A Closer Look at Pelvic Floor Health & Function – Part 1

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1 in 3 people in the western world will have a pelvic floor disorder in their lifetime. It is so common in our population that it’s often considered “normal” as we age to have urinary and/or fecal incontinence. But incontinence isn’t the only dysfunction related to pelvic floor disorder. Those with pelvic floor problems may also experience hip and low back pain, prostate problems, and in some cases, even organ prolapse.

Causes of Pelvic Floor Disfunction

There are several possible causes of pelvic floor dysfunction. This article will focus breathing dysfunction how it can be addressed.

Breathing Dysfunction

While not the most obvious cause of pelvic floor dysfunction, improper breathing may be the most important. This is because the way we breathe has an outsized influence on the strength of the pelvic floor.

Let’s look at the structure of the pelvic floor in order to better understand how our breathing influences its function.

The pelvic floor has 3 layers that include the following:

Endopelvic fascia – This is the non-contractile fascial and ligamentous support network.

Pelvic diaphragm -These layers contain the muscles of the pelvic floor and include the internal sphincter muscles of the bladder and rectum. They are primarily responsible for continence and support of the anus, vagina, prostate and the stability of the sacroiliac or S.I. joint.

Urogential diaphragm – These muscles also support continence as well as sexual function.

Strengthening the Pelvic Floor is Essential

To improve the pelvic floor function, we essentially need to improve its strength in each of these layers. Herein lies one of the key challenges for improving pelvic floor function. We need to strengthen both the muscular layers of the pelvic floor AND the facial layer. But fascia is not like muscle tissue in that it is not contractile, which presents an interesting challenge in trying to strengthen it.

Proper Breathing is the Key

The key to strengthening our endopelvic fascia is found in proper breathing. Correct diaphragmatic breathing throughout the day, and especially when exercising, helps to support the healthy tone of the the facia along with the pelvic floor muscles, which collectively give the pelvic floor its tensile strength.

The Role of Intra-abdominal Pressure

The pelvic floor is essentially the floor of the trunk. The top of the trunk is marked by the top of the shoulders. The walls of the trunk are the spinal column, ribs, abdominal wall and pelvic bones.

When we inhale, our diaphragm moves downwards and this helps widen our ribs, allowing our lungs to inflate. This downward motion of the diaphragm also creates what’s known as intra-abdominal pressure or IAP in the abdominal and pelvic cavity. A healthy pelvic floor will stretch against this pressure, forming a pressurized container out of the trunk.

With exhalation, the lungs deflate and the pressure from the the lower trunk reduces as the diaphragm moves back up. When the pressure drops, the pelvic floor should contract proportionally to the decrease in IAP. This alternating cycle of contraction and stretching/relaxation in response to the movement of the diaphragm and IAP is the primary mechanism by which our pelvic floor gains and maintains its strength.

With every breath, a healthy pelvic floor will contract and relax, always maintaining the IAP that is optimal for the current activity. We may not even feel this as it can often be very subtle, especially when sitting at the computer. But if we stand up and lift a heavy weight, our experience of the regulation of IAP becomes much more dramatic, or at least it should.

Therefore, first and foremost, re-learning to breathe diaphragmatically is essential for proper pelvic floor function. This approach will strengthen all off the tissues of the pelvic floor, including the fascia.

What About Kegel Exercises?

Kegel Exercises are often recommended to people with pelvic floor dysfunction, especially when incontinence is involved. But if your breathing is shallow or you are a mouth breather, your pelvic floor will have a hard time doing what it ought to, even if you do Kegels all day long.

Relax Your Belly!

So how should we go about improving our breathing to support our pelvic floor function? As simple as this may sound, and frankly, for some, counterintuitive, we must start with letting our abdomen and waist relax and expand, especially when we inhale.

Having worked with more than one client who’s been sucking their belly in for half their life, I’m aware that the idea of letting the belly go may not be a comfortable one for some people. But if we’re trying to look thinner by sucking in our belly, we will most certainly develop a breathing problem, not to mention a weak core.

So if you’re not in the habit of releasing your abdomen, or you’re deliberately doing the opposite, consider trying to let it go. I guarantee it will help you get stronger, and not just in your pelvic floor. And if this is hard for you, give yourself time and consider this – many people confuse core-strength with abdominal tension, and I assure you they are very far from the same thing.

Over time, as you improve your breathing, you will find that your core strength and your pelvic floor function will both improve. And as they do, this will open the door to better overall alignment and function – topics we’ll discuss in part 2 of this article.

Stay tuned!

Why WALKING May Be THE Most Important Weight Bearing Exercise

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Older adults often hear in the media or from their doctors that they need to do more weight bearing exercise for long term health. Weight bearing exercise (WBE) has been shown in studies to improve bone density, mostly in patients with osteoporosis, and there is evidence to suggest that it can also help with balance and muscle strength.

I spend much of my time working with the very people who hear this recommendation the most, and I often get insights into how these clients interpret it. My impression is that usually when a client hears “weight-bearing exercise” they think of weight training or exercises that involve the use of external weights.

Does Weight-Bearing Exercise Mean Lifting Weights?

Do we need to be lifting weights for health and longevity? I’m not really sure that’s the case. Lifting weights, while potentially valuable for some, can be problematic for many others, and often problematic for the very people who are told to do more weight-bearing. Perhaps if we were to better understand exactly what WBE is, each of us might better understand what exercises are best for us to do and how we should do them.

Let’s consider first a basic definition of weight-bearing I found in the NIH Library of Medicine:

“Weight-bearing is any activity that one performs on one or both feet. It requires that one carry bodyweight on at least one lower extremity. Weight-bearing is an activity that the skeletal system does against gravity.”

