Under Pressure

This blog is all about the abdomen and the pressure it's under most of the time.   

Structure of the trunk
The abdomen starts below the diaphragm and ends with the pelvis.  In effect, we have three cavities sitting one on top of the other; thoracic, abdomen and pelvic.

  
 

The abdomen is different to the thorax and pelvis because it doesn't have a bony casing.  The thorax, for example, has the rib-cage to protect organs and add stability to the thoracic spine.  

Instead, the abdomen's stability relies largely on muscle and thick sheets of connective tissue that the muscle attaches into.   The abdomen also has the lumbar spine for stability and controlled movement.   

Because of the abdomen's soft tissue structure, it's important to keep the muscles in balance with each other.  This way the abdomen can cope better with the pressures and stresses it faces.

Below is an image we could have for our abdomen from Katy Bowman, an American BioMechanics specialist.

“If you go into my garage, you'll find a deflated air mattress - totally floppy and, more importantly foldable.  But all I have to do is fill it with air and voila!, that same piece of equipment is now rigid and supportive.  I don't need my air mattress to be rigid and supportive all of the time; only when I have guests.  Most of the time, I just need it to fold up and be out of the way.  It's helpful to think of your abdomen in this way.  Your muscles become firm and supportive when you need them to, and soft and relaxed when you don't.” *

The Core
The muscles that Katy talks about are part of our 'core' muscles.    How these 'core' muscles function is covered in previous blogs Getting down to the core   Let's hear it for the diaphragm and Take a breather.  

Core muscles - the abdominal canister

The abdominal cannister
The core muscles extend beyond the abdomen.   The diaphragm starts in the mid-thorax.  The deep abdominals, pelvic floor and related connective tissue attach all the way down at the base of the spine, sitting bones and pubic joint of the pelvis.   Together, they create a deep abdominal cannister that spans across all three cavities - thorax, abdomen and pelvis.

With diaphragmatic breathing, on inhale, the downward movement of the diaphragm produces downward intra-abdominal pressure.  On exhale, the diaphragm rebounds back up together with deep abdominal (transverse abdominal) and pelvic floor contraction.  

In theory then, the abdomen is stable on both inhale and exhale.  This optimal core stability relies on optimal breathing, posture and motor control of these deep core muscles.     

Under pressure
At the same time, these deep muscles are also responsible for our postural control -  this control will vary depending on whether we're standing still, running or carrying an enormous back pack.   

The deep muscles also have to regulate internal pressure changes in the three cavities.    The diaphragm is key here, aiding pressure change due to talking, singing, laughing, coughing and defecating amongst other things.

Deep versus external muscle
Clearly these deep muscles have many functions and face numerous pressures.  They're also not working completely alone.   There are different ideas and models of exactly which other muscles work together with them.   One model includes the deep hip flexors (psoas and illiacus) the deep spinal extensors, part of quadratus lumborum, the internal oblique and the deep hip rotators.  These together form an inner sleeve around this abdominal cannister surrounding the thoraco-abdominal-pelvic cavity.**    

On top of this we have an external set of muscles, closer to our skin.   These include glute max, latissimus dorsi, superficial spinal extensors and superficial abdominals.   We can call the two sets of muscles 'deep' and 'external'.

For optimal core function we need the deepest muscles to coordinate well together, as Julie Wiebe shows in the video below.  We also need the deep and the external muscles to work in balance with each other.

Why we lose optimal core function
Some of the many factors that challenge optimal core function are listed below.

1.  Tension in the abdomen - from gripping muscles consciously or unconsciously

If we grip our abs or hold our breath this will have a significant effect on the other muscles of the core.   This might be holding in the deep muscles abdominals to flatten our belly or it could be a less conscious holding of the upper abdominals and diaphragm as part of our stress response.  

Julie Wiebe's video about breathing below explains more.  Julie is an American Physiotherapist.   She describes a diaphragm and pelvic floor piston mechanism of breathing.  She names abs, diaphragm and pelvic floor as 'team mates' who need to be free and available to work together in a dynamic system of core stability.   Julie stresses the importance of this coordination of our team mates rather than strength of muscles. When she's talking about 'leaking' she's referring to the Stress Urinary Incontinence we'll cover in Part 2 of this blog.

