How to Shovel (Through a PRI Lens)

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The snow is here! And there may be more snow on the way so it’s important to know how to shovel your drive and walkways without causing excessive pain or injure yourself. 

1) Wear good shoes - You’re about to lift a lot of weight so having appropriate footwear is important. A good foundation for your foot allows for proper weight bearing through your legs and overall alignment of your body. If you feel comfortable and the snow is not too thick, just wear your tennis shoes.  If the snow is deeper, wear snow boots with good, supportive or any custom orthotics you may wear. 

2) Choose a good shovel - We all know that tools can make or break a job so choose a shovel that won’t break your back! We like ergonomic designs where the handle is slightly bent so that the shovel blade is lower to the ground. This is useful so you don’t have to bend over so far to get your blade to the ground. It also makes scooping the blade under the snow easier.

3) Squat - Once your blade is under that snow, you’re going to have to lift it. Be sure to squat down BEFORE lifting the snow. Place one foot slightly ahead of the other and press through your heels, as if you’re pushing the ground away from you, while you straighten your knees and stand up. It’s similar to pushing the footboard away from you on a leg press machine. You may be able to rest your forearms on your thighs to help lift the heavy snow off the ground. 

4) Use your abs - Now that you have all that weight lifted you’re going to have to move it off to the side. Do this by using your abs! Their job is to tuck your ribs, round your back, and twist your body. As this post is through a PRI lens, we want you to use your left abs a lot more than your right. In order to do this, you’ll need to have your left foot ahead of your right with your left hand farther down the shaft of the shovel (closer to the blade). As you get ready to through your snow to the side, be sure that your left shoulder stays lower than your right (trunk slightly bent to the left) and sense and feel your left abs rotate your trunk to the left so that your breast bone ends up facing toward the left. Your abs should be the primary force rotating your trunk, not your arms! It’s important to switch your lead arm/leg while shoveling to avoid fatigue and overuse injury, but as mentioned before, shovel with your left arm and left foot forward most often. 

5) Pace yourself - shoveling is much more taxing to our musculoskeletal and cardiovascular systems than we like to admit. Realize it’s ok to take period breaks to avoid fatigue and give your system a rest!

6) Have realistic expectations - Lifting large amounts of weights for a long time is not something most people do on a regular basis. Be aware that you will feel muscular soreness after doing this. This is normal. Even soreness in muscles that PRI likes to inhibit (lower back muscles, pecs, biceps, etc.) will be sore and that is ok. Shoveling is not a specific, rehabilitative activity; It’s an activity that uses many, many muscles in the body in order to complete a difficult physical task. It’s even acceptable if the pain for which you are receiving treatment gets aggravated. We would like to keep that as minimal as possible using the above tips, but if your body cannot tolerating driving a car, making it through a work day, folding laundry, etc. without feeling pain, it is to be expected that shoveling will exacerbate it to some extent. 

7) DO YOUR EXERCISES! - Be sure to do at least one of your exercises immediately before and immediately after shoveling. The idea is that we want to begin this physically demanding activity with our bodies in the best possible position. It’s likely that we will lose our good position or begin using compensatory muscle groups as we fatigue with shoveling so ending with an exercise (or more) will help put our body back in the correct position and quiet down our overused muscles so avoid excessive pain. 

Written by Lesley Callaham, MPT, PRC January 15, 2019

How to Avoid Pain While Using Tech Devices

New Years is approaching and the time to make resolutions is looming. Integrate 360 PT recommends limiting screen time and/or maximizing proper positioning when using your devices!

Screen time is simply unavoidable these days, but the amount of time we are spending on our devices is causing a lot of physical pain. Here are some tips to let you stay functional with your tech while minimizing physical impact.

1) Start with a good foundation. It is easiest to use devices for any length of time while sitting. Be sure that you are sitting on a firm, but comfortable surface with your knees at hip height or slightly higher. Place your feet firmly on the floor or on a footrest if needed (for vertically challenged people like me!). Feel your sit bones on the seat and let your lower back round onto the backrest behind you. This positioning will make sure your pelvis is in a good, neutral position (ie not tipped forward or backward) and will let your spine build up from there and be in a good position as well. 

2) Put the screen in front of your eyes. If you’re working on a computer, make the top edge of the screen level with your eyes. This is also true if you’re using a large screened device like a tablet. If you’re using a smaller screened item like a phone place the center of your screen in front of your eyes. This helps you to keep your head upright and balanced over your thorax and avoid the forward head posture than can stir up neck, jaw, and shoulder pain as well as headaches.

