By: Rachel Miller PT, DPT
The core is our center. It stabilizes the trunk while arms and legs are moving. It not only includes our abdominals, but also our back and scapular musculature, pelvic floor, and gluteal/hip muscles. The core is supposed to help you with daily activities. The more strenuous an activity or exercise is, the more the core should help. Unfortunately, when we have pain or surgery in this area, it affects the core muscles and can cause weakness and the core to not function optimally. The good news is that the core can be retrained, and all of these signs of core weakness can be improved.
1. You have neck or back pain
While there are many causes of neck and back pain, core weakness can be one cause. Pain with prolonged sitting or standing, or pain with change in positions such as sit to stand or rolling over may indicate core weakness as a contributing factor.
2. You tend to slouch
Sitting or standing for long periods of time can be challenging. Our postural muscles are endurance muscles- meaning they need to work a little bit, but for a long period of time. None of us have perfect posture all of the time. That is fine, variety is good for us. But if you are in a slouched position for hours every day, that leads to a forward head position, pec/chest tightness and excessive flexion of the upper back. This can lead to back and neck pain as well as core weakness.
3. You have poor balance
Our core and especially the muscles in our hips/pelvis are important for balance. If these muscles are weak, your balance will be affected. Often one side of your body is weaker or has more difficulty with balance so see how you feel with a single leg balance test. As we get older, balance becomes more challenging so incorporating balance training into your workout routine is important.
4. Core exercise or heavy lifting are difficult
It seems obvious but if you struggle with core exercises, you likely have a weak core. The only way to get better is to practice. But keep in mind that the deeper core muscles that provide stability should be working with our outer muscles that our movers so working with someone that can teach proper form and muscle activation is highly recommended. Do you tend to hold your breath with exercise? If the answer is yes that is a common compensation for core weakness.
Remember that your core is meant to help you with real life, not just core exercise. When you lift a heavy bag of groceries, do you feel your stomach muscles automatically tighten? That is what we want- a reflexive core. If you find heavy lifting or strenuous activities are difficult, or if you don’t feel your core engaging, that is something that you can change.
5. You leak urine with sneezing, laughing, coughing, jumping or exercising
This is a sign that your pelvic floor muscles are not doing their job. Either there is a pelvic floor muscle issue, or your deep core system is not working together properly. If you are leaking even just a little bit, even just sometimes, while it is common, it is not normal and pelvic floor Physical Therapy can help.
You may now be thinking what is the best way to strengthen my core? I believe that it takes some body awareness and education, along with exercise with proper form. Pilates does exactly this, and our Pilates intro package is the best starting place. It gives you access to over 2 hours of educational exercise videos called Core Connections that focus on teaching you proper form and core activation as well as core exercises for the entire core system. The intro package also includes two private Pilates sessions- either in our studio or virtually so you can get feedback and guidance from an expert.
By Rachel Miller, PT, DPT
It is estimated that 50% of adult women experience urinary incontinence. There are a few different types of incontinence. Stress incontinence is leaking urine when you sneeze, laugh, cough, jump or exercise. Urge incontinence is leaking because you can’t hold long enough to get to the bathroom. Mixed incontinence is a combination of both.
Risk factors for incontinence include increased age, obesity, type 2 diabetes, and history of former or current cigarette smoking. Birth history also is a factor, a vaginal delivery or multiple births increase the risk more than c-section. A hysterectomy also shows increased risk of incontinence after.
So, ladies, let’s get real. If you have given birth and are getting older (is anyone getting younger?), statistics are not fabulous. Is it possible to decrease your risk? I believe you can. Keep reading if you want to learn how… and no, the answer is not daily kegels (pelvic floor muscle contractions).
First, check in with your pelvic floor muscles. Are they doing their job well? If you are noticing occasional leaking- even just a little bit, even just sometimes; that is a sign that your pelvic floor muscles need some attention. Seek treatment now- pelvic floor Physical Therapy is the #1 recommended intervention and can not only help you not leak now, will likely help set you up for better success in the future. If you are not having any leaking right now, that is great but I want you to explore a little deeper. Do you have hip pain, low back pain or hip tightness? Do you have pelvic pain (pubic symphysis, SI joint) or pain with gynecological exams or intercourse? If the answer to any of those is yes, the pelvic floor muscles may be involved and are often hypertonic (too tight). How do you know for sure? Get assessed by your OBGYN or a pelvic floor therapist.
How strong is your pelvic floor? Next time you go to the bathroom, can you stop the flow of urine? Do not do this frequently as it can cause problems, but as a one time check it can at least tell you if you know where your pelvic floor muscles are if they are strong enough to accomplish this task. If you cannot do this, it can mean that the muscles are weak, or sometimes all it means is that your brain doesn’t know where the muscles are. If you can do this but are experiencing any of the other issues or occasional leaking, it can be a timing or coordination issue of the muscles. It could also possibly be a hypertonic pelvic floor - if the muscles are already contracted/tight, then there is no additional help when you need it.
