sitting position, your body will automatically be in neutral spine with a natural lordotic curve of your low back. The best part is that as long as you are on your tripod, this position requires no extra work from your muscles. You will notice that when you are in this position, you sit up taller, taking your midsection out of the slumped posture you are usually in. With your midsection stretched out and your chest up, you can now focus on engaging your transversus abdominus muscle to draw your belly button in, essentially tightening up the corset around your neutral spine. It is this conscious effort of engaging your transversus abdominus that will gradually improve the tone of your belly pooch.

To finish your posture up through your shoulders and neck, simply open up your hands. Making sure your thumbs are pointing up throughout your day (you never want to look down and see the back of your hands) will ensure your shoulders are open and where your shoulders go your head will follow!

So a quick review of appropriate sitting posture:

1. Sit to the front edge of your chair with hips higher than your knees

2. Find and sit on your tripod

3. Engage your transversus abdominus

4. Open up your hands

Initially following all of these steps will take a conscious effort but, if you are consistent, it will become an unconscious habit. Not only will it help your belly look better, but you will feel better, take in more oxygen, reduce the stress on your back, shoulders, and neck and, who knows, maybe you’ll be more productive throughout your work day!

Favorites Pelvic Basket Muscles Posture July 25, 2009

What Exactly is Our Core???

Everyone seems to be trying to work their core these days, but many are unclear as to exactly what their core actually is. Today, I hope to give you more insight into this topic as well as provide you with a visualization of your core and the associated actions of your core muscles.

The core is the midsection and the support structure for every step, every reach, and every twist of our body. It surrounds and supports the spine. So, for starters, visualize your spine. Think of it as several building blocks stacked, one on top of the other, with the responsibility of supporting the very heavy and very active shoulders, arms, and head. With this thought, you can begin to understand the inherent instability of our spine and why back pain is so prevalent. The major support structures for the spine are the muscles attached to it, otherwise known as the core muscles. They react like guide wires, pulling, twisting, and stabilizing, allowing only specific segments to move while others hold on tight.

These stacked building blocks that make up our spine are also affected by the movement and position of our hips and legs, adjusting to every step, turn, and squat. Given that, it is truly amazing that we remain upright, as our spine works to accommodate all these forces.

Our core muscles make this all possible and become even more important as we dance, run, jump, swing a bat, or kick a ball. Some of the more important muscles of our core that provide this stability are our transversus abdominus muscle, our lower back muscles, our oblique muscles, our quadratus lumborum muscles, our pelvic floor muscles, and our diaphragm.

Below is some detail on each of the mentioned muscles, to give you an idea of how they work:

Transversus abdominus muscle – tightens around our lower back like a back brace or a corset, cinching up our midsection.
Lower back muscles – these muscles include our multifidi muscles and are found in between each spinal segment, controlling small movements and stabilizing each segment; and our erector spinae muscles, which are the bigger layers of muscles that run up and down our spine, move and support bigger segments.
Oblique muslces – tighten around our spine in a diagonal pattern.
Quadratus lumborum muscles – help to enclose the sides of our abdomen.
Pelvic floor muscles – these muscles are actually the floor of our abdomen, working to support our abdominal organs against the force of gravity.
Diaphragm – the muscle that forms the top, or the roof of our abdominal core, affecting the intra-abdominal pressure as we breathe, talk and laugh.

All of these muscles play an important role in stabilizing our spine, and strengthening them will give you a strong core. For those of you who have worked through pilates or yoga instruction, all of these terms should be familiar to you. Most of these classes will instruct you to strengthen and stabilize from the inside out, focusing on the first movement of pelvic floor elevation, all while continuing a steady breathing pattern. If you have not been able to attend a pilates or yoga class in your area, I strongly recommend you start, or if you prefer to work out in your own home, work out with our Hab It: Pelvic Floor DVD to direct your focus on the right muscles!

Pelvic Basket Muscles Posture July 10, 2009

The Importance of Posture

Posture has an effect on the health of our bones, the volume of air we can take in to our lungs with every breath, and the strength of our muscles (including our pelvic floor (PF)). So how is it that can something as simple as posture can affect so many things within our body?

Well, first of all, posture is not simple. It’s a dynamic balance of the muscles on the front, back, and sides of our bodies. Our skeleton would simply collapse without the support of our muscles, tendons, and ligaments. Our posture is challenged everyday by gravity and the daily activities we perform that are usually out in front of our bodies, requiring us to reach forward with our arms, stoop forward, and sit for great lengths of time. Very rarely do we perform activities that strengthen the muscles on the back side of our bodies. Rather, these muscles are constantly working to hold our shoulders and head back and the natural curves in our upper, middle, and lower back. Over time these muscles get stretched out and give into the effects of gravity and repetitive activities that we perform out in front of our bodies.