3) Support your arms. Since you cannot hold that gadget in front of your eyes with just your arm muscles alone, prop your arms on something. It could be the desk or table in front of you, a pillow on your lap, etc. Just be careful to not “get lazy” and begin leaning on your elbows. This will cause your shoulders to hunch forward and end up in that same forward head position mentioned above. 

4) Don’t stress your eyes. If you have been prescribed a pair of reading or computer glasses, please use them! If you haven’t been to the optometrist for awhile and notice eye pain and/or strain when you read (especially on a screen) after some time, please go for your check up or at the very least pick up a pair of over the counter reading glasses you can get at any pharmacy. When we try to read without the proper prescription to help us out, we’ll over-stress our occular muscles which can trigger a headache. Once our occular muscles have been fatigued, we’ll start moving our heads slightly in order to try to help sharpen the image quality. This, yet again, leads to poor posture and pain. 
   Another thing to be aware of is that our eyes will eventually fatigue when used at the same distance for a prolonged amount of time (ie doing computer work without taking a break). Once this happens, our neurological system will essentially lock our musculoskeletal system into a pattern. It’s a bit like autopilot. Our brains have established that we won’t be using some muscles in our body and shut them down, while overly facilitating and using others. This will eventually lead to posture break down, muscle fatigue, and pain. This can be combatted by taking visual breaks via the 20/20/20 rule. Every 20 minutes try to look 20 feet away for 20 seconds. This helps to freshen our ocular and musculoskeletal systems and keep things fresh. An even better approach to this rule is to move around - go to the bathroom, get a drink of water, or just stand up and wiggle a bit. 

Written on December 26, 2018 by Lesley Callaham, MPT, PRC

Best and Safest Strategies for Pain Relief via Consumer Reports

Consumer Reports recently published an article entitled Best and Safest Strategies for Pain. You can read it by clicking the hyperlink of the title. We wanted to share it with you all because it’s filled with safe, conservative, proven techniques for pain relief. 

The theme of the article is that these strategies can avoid or minimize the use of, or boost the effectiveness of opioid medication. As opioid prescription is simultaneously booming and scrutinized, we wanted to be sure our readers had all of this wonderful information in order to avoid using unnecessary and possibly harmful prescription medication. 

Another reason we wanted to present this article is that a lot of these strategies are not described to our patients until they get to our office. Although it’s true that this information falls in the “better late than never” category, it would be great for people to try these techniques or begin utilizing them regularly before starting physical therapy as it will improve and speed the rehabilitation process. One of the tips listed in the article is that people who move and participate in minimal impact exercise are typically in much less pain than sedentary individuals. This is a major theme in our education with patients! There is a point at which you can push your body too hard and aggravate your pain, but we find a lot of our patients tend to quickly reduce or eliminate physical activity due to pain. Physical activity improves your cardiovascular fitness as well as improve blood flow and synovial fluid synthesis within joint surfaces. These benefits all speed healing. Let us or whatever physical therapist you are working with, help determine what types of exercises are appropriate for your body or how to modify certain activities you may already be doing that could slow your healing. We can also suggest healthy alternative activities you can partake in if your preferred activity is not appropriate at the moment. To be clear, please listen to your body when it hurts, but do NOT top moving!

We also want to point out that this article does not specifically recommend physical therapy as much as we believe is appropriate. Physical therapy can help with all of the conditions listed in the article. Additionally, Integrate 360 Physical Therapy’s use of Postural Restoration Institute (PRI) physical therapy is a global, integrated, and more functional form of physical therapy than you will receive in a standard outpatient office. Therefore, if you’ve tried PT before for your pain and not experienced the outcomes you want, please come see us and let us explain why we’re different and how our approach will differ from your previous experience. 

