Why We Chose To Be An Out-Of-Network Provider

An article entitled "Physical Therapy Burnout is Destroying Our Profession" on CovalentCareers.com is essentially a list of typical complaints physical therapists amass during their career. These issues are often significant enough to cause many to leave the profession earlier than they intended, or leave it entirely.

One significant cause of "physical therapy burnout" is reduced reimbursement rates from insurance companies. This leads to increased demands on the therapist's productivity to make ends meet. This can be done many different ways. Typically, clinics opt to see more patients per day. This requires visits to be shorter in duration or for one therapist to see more than one patient at a time. Either way, the patient is given less one-on-one time with their therapist. Some clinics urge their therapists to be cognizant of reimbursement rates and, if two treatments will be equally effective for that patient, pick the higher reimbursed option. For example, if manual therapy or ultrasound are deemed, by the therapist, to be equally effective at reducing their patient's painful muscle spasm, they're likely to chose manual therapy as it will be reimbursed at a higher rate by the insurance company. Some clinics may recommend their therapists "pad" their billing with treatments that are not harmful or contraindicated in anyway, but may not be totally necessary.  An example of this would be ending a session regularly with electrical stimulation for patients experiencing pain. It is a billable service that will bring the clinic money, but doesn't require the therapist to spend more time with that patient. The therapist is now free to work with other patients and perform additional billable services.

To be clear, most physical therapists and therapy clinics are utilizing morally and legally correct billing practices. However, there is immense pressure on physical therapists to find creative ways to bring more money into the clinic without doing anything illegal or against their better judgement. 

Additionally, a typical physical therapist went to school in order to help people lead less painful and more functional lives. The amount of paperwork required by insurance companies to receive any reimbursement money at all is getting out of hand and requiring physical therapists to put in many, many hours off the clock. Our mission was to help people, not to do endless amount of paperwork only to be denied payment.

This is why Integrate 360 Physical Therapy chooses to be an out-of-network provider. We do not depend on insurance companies to be able to pay our bills and we do not have to play their games.

1) We do not employ a full-time billing professional whose entire job is dedicated to submitting and resubmitting claims until they discover what billing code is effective, or go to continuing education courses to remain aware of the highest reimbursed codes. 

2) We are able to work with our patients to determine what the goals of their physical therapy should be. Essentially, the patient is able to be an active participant in their own plan of care. We do not have to set our goals based upon what insurance companies deem is "success."

3) We can be flexible with the length of frequency of our visits. Many health plans cap therapy visits at 20 per year or at a dollar amount. Without these restrictions, our therapists are able to spend more quality, one-on-one time with our patients. We do not employ therapy aids or assistants. 

Unfortunately, this is just not possible when relying on insurance companies reimbursement rates. 

However, we are able to provide paperwork to our patients so that they can submit their claims. It usually requires a trip to their health insurance's website to see how to do this. Then, forms are uploaded and submitted. If the charges are accepted by the insurance company, they typically write a check directly to the patient for reimbursement. This amount will vary and will be dependent on the patient's out-of-network benefits. A simple call to their insurance company will give them this information. 

For any other questions or concerns about this topic, please call us at 314-733-5000 or email Nancy@Integrate360PT.com

Can't Feel The Burn In The Right Place?

It's happened to all of us. You're working out and know you're supposed to be "feeling it" in a certain target area, but you can't. Do you ever wonder why?

The explanation is actually quite simple. That particular muscle is not burning because it's not firing. Why? It's not in the right position to be properly utilized. 

Our body is designed to stand with a certain posture and have our joints in certain positions. The muscles attach on very specific areas of bone so that when they shorten or contract, the bone moves in a very specific pattern. For example, our gluteus maximus (largest glut muscle) originates from the top of our pelvis and part of our sacrum at the back of the pelvis above the tailbone. It then attaches to the gluteal tuberosity on the back of the thigh bone. When this muscle contracts and shortens, your hip extends or your thigh moves backward relative to your pelvis.