The good news is that these changes in muscle length and gradual decline in muscle strength can be reversed by consistently performing specific exercises aimed at strengthening the muscles on the back side of our bodies. To help with that, I have described two simple exercises below, which specifically target postural muscles.

Bridge with 3 second negative–Lying on your back with your knees bent, squeeze your buns tight, press through your heels, lifting your buns up. Press your hips up and squeeze your buns tight for a count and then lower slowly to a count of 3-2-1. When your buns contact your bed or the ground, reset, press through your heels and lift your hips again. Perform 3 sets of 8 repetitions.

Shoulder blade scarecrow squeezes –Hold your arms out to the side with your elbows bent and your hands hanging down like a scarecrow. Rotate your hands up and pull your elbows down in a “W” position, squeezing your two shoulder blades down and in for a count. Release the squeeze by rotating your hands back down and then repeat for 8 reps.

So, how does better posture improve the health of our bones, our lung volume, and the strength of our muscles? First, let’s take a look at the effects poor posture has on the health of our bones. If we consistently hold a slouched posture with rounded shoulders, we are more likely to experience shoulder pain or neck pain. And if our middle spine is constantly bent forward in a rounded “C” curve, we experience compression on the front side of our spinal vertebrae which can lead to disc problems, sprains, strains, and eventually compression fractures of our spinal vertebrae.

Posture is also very important for our lower extremity. Our knees, hips, and lower back are affected by how our feet contact the ground. So we look at our posture from the ground up. If there is uneven pressure on the inside or outside of our feet, we will have more compression on the bones within the outside or inside of our knees that breaks down the cartilage and eventually can lead to osteoathritis. Another example is the position of our knees. If we allow them to lock back when we are standing, we increase the wear and tear on our hips and/or low back. So you can see that postural awareness is key to the health of our bones from our head to our toes. By holding appropriate posture, we maintain good spacing within our joints, reducing joint compression forces that can lead to arthritis, bone spurs, and fractures.

Appropriate posture also affects the amount of air we can take in with every breath. Rounded shoulders and forward head posture compress the rib cage and doesn’t allow full expansion of our lungs. The less oxygen we take in with every breath, the less oxygen-rich blood that reaches our brain, organs, and muscles. By standing in neutral spine and holding our shoulders back, we are able to achieve greater lung expansion. The challenge is to hold neutral spine throughout our day. It takes awareness and effort to hold this dynamic position when gravity and most of our daily activities are pulling us forward. (See how to find neutral spine below)

If you observe someone with poor posture carefully, you will see the muscles in their neck and upper chest are working hard to pull in the limited amount of air they can. This limits the amount of oxygen reaching the brain, organs, and muscles, affecting our health overall.

How does posture affect muscle strength? The answer to this question is that every muscle has a specific length at which it has its greatest strength. The muscles on the back side of our body get stretched out as gravity and repetitive activities pull us forward so they gradually get weaker. Also, those muscles that are shortened to a point where there is minimal muscle tension also experience a gradual strength decline. This is exactly the case with our pelvic floor muscle when we don’t hold optimal posture. Our PF is at the perfect length to provide good tension, holding up our abdominal organs and keeping us continent when we are in neutral spine. This is because our pelvic floor is attached from our pubic bone to our tail bone (coccyx), so the muscle tension changes as we rock our pelvis from forward (tucking buns under) and backward (sticking our buns out). Neutral spine gives a slight lift to our tail bone giving the perfect tension to our PF muscles. This neutral spine position also shifts our pubic bone down, giving more bony support to our abdominal organs.

So the big question is how do we find our neutral spine position? First, take your pelvis through its full range of motion. To do this, place your hands on your hip bones so you can rock your pelvis like a cradle. Rock your pelvis, first sticking your buns out and then tucking them under. These are the two extremes of the range of motion of your lower back and pelvis. To find neutral spine, rock your pelvis once again, sticking your buns out and now rock your pelvis back ever so slightly so that you are in between the two extremes. Finish by pulling your abdominals in tight. Here you have found your neutral spine. If I were to push on your shoulders, compressing your spine when you are here, you would be solid as a rock and in perfect balance. These are subtle movements of our spine and it’s not easy to control without visual feedback, so I strongly recommend the use of a mirror as you initially find your neutral spine. (For more detailed instruction on posture and neutral spine positioning, please refer to our Hab It: Pelvic Floor DVD)

To finish with optimal postural positioning, let’s take it from the ground up. Place your feet shoulder width apart with equal weight on each leg, careful not to lock those knees. Find neutral spine of your low back and pelvis and draw your abdominal muscles in tight. Then finish by simply opening up your hands so your palms face forward. This action rolls your shoulders back without effort and produces ears over shoulders, over hips, over ankles. Work to find and hold this neutral spine position throughout your day to take care of your bones, to maximize your oxygen uptake, and to achieve optimal muscle strength and support!

