Your Recovery Guide for 17.4

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Another workout down and only one more to go!  I’m back again with your latest recovery guide.

17.4 was a repeat of 16.4:

13 minute AMRAP

55 Deadlifts

55 Wall Balls

55 Calorie Row

55 Hand Stand Pushups

 

This is a highly metabolic, demanding workout.  Some call it brutal and curse “The Dave Castro”!  Ultimately for those who did it last year, this was a chance to test your fitness.  How were you this year as compared to last year? Are you fit? Did you take a different strategy?

A lot can happen in a year and there a many different factors.  Life events, nutrition, injuries, sleep….you name it the list goes on. Personally, I improved my score by 9 Hand Stand Pushups.  I went in with a different strategy on the deadlifts and it paid off.  I decided to stay consistent and do sets of 5, instead of blowing out and doing a big set of 15+ and sets of 10.  As a result I finished them around a minute faster, which left me not as fatigued in my legs so that I could do a big set of wall balls.  I broke my wall balls up into sets of 30, 15 and 10.  I stayed consistent on the rower leaving me with 3 minutes on the clock for the pushups, a movement I’m not very proficient at (checkout my blog Neck Pain and Handstand Pushups). I did sets of 10, 5 and 3.  The only one I failed was my last one, which would have given me 19.  This is a big improvement as I think I failed around 10 last year.  This was my goal going into 17.4: BE CONSISTENT!

As per my last 3 posts about the open here is your recovery guide for 17.4:

1.) Nutrition: checkout the blog about 17.1

2.) Mobility work

Heal up the lower back from all of the loaded flexion during the deadlifts, wall balls and rowing

Improve your ankle dorsiflexion to help you get your heels above the line

3.) Stability Drills

Load through the shoulders and hips as you rock back maintaining a neutral spine and neck

Train the hip hinge – should feel this working the glutes and quads

4.) Recommended Treatment options:

Chiropractic Care

Deep Tissue Laser and Taping

Active Release Techniques

Instrument Assisted Soft Tissue Mobilization (IASTM) with RockBlades

5.) Go for a moderately paced recovery run, bike ride or swim.

6.) Do some yoga

7.) Scale back on your workouts this week, both weight and intensity.

8.) Take a rest day and listen to your body!

9.) Try some meditation

10.) Remember to have fun and that there is one workout to go!!

 

Hope you enjoy this latest CrossFit Open recovery edition.  Please share with others!

 

Yours in Health,

Dr. G

 

 

Your Recovery Guide for 17.3

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17.3 is in the books!  Hopefully you enjoyed the barbell after two weeks of the dumbbell and moved some heavy weights around.  This was a workout where you were “rewarded” with more work the stronger and more proficient you were with your pacing.  Many had an 8 or 12 minute workout and some went longer up to the full 24 minutes. Regardless of where you finished be proud of your accomplishments thus far! 3 of 5 workouts are done.  In an effort to help you recover, here is your Recovery Guide for 17.3!

Here are some drills that can help:

1.) Elbow extension on the wall to recover from catching all those squat snatches.

2.) Quadruped position for Thoracic extension/rotation and Shoulder Internal Rotation

3.) Quadruped position for Thoracic extension/rotation and Shoulder External Rotation

4.) Try this drill using a Foam roller to also improve extension/rotation of the thoracic spine while stretching the shoulder.

5.) Dead Bug on the Wall to reset your core, ribcage and lats from all those pull-ups.

 

Along with these videos:

  • spend at least 10 minutes a day working on your mobility, strengthening a weakness and focusing on breathing with your diaphragm (here are two great resources on the diaphragm, part 1 and part 2 that have additional info and drills).
  • For nutritional suggestions check out my 17.1 post.
  • Go for a run or bike ride. You pick the pace and distance. Personally, I’ve already gone on a 7 mile and a 5k run.

Lastly, as a medical professional I must preface, if you are hurting or are unable to work out the “soreness” on your own, please seek out a provider who understands what you are doing for guidance and suggestions.

Always available to help!

Yours in Health,

Dr. G

Your Recovery Guide for 17.2

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I think everyone can agree how much 17.2 taxed their grip first, shoulders second and glutes third.  If you weren’t feeling it in your glutes then you were doing your lunges wrong or they have permanent amnesia from you sitting a desk job 8 hours a day!  After this workout I’m going to recommended some mobility for the wrist, elbow and shoulder along with some stability glute and core exercises.