 

Notice that it says nothing here about lifting weights. Weight-bearing, and the exercises that employ it, are simply activities that we do that load our skeletal system against gravity. In fact, I’d argue that exercises that train us to manage our own body weight more effectively and don’t involve adding any additional weight are much more important, crucial really, to our health and function, than those that do.

Don’t get me wrong. I see a lot of value in weight-training, especially for athletes or anyone needing or wanting to build strength for a particular sport or a physically demanding activity. Weight-training is also fine for someone who simply wants to get stronger for the sake of being so.

What I’m saying here is that we don’t need to weight-train to have the necessary strength to be high functioning human beings. However, we DO need to do exercises or activities that involve weight-bearing, and we DO need to do them in the RIGHT way if we want to enjoy their benefits.

So what is the RIGHT way to do WBE? Before we get into that, let’s look at why WBE is recommended in the first place.

Weight-Bearing Exercise and Bone Health

Most of the research supporting the value of WBE centers on bone health. Studies consistently show that people who do WBE can improve their bone mass, and people who do not do WBE rarely if ever do. Bone mass is important for obvious reasons. We rely on our bones for support and stability. If the quality of our bone tissue degrades, we are prone to fractures and all of the challenges that go along with them, including a sometimes fatal loss of strength and mobility.

If you’ve ever had a DEXA scan to assess your bone density, you already know that your bone density is not the same throughout your body. If there is lower than optimal bone density somewhere in your body, there will also be normal bone density in other places. One of the places where bone density is often not normal and frequently deficient is in the hip, particularly in the neck of the femur.

If you’ve developed osteopenia or osteoporosis in the neck of my femur, you may improve your bone density by doing WBE. In fact, it’s very likely that you’re already doing the most important WBE you need to do that already, and have been doing it for nearly your entire life. Can you guess what it is?

Walking May Be THE Most Important Weight-Bearing Exercise

The weight-bearing activity that nearly all of us do and do daily is walking. When we walk, we bear our full body weight on our hips, legs and feet. Walking also provides the essential mechanism by which we load our femur bones (thigh bones), and this loading is essential for their health.

Theoretically, if I place my full weight on my femur bones, and I do so with sufficient frequency, I will establish and maintain the necessary bone density I need there, even without doing any other exercises to maintain it. But if that’s the case, why is it that the neck of the femur is one of the places where bone loss is most common? The reason is that while we may be walking, we’re likely not walking in the right way – the way that would otherwise maintain a healthy bone density in this and other parts of the body.

To understand why this is the case, we need to first understand the mechanism by which weight-bearing increases bone density. Our bones have specialized cells called osteoblasts. These cells, when stimulated in a particular way, produce more bone cells and this in turn increases and/or maintains our bone density.

The stimulation these cells need to produce more bone tissue is compression. By placing weight on a bone, the bone tissue is slightly compressed by the weight, and that compression stimulates the osteoblasts in the bone to produce more bone tissue and fill in any gaps in the strength giving matrix our bone tissue forms.

But for compression to happen, the bone needs more than just weight on it. It needs to be loaded relative to gravity, meaning vertically relative to the length of the bone. IOW, I can’t sit on my sofa and put heavy weights on my thighs for a period of time and expect my bone density to increase. Not that you’d do that (would you?). Instead I need to stand up from time to time and align my femurs straight up and down while I put my weight on them, preferably one at a time.

It sounds simple enough but the evidence suggests that many of us aren’t doing this. There are a few reasons why, the primary one being that when most of us stand, our femurs are not aligned vertically. Therefore, when we put our weight on them, we are not compressing the bone in the way necessary to stimulate its growth. Instead we are placing a rotational torque on the bone and unintentionally directing that torque into the soft tissue in our hips, into our knee joints and into our forefeet and toes.

This is not a recipe for a good outcome. Should we go to the gym and add even more weight to this scenario? Clearly the thing we need to do first is correct the alignment issue. Once we do that, then standing up will properly load our femurs and stimulate the growth of the tissue in them. Then once we’ve corrected the alignment issue, then adding more weight might be helpful.

And once we’ve corrected our standing alignment, why not head out and go for a nice long walk so we can keep stimulating our bone growth? Again, seems simple enough, just as long as we can maintain the optimal alignment we’ve achieved standing while moving, which, it turns out, is trickier that you might think.

Why a Functional Gait is Essential

This is where training gait mechanics comes in. My experience has shown me that, even though it’s not always easy, we can improve our gait mechanics, and when we do so we regain an essential mechanism by which we can improve and maintain our bone health, not to mention reduce stress on our hips, knees and feet.

And walking has the potential to do much more for us than just improve our bone health. It can also be excellent for improving muscle strength and balance, two other areas where research has shown WBE to help.

When we walk with a functional gait, we work some of the strongest muscles in our body – those residing along the back of our legs and hips. Muscles such as our hamstrings and our gluteal muscles get stronger when we walk with a healthy gait, and when these musics get stronger, they also keep us more stable when standing and more mobile when transitioning to sitting, a motion that’s frequently compromised in people with balance issues.

As we look deeper into the benefits walking, a weight-bearing exercise that requires no extra weight and no equipment outside of a decent pair of shoes, it’s extraordinary just how much it can offer us in the way of tissue health, improved strength and enhanced mobility. Considering the substantial cardiovascular benefits walking also provides, we might argue that walking is the perfect exercise.

Provided that is, you do it in the right way.

DNS & YOGA 5 Class Intro Series – Digital Version NOW AVAILABLE!

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DNS & YOGA 5 CLASS INTRO SERIES –

NOW AVAILABLE ONLINE!

$108 – Buy Now!

  • The course is APPROPRIATE FOR BEGINNERS who are in reasonably good health.

