Back Pain, Health, Pregnancy, Standing

How to Stand when you are Pregnant

Pregnancy is another place we see the difference between posture and alignment.  You all know the common pregnancy posture: pelvis and belly pushed forward with hands resting on the low back.  It’s normal to see this all around us, but it’s not good alignment.  Ideally, you would stand the same whether you are pregnant or not.  If you haven’t read the last few posts, start by reading “Alignment, is that like posture?” and “Stand up Straight!” to bring you up to speed.

When you are pregnant, you still want all your pieces stacked perpendicular to the ground. In fact, this may be even more important when you are pregnant.  If you add 30 extra pounds to a frame that is unstable, you are going to notice pain or dysfunction at the “weakest link”.  For example, maybe you stand with your pelvis thrusting forward and have occasional back pain.  Then you get pregnant and have excruciating back pain.  Is the pain cause by the pregnancy? No, it’s the result of putting extra weight on a skeleton that was already misaligned.  Pregnancy magnifies whatever misalignment you had going into the pregnancy.

This is my dear friend Leanne about 38 weeks pregnant.  She is such a good sport.  (Fun fact- she actually went into labor an hour after I took these photos.  On the left we have the typical pregnant posture. Imagine her hands on her lower back, belly pushing forward as she waddles along.  (I say “imagine”, because Leanne worked so hard on her alignment during pregnancy that she never actually waddled.) Her pelvis is leaning forward and her torso is leaning back.  Her pelvis is posteriorly tilted (aka, tailbone tucked under), and her feet turned out.  On the right we have a beautifully stacked skeleton.  Her ear, shoulder, hip, knee, ankle are all in a vertical line.  She has a neutral pelvis with her rib cage stacked right on top and her feet straight.

Picture A: Typical Pregnancy Posture (Just say no.)

Picture B: Aligned and Pregnant (Gold star!)

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Picture A
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Picture B

A pregnant woman who stands like Picture A will likely have more back pain, but alignment affects more than whether or not she is in pain. I’d like you to notice two very important things: the shape of her belly and the shape of her rear end.  It’s ok, I asked her permission to have a bunch of strangers (although, let’s be honest, not that many) analyzing her very pregnant figure. Can you see that both her belly and her backside are completely different shapes in the two different pictures? In the typical pregnancy posture (Picture A) her rear end is flattened out and looks smaller.  Her belly is sort of pointing upwards.  In the aligned picture, you can see her gluts look bigger (in a good way) and her belly is pointing straight ahead.

Looking at the shape of Leanne’s body is a subjective assessment, but it illustrates an important underlying concept:  How you stand affects your pregnancy, labor and delivery in very real ways. 

1) Better baby positioning in utero.  You are the container in which your baby lives.  When you change your shape, you change the shape of your baby’s container, and the baby will adjust accordingly.  How you stand during pregnancy can help (Picture B!) the baby to be in an optimal position for delivery.  More on this here.

2) Appropriate pelvic floor tension. Standing with the pelvis in a post tilt (tucked under, like Picture A) causes excessive tension in the pelvic floor and inactive gluts.  You want your pelvic floor to be relaxed enough to let a baby pass through more easily.  You also want your pelvic floor to be strong enough to hold up your organs and hold in your pee.  You need strong gluteal muscles to achieve this not too tight/not too loose pelvic floor muscle length.  When you stand like Picture B, your gluts are being used all day long to hold you up and move you around.  They will become as strong as they need to be to support your pregnant body and balance out the pelvic floor.

3) Increased birth space.  The strong gluts mentioned above will pull the sacrum posterior (back), increasing the birth space (who doesn’t want that?).  In addition to changing how you stand, you can also START squatting and STOP doing kegels.  For more on squatting and pelvic floor health, read what the Alignment Monkey has to say.

For an extra challenge, try this online class that has a lot of one leg squatting: A Balanced Approach to Hip Strength.

If you are pregnant, and live in Middle Tennessee, contact me to start your complete prenatal alignment program!

Back Pain, Habits, Health, Pictures of Exercises, Pregnancy, Spinal Health, Standing

“Stand Up Straight!”