2.  Tension in the abdomen - due to posture and breathing

Posture and breathing pattern are very closely related to each other.    If our breathing pattern is chest breathing say, then our posture will be one of an upward tilted thorax (front lower ribs flare up).  The neck and shoulder muscles over work to draw air in for each breath.   Upper, external abs then force out the exhale.    Its likely that our deep core muscles will have altered motor control, neither diaphragm, pelvic floor nor deepest abdominals able to work as a team.

Other aspects of posture will also create pressures for the abdomen.   One example is a posture of carrying the pelvis out in front of the thorax and the legs.  The pelvis sits above the front of the feet rather than further back above the heels.  This transmits additional forces through the front of the abdomen.   Here, impact forces from running will affect abdominal muscle and connective tissue even more. 

Other common postural pressures come from a tilted or twisted position of the pelvis and/ or the thorax.  This creates pressure through the abdomen as it is pulled in one or more directions by the structures above and below.   

 

3.  Tension beyond the abdomen

We may notice when we exercise how tight our shoulder and neck muscles feel.  Or maybe we're more aware of tense hamstrings.   Either way, tight shoulders, hips and glutes will all create tension through the abdomen via connective tissue (facial) lines throughout our bodies.   This tension is likely to be related to posture, breathing pattern and any torsion through the ribs or pelvis.

4. Excessive loading through the abdomen

On top of all this (gripping patterns, breathing and posture) we then add in movement and loading.    

So this could be walking with a heavy bag on one shoulder, on uneven ground with restricted movement in one hip.    We can imagine the one sided load from the bag.  We can picture what the lower back and other leg may need to do to compensate for the lack of movement in the restricted hip side.

Or, another example of load could be lying on the back of the body with head lifted, legs straight and hovering just above the mat.   The abdomen (and the lumbar spine) are having to bear a huge load and so need to be functioning optimally to cope.   We only need to add in some breath holding here to immediately take away potential optimal core function.

Core dysfunction
And so when things do go wrong, we move from core function to dysfunction.   The deep muscles no longer coordinate with each other.   The deep and the external muscles get out of step too.

Core dysfunction means that the deep system isn't able to stabilise and the external system also can't sufficiently compensate for this.

A common pattern is deep muscles work too little, too late while the external muscles work too soon and at an intensity that is too high.  

In the next blog, we'll look at other associated problems including hernias, urinary stress incontinence, diastasis recti and pelvic organ prolapse. 

For now though, coming back to Katy Bowman's inflatable mattress metaphor - soft and relaxed abdominal muscles are definitely a good thing.

Relaxed muscles function best and are able to work and coordinate as part of a team.  They are better able to cope with the demands we put on them.  Being aware of our posture and how we breathe is also key.   And that goes hand in hand with keeping good, free, even movement throughout our body.   Sounds just like a great Pilates lesson to me...



*  (Katy Bowman, Diastasis Recti.  The whole body solution to abdominal weakness and separation. 2016 Short Run Press Ltd
** Key, J    The core’: Understanding it, and retraining its dysfunction.   Journal of Bodywork and movement therapies (2013) 17, 541-559.

i,

Why neutral?

 Why do Pilates teachers always talk about neutral?   What does it mean and is it important?


Well, neutral can relate to almost all of our body alignment, such as feet, head, rib-cage, pelvis and spine.   And like a car being in neutral gear, it means a position from which we can best move from.  Our muscles are neither shortened nor lengthened.   Our joints are in position for optimal movement and stability with minimal friction.




So, let's just take one part of the body - the pelvis and lumbar spine.  The image on the left shows a neutral pelvis with bony landmarks labelled.

The three pelvic images below and to the left represent neutral as well as anterior and posterior pelvic tilt.

The arrows show the direction of the pelvic tilt.  The relative position of the ASIS (Anterior Superior Iliac Spine), pubic bone (pubic joint) and the hip joint can also be seen.

So, how to know if we are in neutral here or not?   There are several ways to assess pelvic alignment, but there's no gold standard measurement and everyone's neutral will be slightly different as our bodies are unique.

One method is line up the ASIS bones and the pubic bone.    This is most easily felt when we lie on our back, with legs bent.   If the bones feel fairly level on the front of the pelvis and we have a gentle upward curve in the lumbar spine - we're in a neutral position, or working towards one.