Mobility drills  

Wrist Extension- 10 reps each side, 2x/day

Wait Elbow Flexion- 10 reps each side, 2x/day

Behind the Back Shoulder Internal Rotation- 10 reps each side, 2x/day

Stability Exercises

Single Leg Hip Lift- 10 reps each side, 2x/day

Mini Get Up- 10 reps each side, 2x/day

 

As always nutrition is vital so check out my 17.1 post for guidance in this arena.  Also mentioned in that post was my go-to product Phuel 5.0 for post-workout aches/pains/soreness.  This product can also be used pre-workout to ease muscle tension, increase circulation & oxygen and as an antibacterial.  I applied it on my shoulders, neck and forearms prior to the workout and felt pretty good afterwards, all things considered as toes to bar and muscle-ups are not strong movements for me.

There are of course treatment options available to aide in your recovery and/or help you heal up.  Chiropractic care, Deep Tissue Laser Therapy, Kinesiotaping and Active Release Techniques are solid options along with Massage Therapy. **I do have a new Massage Therapist in my office, check her out here**

In closing, congratulations on making it through week 2.  Two workouts down, three to go!  Try these exercises, rest and heal up, get treatment if needed and feed you body to fuel up for 17.3!

Yours in Health,

Dr. G

 

 

Neck Pain and Handstand Pushups

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*photo credit: http://medical.miragesearch.com

 

If you’ve ever attempted a handstand pushup or do them regularly you’ve probably experienced some neck pain.  If you experience neck pain every time you do them, you definitely need to continue reading!

For those who have no idea what a handstand pushup is, watch this….

A common thought of many is….well I’m coming down with my weight on my head, that’s why my neck hurts.  True, but thinking that this is acceptable and comes with the territory and/or not working on your technique to prevent getting neck pain can lead to serious problems with your neck or other àreas of the body.  What may start as a “muscle” strain, can overtime lead to nerve irritation (numbess, tingling, burning), weakness, disc injury or fractures.

I’ve learned from personal experience and clinically treating patients with this being their primary complaint, that the pain can be very mild to quite severe.  Coming down with all the force on your head compresses your neck and overtime can squeeze and put pressure on your discs, joints and nerves.  I’d like to first share an anatomy review of the cervical spine(neck) and some orthopedic tests you can do on your own to see if you have any pain/irritation of these structures.  Secondly, I’d like to share some exercises that can help prevent and/or help to alleviate your neck pain.

Anatomy review of the neck

*photo credit: Veritas Health, LLC and spine-health.com

We have 7 cervical vertebrae and except for the top two we have an intervertebral disc(IVD) between each one.  The spinal cord runs down the spine behind the discs and nerve roots exit on the sides of your neck through holes in between each vertebrae called intervertebral foramen (IVF).

With repeated force, stress/strain of the joints, discs and nerves in your neck they can become irritated and sensitized.  The first symptom will typically be a “muscle pull” feeling and/or a deep, dull ache.  This is the brain’s way to protect these vital structures.  Take this as your warning sign that there could be more going on!

To check if you have some disc, joint compression or nerve involvement here are some tests you can do.

Maximal Foraminal Compression

Any symptoms, especially if this reproduces your main complaint, should be noted.  Keep in mind that there are more advanced tests that can be done clinically.

Upper Limb Tension Tests

*photo credit: pinterest.com/pin/290552613436855824/

For these nerve tension tests, put your arm in the position first and then bend and turn your head away.  These can reproduce some symptoms pretty quickly so use caution stretching to far.

I do encourage you consult a professional if these tests cause pain, numbness, tingling, burning or weakness.  Not everything can be stretched, rolled or massaged out.  More often doing so can make things worse!

If you did have symptoms with these tests, try doing a couple sets of 10 reps of this exercise and then retest.  If your symptoms improve not only is this a good sign, but this also means you may be able to manage your symptoms on your own by performing multiple sets throughout the day.

 

Moving forward if your symptoms improved with the chin tuck exercise or you didn’t have any symptoms with the prior tests then here are 3 Common Faults many have when performing handstand pushups.  I’ve included one exercise that can help correct them.

1.) The neck being extended when pushing up

2.) The neck being extended when coming down

3.) Lower rib cage flare and excessive lumbar hyperextension

For all of these exercises, perform 10-12 reps each set and perform 2-3 sets as a part of your training.