The only catch is that our muscles need to have a proper length tension ratio to contract fully. This means that the muscle must not be too stretched, or too shortened in order to be the strongest that it can be and fully contract all its fibers. Therefore, if the muscle is not in the correct position, and does not have the correct length tension ratio, the body will substitute another muscle that is in better position to work. This is why people who have very arched or "deep" lower backs will feel their lower backs working as they do a glut exercise. Because of the position of their lower spine and the consequential tipped-forward position of their pelvis, their glut is stretched out. Their lower back extensors are then in a shorter position and have a much more efficient length tension ratio. Therefore, that person's body will choose to use their lower back extensors rather than their glut during their glut strengthening activities as it is more efficient from a biomechanical standpoint. 

The therapists at Integrate 360 Physical Therapists can help. We do an extensive evaluation looking at your standing posture and performing tests to see if your joints and muscles are properly aligned. We will then work with you on ways to restore your posture and bone/joint alignment so that you can work out and live in a biomechanically correct way. Depending on your goals, this can be done in as little as one session!

Next time your doing a leg raise while lying on your side and you feel it in the outside of your thigh versus your glut, or performing lower abdominal exercises that you feel in the front of your hip joint, give us a call and let us help you. Contact us at Lesley@Integrate360PT.com, Nancy@Integrate360PT.com or 314-733-5000.

Why Does Everyone's Right Shoulder Droop?

What do you notice in the above picture? At first glance it just looks like three boys hanging out during a soccer game. They're all wearing different clothes and are different heights. Two of the boys are leaning on one another while the third stands independently. Despite their differences, they are all standing with the same postural pattern. 

Take a look at them, no matter how they are leaning, they are all standing on their right legs, crunching or shortening the right sides of their trunks, and lowering their right shoulders. Doesn't this seem weird considering two of the boys are leaning in opposite directions so they can lean on one another? How does that happen?

This common pattern is due to our naturally-occurring anatomical asymmetry. It begins with the asymmetrical attachment of our diaphragm. This primary muscle of respiration attaches to the back part of our lower ribcage and onto the front of our lower (lumbar) spines. The attachment sites are bigger and more robust on the right side. As this side has more attachments, it is "stronger" and tends to pull our lower spines into right rotation. Eventually this will pull our pelvis into right rotation as well. When our pelvis' and lower spines are oriented toward the right, our right hip joint is in a better, more functional position to weight bear. Therefore, we all tend to put more weight on our right leg than our left. 

Additionally, this muscle is asymmetrically domed. Because of our heart, the left side of our diaphragm tends to flatten which flares our ribcage and weakens our abdominals on that side. The liver, on the right side, helps to preserve the muscle's domed shape here. This makes the right side of our abdominals stronger than the left. Due to this and the flared ribs on our left side, our trunks tend to lean to the right. This gives us the classic lowered right shoulder. Complicating matters, when our trunks lean slightly toward the right, more weight is displaced onto the right leg. This further ingrains our postural asymmetry. 

In PRI language, this is called a Left AIC (anterior interior chain) position and it is the most common postural pattern. As our bodies spend more time in this position and our compensatory strategies we use due to this pattern break down, we tend to go further into compensatory patterns and this Left AIC pattern can degrade into others. To read more about this, check out our blog post What's Your Postural Pattern. This poor postural pattern, and therefore problematic loading on our muscles and joints, can lead to pain and dysfunction. A PRI trained therapist evaluates the entire body and it's systems to look for musculoskeletal position and function. We can then intervene on not only the area of pain, but also all of the surrounding areas that are feeding into the problem. Because of this more holistic approach, we are able to bring relief to many patients that have "failed" with physical therapy before, no matter where the site of pain is.

