Oh NPR!

This week one of my favorite news sources put out a story that had my Facebook feed on fire. I have to say that my husband regularly notices that I get different posts than he does. Posts like images of uterine alignment, vulvar-vaginal tissues, and diastasis recti. What can I say? I have friends with connections in “low” places!

NPR did a story on diastasis recti (DR) which refers to abdominal separation that sent my colleagues and me into tizzy. The title “Flattening the ‘Mummy Tummy’ with 1 Exercise, 10 Minutes a Day” with an instructor promising that “you can easily expect to see 2 inches off your waist in three weeks of time,” triggered those of us that are working hard to improve women’s pelvic and abdominal health. Read the whole article for yourself here.

I personally and professionally have so. many. problems. here. With the grabby title, with the promise of an easy fix, and most of all with the content and evidence that was used to validate what was perceived as a positive outcome. Please understand that I am very happy that women’s health challenges are being reported on national media. I also appreciate that the author did present some good information from health professionals and a variety of resources in the article. But the main premise, as the title promises, is a quick fix to a very complex symptom and the research uses a measure that has very little to do with health or function as evidence-based “success.”

Root medicine is about finding the cause of a symptom, not simply solving or relieving a symptom. In fact, symptoms such as pain or dysfunction are regarded as important signals to learn from rather than fix or medicate. DR has several root causes: intra-abdominal pressure, reflexive movement patterns, and muscular integrity through a range of motion. Although DR is generally considered a postpartum issue, women that have never had a baby and many men have experienced abdominal separation. Therefore, clearly, pregnancy is not a root cause; however, all women will have some degree of stress on abdominal musculature when pregnant. DR becomes a concern when abdominal thinning or separation do not heal or when dysfunctional co-morbidities are present.

Many of my colleagues are pushing for postpartum physical therapy (PT) in the US. I mean, we get routine PT for joint surgeries. While that is important, these surgeries are generally less disruptive to overall function than the process of pregnancy and birth. Often accompanied by tissue damage and surgical interventions, birth has very limited follow up care in the US. Additionally, this tender, torn, and tired mama must feed and care for a completely dependent newborn. And then return to work promptly. Stress much? PT, tribal support, meals, maternal/paternal leave, flowers, and much more is needed for our young mothers. What isn’t needed? A promise of an easy fix and a quick  return to a trim waistline.

Because, trust me, if the fix were easy, the problem wouldn’t be so pervasive. There aren’t easy answers and the root causes are not being addressed in our health care system. Our bodies are complex. Although we are able to heal, healing happens most thoroughly when all of our systems are working together in their beautiful complexity.

So, let’s look back at those root causes and how the method of bringing the “belly to the spine” technique supports healing. First off, intra-abdominal pressure (IAP): pulling your stomach in increases IAP–which is one of the causes of DR. So how can the cause be the fix? It can’t. It only displaces IAP. Breathing is dependent on the management of IAP, which is why the women in the class had to take tiny breaths–they couldn’t take a deep breath with so much pressure. If a belly is pressed to the spine, and a deep breath is required, IAP forces are transferred toward the area that can “give.” Forceful abdominal contraction with increased IAP is created reflexively to push something out by coughing, sneezing, or vomiting–creating “give” through the throat and clearing out blockages or poisons. Intentional over-contraction makes a necessary movement like coughing less  effective. Since breathing may ultimately depend on coughing something out, the reflex-driven force increases and may lead to stress incontinence, especially when pelvic floor muscles have been compromised from pregnancy and birth and may have more “give” than the throat. Symptoms are simply transferred rather than fixed when root causes are not considered.

Which brings us to the second root cause of DR: a confused reflexive core. Our societal drive for a sculpted 6-pack is driven by media, not health professionals. Having a “strong core” does not guarantee less back pain, better posture, breathing, or a reduction in the incidence of DR. Overriding our reflexes by constantly engaging the core also tenses the pelvic floor which works in tandem with deep abdominals. Constant tension reduces our ability to relax or even feel tension. This may seem like a way to decrease “give” and reduce leakage, however, since the core is over-engaging, most likely so is the pelvic floor. It is common to have at too-tight pelvic floor as the root cause of many problems such as urge incontinence, nerve impingement, digestive issues, uterine displacement, and difficulty in sexual intercourse or with orgasm. That is why working with a pelvic PT is so important. Besides back pain relief, no other typical co-morbidities are discussed in this article. We know nothing about how the 63 women in this study are functioning the other 23 hours and 50 minutes of their day.