Once again, I’ve seen personally and clinically the negative effects handstand pushups can have on the neck, but on a positive side I’ve seen these exercises help prevent and/or alleviate some or all of the neck pain/symptoms an individual may be having.  Give them a try and I always appreciate the feedback.  Keep in mind it can take time and can be a process, but if you stick with it, it will be worth it!

If you have any questions in regards to these exercises or are need of an evaluation, please contact me.

Yours in Health,

Dr. G

 

Your Recovery Guide for 17.1

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The CrossFit Open is here and 17.1 is in the books.  Week 1 was a brutal workout involving dumbbell snatches and burpee box jumps.  I know many are feeling it in the lower back and shoulder. With this being the case I wanted to share some recovery tips to heal and rest up for 17.2!

We’ll start with nutrition because in my opinion this needs to be the foundation.

1.) Drink a lot of water to re-hydrate

2.) Pay attention to your macro-nutrients (MACROS). Eat protein to help repair your muscles, High quality fats that can help reduce inflammation and Carbohydrates to replenish your energy stores and re-fuel your body.

3.) Supplements can help = Protein, BCAAs, multivitamin, fish oils, probiotic

4.) Recovery drinks, such as FitAid have anti-inflammatory ingredients, electrolytes, BCAAs, Fish Oils and a Full B Complex.

There are some great products to help with aches/pains, but one that I highly recommend is:

Phuel 5.0 can be used to reduce aches/pains, swelling, improve circulation and serve as an antibacterial

Being a Chiropractor there are several treatment options that can help. Some that I provide than can help are Chiropractic Manipulation, Active Release Techniques and Instrument Assisted Soft Tissue Mobilization(IASTM).  Other treatment modalities I do that can be helpful are Deep Tissue Laser Therapy and Kinesiotaping.  Here are a couple videos demonstrating their applications

Lastly, we here are some exercises and stretches that can help:

Each of these exercises can be performed for about 10-15 reps/set. 2-3 sets can be helpful to reducing some of your aches/pains.

Hope this Crossfit Open 17.1 Recovery Guide treats you well and gets you ready for 17.2!  As always don’t hesitate to contact me if you have questions or concerns that need to be addressed.

 

Yours in Health,

Dr. G

Workshop at CrossFit Harrisonburg RECAP

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Harrisonburg VA Chiropractic Center
Move Better. Function Better. Live Better

 

I want to first start out by thanking CrossFit Harrisonburg for hosting my Function 4 Life workshop!

Each time I do these I’m extremely humbled by all of the attendees who come out to hear me share knowledge on ways to improve their quality of movement.  MOVEMENT IS LIFE and the better we move, the better we function.  The more functional we are, the more likely our performance goes up and our injury risk goes down. What I’ve learned over the years is that as a whole, our society doesn’t move well and we most certainly don’t move enough.  We’ve become a sedentary society due to technology, computers, cell phones, etc.  This results in crappy posture, tight and weak muscles, dysfunctional movement, faulty breathing and injuries.  That’s right, you can herniate a disc by sitting at a desk for 8 hours a day (average American may sit an additional 4-6 hours a day!), just like you can deadlifting or squatting 300-400 pounds.  Because of this I encourage everyone to move! Just ask my patients….each one has been given some way to help them move better.  I have a passion to teach people how to move and function better.  Because of this I have made it a personal mission to teach these concepts and principles.  Over the last several years I’ve done many talks and workshops in the community.  I learn and grow from each one, striving to make each one better.  The workshop at CrossFit Harrisonburg was the first of 2017.  For those who missed the workshop and for those who want to re-live the day I wrote a RECAP of the day.

The main focus of the workshop was improving the overhead position.  The overhead position pertains to lifting – snatches, overhead squats/lunges, presses and jerks along with body-weight/gymnastics movements – handstand push-ups, handstand walks, pull-ups, muscle-ups and toes to bar. The vast majority of people would think to improve the overhead position you have to increase mobility of the shoulder.  There is no fault in this thinking, if everything has been ruled out as a cause for a dysfunctional overhead position.  I showed how you can rule out potential causes by performing some screens.

The other focus of the workshop was to demonstrate some screens that can be utilized to identify these culprits of non-optimal movement leading to a dysfunctional overhead position.  I want to stress that the most important thing we want to know when someone is performing a screen is – Does it cause pain?  If there is pain when performing these screens, then the individual should be evaluated by a movement specialist like myself to determine the reason for the pain.