  • This content of this course is intended to prepare a student of ANY LEVEL for practicing yoga in a way that is safe, effective and health promoting.

  • If you have concerns about whether the course is appropriate for you, PLEASE CONTACT ROBERT with your questions and concerns.

  • Anyone who pays the course fee is eligible for a discount on individual sessions (contacts me for details)

  • If you would like additional help during or after the course, I am available for one to one 30 or 60 minute sessions.

I’ve been teaching yoga now for over 25 years and have been studying and practicing yoga for closer to 30 years, and while I can’t claim to have made every mistake possible as a teacher and a student, I’ve certainly made my fair share. As one of the greatest teachers I’ve ever had the privilege to study with, the late Swami Dayananda would say, when we make a mistake the mature response is to ask ourselves “what can I learn from this?”

Learning from mistakes

Answering that question in most circumstances is never easy, but in yoga it can be particularly hard. Yoga is challenging and complicated, and there are very few teachers who have the special combination of knowledge, experience, insight and skill to effectively guide students in the right direction. Thus a common theme during my tenure as a yoga student and teacher has been a failure to understand what I should learn from my mistakes, and therefore a tendency to keep making them.

I spent many years in a fairly advanced yoga class with a teacher who does have that special combination of abilities, but even in that environment I saw students who’d been practicing for decades making mistakes that I’d been making and that I understood needed to be corrected. Ultimately I realized that I needed to take a new approach to yoga if I was going to learn the lessons I needed to learn and find my way forward.

When I began studying bio-mechanical alignment I realized something very important about yoga. When we as students start learning yoga, typically in a group class with an instructor whose abilities are unknown to us, we bring all of our bad habits into the class. It’s up to the teacher to reveal these habits and provide us with alternatives to them. It turns out that very few teachers are skilled at doing this, not because they don’t have the interest but because they typically don’t have the right training.

DNS & Yoga

Upon discovering Dynamic Neuromuscular Stabilization (DNS) I realized I’d found a methodology that fit yoga like a glove. The early developmental movement patterns that DNS employs through specific postures and movements are not new to us. The patterns that DNS helps to reawaken in us have, for the majority of us, always been there. This means that the changes we seek in our breath, body and mind are to a great extent a revealing of what’s already there and don’t require us to learn something completely new.

Over the past few years I have been tirelessly developing an approach to yoga that is fresh and exciting while rooted in a place fundamental to who we are as humans living in the world. Every day I find myself not so much learning something new but finally grasping postures and principles that I’ve had bits and pieces for a long time but was missing the key piece I’d needed for the unifying whole.

Learning DNS while relearning yoga has been endlessly engaging and enlightening for me as a student and as a teacher, and I am thrilled to have the opportunity to share it with you. This course is a culmination of decades of study and work. I hope you will consider taking it and recommending it to your friends and family.

 

What Are You Training For?

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To succeed with any training program I need to clearly define the goals of my training. If for instance I am training to run a marathon, I can gauge the success of my training approach on whether I am increasing the distance I run while decreasing the average time it takes me to run it. These clear goals allow me to track my progress and assess the efficacy of my training approach, perhaps leading to changes or modifications that allow me to achieve my goals more effectively.

The goals of your average “workout” or what we might refer to as “self guided training” are often much less specific. I might spend time at the gym, go out running or attend a local yoga class to “get my cardio,” “get stronger”, or “get more flexible.” For some of us the goal might even be as basic as “to exercise” or “to stay in shape.”

And while there’s nothing wrong with the desire to simply “stay in shape,” my experience has taught me that this type of self guided training can result in putting our time and effort into training ourselves to perform “better” in ways that we may not intend or in some cases, even want.

What Exactly is Training?

To understand the reasons for this, it helps to understand what I mean by “training.” Training is any activity or series of activities we undertake to learn a particular skill and/or to prepare ourselves to perform in either the activity we are training with, or in some other related activity. If I am training to be a better runner, clearly part of my training program should be to run, but it may also include other activities such as jumping rope or stretching.

Training What We Don’t Want

Training is typically done with intention, but it isn’t always. In fact, many of the habits we’ve manifested that impact our health negatively, such as the habit of internally rotating the hips – a major contributor to the development of hip and knee arthritis, are habits that we’ve inadvertently “trained” ourselves to do.

Let’s say my workout is to go running because I want to do more cardiovascular exercise. If when I run my hips internally rotate, while I may succeed in getting more cardiovascular exercises, but I will also speed the degradation of my knee and hip joints.

With this approach to training, regardless of whether I intend it or not, I am effectively training knee damage, and the more I run the faster I’ll wear out my knees doing it.

Our Mental Habits Can Interfere

One of the biggest challenges of my work is not so much figuring out what movements or postures will help my clients improve their function and health, but just getting them into the habit of doing them. Typically the obstacles to establishing a regular movement program are mental habits, often long-standing ones. These habits, established through years of repetition, are like another form of training.

A while back I started working with a new client who had come to me with a back problem. During a session I introduced some movements and postures to her, and our work seemed to be going fairly well. But afterwards, when we were looking at our respective calendars to schedule a follow up, a red flag appeared – she said she didn’t want to schedule anything in the morning, not because she was physically unavailable, but because she had a daily routine of taking her time, drinking her coffee and cozying up with the newspaper, and she didn’t want to plan anything that interfered with that.

I had never had anyone tell me something like this before, and I suppose I should have been grateful for her candidness. No doubt all of us have routines that we cherish and are loathe to disrupt. And while I completely understood and respected the priorities she’d set for herself, I also understood that the impulses behind them were going to be very much at odds with the training that I was recommending for her. She had trained a routine that would make the training she needed to do to improve her back, all but impossible.