Have you ever been told to “stand up straight!”?  This phrase has children everywhere grumbling as a well meaning adult lectures on the importance of good posture.  In my opinion, it’s one of the most  relevant examples of the difference between posture and alignment.   The phrase has permeated the culture with its vague (subjective) recommendation for our spinal health and caused a lot of confusion.  I have many clients who have spent years trying to get their back “straight” because of this misunderstanding and suffered greatly because of it.  For all of you out there in the same boat, I hope this post helps you find some relief.

First of all, the spine isn’t supposed to be straight.  It has curves like an “S”.  I’m going to say it again: a healthy spine has curves.  Specifically, notice the thoracic  (mid back) curve.  This is called kyphosis.  The word kyphosis is often misused to mean “too much curve.” (Too much curve is called hyperkyphosis.) You want that kyphotic curve. It’s supposed to be there.

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This is a side view. The person would be facing the left side of your screen.

Most people translate “stand up straight” to equal “chest up, shoulders back.”  This lifting of the chest/rib cage creates forces that distort the curve of the thoracic spine.  If I asked you to stand up straight or show me your best posture, chances are it would look something like this:

(Again, ignore the “I Dream of Jeannie” arms.  I’m just doing that so you can see the line that is coming up.)

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Looks pretty good, right?  In my last post, you learned how to align your pelvis.  When you did this, you may have felt like you were going to fall over backwards  or felt some discomfort in your back.  If so, learning where your ribs belong will help.  Let’s revisit the super awesome grid app.

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The vertical line is lined up with the bottom of my rib cage.  See how that line falls out in front of my pelvis?  My “good posture” is lifting my rib cage and pushing it forward. Look at any skeleton in an anatomy text book, and you will see that the rib cage is supposed to be right over the pelvis.  Put your finger tips on the most inferior, anterior part (the part that is lowest and towards the front) of your rib cage.  Can you feel the pointy edges of your ribs sticking out?  Now exaggerate your best posture.  Are your ribs sticking out even more? Now relax and let the ribs drop down ALL THE WAY.  (If you feel like you are slouching, you’re on the right track.) At this point you shouldn’t be able to feel any boney edges sticking out.  They will be directly over your Anterior Superior Illiac Spine (ASIS: boney protrusions on the front of each side of your pelvis).  If this description is confusing, or you have a hard time finding these boney markers, see how to test for rib thrusting against a wall.

I have one finger on my ASIS and one on my bottom rib, so you can see where they are.  Now the rib cage is right over the pelvis, where it belongs.

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Take a look at these side by side.  On the left: Ribs are aligned, restoring thoracic kyphosis. (What you want.)  On the right: Ribs are lifted and thrusted forward, distorting the thoracic curve. (A recipe for pain and degeneration.)  Can you see the difference?

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I know these two positions look similar, but the physiological effects of these two positions are very different.  Remember, “good posture” looks good but is not necessarily healthy.  The rib thrusting/chest lifted position distorts your spinal curves and puts excessive compression on the one or two vertebra that you are displacing.  The vertebra that make up the spine stack on top of one another forming a protective housing for the spinal cord. When we lose or distort our spinal curves, the integrity of this protective structure is compromised, and the spinal cord and nerves that branch off are at risk for damage. Displacing the ribs also compromises the abdominals’ ability to do their jobs. One of these jobs is to properly support the spine and decompress the discs.  Many people find huge relief from back pain when they stop thrusting their ribs.  Another job of the abdominal muscles is to support the weight of a growing baby when you are pregnant.  When these muscles are compromised, it can lead to diastasis recti (excessive spreading/separating of the abdominal wall).

When you get your ribs down (ALL THE WAY DOWN)  you might (read: almost certainly will) find that you have hyperkyphosis and your head and shoulders are too far forward. Like this:

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Don’t panic! I know, it’s alarming when you see how far forward your head is.  The good news is you can make changes with some hard work.  Resist the urge to lift your chest/ribs to “fix” this problem!  It will look better in the short term but will not solve the problem. When the ribs are down in their aligned position, it reveals all the tension in the upper body that we typically hide by lifting the chest/ribs. Instead of hiding the problem, use the two exercises below to start correcting it.