In contrast, if, when we lie down, the lower back is flat on the floor and we can't slide fingers under the lower back, then we're in a posterior pelvic tilt.   We may also feel the pubic bone is higher than the ASIS bones.

So, is it important to be neutral?   Have a look at the five following advantages to a neutral pelvis (as compared to a posterior tilt).

1. Muscles
In neutral, our muscles are in mid-range.  Take the gluteal muscles; they are neither stretched nor contracted.  They are ready to work.  However, in a posterior tilt, glutes will be at a disadvantage.  They may well feel tight because they are gripping to hold the pelvis in this position, but they won't be strong muscles.

Similarly, studies of the deep, postural muscles in neutral alignment show higher activity levels.  In a posterior pelvic tilt, the deepest abdominals and pelvic floor are less active.  This means we're less stable in this alignment.

2. Joints
In neutral, our joints are also ready to move.  For example, the hip joint is free to move with a low likelihood of friction and therefore damage.  In contrast, in a posterior pelvic tilt, the head of the femur will be pushed forward in its socket and therefore friction and damage to the joint are more likely.  Hip movement is also likely to be restricted.

In neutral lumbar alignment, the discs, vertebrae, ligaments and muscles are all in an optimal position for movement, stability and shock absorption.   In a posterior tilt, the lumbar spine is flattened meaning the discs are more likely to be damaged because of the forward compression when combined with loading of our body weight.

3.  Bone alignment
In neutral pelvis, the pubic joint and the sitting bones are in place to take the weight of pelvic and abdominal organs.  In a posterior pelvic tilt, the bones are in a different position meaning the pelvic floor muscles and fascia have to help take the weight of the organs instead.  This is one risk factor for pelvic organ prolapse.

4.  Muscle balance
If all of the body is well aligned, muscle balance should be optimal.  This means muscles will be in mid-range, neither lengthened or shortened.   But in a posterior tilt, there is an effect above and below the pelvis on other connecting muscles.   For instance, hamstrings, which attach to the sitting bones, will be shortened.

5.  Intra-abdominal pressure
The diaphragm increases this pressure as we breathe.  With neutral rib-cage and pelvic alignment, this helps to stabilise us.  However, if the alignment isn't neutral, the effects of this pressure can change.  
A posterior tilt can create an altered and upward pressure on the abdominal organs moving the guts closer to the diaphragm and increasing the risk of a hiatal hernia.

So, these are some of the reasons that Pilates teachers encourage neutral alignment.

Body awareness is a big factor here as many of us are unaware of our alignment, Pilates teachers included!

For the posterior pelvic tilt, it tends to come from a gluteal gripping pattern.   This may have started during pregnancy as a way to stabilise or it might be a result of sport or dance training.   Alternatively, we might do it more consciously as a way of flattening the lower abdomen to feel slimmer.

Whatever the reason, it's worth releasing the hips and working on the gluteal gripping to gain the benefits of neutral!

Let's hear it for the diaphragm

Okay, so I'm not talking about contraception, I'm talking about the sheet of muscles in the lower ribcage that we use to breathe.

Here it is (courtesy of 3D Yoga) in motion.

It's funny which muscles we're more aware of in our bodies.   We don't necessarily all leave school with a good understanding of anatomy and how our bodies function.   But if we're a singer or a musician we may be more likely to know about our diaphragm and how it moves as we breathe optimally.

If you work in the fitness industry, go to the gym or read fitness magazines then you may notice that the fitness world appears to be obsessed with certain muscles.   Many of these muscles are associated with body building and weights such as abs, pecs, traps, lats, biceps etc.  In contrast, the diaphragm has a relatively low public profile.  Few people go off to the gym because they want to get their diaphragm firing, stretching and strengthening.   But we should be!   We should be more aware of it!

Perhaps the diaphragm just needs some good PR to help boost our awareness?  Because without this baby, basic functions such as breathing, blood circulation and digestion would either not happen or would not work as well.

It's not going to sell magazines by being on the cover.  But its health should be high up there on our list of priorities. 

If you're not yet convinced, here are 6 reasons to be more aware of your diaphragm and to use it better.