The screens covered were the deep overhead squat, ankle dorsiflexion, bilateral shoulder flexion, bilateral shoulder abduction and the DNS 3 month supine screen.

Unfortunately, there wasn’t any videos taken during the workshop, so I’ve included some that are exactly or close to what was demonstrated. With each screen there will be highlights listed of what faults to look for.

Deep Overhead Squat

Highlights:

  • Does the lower back round?
  • Can the person squat below parallel?
  • Does the bar stay over the middle of the foot?
  • Do the heels rise?
  • Do the feet turn out?
  • Do the knees crash in?

Ankle Dorsiflexion

Highlights:

  • Can the knee go 4 inches past the toes?
  • Does the heel rise?
  • Does the front of the knee stay in line over the 2nd/3rd toe?
  • Does the arch flatten out or collapse?

Bilateral Shoulder Flexion

Highligths:

  • Do the arms flex all the way up so you can’t see the ears when viewing from the side?
  • Is the space between the arms and ears the same of both sides?
  • Are the finger tips the same height?
  • Does the front rib cage pop up off the abdominal wall?
  • Does the lower back arch in order to get the arms up higher?
  • Does the head poke forward in order to get the arms up higher?

Bilateral Shoulder Abduction

Highligths:

  • Is the space between the arms and ears the same of both sides?
  • Are the finger tips the same height?
  • Does the front rib cage pop up off the abdominal wall?
  • Does the lower back arch in order to get the arms up higher?
  • Does the head poke forward in order to get the arms up higher?
  • Does the person shrug the shoulder to raise it up higher?

DNS 3 month supine screen

Highligths:

  • Can the individual contract the diaphragm correctly to achieve optimal intra-abdominal pressure?
  • Is there a difference in contraction when comparing each side?
  • Can the individual breathe optimally using the diaphragm?
  • Can the individual maintain the intra-abdominal pressure while breathing with the diaphragm?

 

Once identifying some problems utilizing the screens a corrective exercise was shown to improve the quality of movement.  The exercises are based mainly on the principles of developmental kinesiology and Dynamic Neuromuscular Stabilization (DNS).  The global concept is that as we age, the movement programs we learned as an infant are lost and/or disconnected and they need to be re-programmed in order to move more efficiently. Thus, once we restore the diaphragm’s function, our “core” will be more “strong” and stable to allow for more optimal movement.  These exercises have been highly effective in the clinical and performance setting. Similar improvements have been seen in both non-athletes and athletes because at the end of the day we’re all human.  We all had to learn how raise our head, turn our bodies, crawl, squat, lunge and walk.  Sound interesting?  I’ve written a couple posts on these concepts, check them out here and here!  Looking to learn about these concepts?  My associate and I are hosting a DNS Exercise Course here in Harrisonburg at James Madison University on March 4-5.  Here is the link to the course registration and information.

Here are some DNS inspired corrective exercise that could help improve the overhead position and the results of the screens.

  • Perform 15 breaths per set

  • Perform 10-15 reps per set.
  • You can also place the band in front of the ankle. Check out that video here, be sure to subscribe to my YouTube channel!

  • Perform 10-15 reps per set

  • Perform 10-15 reps per set. Can use a resistance band, which was demonstrated at the workshop as well.

 

Once again I want to reiterate that I thoroughly enjoy teaching and doing these workshops.  Thanks again to CrossFit Harrisonburg for having me! I look forward to the next one coming up this year, stay tuned!  Would you like to host a workshop? Click here and I’ll be in touch soon!

Yours in Health,

Dr. G

 

 

 

What I Learned in 2016

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Ask yourself the question: WHAT DID I LEARN THIS YEAR?

You’ll ponder for a while, but there will be significant things that happened, both good and bad, some of which more than likely made an impact on your life.  I am a firm believer that everything happens for a reason.  Throughout any given year we all will face challenges, adversity and our biggest fears.  There will be ups and downs.  Sometimes we may feel like we are at a status-quo or on autopilot.  But, I bet more often, the majority of us are having positive things happening in our lives, even when we don’t realize it.  I’d like to share some of the lessons I learned, my thoughts and my experiences of 2016.  I want to preface that these are in no particular order.

Credit: http://www.humblebeeandme.com/things-learned-2016/

Here we go: WHAT I LEARNED IN 2016!

