Lateral (side) rib expansion.
Do you have it? Or is it all chest, or all belly, maybe all shoulders? Stand in the mirror and watch yourself, or take a quick video and see what it is you do.
Lateral rib expansion is so important for getting obliques to chill out and to manage intra-abdominal pressures well. Without this kind of rib mobility problems start to emerge gradually (diastasis recti, prolapse, hernias, constipation, and incontinence to name a few)...or suddenly!
Have good expansion into the sides already? 🙌 Well done! If not, all you need to do is practice! You really can't overdo good breath training. Lying on your side, knees stacked and bent at 90 degrees, and head propped comfortably is the easiest position. As that gets better and you can get 2-3 inches of lateral excursion on each side then start to challenge yourself in sitting, standing, walking/running, lying flat on your back, etc. And remember, do both sides. You may be surprised to find that one side is easier or more mobile than the other side.
It can be deceptively hard to do at first. I have done a LOT of work to get to where I am and I still can do some more work. But, it is a great first step on the road to recovery. The video above is my left side only, and it has been my hardest side since having my second baby. Left rib flare, decreased muscle tone in (everything!) left side abdominals, and really tight right side abdominals. I have had all of the muscle imbalances, I am pretty sure! This makes for maximum frustration but also maximum problem solving and using my clinical brain, which is extremely fun for me :)
Try it out and let me know how it goes! Make sure to check back for more breathing basics as we talk about all of the basic elements of good breathing. Oh, wait...you didn't know there was such a thing as "bad" breathing? This will be fun!
Quick Tip: Shoulder Gripping
When you unconsciously clench your shoulders in some manner. Gripped up, pushed down, squeezed together, lazily rolled forward.
Beware: where your shoulders go, your head often follows. Neck and/or upper back pain? Look at the shoulders.
Start creating awareness of where you hold your shoulders, which are often the place we store a lot of stress. You can often tell much about a person's psychoemotional state based on their shoulder positioning 😎
Just be careful. It isn’t about moving out of one gripped position to another one in an effort to align better, but more about creating awareness of your alignment habits and learning what does and does not serve you. The act of sitting taller through the crown (not the top) of your head is sometimes enough to get things stacked better and relieve some tension. It is easy to do and you can do it anywhere. Even in the car. By the way, bucket seats are slowly destroying our bodies in my opinion!
Un-gripping one area may reveal tightness in another area. That’s okay, and even expected. Take the hint and maybe start to give those things some air time.
Quick Tip: Glute Clenching
When you unconsciously clench your glutes (butt muscles). Do you have nice little scoops or “pockets” on the sides of your glutes/behind the head of the femur? Do you ever get a pinching in your groin when you squat or bring your knee to your chest? Low back pain? Flat butt syndrome getting you down (aka “mom butt”)? Can you get a really good squeeze of both sides of your glutes on command or is it hard to do? One side easier to contract than the other? Then you likely favor one side.
These are some signs you may be a butt gripper!
What to do? Start by noticing it. Check in frequently and do your best to just relax those glutes. Notice when you are doing it and how you are feeling. Tied to stress perhaps?
Usually, you don’t need those glutes working so hard during normal, low load activities, like standing around :) Do you frequently find that you shift your weight to one side in particular? Notice this and start shifting to the other side! Or, better yet, place your weight evenly over both feet!
Chronic butt gripping can lead to chronic fatigue (i.e. weakness) of those enormous glute muscles, of which we really do need for things like walking, running, jumping, squatting, pelvic floor health, etc. There is a saying that “your glutes ARE your pelvic floor.” So, is your pelvic floor flat, weak, and hard to engage when you need it? Or is it strong, resilient, ready when you need it without having to think about it?
Passive Hip Flexor Release
Tight hip flexors. Everyone's got them. And everyone is always wanting to stretch them. The problem is that most people aren't even targeting the source of the problem, the actual hip flexors. The psoas muscles! They are deep, they are long, and they influence so many things. You can have someone do it manually by pushing around viscera and poking in a most uncomfortable manner, but it is effective, and actually quite delicious. But, in the absence of a set of practiced and knowledgeable hands, the passive route is quite effective and also a great way to chill out the system and force some downtime for yourself.
For my postpartum mamas, tight psoas muscles are most evident in those of us with more of an anterior pelvic tilt and/or a high lumbar curve (a.k.a. a hinge point). This is the big “scoop” in your low/mid back that sticks around even after baby has arrived. The culprit can be a few things, but for today’s tip we are targeting the psoas.
The psoas runs down either side of the spine from T12 to L4, grabbing onto each vertebrae along the way, and having attachments with the diaphragm, moves at an angle out towards hips and then wraps itself a bit to attach into the inner part of each hip (in the groin area) at the lesser trochanters. It is huge and you have two. It’s prime activity is hip flexion. Stretch all day like a lot of commercial exercise videos show you for “hip flexor stretching” but most likely you (and they) are not targeting the main player. Hence, the uphill battle with hip flexors.