1. We need it to breathe well (basic stuff - this helps keep us alive - do our biceps do this?)   And when we breathe well we get other benefits too (see take a breather blog).
2. It helps blood pump from and to the heart (again, hard to ignore, basic life-giving stuff).
3. It keeps our ribcage mobile when it's active.  And a mobile upper back can take some of the strain out of the lower back.
4. It is a big part of our core strength (see getting down to the core blog).  More good news for our lower back.
5. It makes a big difference to our digestion (optimal breathing using the diaphragm helps to massage our digestive system improving how well we digest food).
6. It helps to balance out pressures and forces through the abdomen - associated with hernias, organ prolapse and diastasis recti.

If you're convinced, you can get started by feeling under your lower ribs on the front of the body.  Push your fingers up and under the lowest ribs.   As you breathe in the diaphragm pushes your fingers out and away and as you breathe out it moves up and allows your fingers to move further up under the ribs.   You can leave your hands here and watch the video above again and see if you can get a sense of what you feel with the image on the screen.

To keep your diaphragm healthy, like any other muscle, we need to use it.   We can do this by gently aiming our breath down to the lower ribs on the sides and back of the ribcage.  Have a go and keep the effort relaxed and the exhales long.

 Here's to the diaphragm and all it does for us!

Take a breather

Source: my back garden 

A recent study published in the International Journal of Sports Physical Therapy* found a significant relationship between breathing and functional movement.   Participants with normal breathing performed better on the functional movement tests than those with dysfunctional breathing.    The functional movement tests were based on exercises like squats and lunges that involve both mobility and stability.  Normal breathing was defined as diaphragmatic breathing and dysfunctional breathing was breathing that uses just the upper chest, over-using neck and shoulder muscles with less use of the diaphragm.  

Really, the majority of us are somewhere between normal and dysfunctional.    Most of us can improve our breathing and feel many potential benefits from doing so.    These benefits can be better sports performance, improved mobility in the spine and rib-cage, improved core strength (as the diaphragm is a key part of our core (see Getting down to the Core blog)), less pain in neck and shoulder muscles and also decreased stress levels.

I would call this normal breathing optimal breathing as we can work towards it and for many of us it isn't yet normal!

Optimal breathing uses the diaphragm for 75% of effort and the intercostals between the ribs account for the remaining 25%.  This means that neck and shoulder muscles are barely used to breathe with.

Source: Wikimedia Commons

The diaphragm connects to the base of the breastbone, to the lower ribs and to the lumbar vertebrae.   It separates the thorax from the abdomen.   

The diagram above shows, as we inhale, the diaphragm contracts and it's outer edges pull the ribs outward and upward.   The intercostal muscles help by pulling the ribs further apart.  The thoracic cavity expands and air is drawn into the lungs.  

At the same time, the abdominal cavity is compressed and the abdominal and pelvic organs move down meaning the abdominal wall has to expand outwards and forwards to accommodate this.  The transverse abdominus relaxes and the pelvic floor descends as it receives the increased load of abdominal and pelvic organs.

In the optimal exhale the diaphragm elastically recoils back up higher into the rib cage, abs and pelvic floor contract and the intercostals relax.   This sends air back out of the lungs.

It sounds simple, so why don't we all breathe optimally?  Well chances are that we did when we were young.  And then something changed and our breathing changed too.   This might have been a physical change to our body - such as our spine and rib-cage stiffened with a lifestyle of sitting and inactivity or we may have had a baby which can both change our spinal alignment and the position of the diaphragm.   Or it might be that stress and anxiety have changed the optimal breathing to something more rapid and shallow.

The most common breathing dysfunction is chest breathing (referred to as 'thoracic' breathing in the paper).   This type of breathing is short exhalation followed by shallow inhalation.  Muscles in the neck and shoulders overwork to sustain this.  The position of the ribs may well be altered so the front, lower ribs flare upwards.  There is likely to be a lack of mobility in the lower ribs and potentially muscle pain in the neck and shoulders.

So, where to start on retraining your breath?  In many cases it's about re-acclimatising the brain to higher CO2 levels by gradually using longer exhales.   And breathing into the back and the sides of the rib-cage, activating the diaphragm more to encourage fuller inhalation.

The paper concludes that "future research is needed to validate breathing re‐education programs and the role they have in treating pain disorders, preventing injury, and improving movement patterns."   Joseph Pilates understood this many years ago - so perhaps your first call when looking to improve your breathing technique should be your Pilates teacher...