Next time you're at the mall, restaurant, or airport, watch people as they stand. Typically, no matter where they are looking, what direction they're learning toward, or what side they may be holding a heavy bag or purse, they'll likely be standing on their right leg with their right shoulder low. 

Physical Therapy Can Play A Vital Role In Concussion Management

The American Physical Therapy Association has written a tremendously informative article on concussions entitled "Physical Therapists Guide to Concussions." This is important for everyone to read! Not only do concussions happen in contact sports and with serious falls, but are also common with motor vehicle accidents. It is important to know the symptoms of a concussion so you can get medical help as soon as possible. 

As the article points out, physical therapists are vital in concussion management. We see our patients over a longer duration of time and for longer individual sessions than a physician can. This allows us to fully assess your deficits and help tease out what may be related to a concussion and what may not. It also allows us to more clearly see how you are progressing over time. We can help treat your dizziness, muscles weakness and lack of endurance, and refer you to other providers who might help speed your recovery. 

At Integrate 360 Physical Therapy, we look at the body's mechanics as a whole and how the neurological system is assesses incoming information. Through our specific Postural Restoration exercises, we are able to help restore musculoskeletal position and functional strength to help the body work as a whole again. We also have trusted dentists, neuroptometrists and podiatrists we work with if we think your system needs more specific evaluation and treatment.

Last year, I worked with a gentleman who sustained a significant concussion and continued to have symptoms (particularly headaches, dizziness, and visual disturbances) so severe he was unable to work, even several months after the injury. He was told by his doctors to be patient and that his symptoms would ease over time. When he came for his physical therapy evaluation, his musculoskeletal position was greatly disturbed. With our specific Postural Restoration exercises, his joint position was corrected allowing him to have better awareness of where he was in space. We then strengthened him in this position to maintain proper global alignment. This significantly eased his complaints of dizziness. He continued to complain of visual disturbances so he was referred to a neurooptomotrist we frequently work with. After treatment with the neuroptometrist, his visual disturbances were eased and his headaches were infrequent. 

If you suffer a concussion or believe you still haven't healed from one, contact us and let us help you heal from it fast! Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com

The Headache Mystery

Headaches affect millions of people. They can be absolutely debilitating affecting your social and professional lives. This can lead to degradation of relationships and cause depression. Headache sufferers will try things from over the counter pain meds to chiropractic to Botox injections to deal with the pain. CNN has published this article talking about some of the types of headaches, their symptoms, and potential causes in the article "Migraines to cluster headaches: The most painful headaches you could ever have".

As the article infers, headaches are still very much a mystery. Symptoms within a classification of headache are not consistent and  may overlap from one classification to the next. This makes treating them very tricky. It also makes diagnosis difficult.

In our clinical experience, we have been able to bring relief, if not eliminate our patients headaches, with PRI (Postural Restoration) physical therapy. It is not uncommon for us to evaluate a patient that has gone through the medical ringer - MRIs, CT scans, medications, Botox or muscular injections, and even physical therapy without improvement of their symptoms. 

How is this possible? As we've mentioned in previous blog posts, PRI evaluates patients in a very unique way. We not only look at the mechanics and musculoskeletal position of the painful area, but also of the entire body. Once deficits have been identified, we strive to increase strength and range of motion, as well as to reeducate the body how to move in a biomechanically correct and functional way. This is the best way to fully heal and address the source of the pain. We do this by activating muscles in polyarticular chains, or muscles that work in unison when we walk and move. Our bodies do not utilize one muscle or joint at a time, so isolated rehabilitation will not yield fully and/or lasting results. 

We also evaluate sensory input into the brain (how our feet sense the ground, our visual system, and jaw joint position) to see if faulty information is being sent, causing compensated movement strategies. Such compensations can "lock" us into a pattern of dysfunction and pain. If there is a problem in one of these areas, we can help by utilizing exercises and manual techniques. If more is needed, we work closely with a trusted group of dentists, neuroptometrists, and podiatrists to address the problem areas. 