The third root cause is about contraction of abdominal muscles themselves: this is about connective tissue adaptability and recovery from stress. Strong muscles have tone throughout their range of motion–not just in their shortened and contracted state. In the abdomen, range of motion needs to be adaptive enough to allow for expansion of organs–and in pregnancy, to accommodate a full term baby. If a growing baby increases IAP and muscles cannot stretch with integrity and tone, some portion of the connective tissue becomes stressed, undernourished, and weakened. Eventually there may be tearing and separation from attachments. So in a sense, weak muscles are a cause of DR, but the weakening is due to a lack of adaptability and maintaining tone in a stretched state. Limiting the range of motion by constant tensioning is the reason for this lack of adaptability. Re-establishing tone in a shortened state only will not fix the inability of a muscle to stretch and maintain integrity. The next pregnancy will cause DR again.

Finally, the proper way to measure recovery from connective tissue stress and DR is by muscular responsiveness through a complete range of motion. In the research quoted in the article, success was measured by how many inches lost from the waistline and the width of the DR in a contracted abdomen. Waist circumference is not a valid measure for muscle tone since waists include fat, organs, and digesting food. Although measuring the DR split in a contraction is somewhat indicative of tone, it has reliability problems and should only be used as a comparative guideline rather than a validity measure. A much better way to measure tone is through ultrasound and having the client move through a range of motion to test if a muscle is responding.

With a small sample and no control group, poor validation, and mostly, with an extremely superficial understanding of what diastasis recti involves, this pilot study is just plain sad.  As the article indicates, even ACOG recommendations are vague so I will forgive NPR this one time. I’m hopeful that more help, research, evidence-based practices, and reports are on the way. Let’s fill up everyone’s social media with lots of really good information on women’s health. That would make me happy.

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Bone Deep

Ah January–the time for resolutions. After nearly 35 years teaching in fitness facilities, I  know that many, many people will make healthy eating habits a priority, especially after the holiday feasting. Which is a good thing! Better nutrition is a vital part of any integrative approach to health. Without going into detail, our physical body is made up of the stuff of food and to be a little more detail-ish, minerals in particular, when we think of bones. For bones to form it takes more than just ingestion and digestion. There is a healthy competition going on inside us for those minerals that goes bone deep.

How nutrients absorb into your tissues has to do with what happens at the cellular (micro) level. First, think from a macro level: when you move a lot, you get more hungry, right? Well, the same thing happens in your cells. When they move, they absorb more nutrients. But it is important to consider how these cells move, since they are part of a specialized team of cells that form a tissue. Bone tissues have different movement needs from muscle tissues. The study of biomechanics (emphasis on the BIO) researches specifically what happens at the cellular level to create healthy nourished tissues. FYI: mechanotransduction is what happens.

When I was in biology class in middle school, we drew blobs with little floaty parts and called them cells. The floaty parts were organelles and they were sort of cool and we needed to know their names, but that was about it. As it turns out, the human body has patterns that repeat from the micro to the macro levels. Cells have a very tiny bone-like structure that “feels” movement and transmits signals like “I’ve been moving a lot and my cell is hungry” to the organelles. Which then absorb more of the nutrient soup that is extracellular fluid. No movement, no signal, no soup.

So we not only need to move to need to eat, we need to move specifically in a way that signals all of our tissues to get into the soup line. Which, since there is a variety of tissues in our bodies,  we need to move in a variety of ways. I’m just going to talk about bones for now, for the sake of staying sort of non-detail-ish.