Written by Lesley Callaham, MPT, PRC December 11, 2018

Better Postures and Positions for Reading

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As the weather continues to worsen, we are forced to do more activities indoors. Hopefully, one of these activities is brushing up on your reading! Most of us love curling up with a good book and relaxing at the end of a hard day or during a snow storm, but it can be really hard to maintain good posture the entire time. Here are some tips to allow you to increase your reading time without increasing your pain:

1) Sit as much as you can. This is the most friendly position to read a book. Try sitting in a comfortable, but supportive chair. The chair should have a good back support without pressing into your lower back and exaggerating its curvature. Also, the seat needs to be short enough that only your thighs rest on it. If the seat extends beyond your knees onto your calves, use a large pillow to essentially bring your backrest forward and your knees can bend over the edge of the seat. Again, be careful not to exaggerate the curvature of your lower back when using this pillow. 
  In order to comfortably raise the book closer to eye level (so that you don't look down and assume a forward head position over time), place the book on a table, desk, or even a large pillow on your lap. This will allow your arms to rest on the surface and place less stress on your neck. 
  Remember that our bodies are not designed for sit for more than 20-30 minutes, so remember to take quick breaks in between chapters to switch positions, get a drink, or even go to the bathroom. Your body will thank you!
  *This position can be easily adapted to sitting in bed if you pad your lower back with a specially designed cushion or a few pillows. Remember to be sure you can feel your lower back rounding into the padding. Place a small pillow under your knees to keep your hamstrings and back of your knee joint pain free. Use a pillow or two on your lap to elevate the book. 

2) Choose good “lazy positions.” The above position will eventually begin to tire your body. In order to continue to sit comfortably without wrecking your body, try curling your legs up onto the chair seat so that your feet are located near your left hip. It will look like your side sitting or “mermaid sitting.” Be sure that your trunk is bent toward the left and more rounded on the right. Essentially, your left shoulder and hip should be closer together than your right shoulder and hip are. You can use pillows to support you in this position if needed. Continue to keep your book elevated with your table/desk/pillow. If you feel neck tension in this position, please get out of it right away. 

3) Lie Down. If you’re reading before bed, you are probably lying down. Lie on your left side with a pillow between your legs and lower left ribcage. Then, fluff your pillow up (or use multiple, thin pillows) so that your neck is bent slightly, and comfortably, up toward the ceiling. Your neck should now be slightly bent to the right. Using your arm to help stabilize it, lean your book on a pillow in front of you. Your eyes will be nearly horizontal so it’s much easier to read in this position than it may seem. 

4) Avoid bad positions. Do not lie on your back or stomach when reading. Either position will cause excessive stress to your neck and/or back. 

Happy reading!

Written by Lesley Callaham, MPT, PRC November 14, 2018

How Breathing Affects GI and Pelvic Health

First, look at these great videos from FXNL Media and Stockbridge Orthopedic Practice before reading the rest of this article. 

As one can clearly see in these videos, proper diaphragmatic breathing is essential for GI and pelvic health. When the diaphragm is able to contract and descend during inhalation followed by a recoil into its original domed shaped upon exhalation, the abdominal contents including the GI and pelvic floor muscles essentially get a massage. This massaging and pumping action helps to move food and gasses throughout the GI system. It also allows the pelvic floor muscles to cycle through ascended/descended positions and active/relaxed muscle tone. This allows the pelvic floor to be able to attenuate to the forces applied on it from the gut as well as the core during weight bearing activities. It also allows the pelvic floor to stay active all day long without fatiguing. 

When we develop compensated breathing patterns, our resting abdominal muscle tension plummets. Because there is no force from the abdominals to prevent this, our bellies then distend as we inhale instead of applying a healthy pressure down into the abdominal cavity. As that pressure begins to move forward instead of downward, our GI and pelvic floor no longer receive that important massage. This can result in a multitude of problems from constipation, gas, bloating, pelvic pain (with or without intercourse), urinary/gas/fecal incontinence, and even sacroiliac (SI) joint dysfunction.

Proper diaphragmatic breathing is the cornerstone of Postural Restoration Institute and is available at Integrate 360 Physical Therapy. Because of it’s attachment sites and constant use (about 22,000 times a day) diaphragmatic breathing is essential to avoiding and treating a seemingly endless list of problems including those already discussed in this article to anxiety and musculoskeletal pain of all manners (for more information on this please refer back to our previous posts). No other approach to physical therapy takes into consideration the importance of this muscle as well as its innate asymmetries that often lead to us developing our compensatory strategies around it. 

If you have pain (especially pelvic or women’s health in nature), GI dysfunction,  anxiety, or breathing problems and haven’t found relief in the past, please come in for an evaluation. Let the therapists at Integrate 360 Physical Therapy evaluate your body and your respiratory capacity and inform you how it is related to your complaints. We will discuss a plan of care and give you exercises to improve your breathing and your overall health! Don’t wait another day! Call us at 314-733-5000. 