Due to the fact that headaches can come from a multitude of causes (poor posture, stress, increased fight or flight nervous system tone, visual strain, TMD/TMJ, neurological conditions, etc.) and may be due to several at the same time, PRI's holistic and integrated approach evaluates and treats all of these issues on some level. Medical imaging of the brain and neck (routinely used when trying to diagnose the medical cause of a headache) cannot see poor movement patterns, increased fight or flight nervous system tone, and/or jaw joint dysfunction. Therefore, the physician often makes an educated guess on what type of headache you have and how to treat it. This helps explain why headaches are so difficult to treat since headache symptomolgy and classifications are ever-changing and hard to pin point. 

Integrate 360 Physical Therapy's integrated, holistic approach allows us to cast a wide net in terms of areas treated and treatment interventions. This typically allows us to catch the deficit that had been missed by previous healthcare team members. Let us help you take back your life.

If you'd like more information or want to see how we can be of help in eliminating your headaches, call 314-733-5000 or email Lesley@Integrate36PT.com or Nancy@Integrate360PT.com 

How Physical Therapy Can Help Your Anxiety and Stress

We have mentioned many times in our blog posts that PRI is a holistic and global form of physical therapy. Not only do we look at the body and its mechanics as a whole to assess and address our patient's pain and dysfunction, but we also address the neurological system that is impacting movement patterns as well.

The Autonomic Nervous System (ANS) can be broken into two parts: the Parasympathetic Nervous System (the "rest and digest" system), and the Sympathetic Nervous System (the "fight or flight" system). Symptoms of an overactive sympathetic nervous system include increased heart rate, shallow breathing dominated by our accessory respiratory muscles versus our diaphragm, muscular contraction or tightness, weight bearing on the balls of our feet, and/or biting on our front teeth. 

Our patients typically present with an extended lower back and forward tipped pelvis. This places weight on the balls of our feet, shallow breathing with our accessory respiratory muscles (because our diaphragm is now in a non-functional position), and poor jaw position causing biting on our front teeth versus our molars. This begins a vicious cycle: increased sympathetic nervous system tone causes more of these muscular impairments and positions which causes more sympathetic nervous system tone. The goal of PRI is to reduce sympathetic nervous system over-activation in order to restore musculoskeletal balance and reeducate the body how to move. 

Although we are typically manipulating the ANS in order to address musculoskeletal issues, our techniques directly effect anxiety as well. It is impossible to feel anxious without an increase in our sympathetic nervous system. Therefore, the very same exercises that PRI uses to fix our patient's low back pain, can have a profound effect on their complaints of anxiety and be used as a tool to manage it. 

The use of a balloon and abdominal muscles that is at the heart of PRI principles is meant to reposition and regain function of the diaphragm. Not only does this help restore posture and musculoskeletal function, but it also directly decreases sympathetic nervous system tone while increasing the parasympathetic system. We have heard many stories from our patients about how they use their home exercises to help them manage stress more than they do for their lower back pain. We have also seen the change in our patient's nervous system tone while performing exercises. The patient that used to breathe quickly and shallowly and had a slightly flushed look has a more relaxed respiratory pattern and complexion. We also frequently hear things like "I can finally take a deep breath!"

Interested in learning more or want to see this in action? Call Integrate 360 Physical Therapy at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com today to set up your evaluation. 

Why Your Orthotics Don't Work

Many of us have had some experience with orthotics. Most of us have purchased a cheap, off the shelf variety that we purchased on a whim or were suggested to us by a shoe salesman. Others of us have purchased the expensive, over the counter, "customizable" variety that you heat up in the oven and step onto as they cool, making a mold around your foot. No matter what route you took to get there, I'm guessing that your symptoms either worsened, lessened temporarily, or moved to another place in your body. 