Posture July 6, 2009

Getting Rid of the Belly “Pooch”

So often I get asked: “How do I lose this belly pooch up front?” Women will tell me that they have lost all of their weight after pregnancy, but they just can’t shrink their belly. It is true that this is the area most stretched during pregnancy, but you don’t have to settle for the post pregnancy belly pooch. This is an area that can be trained with the appropriate exercises and appropriate posture.

I want to highlight the importance of posture in ridding yourself of the belly pooch. Realistically, if you exercise for 30 minutes to 1 hour a day, you have to recognize that the way you hold your body for the remaining 23 hours will have an effect on your body shape and tone as well. So even if you master all the exercises I will teach you that target your midsection, and you do them every day for 10-20 minutes, but you go right back to sloppy/untoned posture for the rest of the day, you are destined to keep your belly pooch.

However, if you are diligent with the exercises I have listed below AND you work to hold optimal posture as much as you can throughout your day – which requires engaging your transversus abdominis (TA) muscle to hold neutral spine – you will see your midsection cinch up in 4-6 weeks.

So let me introduce you to your TA muscle. It acts like a low back brace, wrapping around your midsection from front to back. You can picture this muscle tightening much like tightening the laces on the front of a corset, squeezing your belly flat.

The following exercises are 3 examples aimed at tightening up your TA and oblique muscles (the abdominal muscles that pull into a “V” position). The last exercise listed is coaching through optimal posture, which is the final key to ridding yourself of the belly pooch.

Before starting, I want to help you help you identify and feel your TA muscle contract within your own body. Finding your TA muscle can be tricky for those of you who haven’t been coached through it before. The easiest way to feel this muscle contracting is to first get on your hands and knees. In this position, keeping your hands and toes on the ground, lift your knees slightly – just barely lifting them from the ground. It is your TA muscle that is working to lift your knees from the ground. To ensure that you’re doing this correctly, remember to barely clear the ground. If you lift too high, other muscles will begin to assist. The closer you keep your knees to the ground the more you isolate your TA muscle. Perform 10 of these TA lifts, holding for a 3 count with each lift and you will feel exactly where you TA muscle is. If you like this exercise, perform 3 sets of 10 repetitions and add it to the other two exercises as part of your routine. The next two exercises target both your TA muscle and your obliques, which are key in ridding yourself of the belly pooch.

1. Plank position with knee drive/rotation – Lie on your stomach and curl your toes under and place your hands under your shoulders. Push up through your arms, lifting your body straight up and ensuring that your weight is on your hands and toes (you should be in a rigid straight positiong, making sure that your back is not sagging and that your buns aren’t too high in the air). Pull your belly button in toward your spine and then pull your right knee up and across toward your left elbow and hold for a two count. The closer your knee gets to your elbow, the better the oblique crunch. Extend the leg out straight and elevate your leg slightly, squeezing your glute for a count and repeat. Begin with 3 x 6 on this exercise and then progress as you are able up to 3 x 10. Remember low back pain/ache is a sign to stop.

2. Quadriped opposite arm/leg – Position yourself on hands and knees with your eyes looking down. Draw your belly button in toward your spine, take in a breath and now exhale as you extend your right arm and left leg out straight. Hold for a 2 count and inhale as you bring them down. You will feel the difficulty of this exercise as you extend both your arm and leg out away from your center of stability. You should be feeling your lower abdominals working hard to keep your body from rocking side to side. As you fatigue, do not rush the exercise. Continue to hold your arm and leg extensions for a 2 count, focusing on keeping your body rigid. Perform 3 sets of 10 repetitions.

3. Optimal postural positioning – Let me remind you again about the importance of holding optimal posture throughout your daily activities. This will increase your muscle tone throughout your midsection in just a few weeks, but it does take work. Optimal posture, from the ground up, starts with your feet. Place your feet shoulder-width apart with equal weight on each leg. Be careful not to lock your knees. Find neutral spine of your low back and pelvis, using a mirror to view your lumbopelvic mobility. For more in depth instruction on finding neutral spine of your low back and pelvis, please refer to my previous posture blog and /or our Hab It: Pelvic Floor DVD. To finish and hold this optimal posture you have to draw your abdominal muscles (TA) in tight. Remember, this is like cinching up your corset or low back brace, and work to hold this toned midsection as you go through your daily activities. Then simply open up your hands so your palms face forward. This will roll our shoulders back without effort and produce ears over shoulders over hips over ankles. That’s optimal posture! Good luck everyone!