Written by Lesley Callaham, MPT, PRC on October 30, 2019.

What Is Proper Diaphragmatic Breathing?

There is a lot of misinformation out there on diaphragmatic breathing. Considering how essential proper diaphragmatic respiration is to our overall health and success with a Postural Restoration Institute physical therapy program, we wanted to clear it up a bit. 

Diaphragmatic breathing is NOT belly breathing!

The diaphragm is our primary respiratory muscle and is positioned at the bottom of our ribcage. It attaches to the inner portion of our lower ribcage and the front portion of our lower (lumbar spine). At rest, it is supposed to be in a domed position within the ribcage. When we breathe in, the diaphragm contracts and flattens. This causes negative pressure within the chest and allows us to take in air. When we breathe out, the diaphragm relaxes and returns to its domed position (or at least it’s supposed to) and the air is moved out of our lungs. In order for this to happen, the internal obliques and transverse abdominis (deep abdominal muscles) need to be active to keep the lower ribcage in a proper position. For a more detailed explanation of this action as well as some cool visuals, check out our previous blog Balloons- Quite Possibly The Most Underrated Therapy Tool.

So, what is diaphragmatic respiration supposed to look and feel like? For a relaxed inhale, the lower ribs should move genially out toward the sides, or laterally. Then, the lower ribs will move slightly forward with the abdomen moving along with it in almost a 1:1 ratio. During a deeper breathe, the upper chest will rise slightly after the the lower ribcage and abdomen have begun their movement. 

This can easily be felt by lying on your back and placing one hand on your lower ribcage (just below your breastbone) and another hand on your stomach above your belly button. Be sure to do this when you’re either sleepy or meditating as it is more likely you are naturally diaphragmatically breathing at these times. Feel the gentle lifting and lowering of your lower ribcage and abdomen almost in unison. You should not feel one area moving significantly more than the other, particularly your abdomen moving more than your ribcage.

In order to belly breathe, those essential abdominal muscles must be turned off to allow the belly to be loose enough to take in breath. Once those muscles turn off, the diaphragm loses it’s foundation on which to work. Essentially, when our breath fills our belly, there is no way we are actually using our diaphragm. Additionally, if you think about it, it just doesn’t make sense to breathe this way. There is no lung tissue in the belly. Therefore, why would be focus on moving air into an area that our lungs are not?

If you lie on your back and notice that your belly moves first or farther than your lower ribcage, you need to correct the issue right away. Poor diaphragmatic breathing can cause anxiety, lower back/neck pain, pelvic floor or women’s health dysfunctions (such as incontinence, pain with intercourse, constipation, etc.), GI dysfunction, and many other problems. Typically, individualized, guided restoration of the diaphragmatic breath is needed. Simply doing online research and trying to fix the problem yourself will likely lead you to more misinformation or may cause you to adapt a new, non-diaphragmatic breathing pattern such as overusing the muscles of your neck. Diaphragmatic restoration can be achieved in as little as one visit with the therapists at Integrate 360 Physical Therapy so give us a call today at 314-733-5000!

Written by Lesley Callaham, MPT, PRC on October 16, 2018

Ease Headache and Neck Pain In The Car

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Although it may not seem like it, the car is a very difficult environment for your body to manage. The floor/seat is constantly shifting as you speed up, slow down, or turn. Manipulating the steering wheel is hard on your arms, neck, and shoulder muscles. The windshield set up and personal habits of where to look can irritate muscle tension. Because the car itself, environments in which you drive, and your personal compensation pattern are all highly variable, it’s best to talk to your therapist about what is best for your body. However, here are some tips to help you get started. 

1) Get grounded as best you can. Feeling as supported as possible allows your body’s resting muscle tension to ease. It also gives you more information about the forces acting on your body at any given moment and how to respond to them. Think about it, if you replaced your car’s seat with a barstool, the muscles in your body would be much more rigid to try to give you stability. Couple that rigidity with the motions of the car when you’re turning, your body cannot react appropriately to negate the force on it, and it will only become more rigid. This will end with your falling off of your stool during a turn instead of being able to rebalance your body and stay seated. 
   Allow your left foot to rest solidly only the floor, not falling against the side of the door. Adjust your seat position and lumbar support so that you can easily feel your sit bones on the seat and your lower back against the seat back. Be careful to not over-support your lower back and cause a lot of arch- you’ll notice that you’re no longer on your sit bones. 