Physical Habits Can Train What We Don’t Want

While mental habits can be a major obstacle to success in training, even when we are motivated to train, our physical habits can be just as big a challenge to its success. Walking, for example, can be one of the best ways to use movement to improve health and function. But whether walking more will really help us depends a great deal on how we walk.

Many of us develop habits in our gait that place significant stress on our bodies. It’s no wonder this happens. Our gait is a complex series of movements that happen so quickly it’s extremely difficult to be aware of our mistakes. Nevertheless, mistakes we make while walking are both highly impactful and very hard to correct because every time we walk we reinforce and re-train them.

Let’s look at another example – squatting. When I work with a client who has knee pain, I always look at their squatting mechanics. Invariably, clients with knee pain overload their knees when they squat. And since squatting is a motion we must do in some form or another multiple times a day, these folks are stressing their knees, not to mention their hips and lower back, repeatedly.

Clients who overload their knees when squatting are unaware that they are doing this. They are also unaware that there is any alternative to how they squat. For these clients, squatting is essentially “training knee pain,” and therefore if they are not trained to squat differently, the squatting habits they have trained will persist until they simply can’t squat anymore.

Training For Health & Function

I’m an advocate for an approach to training that is fundamentally different from most other forms. In my view, training should be done with the goal of health and function, rather than performance. This doesn’t mean you won’t also get stronger, more flexible, more mobile and more skilled at the movements you are training. It just means you won’t be achieving these benefits at the expense of your joints and your health in general.

Training to Be Better at Living

The training I do is essentially training for human movement. It may sound strange that I’m in the business of training people to move like a human being, but it turns out that this is exactly what works best from a health and longevity standpoint. We are all designed to move and in specific ways. When we do this things tend to go well for us health-wise.

So next time you get ready to start your workout, take a little the time to reconsider your exercise habits by asking yourself this question – “What am I training for?”. Then think about whether the time and energy you are putting into your training is really serving your goals.

If you conclude that your current training is in line with your long term goals, then continue with it for as long as that’s the case. But if you discover your training is not moving in the direction you’d like, consider changing your approach until it better aligns with what you’re after.

And if you need help, get in touch!

 

 

Your Diaphragm is a Back Muscle!

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by Tiffany Turley

When you think of your diaphragm you probably think of it as something that helps you breath and not much more than that. But your diaphragm is actually one of your major back muscles! Because of its attachments to the spine, ribs and sternum, the diaphragm is integral in supporting the joints and disks of the back and in keeping your spinal column upright and stable.

How do we keep this muscle strong and healthy? Diaphragmatic breathing. When we inhale and the diaphragm contracts, it moves downwards, not upwards like we might imagine. This downward movement creates an expansion of the lower ribs, waist, lower back and front of abdomen. This expansion is caused by pressure that builds with the downward movement of the diaphragm in the abdominal cavity called intra-abdominal pressure (IAP).

Optimal IAP causes a relatively even, 360 degree expansion of the abdominal cavity. To visualize this, imagine a circle expanding evenly into an even larger circle. The inner circle is the abdominal cavity while the outer circle is abdominal wall. The optimal expansion of IAP sends a signal to abdominal wall, formed by the trunk muscles including many of the abdominal muscles, to gently contract against this pressure. When these muscles respond appropriately to IAP, the abdominal muscles expand (stretch) and contract (resist) at once. This response maintains the pressure so that your organs, joints and disks are protected.

A healthy back is one that is upright without excessive lordosis (arching in) or kyphosis (rounding out). When we consider the essential role of the diaphragm in developing and maintaining a healthy spine, it is abundantly clear that diaphragmatic breathing is a necessity for spinal health.

So why is it that so many adults don’t breath diaphragmatically? As adults we may adopt one of several different dysfunctional breathing patterns. This is mainly due to 3 factors:

1) Cultural ideas about posture and breathing:

It’s common for many of us to have been exposed to certain ideas and expectations regarding our posture. We may have been told we need to “stand up straight” or “open up our chest.” Dysfunctional habits such as pulling our shoulders back or taking deep chest breaths to improve our posture often manifest as a result of misunderstandings about how and why to improve posture, and these habits often lead to chronic chest breathing rather than diaphragmatic breathing.

2) Breathing in and out of our mouth

When we mouth breath, the air is not pulled down as deeply into the lungs because the diaphragm does not fully contract. Mouth breathing is not only shallow breathing, it also recruits the upper back and neck muscles and this can, over time, contribute to chronic tension in the neck and shoulders.

3) Tightening the abdomen to “flatten the stomach” and brace the lower back.

For those with lower back pain, tightening the rectus abdominus, or our main abdominal “tucking muscle,” might be relieving, temporarily. But remember, in order for you diaphragm to support your back you need to have the appropriate amount of IAP. For the right amount of IAP, your abs need to need to be able to expand on inhalation. Also remember that your diaphragm needs to be able to move downward to create IAP, and it can’t do that if your abs are held tight. “Sucking it in” creates a dysfunctional tension that will only make your back tighter and weaker with time.

So how do you strengthen your diaphragm in a way that is good for your back? Just like with any other muscle it takes practice to re-learn how to use the diaphragm properly and time devoted daily to challenging it and making it capable of responding when called upon.

A very basic posture called “3 Months Supine” is a great way to start improving the function of your diaphragm and restore your abdominal responsiveness. Watch the video below for some simple cues on how to perform this very powerful and fundamental posture.

Diaphragmatic breathing will change your life. It has changed mine.

For more instructional videos and supporting content, follow us on Instagram at robertbrookyoga.