1.) The earlier you get up, the more you accomplish in a day

2.) If you keep knocking, the door will open

3.) If you don’t ask, you won’t know and you won’t receive

4.) Time management is a must

5.) Sometimes you have to let go of the things that are weighing you down

6.) When you set goals, staying consistent is the key to reaching them

7.) You need to step out of your comfort zone to grow

8.) Someone is always watching over you and listening without you realizing it

9.) When you’re like-able and provide quality service, people see the value and will pay and drive long distances to see you

10.) God has a plan and he puts people in your life for a reason

11.) Worry less and/or not at all about what you can’t control

12.) Decluttering is very stress relieving

13.) Experiences and special moments/events are far more rewarding/important than items/stuff/materials

14.) I was reassured how I have affected/helped people and made an impact on their health by having the most returning patients and patients who referred other patients to me than other year in practice

15.) When you’re in the dumps, depressed, over-stressed, etc – family/loved ones have your back and will always support you.

Credit: http://loves.creative3ddesign.us/inspirational-quotes-about-self-reflection/

 

These are 15 things that really stuck out to me about 2016.  Moving forward here are some things I’d like to strive for in 2017.

1.) Be the best husband, father and friend I can be

2.) Always be “present” in the moment

3.) Spend less time on the phone

4.) Meet more people

5.) Work hard, stay driven and passionate

6.) Continue to journal(this has helped me tremendously with my growth in life and business!)

7.) Write at least one blog-post a month

8.) Continue educating people on ways to improve their health

9.) Complete the Spartan Trifecta and possibly a marathon(if weekends line-up with family schedule)

10.) Procrastinate less and do more!

 

Thank You for reading.  I wanted to do another post like this, as last year’s was a success and I got a lot of positive feedback.  Please share with others. I hope you reflect on 2016 and see how you can grow in 2017.  Feel free to share your reflections/growth with me via email or comment below.

 

Yours in Health,

Dr. G

 

“Self reflection is a humbling process. It’s essential to find out why you think, say and do certain things…then better yourself” ~Sonya Teclai

DEDICATION DECEMBER

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dedication-frank-lloyd-wright*photo credit: quotesgram.com

We have 29 Days until 2017, you heard me – 29 DAYS!

If you are thinking about making a resolution starting January 1st, let’s get a jump on it in December.  Many people have the resolutions to lose weight, get in shape, be healthier, lose the beer belly or baby fat.  Some people have the breaking bad habits, be more faithful to/in whatever aspect of life or start a new career resolutions.  No matter what your resolution is, I guarantee it will be an easier, smoother transition if you start it before the holidays.  The holidays bring good things like joy, happiness and great food, but can also bring bad things such as, guilt, grief, stress and depression. To combat the bad, let’s bring on a LOT of GOOD this December!

I invite you to join me on a journey of making yourself into a better version of YOU.  Let’s have the dedication to improve ourselves in all aspects  of our life.  The dedication to improve mentally, physically, spiritually and emotionally is upon us, you just have to take it!

I’d like you to join my Facebook group – DEDICATION DECEMBER.  I’ll be sharing articles, videos, workouts, recipes each day, but am encouraging everyone to join in on the sharing.

 

dedication-pinterest

photo credit: https://www.pinterest.com/kiberyan/hard-work-and-dedication/

I decided to kick off my dedication by doing a quick workout at home.  Took me around 30 minutes to complete.

Every minute on the minute for 12 minutes – starting at 10 KB Swings, add one KB Swing each minute working up to 21 on the 12th minute. Then rest 2 minutes and then complete as many pushups as you can in 2 minutes.

Afterwards, I worked on some mobility to aid in recovery. **10 reps, on each side**

I then ended with some stability work.  **10 reps, on each side**

**Always save your core work until the end of your workout. You don’t want to fatigue your support system**

Please share and post how you did in the comments.  Questions also welcomed in the comment section.  Let’s get the ball rolling towards 2017!