Many thanks to Heather King-Smith for her fantastic Breathing and Alignment training.

*  Bradley H & Esformes J Breathing Pattern Disorders and functional movement.  Int J Sports Phys Ther.  2014 Feb; 9(1): 28–39.

How does Pilates help manage persistent lower back pain?

Lower back pain can be broken down into acute and persistent.  The latter is pain that continues for more than three months after the initial episode.   Persistent back pain defines the ongoing back problems that many of us experience.

And why do we suffer pain in our lower backs?    If we sprain a calf muscle in our leg, it causes acute pain and we initially rest the muscle and avoid over-loading it or over-stretching it.   Then, when the calf feels better we start to use it again and we gradually build back our activity levels on the leg.

In contrast, lower backs are more complicated.  For starters, it's much harder to move around without bending or twisting or loading our backs - than it would be for a calf or a wrist.  

And then something changes in our pain response, meaning we carry on feeling pain long after the initial tissue damage has repaired.   Our sensitisation to pain becomes different.   Our pain threshold lowers and we feel pain when we make small movements that shouldn't damage or hurt our backs.

Our bodies are tough and designed to take heavy loads.  If we feel pain because we've lifted an excessively heavy weight then that might cause a back injury.  However, feeling pain when we lift a leg to get out of a car, is unlikely to be due to actual damage to our backs.   The pain is real pain, but it is likely to be part of the increased sensitivity to pain, rather than due to actual injury.

And so with this persistent pain, we alter the way we feel about our back and the way we hold ourselves and the way we move.    We become less likely to move our backs and we develop stiff, tense muscles, altered blood flow and vertebrae and discs that don't get enough movement to stay healthy and hydrated.

Now, we're stuck in a pain cycle of increased awareness of pain and protecting our backs by moving less.   Often there are other factors too.  We sleep less, we feel increasingly stressed and there may be other difficult events going on in our lives at the same time, all coming together at once.

So the good news here is that Pilates can help and be a part of the plan to manage this pain.  Pilates exercises can work in several ways to help break this pain cycle.    Firstly, it helps increase more positive awareness of how our bodies feel and move.   And without awareness, we're unlikely to change anything in our body (such as our posture, our movement patterns or our
physical activity levels).

Secondly, it helps us to relax our mind and body and so we can feel more confident about movement.   The Franklin Method releases are particularly good here.  

Then Pilates helps us to find the gentle movement that we need for our spine to be more mobile again.

And last but not least, Pilates builds up the core stability that we need to stabilise our lower back and pelvis.

So if you haven't yet tried Pilates, do get in touch to talk about a 1-1 or joining a class.

Getting down to the core

 

The core is the centre, the inside.  And our core, like this apple's, is central to our body and pretty deep inside us.

Unlike the apple, we have an 'anticipatory core.'   This is a motor control system involving sets of muscles designed to fire up to stabilise us before we move.  This means stability for the abdomen (and therefore our lower back) every time we need it.

Muscles of the anticipatory core 

These include;

- our diaphragm (our primary breathing muscle in the lower ribcage)

- our deep abdominals (Transverse Abdominus that wraps around the abdomen like a muscular corset)

- our pelvic floor muscles (several layers of muscle at the base of our pelvis)

- our Multifidi (the deepest muscles running along, and stabilising, the spine)

These muscles are constantly active if we breathe optimally.

                                                                              Core function

 

Core muscles

For this anticipatory system to function well we need the following;

1. Optimal posture – particularly head, rib and pelvic position, both as independent units but also in the way they align with each other (e.g. ribs to pelvis).

2. Optimal breathing – gentle expansion and deflation of the lungs inside the rib cage, all of the muscles, organs and fascia involved in the breath.

3.  Optimal motor function of all of these muscles – they need to be able to contract and expand as required.   This is happening in optimal breathing patterns.  It’s also needed with movement and loading.  For example, as we move from sitting to standing, the deepest muscles (especially pelvic floor) need to respond appropriately before we move, to create sufficient stability.

Core dysfunction

 

It’s very easy to knock this system out of balance.  When we lose optimal breath, we tend to create holding patterns to stabilise us instead.  This might be chest gripping which then creates unhelpful pressure in the abdomen.