Even our bones have a variety of needs that are based their shape and function. Long bones, such as your femur (thigh bone) need a certain amount of compressive and vibrational impact to get hungry. Movements like walking provide most of those needs, but the walks should encompass a variety of terrains and inclines rather than be flat and level, like most walking paths. The changing vibrational directions of non-flat walking creates a better diet for femurs. Running is fine, but it should be done on varied surfaces as well. Running on flat, level concrete may be too much of a good thing; steadily feeding the same area in a bone creates excessive growth such as spurs or arthritis.

The tiny sesamoid (“sesame seed”) bones in our body in places like hands, feet, and neck prefer pulling or tensile movements rather than impact. These bones are embedded in joints that have a lot of tendons and they help to create sliding movements. Your knee cap is the largest sesamoid bone. Compressing your kneecap doesn’t make it stronger and usually doesn’t feel good at all, which is a signal that it is getting the wrong kind of diet. Rather, the knee cap helps the knee to slide well and the pull from that sliding is what stimulates its appetite for some good calcium rich soup.

The human pelvis is maybe one of my favorite bones. Well, it is actually several bones that change over a lifetime, especially for women. Within the pelvis are the pubic symphysis, the sacroiliac (SI) joints, and the hip joints. Any of these can become mineral poor if not given a healthy movement diet. Hips are one of the main sites for osteoporosis. And no matter how much calcium you eat in your macro diet, the hip joints need specific movements to absorb it. There are several shapes of bones that come into the structure of the hip joint, so movements need to be varied including squatting, climbing, crawling, and walking. Standing posture is also important since the bowl of the pelvis is what holds the belly of our body and that creates a specific compressive load as well. The pubic symphysis needs tension that moves diagonally across from thighs to abdomen for the joint to be stable. And the SI joint needs a bit of both tension and compression in balance. Bottom line (hee hee) is that you need to move your bottom in a variety of ways. all. the. time.

So, when you make your resolution for the New Year—be sure to think bone deep. Move in a way that serves all of your needs, not just the need to reduce your calorie load. Your tissues will be inclined to help you with that if you create a hunger within their cells!

Science Discovers: Your Brain is Connected to Your Body!!

This has been an exciting week in body-nerd world! Two important discoveries were in the news, both of which sort of discovered that the workings of the brain are undoubtedly connected to the body. Yes!

The first study, “Hacking the Nervous System” reports on the importance of the vagus nerve in organ regulation–specifically on inflammation response. Read the article, because it is truly important and interesting, but I am just going to for now point out that the brainstem (a part of the brain) is connected to the body through the vagus nerve via the neck and shoulders (parts of the body).

The second report is really ground breaking: scientists have discovered lymphatic vessels in the central nervous system (the brain). “In a stunning discovery that overturns decades of textbook teaching, researchers have determined that the brain is directly connected to the immune system by vessels previously thought not to exist.” (link here to read report).

Maybe I’m being too snarky, but I’m glad that science has discovered the links between the brain and the body. Maybe now we can move into more integrative medicine. One can hope.

In the meantime, I would like to point out the absolute importance of HOW the brain connects to the body through the neck and shoulder girdle. If the alignment of those areas is not optimal, then much of these important connections can be lost. Vessels and nerves are extremely sensitive to geometry and pressure. Having incorrect alignment can result in poor communication (think “telephone game” from your childhood).

SO another, more “science-y” reason to DO THE HANGING CHALLENGE WITH ME THIS SUMMER!!! Your shoulders were meant for so much more than typing and driving–they need this! I have looked at hundreds (thousands?) of spines and seen for myself the amount of hyperkyphosis–both apparent and hidden we are currently carrying around. Increased neck posterior flexion and shoulder girdle weakness are rampant. And now, more than ever, maybe we can realize how important it is to have a properly aligned neck–to connect the brain to the body.

Here is a video of your next portion of the challenge:

Older Than Dirt

Last week two things occurred: I read Natural Born Heroes by Christopher McDougal  and I got to dig in my garden for the entire weekend.

McDougal’s book delves into natural movement–its ancient and modern applications. This is an area that I have done extensive research and some bit of training. It is the source of my summer hanging challenge–which I PROMISE I will return to. But before I do, I want to–actually I feel I need to–get a little more philosophical.