 

Yours in Health,

Dr. G

Harrisonburg VA Chiropractic Center

A Functional Approach to the Pelvic Floor

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Harrisonburg VA Chiropractic Center
Move Better. Function Better. Live Better

 

A Functional Approach to the Pelvic Floor

The pelvic floor is typically something we don’t talk about, even though Pelvic Floor Disorders are quite common.  We seem to just brush them aside as a normal aging process when we have symptoms such as incontinence, pelvic organ prolapse and pain.  Are you aware that Pelvic Floor Disorders also include bowel dysfunction, constipation, instability of the surrounding joints, muscle imbalances/weaknesses and core dysfunction?  Did you know that it also occurs in men, women and children of both genders?  Well, I’m here to tell you that there are things that can be done and we SHOULD BE TALKING ABOUT IT!  The focus of this post is to discuss incontinence, general and functional anatomy, simple drills you can do to test your pelvic floor and provide some information on what the research shows on pelvic floor disorders.

Incontinence can be both urinary or fecal and is defined as the involuntary or accidental voiding of either urine or feces.  This can happen during sports activities(running, jumping, lifting), singing, dancing, coughing or sneezing.  Urinary is more common than fecal, it can affect as many as 29% of women after pregnancy and 40% of women(Gyhagen 2015).  Urinary can be present in roughly 50-60% in women who have given birth(Dolan et al. 2003).  If we simply look at incontinence alone from a post-partum, ie. after pregnancy, perspective it should resolve within 6 weeks to 3 months according to the evidence(Burgio 2003, Rogers 2007, Brown 1999).  We know that there is an increase chance of incontinence related to vaginal births(Quiroz 2011), but this does not exclude women who had a caesarian section, as around 52% of pregnant women can have symptoms(Pool-Goudzward 2005).  This is in large part due to structures being stretched; muscles(pubococcygeus – up to 3.26 times its length)(Delancey, 2003) and nerves(up to 35% longer)(Kuo-Cheng Lien, 2005) and muscles being injured(up to a grade 4 tear).  Pelvic Floor Disorders become more complicated when a grade 3 or 4 tear occurs, at which point treatment is recommended to retrain and heal the area.  One study has even shown through MRI the prevalence of subcortical pubic bone fractures and edema in the bones and muscles at 7 weeks post-partum(Van delft 2014).  Like many conditions, there is also an increased risk associated having a prior incidence of incontinence whether it is related to pregnancy or other trauma, injuries or conditions.

As a Chiropractor, who has rehabilitative training in helping with pelvic floor disorders, it’s refreshing that the leading treatment guidelines and protocols dictate providers to rule out the lumbar spine.  It is very common to have derangement(referred pain) from the lumbar spine, usually in the form of disc involvement.  Once the lumbar spine is ruled out, other structures of the pelvis, hips, abdominal cavity, pelvic region can be ruled in. Many times these structures are ruled in from a functional aspect = THE KINETIC CHAIN!  Respiratory dysfunction for example is highly correlated with incontinence.  Reflexively and fundamentally the pelvic floor activates prior to upper extremity tasks, such as lifting.  Clinically, I’ve seen hip, groin, knee and foot pain be resolved once respiratory and pelvic floor training was initiated in the treatment plan.  What does this mean?  Your body craves stability at it’s”core” in order for you move, run, walk or pick up things, ie. your child!

I’ve used this quote before, but it’s so true: “proximal stability allows for distal mobility” – Professor Stuart McGill, PhD.

 Moving forward let’s define the function and structures of the the pelvic floor, ie. “the floor of the core”.

CREDIT: advantagestrength.com

It’s function:

  • to maintain and increase pressure, especially intra-abdominal pressure
  • provide stability for lumbar spine, pelvis & hips
  • help unload the spine
  • support & control sphincters of pelvic organs(rectum, bladder, uterus)

Structurally its comprised of:

  • muscles(levator ani[pubococcygeus, iliococcygeus], pelvic diaphragm, coccygeus)
  • Ligaments(puborectal, dorsal sacral ligament, sacrospinous, sacrotuberous)
  • Associated Structures(abdominal diaphragm, rectus abdominis, transverse abdominis, internal and external obliques, obturator internus and piriformis)
  • Bones(pubic, ischium, ilium, sacrum, coccyx)

CREDIT: pittsburghpelvichealth.wordpress

 

The majority of these structures are able to be palpated and be contracted by oneself.  Here are some quick tests you can do to assess your pelvic floor:

How to palpate your pelvic floor:

  1. While seated, find your sit bone in your butt(ischial tuberosity) and place your fingers between it and the anus. You may need to lift your glute muscles up/out of the way
  2. Then draw your muscles of the pelvic floor from the pubic bone to your anus. You should feel a contraction, now relax.
  3. Now with your hands in the same position, push your muscles out into your fingers.
  4. Was one harder to do than the other? If so you may have an imbalance that can be addressed with specific exercises.