Why? All of those orthotics are simply putting a band-aid on the problem and may not be any better for your body than if you were walking around barefoot all day. Any time you chose a shoe and what may be going inside of it, your anatomy, your compensatory patterns, and your pain need to be taken into account. Otherwise you're either putting your foot in a different, but still not properly aligned position. This will either increase pain immediately or after some time as your body adjusts its compensatory pattern and develops breakdown.

No matter where your pain is, the position and function of your entire body needs to be assessed to see where the breakdown in your movement is. The site of pain is not always the site of the dysfunction. For example, someone may be experiencing neck pain and headaches because they keep all of their weight on their toes and lock their knees. This moves their center of gravity forward causing their hips to move forward while their shoulders lean back to rebalance themselves. The head will then move forward so that they can see the world in front of them. This places excessive stress on the neck muscles and will lead to pain. 

One major theme to proper position and mechanics of the entire body is the ability to sense and feel where we are in space. Our body must be able to feel where the weight is in our foot in order to tell us where our body is on the ground. Proper positioning of the ankle joint is also essential so that our proprioceptors can tell us, again, where we are on the ground and how we are moving on it as we walk. If we cannot accurately sense and feel where our body and feet are, we develop compensatory movement strategies which eventually lead to pain. 

Cheap, over the counter orthotics are a "shot in the dark." The chance that the amount of arch support that is built into the orthotic is actually the amount we need is unlikely. The "customizable" over the counter orthotics that are heated in the oven simply support your foot in it's improper position. This is also how corkbedded shoes work. They are typically very comfortable, but as they support you in your dysfunction, your compensatory pattern will only worsen and you will eventually experience you pain again. Rigid orthotics do not work because they do not allow your foot to change from a "loose bag of bones" that is needed when your heel first strikes the ground (this is needed for your leg to appropriately absorb the force the ground exerts on you leg at initial impact) to a rigid lever that is needed when you're pushing off of your toe of your back foot. It also doesn't allow your foot to feel and sense and change in pressure as your weight moves in your foot. 

What your body needs is to sense and feel the floor. The first line of attack to achieving this goal is to be sure that you are wearing the approparite shoes for your feet. Some people need more guidance for their foot while others need the motion of their foot to be controlled as they walk. If appropriate footwear will not solve the entire problem (likely to due a structural change in the foot or ankle from surgery, fractures, arthritis, etc), orthotics may be appropriate.

The orthotics made at Integrate 360 are made of a dense foam and are customized to each of your feet. We take measurements of the foot and ankle, pictures of the alignment of the foot in relation to the lower leg, and impressions of your feet. The orthotics are made by Dr. Paul Coffin with respect to your PRI rehabilitation goals. Once you receive your orthotics, they will have been made to support your foot/ankle where they need some assistance and, more importantly, allow you to sense and feel certain areas of your foot as you walk. This is essential as your brain needs to sense where you are on the ground to activate your muscles appropariately. This allows your underactive muscles to turn on, while keeping overactive muscles off. From here, your therapist now has a "blank slate" to help teach your body to use these cues appropriately, strengthen "weak" muscles, and help your body to learn to move in a balanced way again. 

Just by changing either your footwear or orthotic, your body is now able to regain proper joint/muscle position and restore reciprocal movement allowing for perfected mechanics versus putting a band-aid on their symptom. 

Interesting in an assessment to see what will fit your needs? Call Integrate 360 Physical Therapy at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com

What Makes PRI Unique?