You see, I went to visit my mom a couple of weekends ago. She is in the final stages of her life. My trip left me satisfied and yet unsettled. Not because of her dying–she has had a good run and is ready, as ready as anyone can be for their life to end. No, rather I am unsettled by living, having another birthday that officially brings me into my mid-fifties and another year closer to the end of my life expectancy. And reading this book. And digging in the garden.

One of the people McDougal researched was French naval officer George Hebert who witnessed the volcanic eruption of Mount Pelee on Martinique in 1902. He was a part of rescue efforts as people ran into the water to escape the burning ash and then drown as they panicked. Almost the entire population of the capital city died. The “uncivilized” native population however were more fit to survive the disaster–they recognized the signs that lead to the eruption, knew what to do, and were able to stay afloat even when their canoes were burnt by the flying embers. Eventually, Hebert developed a philosophy to fitness: “be fit to be useful” was his credo. These words attached themselves to my heart as I read them. I reread that passage from the book throughout my week as I taught yoga–a practice that could be deemed “UN-useful” if viewed in certain ways. But my purpose was to shed light on the practice that is entirely useful: to really understand what it means to be human, you need to spend time exploring consciousness. And exploring consciousness is the root of a yogic practice.

 

And then I went out to the garden. And dug in the dirt that wasn’t there fifteen years ago when I first put my trowel in. The place in my yard I chose for a vegetable garden, it turned out, used to be a gravel driveway. No dirt–just rocks and sand–which are not the best medium for growing. So over the years I sifted out rocks, added topsoil, hauled manure, composted and slowly created a garden of 4×4 beds. I was amazed last year when a friend brought over his tiller to help me turn the beds. His machine was too big for the small beds, so he tilled between them. I stood in amazement as I saw dirt between the beds. No gravel anywhere. And this weekend as I hand dug to plant, my trowel sunk into a good 6-8 inches of real, live soil. I had been useful–I made dirt. And I felt very human and very deeply alive.

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In my years as a fitness professional, I have seen many strong and sleek bodies. I have seen–and participated–in feats of both physicality and courage. All of it is inspiring, but I’m not so sure about how useful any of these feats are in the long run of life. Especially when our physical efforts result in injury. And what amount of these efforts were made to overcome a sense of humanity rather than participate more deeply within it? This is the source of my unsettling. What does it mean to be useful? and what do we do to become fit so that we can be useful? As I–we–approach the end of our lives, how do we assess our usefulness?

“Exercise with only the intention to carry out a physical gain or to triumph over competitors is brutally egoistic…and brutal egoism just isn’t human,” Hebert is quoted as saying. McDougal goes on, “We like to think of ourselves as masters of our destinies, as lone wolves in a dog-eat-dog world, but guess what: Dogs don’t eat dogs. They work together. As do most species. As do we. We’re the most communicative, helpful species that’s ever existed.”

My dear mother is maybe the least physically fit person I know. But she was very good at being a mom. Even though she might not have been able to save me from drowning in a sea of ash, she saved me from a shadow that hovered over our family life and kept me free and innocent. I’m not sure even what that shadow was, exactly, due to how useful she was in protecting me. The Greek term “hero” means protector. My mom was my hero growing up.

One final quote from McDougal: “Empathy, the Greeks believed, was a source of strength, not softness; the more you recognized yourself in others and connected with their distress, tho more endurance, wisdom, cunning, and determination you could tap into.” Being useful is sort of a mystery when you are in the midst of a crisis. Most heroes have no idea why or how they did what they did. What matters, what lasts, is how those heroes made other humans feel: recognized and worthy.

Heroes come in many forms–not all are strong or sleek. Awards aren’t all brass and glass–some of them crumble easily and are full of worms. As I grow older I am challenging myself to learn how to strengthen my shoulders not so I can perform a pull up and overcome aging, but so I can continue to reach out to others. I know what it means to get a good hug and thank god, my life is full of them. I want to be useful back. Hug back. Hang out and extend myself to others–whether that is by reaching into an isle of lava or across an aisle of difference. You are very human and hug-worthy.