2) Give your arms a chance. Most of us have flattened ribcages in the back. This is problematic because the scapular bone (the foundation of our shoulder joint) is slightly rounded. When that slightly rounded bone is sitting on a flattened ribcage, it has inherently less stability than if it was sitting on a slightly rounded one. Proper alignment allows your scapular muscles to work more efficiently and create a stable base for your long, heavy arm to work off of. 
   This is best accomplished by rounding the upper back slightly so that the area at the bottom of the scapular (bra-line for women) is touching the back of your chair and the area above that is slightly away from it. 

3) Give your arms a break. Even with a nicely rounded ribcage giving your scapula a proper foundation and good stability, keeping your arms upright on the steering wheel for long periods of time is more than most people can tolerate. Once appropriate muscles fatigue, we’ll often use our upper traps and necks to try to hold them up and this creates or worsens pain.
   Try taking turns with your arms and driving with only one arm at a time (obviously don’t sacrifice safety to do this). When you want to drive with both arms, change the spots on the steering wheel that you’re grabbing. First have your arms at 11 and 1 o’clock, then move them to 9 and 3, then again to 7 and 5. The constant change in arm elevation and rotation will help fight muscular fatigue. 

4) Optimize your eyes. Make sure you’re always driving with the correct lenses or glasses if you need them. Avoiding eye strain will not only ease ocular muscle tension and headache pain, but you won’t be straining your neck to help you see better. Also, try to not lock your vision on one thing (such as the license plate ahead of you). This places your muscular system on autopilot and produces muscular rigidity. By simply looking around your visual field, your muscular system has to stay alert and flexible. This keeps pain low!

5) Try to stay relaxed. Driving, especially in traffic, is stressful! Be mindful of any bad habits you may be slipping in to such as white knuckles on the steering wheel, clenching your teeth, holding your breath. This will all add to muscular rigidity and increase pain. Try listening to calming music or a podcast. You can even try placing stickers at various places in your car. When you see them, check to make sure you’re not clenching (or whatever your habit tends to be) and go about your day!

Happy driving!

Written by Lesley Callaham, MPT, PRC October 8, 2018

Improving Your Sleep Hygiene

Our most recent blog topic was on proper positioning during sleep. As we mentioned, this is really important to cut down on night waking due to pain or pain felt first thing in the morning. However, proper sleep hygiene is essential to allow you to fall asleep asleep and help to keep you asleep throughout the night. The Mayo Clinic has a great article on their 6 tips here. Below is the bulk of the information directly from the article. 

“1. Stick to a sleep schedule

Set aside no more than eight hours for sleep. The recommended amount of sleep for a healthy adult is at least seven hours. Most people don't need more than eight hours in bed to achieve this goal.

Go to bed and get up at the same time every day. Try to limit the difference in your sleep schedule on weeknights and weekends to no more than one hour. Being consistent reinforces your body's sleep-wake cycle.

If you don't fall asleep within about 20 minutes, leave your bedroom and do something relaxing. Read or listen to soothing music. Go back to bed when you're tired. Repeat as needed.

2. Pay attention to what you eat and drink

Don't go to bed hungry or stuffed. In particular, avoid heavy or large meals within a couple of hours of bedtime. Your discomfort might keep you up.

Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine take hours to wear off and can wreak havoc on quality sleep. And even though alcohol might make you feel sleepy, it can disrupt sleep later in the night.

3. Create a restful environment

Create a room that's ideal for sleeping. Often, this means cool, dark and quiet. Exposure to light might make it more challenging to fall asleep. Avoid prolonged use of light-emitting screens just before bedtime. Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs.

Doing calming activities before bedtime, such as taking a bath or using relaxation techniques, might promote better sleep.

4. Limit daytime naps

Long daytime naps can interfere with nighttime sleep. If you choose to nap, limit yourself to up to 30 minutes and avoid doing so late in the day.

If you work nights, however, you might need to nap late in the day before work to help make up your sleep debt.

5. Include physical activity in your daily routine

Regular physical activity can promote better sleep. Avoid being active too close to bedtime, however.

Spending time outside every day might be helpful, too.

6. Manage worries

Try to resolve your worries or concerns before bedtime. Jot down what's on your mind and then set it aside for tomorrow.