Success in Yoga: Applying DNS Principles to Classical Yoga Postures For Better Asana

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As I continue to explore the various ways that Dynamic Neuromuscular Stabilization (DNS) informs my movement and that of my clients, I continue to be impressed with how well DNS complements my practice and my teaching of yogasana (yoga postures). Classical yogasana are varied and complex, but they are always informed by the movement skills we bring to them. If those skills are limited or flawed in some way, so too will the be postures. When our movement skills are intelligent and aware those qualities will also be expressed in our asana and they will help us to bring our postures to life.

Thus far, after more than 25 years of study and practice, I have not yet found an approach to yoga that complements my practice and my teaching and that facilitates deeper knowledge of the subject the way that DNS has, and there’s every indication that will continue. As my knowledge and understanding of alignment, movement and asana grows I hope to share more of what I learn with you in the form of the posts and videos that Tiffany and I are creating and making available here on our website.

The following video shows part of sequence I’ve been working on for a while now and one I’ve begun to share with many of you in our sessions. If you are unfamiliar with the content, this video is by no means a substitute for skilled instruction. If you wish to explore the postures demonstrated in the video, I would caution you only to do so if you’re already familiar with these postures and to avoid continuing them if you experience any pain or are recovering from an injury that would make such postures inappropriate. Of course feel free to contact me for help or advice!

A Deeper Look at Pelvic Floor Strength and How to Build It – Part 1

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A quick online search for “strengthen the pelvic floor” reveals a lot about how many of us view the pelvic floor and its role in our health and function. There are any number of recommended exercises for the pelvic floor, some that include products to assist you, and with most advocating an approach that involves isolating the contraction of the pelvic floor muscles. This approach can be helpful for building some basic awareness of the pelvic floor – an important component of developing pelvic floor strength. But this approach is also limited in that it fails to address the broader and more essential role of the pelvic floor in facilitating alignment and functional movement.

The Pelvic Floor Does Not Work in Isolation

The pelvic floor muscles coordinate with several deep muscles in the trunk in order to stabilize the lower trunk and maintain the integrity of the pelvic organs, preserving continence and sexual function. These deep trunk muscles work synergistically with the pelvic floor and include the diaphragm, psoas, spinal muscles and the deep abdominal muscles. Collectively these muscles act as a flexible cylindrical, called the Thoraco-lumbar cylinder or TLC, with the pelvic floor forming the bottom of the cylinder. In addition to the muscles themselves we have a fascial layer that acts as a web-like connection between them. This facial layer interweaves the trunk and pelvic floor muscles and helps give the trunk and pelvis its shape and tone.

Diaphragmatic Breathing is Essential for Pelvic Floor Strength

This fascial connection between the trunk muscles and the pelvic floor assures no individual muscle will work properly unless there is appropriate movement and engagement in all of the muscles that form the cylinder. In other words, the pelvic floor muscles never contract in isolation, rather they co-contract in response to the movement of the diaphragm and the subsequent abdominal response needed to support the trunk. This means that in order to strengthen the pelvic floor we must breath diaphragmatically, and to maintain consistent optimal pelvic floor tone we must breath diaphragmatically throughout the day and especially during any exercise or activity.

The Role of Intra-abdominal Pressure

When we breath diaphragmatically, pressure is created inside the TLC which is similar to the pressure created inside a ballon filling with air. This pressure is called intra-abdominal pressure (IAP), and under ideal circumstances the muscles forming the TLC all respond to this pressure by contracting against it. This response should be relatively equal throughout the walls of the cylinder and serves to contain,  maintain and regulate the IAP. Maintaining IAP helps us avoid stress on the pelvic and abdominal organs, spinal muscles and vertebral joints. Thus the pelvic floor has the important role of regulating IAP by helping to maintain relatively constant control of the cylinder, and in this way the relative tone of the pelvic floor directly influences the strength and function of the whole lower trunk.

If we do not breath diaphragmatically then we do not create proper IAP, and without proper IAP there simply cannot be the coordinated contraction of all the muscles of the cylinder necessary for trunk stability. In other words, there will be no response in the pelvic floor muscles if we are not breathing correctly.

Picture this: upon inhalation the pelvic floor widens to support the downward pressure created by the diaphragm. Then upon exhalation the pelvic floor co-contracts with the diaphragm and moves slightly up into the pelvis while the diaphragm moves back up into the ribcage. This coordinated movement between diaphragm and pelvic floor has a gentle squeezing effect on the spinal column and disks, keeping them plumb and lengthening the spine.  This protects the joints of the spine from wear and tear and prevents damage to the disks.

Before beginning any pelvic floor specific strengthening exercises, diaphragmatic breathing with correct intra-abdominal pressure must be mastered!

For some people diaphragmatic breathing may be challenging at first, particularly if there is a a lot of tension in the trunk muscles. For others, years of chest breathing and/or shallow breathing can also make the trunk muscles weak and the back muscles too tight, preventing the alignment of the pelvis and ribcage necessary for diaphragmatic breathing to occur. Very often in these circumstances the pelvic floor muscles themselves are too tight, and this tension increases the tendency for pelvic floor disfunction.

Signs of and Contributors to Pelvic Floor Tension

Signs of a tight pelvic floor include lower back pain, incontinence issues, prostate and or bladder issues, prolapsed organs, and impairment of sexual function. Typically a tight pelvic floor is accompanied by certain muscular habits that manifest in conjunction with the pelvic floor tension. Habits that contribute to pelvic floor tension include clenching the lower glutes, tucking the pelvis, and sucking in the abdominal wall.

We live in a busy, stressful world and all of us are subject to potential stressors daily. An overactive stress response, either accompanying or even caused by long term habitual chest breathing is another important cause to be considered with pelvic floor disfunction (PFD). In such cases an effective approach to stress reduction is an essential component to any remedy.