If you have ever given birth or had a pelvic or lower abdominal surgery, request PT. It is not the standard of care but when the muscles are overstretched in pregnancy/birth or cut through (c-section or surgery), having a little help to reconnect after can be so helpful. Don’t worry, it is never too late to make changes. Also, minimize all other risk factors you can. If you have a high BMI, focus on weight loss. If you are a smoker, consider stopping. Set yourself up for success.
You can start by taking action now! If you are experiencing incontinence or other pelvic floor issues, schedule a free virtual discovery session with a Physical Therapist to help determine what is the appropriate next step for you. If you are not having issues but want to be proactive, schedule a Mommy Tune Up- a private wellness session with a women’s health Physical Therapist that will assess core strength, flexibility, and more. And now includes a screening of your pelvic floor muscles with real time ultrasound (that is performed on the lower abdominal wall) so we can make sure your pelvic floor muscles are doing their job!
by Dr. Cathy Malloy & Dr. Rachel Miller
It's summer! Many of you are likely busy in your yards gardening or performing other lawn maintenance including weeding. Repetitive bending and lifting can lead to back pain or stiffness. Here are a few tips to keep you feeling good so you can enjoy your time outside.
When it comes to gardening we want to remember good body mechanics. The closer you are to what you are pulling, the less strain it will be on your back. Instead of standing and leaning over something closer to the ground, try kneeling (either on both knees or one and then switch sides) on pads. Instead of repetitively bending forward (spinal flexion), perform a hip hinge.
To hip hinge, pretend you are holding a light stick against your back. Your head, mid-back, and bottom would all be touching the stick with a little space behind your low back and neck due to the natural curve of the spine. This is called a neutral spine position. When you bend forward, the three points of contact should remain touching the stick. If the bottom part lifts away it is because you are flexing your lumbar spine/low back. If the middle part lifts away, it is because you are overarching your mid-back. Both of these can contribute to tightness in your back muscles which may contribute to stiffness in the spine and possibly back pain when performing this motion repetitively, especially when performing strenuous tasks like pulling and lifting. Hip hinging will optimize your core and glute activation so those muscles can do the work instead of your back. If you are a visual learner, watch this video of a standing hip hinge or this video of a kneeling hip hinge.
Lastly, work smarter not harder. Invest in a hand weeder so it is easier to get the roots, which will also decrease the probability of the weed returning. Also try to pull weeds on days that the soil is soft. If it hasn't rained in a while try watering the soil first to make pulling the weeds easier on your body. Happy gardening!
by Rachel Miller, PT, DPT
Pilates was originally called Contrology
Developed by Joseph Pilates, he named his exercise method after one of the most important Pilates principles, control. You truly have to think about what you are doing. We all use our easiest to find, strongest muscles by default and the only way to change that pattern is to consciously do something different. This will create better balance in your body.
The Pilates equipment is meant to be the starting place
It can look intimidating, but the reformer and other Pilates equipment is actually designed to ASSIST you. For example, think about double leg lower, which is a core exercise where you lay on your back with legs straight up in the air and lower them down and lift them back up. This is a hard exercise, and often is not done correctly. On the Pilates equipment, the legs are supported by putting the feet in straps which are connected to springs. This makes it easier to hold the legs up and also provides resistance as you lower the legs. This provides eccentric strengthening (which means strengthening into a position of stretch) which will help with flexibility. The mat exercises are often more challenging and are meant to supplement the equipment.
Pilates is for a wide variety of ages and ability levels
Our clients range from 12-90 years old in the studio. The equipment is extremely adaptable - we can change support, resistance, and range of motion. What I love most about the equipment is that there is always a choice. For example, footwork on reformer. This exercise is usually performed lying on your back. But it can also be modified to sitting on the arc or sidelying. Choosing a heavier spring tension will make the focus leg/lower body strength. But a lighter spring will focus on deep core and hamstrings. In Pilates, heavier is not always harder- it depends on your body. Most of the exercises have modifications to make it easier and progressions to make it harder. This is why it is a perfect fit when used as part of Physical Therapy. It is also great for ongoing fitness and is a fabulous addition for cross training, which is why many professional athletes practice Pilates regularly.
To experience the benefits of Pilates- increased strength, flexibility, body awareness, posture and so much more, you need to try it for yourself. The Pilates PT offers private and semi-private training and small group equipment classes, specialty classes and a weekly live virtual mat class- plus we have a Pilates PT on demand video library. The best place to start if it is new to you? Our Pilates intro package! As Joseph Pilates says, “In 10 sessions, you’ll feel the difference. In 20 sessions, you’ll see the difference. And in 30 sessions, you’ll have a whole new body.”
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Just click on the picture: 7 Tips to help your back pain feel better without pain medication, injections, or surgery or Post-baby Body Basics: what every Woman needs to know about their postpartum body.