Get thee a beach towel rolled up or a firm yoga-type blanket folded up a few times, place it under the sacrum, bend your knees, and just let yourself relax into the position. No forcing ribs down, just let gravity do its work. I usually hang out here 3-5 min each time, 1-2x/day. The anterior pelvic tilt (think butt sticking out) I have had FOREVER improves significantly when I stay focused on releasing the psoas muscles. I prefer passive because I can do it myself, it doesn't hurt(!), and I can work on my OM while I hang out which then helps with vagal tone (getting that vagus nerve on board) 🧘♀️, and I can then do my core strengthening and actually make some gains because everything is lined up as it should be allowing for optimal muscles firing and recruitment. It's like the nesting doll of exercise!
Having your psoas muscles relaxed allows them to work most efficiently when you actually need them, and it also allows you to hold a neutral pelvis without fighting tight muscles. Everything works together. Isn’t it so beautiful?!
Diastasis Recti Self-Check
Today let’s learn a little about diastasis recti (DRA)! Specifically, how to check for it. It is best to get an official diagnosis from a pelvic floor physical therapist but if you are curious about how to check for yourself then here is the easiest way to do so.
Note: it is truly best to check in every position you utilize, and with every exercise you perform just to see what is happening with your abdominal wall.
Lie supine (on your back) with knees extended and abs relaxed. Find your belly button, then raise your head without contracting the abs. Can you feel the margins of your rectus abdominis (the “six pack” abs)? How many fingers wide is it? Palpate above and below the belly button? How far down can you feel it, and how far up toward the ribs can you feel it, if at all?
Next, repeat the same motion but this time begin by firming up your deep abdominals as if you are bracing against someone trying to tickle you. Then lift your head and re-check. Any different? Is it wider, narrower, soft and squishy, firm? Now how far down and up can you feel a separation, if any?
DRA is very common in pregnant and postpartum women but it is not just this population that experiences it. In my clinical experience it has been just as common in men! I am in the habit of checking everyone who mentions low back pain, regardless of gender or childbearing history. It’s an easy check and can help guide rehab and corrective exercise prescriptions.
As always, check with a pelvic floor physical therapist for an official diagnosis. This is meant purely as a fun curiosity check and by no means a diagnosis, but you knew that, right? 😎
Further, more and more literature is coming out revealing that the width of the separation is much less important than the depth of the separation and tension beneath it. Soft and squishy between the two sides indicates weakness of the deep transverse abdominis (TA), even if it is just a single finger width. But some people can have several fingers wide and able to create full tension of the TA when cued, and this is seen as being better than a narrow gap with no tension. Also of note, it is considered an "abnormal separation" when the gap is greater than 2.5 cm or two fingers wide. Why? Who knows. Because if the person cannot create tension in the TAs then 2.5 cm is significant. It all just depends!
*By the way, I had a video that went along with a portion of this post originally posted on my Instagram account, but it requires far more tech knowledge than I possess to learn how to do that here :)
Quick Tip: Ab Gripping
Ab gripping. It is way too common, especially in women. AKA “sucking in.” It is something we do so much that we stop even noticing we are doing it.
Are you doing it right now? Take your had and place it on your abdomen, close to the ribs and gently jiggle the abs. Feel relaxing? Or was it hard to do? Probably gripping. Check out your abdomen in the mirror: is there a cinched in area at about the level of the belly button, looking from the side? Gripping/sucking in. Are the top abdominals more defined than the lower half? Gripping. Can you "zip up" your abs from the pubis/crotch without those upper abs firing? Gripping. Looking from the side, does it look like your lower abdomen sticks out farther than the upper half? Gripping and lower abdominal weakness.
It is constant, long term tension in a group of muscles (usually upper rectus abdominis/"six pack abs" and upper transverse abdominals (TA)) and over time, those muscles adapt to what we ask of them and shorten/weaken so when you go to ask something of them (a heavy lift, core exercises, weight gain, pregnancy, etc.) they have nothing left to give and the pressure has to leak out somewhere, soooooo...yea, diastasis recti (abnormal separation of the abdominal wall) prolapse, leaking of urine or feces, inability to control gas, disc herniations, herniations of the abdominal wall, hemorrhoids, etc. Fun, huh?!
Imagine flexing your biceps muscles all day every day. You wouldn't really be able to use your arms very effectively if your biceps were constantly flexed, ha! What would you expect to happen with those muscles? They would shorten and become very tight. Same idea with your abdominal wall. This sort of abdominal weakness is perfect staging grounds for lots of fun stuff, as mentioned above.