Many of us have jobs that require a lot of sitting, either at the office and/or in the car on the way and home again. Those of us in this group are especially at risk of developing pelvic floor disfunction because long term sitting increases pelvic floor tension. The employment of a standing desk can help in these instances, but a more careful look at how we’re standing, or sitting, is an important part of any long term resolution.

Ignoring calls of nature because of busyness or distraction can be yet another source of stress that directly contributes to pelvic floor tightness and disfunction in a very obvious way. “Holding it” can become a habit that should be taken seriously, especially if PFD has already manifested.

Less obvious but no less important a contributor to PFD are cultural influences and images that present alignment pattens that we may try to emulate. Patterns such as a military posture with its arched lower back and tight glutes, as well as images from the fashion industry presenting beauty in the form of female bodies with forward hips and tucked pelvises no doubt reinforce patterns in younger people who are already developing these patterns through excessive sitting and staring at screens. Limiting screen time and setting healthier examples with our own alignment and movement habits are important considerations when managing this issue with our children.

Even in the wellness/fitness industry we are regularly presented with images of “healthy” bodies with sucked in over developed abdominals that are bulging and tight. We must remember that muscles that are too tight are also too weak to be functional. In order for a muscle to function well, it must have its full range of motion and be able to both contract well AND relax well. This is important to keep in mind not only with respect to aesthetics, but also with respect to steps we might take to mange pain. Bracing with the abs to manage back pain or PFD, for instance, is one of many habits that may be contributing to rather than solving our PFD.

A psoas release is a simple yet extremely effective way to help to begin to release many of the habits that contribute to PFD:

Once you begin to breath diaphragmatically and freely throughout the day and you combine it with a daily practice of letting go of dysfunctional tension habits, you will be ready to practice more specific pelvic floor re-training and strengthening. Because of the inter-connected fascial webbing, strengthening your pelvic floor muscle necessitates the ability to feel and develop responsiveness to the co-contraction of the muscles of the thoracolumbar cylinder.

Since the pelvic floor muscles are hard to feel, it can help to have a basic understanding of their anatomy to visualize and increase awareness of them. The pelvic floor muscles connect the pubic bone to the tailbone and each ischial tuberosity (sitting bone) to the other, and these muscles reside in three detailed layers.

Again, pelvic floor muscles are part of a deep myofascial grouping (close to bones and deep in the body), and because they are deep within the body these muscles are hard to sense. The function of these deeper muscles can also appear more subtle than that of the large superficial muscles like the quadriceps or gluteals which are much easier to feel and to activate.

But the deeper muscles of the trunk contain a larger amount of proprioceptive nerves than the superficial muscles, and these nerves help our body respond to changes in movement and loads quicker than our superficial muscles can – even quicker than we can respond with our thoughts. This is why symptoms of mild incontinence often occur with quick motions like jumping, running, and sneezing. Each of these motions requires the deeper muscles to be strong and responsive in order to manage the increased loads these and other movements may place on the pelvis and lower trunk. Strong and responsive trunk and pelvic floor muscles serve to prevent excessive loading of the bladder and urethra which might otherwise cause leaking.

To help you feel how these muscles co-contract together, here is a simple exercise:

In part 2 of this post we will look further at how to further strengthen the pelvic floor with more dynamic movements that involve bending, lifting and walking. Stay tuned!

A Case for Yoga: Improving Strength, Mobility and Overall Health

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As a yoga teacher I’ve been advocating for a proactive effort to increase flexibility in the body for more than 2 decades. Yoga is generally seen these days as a valid way of increasing flexibility, but not necessarily one that offers the complete complement of physical benefits regarded as essential for overall health and wellness. For instance, many yoga students feel they need to engage in other activities for cardiovascular exercise, such as spinning, Zumba or running, to keep themselves healthy. Yoga, it appears for these folks, is not enough.

A decade or so ago when yoga was still “the new kid on the block” in the fitness industry, it enjoyed a sort of “cure for everything” status that temporarily shielded it from the responsibility to deliver on that promise. Now that yoga has slipped from it’s peak of popularity into the ever expanding menu of fitness options, it is held to the same standards that other types of “exercise” are and its strengths are weaknesses as an exercise form, depending on the type of yoga or the skill level of the instructor, have become more commonly known and accepted.

One strength of yoga that appears to be gaining ground in the scientific community and with the public is its efficacy in reducing the effects of stress and as a contributing factor to overall health and well being. A 2012 National Health Interview Survey (NHIS) found that, among the people surveyed who practiced yoga, 94% said they did so for “wellness-related reasons – such as general wellness/disease prevention or to improve energy,” with 82% of the respondents saying that it “improved their overall health” and 86% saying yoga reduced their stress.

I should point out here that the benefits of yoga reported above, along with other benefits reported for its positive effects on back pain, sleep, menopause, diabetes and other chronic disease and weight loss are mainly anecdotal. There is limited scientific support for nearly all of the claims made in yoga magazines and websites. But for some of these claims, such as yoga’s efficacy in building strength, the benefits are clear and undeniable.

The fact is, yoga postures done correctly place mechanical loads on our muscles, ligaments and bones in controlled and specific ways, and this type of loading, as dictated by the laws of our physical universe and the biological nature of our tissue, increases the load bearing capacity (ie- strength) of these tissues quite effectively. Without a doubt, yoga makes us stronger.

So if there is at least some evidence, even though mostly anecdotal, that yoga is good for stress reduction and overall health and well being, and clear evidence that yoga can be an effective way of building strength, then I would argue that latter is closely related to the former. The fact that yoga helps build strength is the reason that it helps with stress reduction and overall health.