DO THIS:

First, elevate your head and shoulders and relax here until your ribs start to relax down towards the floor.  You can let your arms rest on the ground by your sides.  This helps relax a muscle called the psoas.

Next: After several minutes, add SLOW arm motions like you are making a snow angel without letting the ribs pop back up towards the ceiling. Rotate the arms so that your thumbs are closer to the floor than the pinkies.  This will stretch the chest and shoulders.

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The ribs might start out lifted towards the ceiling like this.
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Let them relax down towards the floor, like this.
If you find that your upper body is REALLY tight, I would suggest taking Katy Bowman’s online class called Super Supple Shoulders or any of the “Alignment Snacks” dealing with the shoulders.
Back Pain, Habits, Health, Hip/Leg Pain, Pictures of Exercises, Pregnancy, Standing

“Alignment, Is That Like Posture?”

Happy New Year!

I thought I’d start off 2014 by addressing one of the questions I was most commonly asked last year: “Alignment, is that like posture?”.  

When I tell people that I teach alignment, what usually comes next is something like  “Alignment, is that like posture?” or “Oh, I need that, I have terrible posture.”  While they may sound like the same thing, alignment and posture are actually two different things.  Posture is how something looks. Alignment is how something works. Posture is subjective and cultural. Alignment is objective and scientific.

“Good posture” means different things to different people.  We decide that a particular posture is good if it creates a look that is seen as desirable.  Certain postures might look good, but that doesn’t mean they are healthy.  Different sports or activities require a particular posture  to maximize performance or to create a certain aesthetic.  (This usually occurs at the expense of tissue longevity.  Look at all the best athletes and dancers.  They are REALLY good at their sport, but their career is usually over by age 40.)

balletWhether it’s intentional or not, we often use our body position to say something about ourselves— a macho guy who puffs up chest to look tough, a tall kid who stands slouched over to appear shorter, a woman who sucks her stomach in to look thinner—you get the idea.  Sometimes we adopt a particular posture for a good reason, such as coping with an injury or surgery, but continue the habit once the need is no longer there without even realizing it.  

Bad posture370

I’m writing this on an airplane, and one of my seatmates asked me what I’m writing about. We got to talking about posture and where the notion of good posture comes from. Seatmate #1 said  her parents told her good posture meant standing up straight and holding your stomach in. Seatmate #2 said she spent time living in another country (I wish I could remember which one…. somewhere in Asia) and that the desired posture for women in that culture was a stooped over position because it showed humility. A woman who walked around with her head held high and “stood up straight” would not be respected.  Subjective & cultural.

Optimal skeletal alignment is objective.  It’s based on science—anatomy, physiology, biology and physics—rather than culture.  It’s the orientation of all the parts that allows everything to work the way it is supposed to work with the least amount of damage.  Think about the alignment of your car.  You go to the mechanic, and they adjust the alignment.  (No one ever took their car in to get the posture checked.)  They make sure all the parts are in the proper position—not just to allow your car to run, but to help all the parts wear evenly, and ensure that the vehicle doesn’t sustain unnecessary wear and tear.  The same is true for your body.  When your musculoskeletal system is aligned, all your body systems can function properly, for as long as possible, with the least amount of unnecessary wear and tear.

This image is taken from the Restorative Exercise™ Specialist training manual. It shows the 25 points to consider when assessing skeletal alignment.

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The 25 Points of Alignment described by Katy Bowman.

Here’s your first step to good alignment: Back up your pelvis.

First, let your pelvis shift forward.  (Notice the picture on the left.)  You will feel more pressure in the front of your feet than the heels.  Now back your pelvis up until you feel more pressure in your heels. (Notice the picture on the right.)  That’s where you want it.  Your legs should be straight (no bent or locked knees) when you do this. Can you feel the difference?


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 Left: My pelvis is out over the front of my feet, and my upper body is actually behind my pelvis.

Right: My pelvis is stacked right over my ankles. There is a vertical line from ear, shoulder, hip, knee, ankle.

(Don’t let the “I Dream of Jeannie” arms confuse you…they aren’t part of it.  I’m holding them up so they don’t block the view of my pelvis.)