Men, too! Women are by no means the only ones suffering these issues. Men are just as likely to develop these kinds of problems via means other than pregnancy. Obviously :)
If you can’t just relax your abdomen on command (one way to tell you REALLY need this!) then get down on all fours and allow gravity to assist you. Let your belly relax down toward the floor gradually. I know, it feels really weird at first and you will likely be able to feel your body tensing against it, but work through this. Try to keep the shoulders engaged and don’t sink into them. Keep your spine as neutral as you can, trying not to let your low back curve too much. Focus on breathing deeply and slowly, in and out🧘♀️
If you can get in the habit of checking in throughout the day and seeing what your abs are doing (particularly in times of stress) make note of it and try to relax. Hate having your belly "pooch" (terrible word, but everyone can picture it!) out? I get it! But that is what loose-fitting shirts are for in this stage of the game, right?!
All sorts of things improve when we stop holding tension, particularly in our abdomen. Digestion, breathing, stress response, constipation, you name it. Try it out and I hope you find some relief!
Another quick chill trick: left tragus stimulation. The tragus is that part of your ear that sticks out over the opening (in the pic) and tapping or gently rubbing this part of your LEFT ear for *30 seconds* stimulates the “rest and digest” part of the nervous system (parasympathetic, vagus nerve) and will bring you a needed chill out. DO NOT do the other side. LEFT SIDE only :)
Really, that’s it. Seems too simple? I know. But try it and see what you think. Sitting in traffic? Tap away. Kids screaming at you for the 18,472 time today? Tap tap tap. Sitting in a frustrating meeting? Tappity tap tap. Feeling pelvic floor heaviness more? All of the tapping! Watching/reading the news? Turn it off and tap the rest of the day! Kidding, but only a little.
As a member of the hypertonic (tight) pelvic floor group it is especially important to continue to add to my relaxation skillset and find ways to make it happen regularly so that I can decrease symptoms. I love this trick for its simplicity and ability to do it anywhere.
Unnecessary stress can lead to all sorts of damage and our pelvic floor is one area particularly vulnerable to stress. Tension in your face? Shoulders? Neck? Very likely the same thing is happening down below. Go try it and show that vagus nerve some love!
Quick Chill: Full Body Breathing
We all need to take a chill pill, multiple times daily. Especially if you are a parent. Or a human. Try this one out for size and see what you think. No side effects, just straight relaxation. The hardest part is remembering to take a step back when you need it.
Did you know that your pelvic floor also responds to your perceived stress? For me, it tenses up and the symptoms can flood in (hello leaking, hello pelvic floor heaviness, hello frustration!). Having awareness helps to keep those things at bay. Luckily, the pelvic floor also responds well to our ability to chill out. And, just because you've had a bad pelvic floor day it does not mean you are ruined for life. Nope. Stop your pity party and start taking care of yourself again. There is not better time to start than now! We all have setbacks, but we all have the power to move past it and improve a little more each time.
What is your favorite quick chill movement or stillness?
Mind Over Matter...
Henry Ford gets credit for this one (though it is a shortened version of the original). And it is completely true. Don’t forget about the ‘mind’ part of the mind-body connection. They work in tandem. You train your body to do all sorts of things but if you don’t mentally buy-in then stop wasting your time. So which will it be today?
I often find that the right track can be the hardest to commit to mentally. Maybe it seems to easy, too tedious, too boring, too hard, too annoying, too whatever! No one can make you do the thing, only you can decide to do it, whatever it is. When I was told I was going to have to start from even before square one (square 1/2?) I felt mentally crushed and was almost tempted to try something way "easier" (but ultimately would have been a short term boost with very long term negative consequences). But then the rational mind took over thankfully and I decided to buy in. I could do this, I will do this. And so, I started to rebuild my body and my mind and started down the path that has ultimately led me here, to The Pelvic Underground.
Maybe today isn't your day, and that is totally fine, normal in fact. But the key is believing that maybe it will be tomorrow and trying again. Believe in yourself, believe in the process, then so it shall be. Postpartum rehab is hard when you want to do it the right way. I guarantee is is worth every single tear, expletive, setback, crappy day, and boring workout at the beginning (because, seriously, it can be SO BORING, but SO WORTH IT!).
So, again, which will it be today? I can or I can't?
Quick Chill: Deep Breathing
Every happy pelvic floor starts with good breathing habits. If you aren’t being chased by a lion then you don’t need to be stress-breathing into your chest and shoulders. Breathe deeply and slowly into your belly, back, and sides 3-5 times as often as you think of it. Reconnect that diaphragm with your pelvic floor. This goes for men, too. Are you a runner? Try this out on your next run. It is magical!
Runner, lifter of children, PTA, CPT, PCES, pelvic health zealot