Postural Restoration (PRI) is a form of physical therapy unique from the traditional model. It allows us to prevent injury, treat the source of pain rather than the symptoms, and treat the body holistically in ways that traditional therapy cannot. Here are some of the major differences:

1) PRI appreciates the naturally occurring asymmetries of the body. Although we may look symmetrical from side to side, we actually are not. The diaphragm (the main muscle of respiration that attaches to the backside of the front of our ribcage and the frontside of our lower spine) has a much larger attachment on the right. Additionally, we have organic differences as well. Our heart is only on our left side and we therefore have one less lung lobe on the left side. The liver sits under the right diaphragm keeping it in a better position for respiration. These differences tend to make us shift our weight on our right foot with our pelvis and lower spine orienting toward the right as well. On top of this, our world is set up to bias the right side. When entering the supermarket, you must first turn right, our car's radio is typically on the right, and we typically walk/drive on the right hand side of the street or walkway. All of these factors come together and cause us to develop certain movemement strategies or habits in which we use the right side of our body far more than the left. This can lead to repetitive injuries and/or unbalanced musculoskeletal systems causing pain.

2) Diaphragmatic function is key. We breathe, on average, 20-24,000 times a day. Breathing in an unbalanced way will quickly lead to pain or dysfunction unless we intervene. Additionally, the diaphragm essentially connects the upper and lower body. PRI is the only treatment approach that works to rebalance the diaphragm, then restore normal and symmetrical position/function. This "unlocks" the ribcage and pelvis and allows us to stabilize them in a more neutral position, and teach our arms and legs to work off of this new, correctly positioned foundation. 

3) The body is connected. The site of pain may not be the source of pain at all, it may in a completely different spot! For example, a patient with neck pain may ultimately need foot orthotics for pain relief. If their right heel twists inward (toward the center of their body), the patient may place more weight on the ball of their feet as it is wider and can support more weight. This weight shift will cause their pelvis to tip forward and their lower back to extend. This then causes their ribcage to extend backward (to keep them from falling forward) and forces their head to stick forward in order to get their eyes on the horizon. By putting an orthotic in place that corrects their heel position, they can appropriately weight bear on that bone and have better spinal alignment with less tension on their neck. PRI assess position, motion, and strength throughout the body, no matter the site of pain, so that we can fully understand how well your body moves as a whole and work to restoring mechanics to fix the source of the problem, not just treat the symptoms. 

4) Other specialties may be needed to fully address musculoskeletal pain. Our body uses "reference centers" to help us know where we are in space: feeling our heels on the ground, being equally aware of our peripheral vision, feeling pressure differences side to side in our joints. One powerful reference center is our bite. If we are missing teeth or our teeth don't fit together well, the body will move or position itself differently to try to correct for this problem. Check out the video below to see how a simple bite guard can allow us to feel those reference centers appropriately and allow our bodies to move correctly. PRI maximizes interdisciplinary care with dentists, orthotics (someone who makes foot orthotics), and neuroptomotrists (who assess vision and how the eyes work together) so that our reference centers can appropriately tell us where we are in space so that we can move through it from a mechanically correct perspective. 

Interested in seeing how PRI can help you? Want more information? Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com . We are the only PRI certified clinic in the St. Louis area. 

What's a Rib Flare and What Does it Mean?

Next time you're lying on your back, place your hands on your lower ribs. As you move your hands down those ribs toward your belly button, did you notice a drop off as your ribcage ended and your hands moved onto your abdomin? Was one side worse than the other? You, my friend, have a rib flare. These are very common, but are not normal. They are a clear warning sign that your core strength is lacking and you are on your way to pain and/or dysfunction.

Our abdominal muscles all attach to the bottom part of our ribcage.  The rectis abdominis (or six pack muscle) attaches to the ribcage in the front where it then travels down an attaches to the pelvis in the front. This muscle curls the trunk forward and is NOT a postural, or true core, muscle. It is also the most superficial muscle.

The next two groups are deeper toward are spine and do function as postural muscles. These are the obliques, specifically the internal obliques, and the transverse abdominis. These groups of abdominals are much wider and also attach to our lower ribs and top of the pelvis, but touch more bony surface area. When these muscles are strong and have good resting tone, they keep the ribcage held in an upright position. When these muscles become weak, they allow the front part of the bottom of the ribcage to flare upward and outward. The entire ribcage becomes extended which flattens out midback, overly arches our lower backs, cause our heads to more forward, and disallow good ribcage motion with walking and breathing. This can cause any number of issues- headaches, neck pain, shoulder problems, lower back pain, etc. 