Stress management might help. Start with the basics, such as getting organized, setting priorities and delegating tasks. Meditation also can ease anxiety.

Know when to contact your doctor

Nearly everyone has an occasional sleepless night — but if you often have trouble sleeping, contact your doctor. Identifying and treating any underlying causes can help you get the better sleep you deserve”

These tips with the information from our previous blog post will, over time, allow you to get more restful sleep. This is essential in tissue healing, posture modification, motor planning retraining, and progress in your journey to eliminate pain!

Sweet dreams!

Written by Lesley Callaham, MPT, PRC October 2, 2018

PRI Sleeping Tips

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We all know sleeping is essential to overall health, but did you know that poor sleep can rob you of producing certain hormones that are necessary for tissue healing? Whether you’ve never been a “good sleeper” or pain is waking you at night, your sleep quality is important to improving your pain and needs to be addressed. Our upcoming blog post will be about improving your sleep hygiene and the quality of your sleep, but this week we will be highlighting the environment and positioning involved with sleeping to minimize pain at night. 

1) The right mattress is important! The Postural Restoration Institute (PRI) recommends a regular, coiled spring mattress. As the mattress is made up of many springs that individually adjust to different areas of the body, it is a great tool for our patients to sense and feel how their body is lying on the mattress and make appropriate adjustments. Conversely, a foam or sleep number mattress is either made of one large piece of material or much larger sections of air/foam. These designs cannot give our patient’s brains/bodies very specific information as to how they are lying, where most of their weight is, etc. Just as important as the type of mattress, be sure you have a quality mattress or make sure it is relatively new. All mattresses pad down overtime which will limit the mattress’ effectiveness in supporting our bodies, helping us realize where we are in space, or cause us to “fall into the ditch” of where the mattress is the lowest. All of these will increase pain and can cause night-time waking.

-If getting a new mattress is cost-prohibitive for you, you can usually find a donated mattress that’s under 90 days old. Most mattress companies offer free 90 day trial mattresses that are rejected are donated to off-set the company’s loss of income. Call around to your local donation centers and you’ll be able to find where the mattress companies donate their almost-new products. 

2) How you support your body differs depending on the position in which you sleep.

- Back sleeping- This is a great position to sleep in, but definitely is the least popular. Be sure to keep a pillow under your knees. This slackens the muscles on the front of our hip and thigh which can pull our pelvis forward and arch our back when we sleep with our knees straight. Use a pillow that is relatively flat, but has enough structure that the arch in your neck is maintained. 

- Stomach sleeping- Unfortunately, this is a pretty bad position to sleep in. It allows your lower back to excessively arch and places your neck in a significantly rotated position. Even if you do not use a pillow, the TMJ (jaw joint) is placed under a lot of strain as the weight of your head is directly on this non-weight bearing joint. Many people will kick a leg out to the side in this position which places a lot of strain on your pelvis and sacroiliac joints. If you are having a lot of trouble breaking this habit, try sleeping with a pillow under your stomach. Make sure your belly button is directly in the center of the pillow. This will help to keep your lower back in a less-arched position. Keep your legs together and avoid kicking them to the side. Lastly, do not use a pillow.

- Side sleeping - This is a great position to sleep in, but you want to support your body differently depending on what side you are sleeping on. This is based on the fact that our body is not symmetrical; Our diaphragm (muscle that we breathe with) does not work as well on the left which causes our left abdominals to weaken (first) allowing our left lower ribs to flare, our pelvis tends to twist to the right, and our left hip tends to rotate outward while our right tends to rotate inward.

- Left side sleeping - Use a pillow that will allow your neck to stay parallel to the mattresses or causes your head to become elevated slightly (right ear should move closer to the right shoulder). Place a pillow under your left lower ribs. This helps to keep your ribs in a better position and let your diaphragm function better. A diaphragm that works efficiently will allows our neck/shoulder/back muscles to relax as they are no longer needed to help pull in air and can decrease apnic episodes! Place another pillow between your knees and try to push your right knee forward a bit forward compared to your left. This will keep your pelvis from twisting to the right and place your hip in a better position which can decrease lower back strain and irritation to the joint itself. 