NOW, check out the lines I can make with my super awesome (not at all nerdy) grid app.  It’s much easier to see the differences when there are actual lines.

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SO COOL, right?  I’m not a very “techy” person, but I LOVE this app.  Go by the objective alignment marker (a vertical line) rather than how it feels.  If you go by what feels right (subjective), you will always go back to your old postural habits.  To see the lines on yourself, you can hold a belt or strap at the center of your hip joint and watch where it falls.  It’s helpful to do this in front of a mirror.  You would want the weight bearing, structural beams of your house to be completely vertical (perpendicular to gravity), and it’s the same for your legs.

IMG_1236Just backing your pelvis up will reduce unnecessary damage to your feet, knees, hips, and spine.  This position gives you stronger bones and better pelvic floor function. You will use more leg muscle which means a higher metabolism and better circulation– all this just by shifting your pelvis.

Whatever your health goals are for 2014– less pain, stronger muscles, better balance, fewer headaches– working on your alignment is the first step!  In the next few weeks, I’ll be sharing more about the differences between posture and alignment and giving you simple, practical steps to make big improvements. 

PS- Read part 2: “Stand up Straight” here. 

Back Pain, Habits, Health, Hip/Leg Pain, Sitting, Standing

More Exercise Isn’t The Answer

WHAT?!

I know, I know. Hear me out.

You may have seen this article in Buinessweek that came out a few years ago titled Your Office Chair is Killing You. It focuses mainly on the way that sitting negatively affects the alignment of your spine, encouraging a “C” shape instead of the natural “S” curve, which leads to degenerative disks, neck/back pain, osteoporosis of the vertebra, bulging disks, high blood pressure and about a hundred other things. It also talks about the metabolic changes that occur after prolonged sitting, which increase our risks for obesity, diabetes, and heart disease.

Sitting in a chair all day make the muscles of the legs very tight, which causes hip/leg pain and significantly reduces the circulation to the lower body. Do your feet or legs get numb halfway through the work day? Now you know why! Tight muscles of the hips and leg are also a huge culprit in back pain because they can pull the spine out of alignment. When you are sitting, your muscles are pretty inactive, which significantly affects metabolic processes in your body.

We all know that it’s unhealthy to be sedentary, but here is the part that is often misunderstood.

“People need to understand that the qualitative mechanisms of sitting are completely different from walking or exercising,” says University of Missouri microbiologist Marc Hamilton. “Sitting too much is not the same as exercising too little. They do completely different things to the body.”

Did you catch that? Sitting too much is not the same as exercising too little.  If you go to the gym everyday, you may  consider yourself an active or fit person. What you need to understand is that an hour at the gym everyday is not enough to counteract the damage of sitting all day.  That’s like eating a salad for dinner to make up for the fact that you smoked all day.  It doesn’t work like that, right? No amount of kale is going to undo those cigarettes.   The research shows we need to sit less, not just exercise more.

Take this quiz to find out how much you ACTUALLY sit each day. It’s very eye opening.  The first time I did it, I was shocked!

If you are a student or have a desk job, sitting less requires some creativity. Read how to transition to a standing desk here.

This is my new desk that I made recently.  It started out as a $19 baby changing table from the thrift store.  Unfortunately, in my excitement, I forgot to take the “before” picture before I tore off the box part on top. (You know, those side pieces that keep the baby from rolling off.)

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I attached a piece of plywood on top, painted it, and found some cute hardware in the clearance bin at Cost Plus World Market.  A non traditional desk doesn’t have to be expensive or ugly!

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I like to multi task by stretching my calves while I work. My dog likes to be RIGHT next to me all the time. Sometimes it ends up looking like this.

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Just by standing up you will:

  • Increase your metabolism & circulation
  • Use more muscles during your day
  • Reduce hip, leg & back pain
  • Build bone density
  • Decrease your risk for cardiovascular disease, obesity & diabetes

It’s not that standing is a magic pill, it’s just a simple way to start reducing the amount of time you are sitting in a chair.  You can swap your chair sitting time for sitting on the floor in different positions and other types of movement.  The goal is varied and regular movement throughout the day.