Demonstrating the relationship between your breathing and diaphragm with the pelvic floor:

  1. You can have your fingers in the same position as described above.
  2. Notice what happens when you breathe in and out. Do you feel the muscles rise up towards your stomach when you breathe in and down into your hands when you breathe out? Well it should.
  3. Think of the abdominal and pelvic diaphragms working like a piston, going up and down in unison.  If this isn’t happening then this could be the reason your experiencing incontinence, pain, injuries and instabilities/weaknesses.  Don’t worry there are exercises to help! Such as this one…

Demonstrating the relationship between the core and your pelvic floor:

  1. Place your hands on your lower abdomen inside and below the ASIS(anterior superior iliac spine).
  2. Lightly contract your abdominals under your hands so that you feel them flatten slightly(do not suck in and hollow, you should not feel your pelvis rotate, your glutes contract or any movement in your spine).
  3. Maintain the light contraction of the core and contract the pelvic floor in the same manor as the prior two tests.
  4. You should feel an increase in power pressure under your hands and a contraction in the muscles.  If not, then there is a disconnect between the two, which needs to be addressed.

Lastly, is a demonstration of maintaining pressures between the abdomen and pelvic floor structures:

*Side note: this will affect bladder and urethral pressure; if bladder pressure is greater than urethral pressure or abdominal pressure is greater than pelvic floor structures, incontinence is more likely to occur.*

  1. Contract abdominal region by pushing out, ie. abdominal brace, lightly.
  2. Now forcefully contract as if you were filling up a balloon in your belly.
  3. Notice what happened to your pelvic floor? You should have felt activation of the muscles in the pelvic floor.  If not, this needs to be addressed.

I encourage you to do these tests, especially if you recently had a child or have been dealing with incontinence issues for years.  Even, if incontinence has never been an issue, these tests could shed light on why you’ve had chronic pain or instabilities anywhere in your body.  Do not fall into the trap of telling yourself, well I’ve done kegels and it didn’t help, or well this is just normal. It doesn’t have to be normal, there can always be room for improvement. “The pelvic floor and associated muscles can be trained just like any other muscle to return to their fitness level” – Suzanne Badillo PT, WCS – Rehabilitation Institute of Chicago.

In closing, I hope you find this helpful.  Comment below or contact me directly with questions and let me know how I can help.

Yours in Health,

Dr. G

BABY GOT BACK…TO EXERCISE

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OH BABY EXPO

This past week has been great since being a vendor at the OhBaby Expo on April 24.  I was able to meet many expecting mothers and women who had just recently had a child along with their family.  It was great seeing all of them and the many vendors, many of whom I was able to connect with, all under one roof.  It shows that there are a lot of people with a vested interest in helping women and their families during what can be an overwhelming time in their lives.  If you missed this event, be sure to check out the next one!

Along with being a vendor I was asked to do a presentation on ways for the new mom to return to exercise and a common complication during pregnancy, Diastasis Recti.  Safety is always a concern during any exercise program, which includes factoring in any health concerns.  Diastasis Recti is one health concern that is often overlooked and/or written off by many healthcare practitioners as being “just a normal thing that happens during pregnancy”.  When in reality, it has huge implications for spinal and pelvic stability, which can lead to chronic pain, if not managed properly.  I also want to point out that this doesn’t solely affect women, it can occur in men as well.

Diastasis Recti is a separation of the connective tissue in the mid-line of the abdomen between the two halves of the rectus abdominis muscle, ie. the 6-pack muscles.  This usually occurs in the 2nd or 3rd trimester due the pressure from the uterus and fetus growing in size stretching the tissue in the abdomen.  A separation can occur anywhere either above the belly button to the sternum or below as far as the pubic symphysis.  This can make day to day tasks more challenging when caring for your child or children, especially ones that involving lifting, bending and twisting.  These actions involve just about anything we do in life and when exercising, so choosing the right activities to do will effectively prevent further separation of the tissue, but also facilitate healing.  These activities include keeping your spine neutral and make sure you aren’t drawing your rib cage toward your groin/hips(crunching) or tucking your pelvis back/up towards your belly button(pelvic tilts).  The goal is to always maintain a parallel relationship between your rib cage and pelvis:

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You may be wondering….How do I test for this condition called Diastasis Recti?  It’s simple:

  • Lay on your back and place one hand on your abdomen above your belly button and one hand below
  • Perform a crunch and note if you feel anything bulge upward into your hand/s(typically it is either above or below, but anything can happen)
  • If you feel any tissue bulge or mound up into your hand then you have it

Now that I have this what do I do?

