We recently moved to Nashville, and although this move was considerably easier than our last one, it still takes a toll. For most people moving and back pain go together. We’ve all been there: I think I can move that couch by myself….this box isn’t THAT heavy….I don’t need help…. Usually what follows next is a back spasm (and maybe some cursing) followed by days/weeks of pain. Even if you get off lucky and only have some mild soreness, it’s both uncomfortable and avoidable. Here’s how I got through the move without the typical back pain:
1) I used my HIPS. You’ve heard “lift with your legs, not with your back”, right? I’d like to revise that saying to “lift with your hips, not with your back”. I think a lot of people get into trouble when they THINK they are using their legs because their knees are bent. It’s true, some of the leg muscles are working when the knees are bent, but the position of the pelvis determines whether the big muscles on the back of the leg (gluts & hamstrings) can work here. The position of the pelvis also effects what is happening in our back (because they are attached). When our hips are tight, we tend to over use and abuse our spine and/or knees when bending over to pick something up. The pelvis will tuck, the low back will go into flexion (round) and the knees will move forward. In addition to being a vulnerable position for the spine and hard on the knees, it prevents a person from being able to effectively use the gluts and hamstrings to do the heavy lifting. A person who lifts like this might use some leg muscle but will also use their back:
Try this instead: Bend down like you are going to pick somethings up. Now, do it again, and pretend like you are squatting. Untuck your pelvis and back your butt WAY up until shins are vertical. This allows you to use the gluts and hamstrings (hips!) as well as save your back when you lift:
Now, you might be thinking “I don’t think I can get into that position, much less lift a box in that position.” Can you see how my knees are coming forward in the picture on the left? I can’t quite make it all the way to the ground with vertical shins, so I allow them to come forward, then on the way up, back my pelvis up as soon as possible, so I can use my hips to do the work. You might also notice that my pelvis is a little bit tucked. It’s not perfect, but it’s still enough to keep me from the full on back spasms of my past. I’ve been working on building the strength and mobility to be able to do this for years, and I still have a ways to go. It takes time. You’ll find some hip opening and squatting homework at the bottom of the page to help you get there.
2) I paid attention to my body’s warning signs and asked for help. What are the warning signs? I’m so glad you asked. All of these are signals that you are not strong enough to do what you are attempting to do. Stop and ask for help if you:
- Have to hold your breath, bear down, valsalva
- Leak urine (Yes, it’s common. No, it’s not ok.)
- Feel any downward pressure, straining or bulging in your pelivc floor or abdomen
- Experience back or pelvic pain (during or after)
By the way, if you experience these signs during a workout, the same guidelines apply. It’s your body’s way of telling you that you are not ready to do that particular activity. Continuing to do an activity that causes theses things to happen can make back, pelvic floor and core issues worse. There are steps you can take to gradually build strength without compromising spinal health or core/pelvic floor function. (See the suggestions below.)
3) I relaxed & released my psoas. If you try your best, but still have some pain at the end of the day, try these psoas releases. The psoas is a muscle that attaches on the spine (T12 & all lumbar vertebrae), goes through the abdomen, and attaches on the femur (thigh bone). It is often a culprit in low back and pelvic pain. During this move, some days I had mild soreness/stiffness in my back, but when I did these two releases, it was gone the next day instead of lingering or becoming worse. Notice I’m calling them RELEASES not EXERCISES. This is because all you have to do here is relax and let the tension release. There is nothing to do or force. If you want more, my colleague Susan demonstrates more psoas exercises on her blog.
Here are some ways to start gaining the strength and mobility you need to prevent injury:
- Get started at home with this easy series.
- Try an Alignment Snack (20-30 min online class). I like “All Around the Thighs” and “Frankie Says, Relax the Posas” for stretching all the muscles around the hips and addressing the psoas.
- Join me for Aligned & Fit on Mondays at 8:30 (starting 9/14) at Blooma Nashville Yoga. This class focuses on building functional strength– the kind of strength you need to do daily life. Play with your kids, lift heavy boxes, climb stairs, chase your dog, carry babies…. without peeing your pants or ending up in pain!
PS- This isn’t just for moving! Apply these principles to any heavy lifting or repetitive bending down you might do– lifting your kids, cleaning the house, lifting weights, loading the dishwasher, etc. to use your hips and save your back.
Sneeze pee. If we are honest, most of us will admit that this has happened once or twice….you laugh, sneeze, cough, jump, or some other high pressure activity….and you pee yourself. Just a little. (Or a lot.) It’s VERY common, which has led many of us to believe that it’s NORMAL. We accept it as an inevitable part of aging or something that happens once we’ve had children. Incontinence is prevalent among women who have never given birth and in men as well. I experienced sneeze pee in my early twenties before I found Restorative Exercise™. (I’m happy to report that it’s now resolved.) I’ve been talking about urinary incontinence, but you can have fecal incontinence too. I came across this ad in a magazine last week.
The message I have for you today is this: incontinence is not a natural part of human function, and you have the power to change it.
Here are 3 things you can do right now to start improving it:
1) Stop doing kegels. A too tight pelvic floor is at the root of incontinence (and other pelvic floor disorders), and kegels will make this worse. Kegels may help in a short term way, but they are a band aid and don’t address the root cause. You can read why here.
2) Instead of kegels, start squatting. Squatting uses the gluts. Strong gluts pull posterior (back) on the sacrum, which in turn pulls on the pelvic floor, stretching it out to its proper length. It’s good to note that we are often too tight and weak to squat without some preparation. Try these prep exercises to start increasing mobility as you practice squatting. You don’t have to go into a deep, full squat to reap the benefits. Keep your shins vertical (see below) to help you use the gluts and hamstrings (on the back of the thigh) instead of the quads (on the front). Hold onto a door knob or pole if you feel like you are going to fall over backwards.
3) Exercises are great, but you will see changes MUCH faster if you change your habits too. Read Fast Fixes for Pelvic Floor Disorder to learn some simple lifestyle changes you can make.
If you are dealing with incontinence or any other pelvic floor disorder (and live in Middle Tennessee), you may want to attend the Pelvic Floor Workshop at Blooma Nashville this Saturday, September 19. This class will use a combination of lecture and exercise to help women understand the mechanical causes of pain and disease and give them practical tools for change. Participants will learn corrective exercises and lifestyle modifications to heal and prevent common ailments.
This class is for any woman who has experienced (or would like to prevent):
Pelvic organ prolapse
Hip, knee, back and pelvic pain
High blood pressure
SI joint pain
A cesarean section (a pelvis that was “too small” or a baby that was stuck/breach/posterior)
Pelvic floor trauma
If you can’t make the workshop, consider a private session. We can work together to get rid these painful and embarrassing issues!
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!)
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!