Here are a few ideas:

  • Instead of meeting a friend for coffee, meet at a park and take a walk.
  • Take the stairs instead of the elevator.
  • Instead of sitting at a desk, try sitting on the floor while studying or working on the computer.  Cycle through different sitting positions.
  • Look for the furthest parking spot instead of the one closest to the store.
  • Stretch while watching TV or reading rather than sitting on the couch.
  • Read Don’t Just Sit There, by Katy Bowman for ways to get in more movement while you work.
Balance, Habits, Knee Pain, Standing

Paddle Boarding Part 2: Take a Stand for Your Knees!

In Paddle Boarding Part 1 we looked at my sister’s default position when on an unstable surface.  Another common response when on an stable surface is to lower our center of mass (in the pelvis) to feel more steady. Your center of mass is closer to the ground when you are kneeling, making it easier to balance. Here my mom and I are trying to get up from our knees to our feet.

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bent knees

Once we got to our feet, we had our knees bent, again slightly lowering our center of mass. Bending the knees is instinctual when you feel wobbly, as is turning your feet out and widening your stance. If you’ve ever played sports, this is the common “ready position”.

Here's Hanley Ramirez of the Dodgers in his ready position. (As recommended by my husband)
Here’s Hanley Ramirez of the Dodgers in his ready position. (As recommended by my husband)

This position is helpful if you are trying to get your balance during an activity or preparing to run/jump/etc into action while playing a sport. The problem comes when you are so conditioned to hold this position that you start doing it all the time. You may have learned not to lock your knees but instead to keep a slight bend in them. This can be just as damaging as standing with locked knees. There is actually another option: standing with legs that are fully extended but not locked. This position is the least damaging and most beneficial for long term health. Let’s take a look at standing positions in more detail.

Option #1: Locked Knees- Legs are fully extended and quadriceps (muscles on the front of the thigh) are contracted, pulling the patella (knee cap) up and back into the joint space.

Downside- when the quads are overused, and the  patella is pulled up/back, it starts to cause friction and irritation in the knee joint which causes inflammation, damage, pain and (eventually) cartilage degeneration.

Option #2: Bent Knees- Knees are kept slightly bent.

Downside- when the knees are chronically bent, the body adapts by shortening the muscles around that joint to keep things taught. This passive shortening  is different than an active contraction a muscle does when it is working.  When these muscles get too short and tight, they start to decrease joint space, inhibit range of motion, and compromise circulation. Eventually, it can become difficult to fully straighten the leg because of this tension. Here’s an example: Think about an arm in a sling. It is passively held in a bent position, and the muscles shorten. When the sling is removed, you can feel the tension that has accumulated. It takes time to be able to straighten the arm again.

Option #3: Fully Extended Legs with Relaxed Quadriceps– Legs are fully extended with relaxed quadriceps. To test whether your quadriceps are relaxed or not, contract and release your quads and watch your knee caps dance up and down, then leave them in the down position. If you can’t do this, make sure your knees are not bent and try backing your weight up into your heels. If you still can’t do it, try leaning forward with your backside against a wall. Often the quads are stuck in the “on” position (knee caps up), and it can take time to get them to release. Practice daily until you are able to do it standing upright. Other components of optimal stance include standing with the outside edges of your feet straight, feet the width of your pelvis, and hip/knee/ankle all in a vertical line. (I’ll have to cover these in more detail in a future blog.)

Downside- It’s really hard. There are no physiological consequences to standing this way, it’s just a lot of work. Whenever you think about it, adjust yourself to this position and eventually it will feel natural.

Hyperextended Knee Joint. Vertical Leg.
Hyperextended Knee Joint.           Vertical Leg.

(NOTE: When most people fully extend their knees, they end up with a vertical leg. If you tend to hyperextend your knee joints, “fully extended” is too far for you because when your knee is fully extended, it goes beyond the natural boundaries of the joint. A better cue would be to extend until you reach a vertical leg.)

In real life, there are times when it’s appropriate to stand with bent knees or make other adjustments to perform a particular activity; however, the more you can stand in this optimal position while doing daily activities, the healthier your knees will be. In the end, I needed to use the wide stance to keep my balance but finally got my legs straight and quads relaxed!

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