Do Your Arms Hang Low?

….do they wobble to and fro? Well, in that song, I think it was about your ears, and there were more subtle meanings as well that I didn’t get as a child. I also didn’t get the subtleties of hanging either. I was a child that liked to be planted firmly on the ground!

And now I’m making some advancements toward a healthier shoulder girdle by learning to hang. Last week, I posted about hands and wrists. Today I’m talking upper arms and getting them into correct positioning to hang well.

I’m also learning how to post a video. I hope. Rotation in the upper arms is easier to show than describe. I love this exercise in finding your upper back muscles! I hope you have fun with your challenge for this week:

The Problem Isn’t Always Where You Think It Is

This weekend I went for multiple walks and each time I did just a little bit of hanging. Once it was about hanging on to the dog but also, we went out to the woods for an afternoon walk and found a few tree limbs. I love to have bark beneath my skin rather than metal. I think you will find that the first problem of hanging isn’t so much the strength of your shoulders–it is the softness of your skin. Calluses are healthy adaptations on skin surfaces and the first step to hanging from your hands is to develop some thicker skin. Literally.

The second thing is wrists. Mine are totally wimpy. And not surprisingly (although I WAS surprised) my forearms were stiff and sore today. So, let’s begin our challenge, not at the shoulders, but in the hands and forearms.

To watch an 11-month old baby do some hang time, check out this video of my teacher, Katy Bowman’s little girl, Roan. See how often she checks her hands? But she isn’t crying or acting like they are hurting, she’s just connecting to them. Also notice that her hands are almost vertical and pretty open along that bar. No need for a tight grip! I think it is safe to say that as adults, we don’t have that kind of strength in our hands and wrists, especially in extension.

Begin by mobilizing those tissues and taking them through a complete range of motion. Here is your first week’s assignment: do these hand movements throughout your day:

Full extension

Full extension

Full flexion of fingers and wrist

Full flexion of fingers and wrist

 

 

 

 

 

 

Notice which direction is more difficult. Why? What is your hand position during most of your day?  To correct a movement limitation, we need to introduce small changes  throughout the day  to avoid injury. I like to do the extension one at my desk regularly, while I stop at a light when driving, and while sitting around doing nothing in particular. I use the desk, steering wheel or my other hand to provide gently pressure toward my limit of mobility and hold it for about 30-60 seconds. This was the exercise I was doing today that made it clear that I HAD done some work yesterday.

Tissues–whether it is skin, fascia or muscles–will adapt to changes in loads. The key is to do these changes slowly and apply the loads where it does the most good first. Take a tip from Baby Roan and check out your hands!

The Hanging Challenge

This will be the summer of the hang. As in me hanging from my arms. I’m not dubbing it as the summer of the pull up, because at 53, so far I have never, ever been able to do even a single pull up. Which, I have to admit, pisses me off a bit.

In my 20’s, when I was working as a trainer in a weight room, I tried. I really, really tried. Every day I would use the pull up bar and give it a go. And I continued to fail. Every. Day.

So, rather than get my hopes up, I am going to do what I succeeded in doing–hanging. In as many different ways as I can. Every. Day.

Because, even if I never do a single pull up my entire life, I need to use my arms and shoulders as they are designed–to be mobile, strong, connected to the rest of my body, and when needed, able to support the weight of my whole body. I have seen too many people take a little fall and end up immobilized due to a broken wrist or arm.

As a Restorative Exercise Specialist™ I learned the importance of the positioning of the rib cage, how poor alignment can affect breathing, digesting, birthing, eliminating, and the functionality of the entire musco-skeletal system. Rib positioning is totally related to shoulders. So, weak shoulders CAN mean poor pooping. Who knew??? Who cares? Well, if you don’t eliminate well, you probably do–or rather don’t doo (sorry can’t resist)–and well, you probably care. Because constipation sucks. Or something…

Anyway. The summer of hanging has begun. Here is my first attempt:

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Keep reading dear reader! I’ll be posting every week or two about my experience. Can I challenge you to join me??