Pelvic Basket Muscles Posture June 29, 2009

To Kegel or Not To Kegel…

The Kegel exercise is the cornerstone of pelvic floor (PF) rehabilitation for incontinence and prolapse. Some have called Kegels a worthless activity or a waste of time. Nothing could be further from the truth. Kegel exercises are highly effective if performed correctly and that is where women need more direct instruction. Today, I will give you that direct instruction.

Let me begin by telling you a proper Kegel or PF contraction is a two-step process. The first step is to squeeze your PF muscles as if to stop the flow of urine or the passing of gas. Usually, this step is the only one women are instructed in and the second most important step is left out. That critical second step is to draw your PF up into your pelvic outlet, as if there is a string attached from your belly button to you PF and you are attempting to pull it up into your abdomen. This elevation takes your pelvic floor from a bowl shape to a flattened, tighter position within your pelvic outlet.

You can confirm that you are doing the first part of the Kegel correctly by inserting your finger tip into your vaginal opening. You will feel a light squeeze on your finger when contracting your PF. The second part – the PF elevation – cannot be felt with palpation since the muscles that are working are internal. You can, however, feel your belly button draw in as you work to elevate your PF. The movement you are feeling is the contraction of your TA (Transversus Abdominis) muscle which cinches up your midsection and works in a coordinated fashion with your PF. One final cue is to remember to keep breathing as you elevate you PF. If you are holding your breath to draw your belly button in, you are using the wrong muscles. Therefore, focusing on continuing a steady breathing pattern is important.

It’s important to note that PF elevation is not easy as you first begin. It requires concentration and visualization because this is a contraction that you cannot see, but can only feel. Initially you should perform this exercise lying on your back with your knees bent. Work to hold your PF elevation for 8-10 seconds (remember to keep breathing normally!) before releasing and allowing your PF to completely relax.

On our Hab-It: Pelvic Floor DVD, I then instruct patients to follow this long hold with four “quick flicks” which are actually quick contractions of your PF or simply part one, outlined above, of a Kegel contraction. These don’t require a longer hold. Rather, they are performed to a rhythm of “contract-relax-contract-relax…” and so on. You can visualize these quick contractions being important for strong and fast reactions of your pelvic floor as you cough, laugh, or sneeze. The elevation of your PF that is the second part of the Kegel contraction works the muscles of your pelvic floor that have endurance roles. This includes supporting your bowel, bladder, and uterus, and giving effective compression to the pathway extending from your bladder to your urethral opening. It is this compression that will help to completely resolve your incontinence symptoms.

Simply performing the first part of the Kegel and just tightening the muscles around the three openings of your pelvic floor will NOT help with prolapse issues and usually will not completely resolve incontinence. It is this incomplete exercise instruction that is giving the Kegel a bad rap. Many women blog that they performed 40 + Kegel exercises per day for weeks and saw no results. My message is to try it again, focusing on a 2-step process and let us know the changes you experience after four weeks.

So, back to our initial question…”To Kegel or Not To Kegel?” I give an emphatic “YES”, you must Kegel but you also must do it right!

Kegel June 22, 2009

Is my leaking just a function of my weak bladder?

The answer to this question is a resounding “NO!” The bladder is made up of smooth muscle, over which we don’t have voluntary control. Muscles that we can voluntarily contract and relax and strengthen are called skeletal muscles. Our pelvic floor is made up of these types of muscles – skeletal muscles – and controls the passage of solids, feces, and gas from our bodies. These muscles include the sphincter muscles, the urogenital triangle, and the levator ani (which is made up of the pubococcygeus, illiococcygeus, and puborectalis muscles). The names of these muscles are not so important to remember, but their actions are.

The pelvic floor muscles perform two very important and distinct actions. The first is to tighten around the openings of our pelvic floor (you can contract those muscles by simulating stopping the flow of urine or the passing of gas). The second action is to elevate or to draw up the pelvic floor from its relaxed position (in this state, it’s shaped like a bowl) to a flattened, tighter position, higher within our pelvic outlet (the space bordered by our two sit bones, our pubic bone, and our tail bone, also known as our coccyx), giving better support to bladder, bowel, and uterus.

So the answer is that your leaking is not due to a weak bladder, but rather to weak pelvic floor muscles. The good news is that you can strengthen your pelvic floor muscles to stop this leaking by following an appropriate pelvic floor strengthening exercise program. You can get a specific pelvic floor strengthening program through physical therapist-guided DVDs or books or, if you prefer, through one-on-one coaching from a physical therapist. You can find a physical therapist in your area who focuses on women’s health by clicking on the link on our www.hab-it.com website.

Understanding Incontinence June 15, 2009