- Right side sleeping - Use a pillow that keeps your neck parallel to the mattress. A small pillow can be used under your right lower ribs if you have a flare on that side or know you have abdominal weakness on both sides. The last pillow is placed between your ankles which places your left hip in a better position. Lastly, pull your left knee back a bit compared to your right in order to keep your pelvis from rotating toward the right. 

3) Doing your exercises immediately before bed can have a huge impact. Our PRI exercises are designed to inhibit overactive musculature that are holding your body in a bad position/posture and decrease pain. By performing your exercises immediately before getting into bed, you’ll be going to sleep in the most balanced, relaxed, and pain-free state you can achieve! It also helps to decrease your fight or flight nervous system and increase our REST and digest system. This can have a dramatic impact on your quality of sleep, decrease in pain, and progress in your program.

Sweet dreams! 

Written by Lesley Callaham September 18, 2018

PRI Tips For Caregivers of Young Children

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Let’s face it, raising and caring for kids can be complicated! How much screen time should they have?  What foods should they eat? What is a balanced schedule? The decisions can be difficult, and keeping up with them physically can be really challenging. Here are some tips to avoid pain or keep it at bay for those that work with young children. 

1) Sit on the floor with them. Kids love to play on the floor. As caregivers we find a lot of creative ways to get closer to their level and a lot of them aren’t great for our own bodies. Go ahead and sit on the floor with them! Try to sit somewhere with a back support (wall, piece of furniture, etc.) and sit with either your knees bent up or with your legs out in front of you. Try to be sure that your midback (from the bottom of your shoulder blades or a woman’s bra-line) and below is on the wall. Lean your upper back and shoulders away from the wall slightly by using your abdominals to pull your lower ribs down. If you’re sitting with your knees bent, your shoulders will likely already be pulled away from the wall. Be sure you can feel your sitbones well on both sides. 
   - Try to avoid sitting cross-legged as this places your hips in an exaggerated amount of rotation for a prolonged period of time and places stress on your sacroiliac (SI) joints. 
   - You can also try “mermaid sitting” for short periods of time if it’s comfortable to you. This is essentially side sitting on the floor with both of your feet over toward your left hip. This will mimic proper hip rotational positions and left trunk sidebending that we try to accentuate in Postural Restoration (PRI) programs. Just be careful to NOT do it the other direction (like the woman in the picture above)!

2) Make use of your left side. As a part of our natural bias that often gets over-exaggerated over time and for people with pain, we tend to utilize the right side of our body a lot more, particularly with reaching, standing, and bending our trunks to the right. Simply try to reach more with your left hand as you’re preparing their meal, passing them a toy, or tidying up while they’re napping or playing by themselves. 
   - You can also promote left trunk sidebending by sitting on their right-hand side. Now whether you’re sitting next to them at a chair or on the floor, reading them a book or helping them eat their meal, you will constantly be practicing bending your trunk toward the left. This is essential for progression in your PRI program!

3) Hold/carry them on your right hip. This relates to tip number 2. We tend to place our kiddos on our left hip so that we can manipulate objects with our right arm. By simply placing them on our right hip, our left hand is free to be used more throughout the day. Additionally, the excess weight on your right side will force you to use your abs and bend your trunk to the left in order to counterbalance the weight. This is such a simple trick that can help in so many ways!

4) Use that stroller to your advantage. When taking your kid(s) on a walk, the added weight of the stroller can really help train your abs. When walking, especially when you’re going uphill, think about pressing/reaching your arms forward on the stroller handlebar as your lower ribs move backward and down toward your lower spine. This will help to engage your abs and properly align your spine as well as gain some strength and endurance in those postural abdominal muscles! 
   - When going uphill, be sure to keep your tailbone tucked under (or avoid arching your back) and pushing through your heel behind you as long as you can before letting your body weight move onto the ball of your foot. 

5) Relax. This is something most caregivers understand to be important as we cannot properly care for our kiddos if we are in need. Relaxation is also very important from a PRI perspective. Life in general, especially a life filled with young ones, can be very stressful. It’s easy for our bodies to live in fight-or-flight mode and it can be difficult to get out of it. This disallows the muscles associated with heightened fight-or-flight levels from fully turning off and can lead to muscular imbalances and poor joint positions in our body. Simply relaxing in some way (meditating, diaphragmatic breathing, reading, going to bed a little earlier, etc.) will help to stay in touch with our rest-and-digest systems and remain more balanced emotionally and physically. 

Written by Lesley Callaham, MPT, PRC September 6, 2018