This is because our overall health is largely defined by the health of our tissues. What are we but a highly complex arrangement of tissues and extra-cellular fluid (leaving aside the mind and the soul which are a subject for another time). We cannot be healthy and have a significant amount of unhealthy tissue in our body. Conversely, our overall level of tissue health is directly related to our overall health in general. The healthier our tissue is, the healthier we are.

So what exactly does strength have to do with tissue health? The answer lies in understanding our tissues on both macro and microcosmic levels. If for instance I want to strengthen my legs and hips I might choose to do more standing postures. The mechanical loads these postures place on the muscles and other tissues in my legs and hips will help these tissues handle loads better, thereby making them stronger. But what happens to the individual cells in the various tissues in my legs? I would argue that these same postures also improve the strength of the individual cells in the tissues that make up my legs and hips. This is due to a phenomenon knowns as mechanotransduction.

Mechanotransduction occurs when a mechanical stimulus is converted into a set of biochemical reactions and corresponding a cellular response. This cellular response can vary depending on the type of cell and stimulus, but generally involves enhanced gene expression and positive physical changes to the cell. Scientifically, mechanotransduction is a concept still in its infancy in terms of study and understanding, but the studies that have been done suggest that mechanical loads on the microcosmic level mimic those on the macrocosmic. That is, mechanical loads that make our muscles and bones stronger also make our cells “stronger” in the sense that they improve their adaptiveness and enhance their functional role in our bodies.

Therefore I’d suggest that “weight bearing exercise”, which is basically deliberate mechanical loading of our tissues, not only has the potential to build strength and resiliency in that tissue but also, as a result of mechanotransduction, similarly loads our cells and stimulates greater responsiveness and resiliency on the cellular level, improving the health of those cells, the tissues they make up and our overall health in general.

I place “weight bearing exercise” in quotations here because it can and does mean more than it’s common interpretation suggests. Sitting for example, can be a kind of “weight bearing exercise” in the sense that it places mechanical loads on the tissues of our hips and legs and, if done in the right way, has the potential to make them stronger and more resilient. On the other hand, sitting can and often is counterproductive in this regard because it is not done in the right way, or is done for too long, and will in this case damage tissue health by limiting mechanotranscduction and impairing tissue health.

This brings me back to the importance of flexibility, or as I prefer to think of it, mobility. Having good flexibility means having functional mobility which is the ability to mobilize the body in a variety of ways. Mobility allows me to move more of my joints and tissues through their various ranges of motion and this means a wider and more varied distribution of mechanical loads to more of my tissues. A major benefit of mobility therefore is the stimulation of mechano-transduction in more of the cells in more of my tissues and an improvement in the healthful expression of those cells and those tissues. Floor sitting done properly, for example, can be and effective way of improving the mobility of the hips, knees and ankles and can therefore promote the health of the tissues in the lower half of the body.

A less obvious benefit to functional mobility is the enhancement of my cardiovascular system. Improved and varied mobility of the body generally improves the mobility and more specifically the elasticity of my arterial system, helping to normalize blood pressure and reduce the effects of various types of stress on vessel walls. This particular benefit of functional mobility, which incidentally is facilitated rather well by regular and correct practice of yoga, improves the responsiveness and resiliency of my cardiovascular system and prevents chronic diseases related to it.

I’ve tried here to make a case for yoga as having the potential to be as complete as any other form of “exercise” for promoting and maintaining health. It’s reputation for helping mainly with flexibility and stress is a very limited view that fails to tell the whole story of its full potential. This potential, to literally enhance and maintain our tissue health on the cellular level, is open to anyone willing to spend the time and energy to learn it.

Strength Training: Open vs. Closed Kinetic Chain Movement

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At Alignment Lab we always encourage our clients to move more and build strength, but it is common in our practice to see clients who have developed injuries from working out at the gym with certain machines or when doing isolated exercises with weights. Many of the exercises these clients are doing involve movements that fall under the category of open kinetic chain movement (OKCM). In the interest of maximizing the health benefits of exercise and minimizing the chances of injury, we generally try to steer our clients away from (OKCM) exercises and guide them towards exercises that feature closed kinetic chain movement (CKCM).

What is the difference? OKCM exercises involve isolating a particular muscle and then challenging it with weight and or resistance by shortening (concentrically loading) the muscle. A classic example is the biceps curl, which involves picking up a weight, say a dumbbell or kettle bell with the hand, and then bending the elbow to lift the weight toward the shoulder. This exercise can be done with one or both arms, and in either case the hands are not fixed, thus the “open” kinetic chain.

CKCM involves movement relative to a fixed point. This means that some part of the body, usually a hand or a foot, is brought in contact with a stable surface such as the floor or a wall. Typically there is some amount of weight bearing involved to keep that contact point stable. The stability provided by the fixed point and the weight bearing promotes stability in the body where needed so that the exercise can be done with greater safety an efficacy.

In the example of the biceps curl, there is no fixed point. Every part of the body has the potential to move in some way during the exercise, and thus there is a lack of stability and a greater chance of strain. This exercise not only increases the chances of straining the biceps, but also the shoulder joint. Without the added stability of a fixed point the body will have a harder time keeping the humerus stable in the shoulder socket, increasing the chances of exceeding the load bearing capacity of the joint. In the end, we may end up with bigger biceps, but likely more wear and tear on the shoulders.

One solution to this problem with the biceps curl that is often used to improve its efficacy is to stabilize body by sitting on a stable seat and then placing the elbow of the working arm on a support. These changes do serve to focus the action of the arm more effectively on the biceps, but they do not necessarily make it more safe. The reason is that even though to some degree stability has increased, it has not increased in a way that eliminates potential impact on the shoulder joint.