 

Or, we might consciously hold ourselves, for example, holding in the belly.  This will affect all of the other muscles in our team.  It creates weakness in the abdominals as they can no longer function well, neither expanding nor contracting fully.  Plus, it causes unhelpful pressure in the abdomen, often meaning problems for the pelvic floor.

The core and Pilates work

 

If we focus on this anticipatory core in our Pilates work, we need to start with the basics (and keep returning to them often).  This means working towards optimal breath, alignment and motor function. 

 

It will involve gentle movement without excessive load.  Key is awareness of breath, alignment and efficient movement without excessive effort. 

 

Challenging the body’s stability comes next, introducing wobbliness to positions. 

 

Then, as we are functional beings who stand up (as well as lie down on mats!) we need to find movements that integrate the whole body.  When we’re standing on one leg (something we do all the time in walking and running) – we are relying on much more that just our anticipatory core for stability.  

Understanding the current science around how our fascia functions gives us more answers and also many different strategies and exercises to help us work on greater stability. 

How Pilates helps
 
Two clients share the benefits they’ve gained from this way of training.

I have been surprised at the impact small and seemingly gentle movements have had on my body. Pilates has improved my body awareness, flexibility and strength. I come away from each session feeling more toned but at the same time really relaxed and stretched out.

My job causes me to hunch my shoulders a lot thus causing a lot of stress on my neck, shoulders and arms, physical activity does not relieve this but Pilates has helped an incredible amount, through muscle release, breathing techniques and strengthening core muscle.  In particular one to one sessions have helped me to really locate the different muscles and work on them to relieve the tension. I also used to suffer a lot with headaches but they are much less frequent now and if I feel one coming on then I can usually apply something from Pilates to relieve it.

Elizabeth H 

Caroline’s classes are well structured and she is a careful and focussed instructor.  I have begun to understand how small but targeted movement can really help flexibility and mobility.  I enjoy the classes and feel I am learning about how my body works and how I can maintain it in good working order.

Jane G 

Principal Pilates' Picks

Thought I'd share some gift ideas now Christmas is coming...

For clothes (Pilates or not) I'm loving BAM bamboo clothing I think you can feel greener buying bamboo clothes as it's a faster growing crop than cotton and uses a lot less water.  I like this Women's Bamboo Horizon Sweat - very soft and cosy, great for winter!

Women's Bamboo Horizon Sweat

Men's Bamboo Contrast Stitch Baselayer

And I love the feel of their base layers - available in his and hers sizes!

Sweaty Betty's Intensify Merino Seamless leggings

So that's tops, now for leggings. My pick for this time of year is extravagant but feels so good.. They are Sweaty Betty's Intensify Merino Seamless leggings - wool but definitely not scratchy and so fantastically warm!

And to complete the outfit - socks! Here are two pairs for the colder months - the dusky pink are short without grips so good for everyday. The long blue pair do have grips and will get you to and from classes with warmer legs!

ToeSox With Toe Casual Crew Dusk

Full Toe Knee High Grip Socks in Polka

Next, on to some kit to use at home over Christmas to work on any tight muscles - Franklin Method of course!  

Soft Franklin Ball, 10cm, orange

Franklin Ball, green, 10cm

Sleep: The Myth of 8 Hours, the Power of Naps...

And when you've put your feet up, how about something to read? Just three books to choose from that may help you start 2017 even more healthy and happy. The first is Nick Littlehale's Sleep.  For me, you can't underestimate the effect of sleep on health.  And Nick tells us about helping numerous athletes achieve gains in their sport by sleeping better. But good sleep isn't just for Bradley Wiggins - this book could help anyone getting a better night and it contains the revelation (to me at least!) that decaffeinated doesn't mean caffeine-free - who knew?!

Living Well With Pain And Illness

My second book is Living Well with Pain and Illness by Vidyamala Burch. A book that helps us understand more about what pain actually is and how awareness, breathing and mindfulness can help improve our lives.

Joanna Hall's Walkactive Programme:

And lastly a good book for January to help us get more active outdoors by walking more.   Most of us walk on autopilot much of the time but to walk as we're designed to takes more awareness. Joanna Hall shows us how to optimise our gait and how to get fitter at the same time. What better way for body and mind to start a year?

Ah, there is one way - and that's a Principal Pilates 1-1 of course! Vouchers available from Caroline!

Merry Christmas and looking forward to a Happy 2017 for all!