  • Mention it to your healthcare provider
  • To allow for healing after the pregnancy it is recommended to wait to begin any exercise until your first post-natal follow up appointment, which is typically 6 weeks after giving birth.
  • Make sure you are cleared to begin exercising by your healthcare provider
  • Don’t worry, it does not require surgery

Once you have been cleared to begin exercising….

  • Avoid any traditional ab exercises: Situps, Crunches, Pelvic Tilts & Twists
  • Avoid sucking in, as it is usually associated with similar contractions of the abdominal muscles to that of a crunch
  • Avoid slouching while sitting.  Not only is this bad for your posture, but it will crunch your abdomen and weaken your core!
  • Include neutral spine exercises: planks(try this modified side plank), curl up, dead bug
  • Breathe with your diaphragm. Learn more about breathing with the diaphragm here
  • Maintain a neutral spine and learn how to properly contract your abdomen, using the abdominal brace.
    • Here’s how you do it ~this is a snippet from The Almighty Diaphragm Pt. 2~
      • Moving forward we have to get you to feel the diaphragm contract, ie abdominal brace, for postural stability(IAP).
        1. Place your thumbs underneath your rib cage in your lower back, just to the outside of the large muscles.
        2. Let your finger tips wrap around your sides towards the front.
        3. Contract your diaphragm by pushing into your thumbs, outward into your fingers and your belly button away from your spine.  No hollowing or sucking in.
        4. You should also feel your rib cage draw down, like with the breathing exercise.
        5. If you aren’t feeling this, then imagine you have a belt around your mid-section, now push outward into it.  Doing this in front of a mirror can help, especially of you’re a visual learner.
  • Seek out someone who specializes in functional rehabilitation and exercise training like myself that can guide you and coach you on the right ways to breathe, brace and move
  • Chiropractic care and soft-tissue release(ART)can help to make sure your joints are functioning optimally and your muscles are moving freely through their full range of motion along with reducing any pain or soreness.

Lastly, for those who missed my presentation I wanted to include the workout routine my lovely assistants, my wife Jen and my 3 month old son Noah, helped me demonstrate.  Jen actually has Diastasis Recti and has been dealing with some pain/discomfort as a result.  She has also been diligent on exercising in a safe manner and her diastasis is reducing and her symptoms are improving.  The workout includes movements that reflect common day-to-day tasks that will allow you to exercise, train & heal your abdomen, get a sweat going and strengthen the bond with your child.  The recommended reps per exercise is 10 reps(*10 each leg for the lunges, 10 each alternating arm/leg for the dead bug and 10 rocks each way for the happy baby*).

Workout

1.) Squat  13023562_10204876748033334_215953196_n             2.) Front Lunge  13077161_10204876745793278_2032421683_n

3.) Backwards Lunge  12596011_10204876745713276_1293904979_n                     4.) Side Lunge  13081991_10204876745633274_1751188381_n

5.) Rotational Lunge  13081778_10204876745513271_916914666_n      13084183_10204876745313266_1448707410_n

6.) Shoulder Press  13059436_10204876745393268_128544154_n    7.) Dead Bug  13090353_10204876745073260_234399334_n

8.) Happy Baby  13059538_10204876744873255_1644180118_n

9.) Curl Up Kisses  13045703_10204876744313241_268026077_n

10.) Push Up Kisses  13059457_10204876744233239_765329391_n

So in total, this workout comes out to 160 reps and could take you around 10 minutes to complete(don’t hold me to the time!) and is a nice little workout to do especially when just getting started with your exercise routine again.  The main thing is to be aware of your posture, breathing and bracing and remember to take things slow and controlled.  If you need to take a break during the workout that’s fine!  Pace yourself accordingly and remember it’s all about you.  When you feel you are ready to get back into a more advanced exercise routine, consulting with a personal trainer can also be a good idea, especially one who specializes in post-natal training.  You can also try out the workouts in my blog here, Do you have a newborn and struggle to get a workout in?

I encourage you to test yourself and see if you have this.  If you do, start training safely and efficiently.  As always, let me know if I can help.

Yours in Health,

Dr. G