Because there is a greater amount of force on one isolated joint, in this case the shoulder joint, this movement can easily lead to strain in the tendon of the bicep attaching to the shoulder joint.  This is because mechanoreceptors in the shoulder are not well activated in this exercise. The mechanoreceptors help us feel joint position, and if they are not activated it will be more difficult to sense whether or not the shoulder joint maintains functional alignment. If the exercise is done without a functional alignment in the shoulder joint it may result in an injury.

It is important that we continue to challenge our muscles and their ability to bear weight, but preferably not at the expense of our joint health. Open kinetic chain movement (OKCM) exercises tend to increase this likelihood. Closed kinetic chain movement (CKCM) exercises on the other hand provide an opportunity to increase our strength with much less chance of injury.

While the primary difference between a CKCM exercises and an OKCM exercise is that CKCM exercises feature movement relative to a fixed point, another equally important difference is that CKCM typically feature some approximation of the joint due to the weight bearing on the fixed limb. This means that pressure, usually caused by the weight of the body, pushes the arm toward the shoulder joint, soliciting a stabilizing response in the joint. A great example would be a side plank. In this exercise one hand is fixed on the floor, and the shoulder on the same side gets approximated by the weight of the body. This helps stabilize the shoulder joint and facilitates healthy rotational movement (abduction) around the joint.

CKCM exercises have several features that account for their improved efficacy relative to OKCM exercises. First, the increased joint stability in CKCM allows for better eccentric loading of the involved muscles. Eccentric loading means that the muscles involved contract and lengthen at the same time. When a muscle contracts while lengthening, sliding motions are introduced into the fascial sheets that cover muscles groups and individual muscles. This sliding of the fascial sheets adds lubrication, nerve stimulation and a protective barrier against injury.

Another feature of CKCM is that it involves the motion of muscles across multiple joints. This means that these movements go beyond the isolation of one particular muscle, unlike many of the OCKM exercises commonly used in strength training (such as the biceps curl). Moving across multiple joints requires a complex synchronization of different muscle groups and therefore not only works more muscles but works them in tandem with one another, promoting strength in a functional way.

In addition, when movement occurs across multiple joints with many muscles involved it facilities co-contraction between muscles and this co-contraction, it turns out, is a more efficient way to to bear weight. When muscles co-contract with other muscles, the load is distributed across a broader area, preventing isolated muscle fatigue and decreasing shearing forces on the joints and tissues, ultimately decreasing the likelihood of strain and inflammation.

This alludes to the fact that CKCM’s are good for our tissue. These movements improve blood flow, flexibility, lymph drainage, muscle health, circulatory function and cardiovascular health in a far greater way than any open kinetic chain exercise. CKCM’s will have increased metabolic effects compared to OKCM’s, and they also promote joint health by helping to re-establish proprioception and our ability to sense joint position.

One further benefit of CKCM’s is that these movements improve function of the nervous system. This is because when more muscles and joints are moving in a complex closed-kinetic chain pattern, more nerves are firing. More nerves firing means more blood flow, better communication with the brain and thus a greater ability to dynamically move through space with intelligence.

Finally, closed kinetic chain movements are simply more functional than open kinetic chain movement in that CKCM’s are more often based on movement patterns that are innate to the human body. As babies and toddlers, each of us develops our physical function through a series of innately choreographed movements, and these movements manifest from the age of three months up to the point of walking without any instruction or mimicry taking place. This means that we don’t learn these movements from someone else, we just do them. These movements are innate in all babies, everywhere in the world, and they tell us a lot about functional motion and how the utilization of the hands and feet in a closed kinetic chain is the basis for all natural human motion.

Going back to our bicep curl exercise, let’s compare it with a closed kenetic chain movement involving the biceps and triceps using the example of a wall plank. A wall plank is basically a plank position where the head, shoulder girdle, rib cage, pelvis and legs are all in a stacked, vertical alignment with the hands on the wall standing at arm’s length. The movement involves pushing into the wall to fully extend the elbows.

In a wall plank, the triceps contract in order to extend the arm, but at the same time the biceps co-contract in conjunction with the triceps to stabilize the elbow joint. The biceps also must lengthen to increase pressure into the wall and bear the weight of the upper body. Because the hands are fixed, a whole chain of muscles from the hands into the shoulder joints on into the back and into the abdominal muscles and down into the pelvis and legs also co-contract to help support the body’s weight.

Once it becomes relatively easy to do a wall plank while maintaining good alignment, a full plank can be introduced involving the more challenging version of pushing up off the floor. In a full plank the biceps and triceps get worked but in a clearly functional way that facilitates our ability to lower ourselves down to the floor and lift ourselves up off the floor.

There’s a lot of press about strength training these days with ever growing evidence of its importance for human health and longevity. At Alignment Lab we’re big fans of strength training and we provide it daily with every one of our clients by teaching them mainly closed chain kinetic movements. We’ve found this approach to be ideal for promoting functional strength that is at once empowering, health promoting and practical.

Warrior 1 (virabhadrasana 1) – Set Up and Cues

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Arguably the most challenging of the classical standing postures, virabhadrasana 1 or “Warrior 1” places great demands on our pelvic and trunk stability, along with the strength and mobility of the hips and shoulders. This posture requires the ankles and feet to work well, and that our spinal column has good mobility.

When doing Warrior 1, we must maintain constant awareness of where all of the various mechanical loads are placed, and thus Warrior 1 also poses a great challenge to the mind. We must remain present at every moment we are in the posture, both for safety as well as a successful outcome.

Warrior 1 includes a back bend as one of its key elements. If you have a low back injury, I would not recommend learning this posture on your own. PLEASE SEEK A SKILLED INSTRUCTOR FOR HELP.

Even if you’ve had experience with the posture, I would encourage you to watch my video on stabilizing the lower back for backbends before watching this video for a better understanding of how to approach the back bending element in Warrior 1.