This also causes our diaphragm to move from a functional, domed position (similar to that with a held exhalation), to a flattened, ineffective one (similar to that with a held inhalation). When the diaphragm loses it's "zone of apposition" that would normally be maintained with good abdominal strength, we cannot effective breathe with it. When we cannot breathe with the diaphragm, the primary muscle of respiration, we must find other ways to get air into our lungs. We can do this many ways: extending our lower backs to open up our abdomin, using our neck muscles to try to lift the ribcage upward, or a combination of the two. This is how pain develops. 

To fix this, the internal obliques and transverse abdominis muscles need to be targeted. Not only does the rehabilitation effort need to be very targeted, it needs to be functional, i.e., it needs to be done with proper breathing mechanics. We must return the position of the diaphragm to one of a functional, domed, exhaled position. The only way to properly do this is with your internal obliques and transverse abdominis. 

It is not possible to fully rehabilitate and restore core strength and control without proper respiration and abdominal strengthening at the same time. 

This is the foundation of any PRI treatment plan. Proper respiration cannot occur without a functional core, and a functional core cannot happen without proper respiration. Let the therapists at the only PRI certified clinic in St. Louis help you to restore your function and reduce or eliminate your pain. Call us at 314-733-5000 or email Lesley@integrate360pt.com or Nancy@integrate360pt.com 

Our Response to NPR Article About Fixing "Mum Tum"

NPR recently published an article entitled "Flattening the 'Mummy Tummy' with 1 Exercise, 10 Minutes a Day" (read it here) that has been getting a lot of attention. We wanted to give our patients and readers our take on this abdominal strengthening program.

First of all, the "mum tum" or "mommy pooch" as the article calls it, is a real thing. They do a great job describing diastasis recti (read our article on this topic here)  and it's known to cause lower back pain as well as a lot of other pain or dysfunction. Strengthening the abdominal muscles is the best way to correct this problem. In severe cases, a mesh can be surgically applied to essentially replace the ruptured tissue, but this is generally only done if the patient has developed a hernia.

In the article, Leah Keller, fitness coach and creator of this particular exercise program, states that the abdominal muscles need to be realigned in order to resolve this issue. For her exercise, she has her clients sitting cross-legged on the floor. She then has them take a deep inhale and expand their bellies. Then, as they exhale they pull in their abdominals by pulling their belly toward their spine. Next, they take short inhales followed by an exhale in which they try to pull their belly button closer to their spine. Every 2 minutes they change position, sitting on their heels, hands and knees, squatting, etc. until they've exercised for 10 minutes.

In our opinion, the basic component of this exercise is good. By having these women pull their belly button toward their spine as they exhale, they are engaging their transverse abdominis (TA) and internal obliques (IOs). This is essential in correcting a diastasis recti. Although the problem itself lies in the overstretched or ruptured linea alba that lies between the two sides of the rectus abdominis muscle (or six pack muscle), exercising the rectus itself will not improve things at all. The TA and IOs have to be targeted as those are the muscles that create a natural corset around our core, cinching in our waists and giving support to our spine and abdomen.

One problem that we have is initiating this exercise while sitting cross-legged on the floor. This places the thigh bone in too much external rotation in the hip and will draw the pelvis forward, arching the back, and placing the abdominals in an elongated position called "positional stretch". Trying to contract a muscle this way is very difficult and not very efficient.

The main problem we have this exercise is the breathing technique. By taking in small breaths, ribcage motion is restricted, utilizing accessory respiratory muscles from the neck and shoulders is encouraged, and poor respiratory mechanics are being taught during abdominal activation. Sure, this may cause some TA an IO strengthening as the muscles are being contracted for some time, but it's completely nonfunctional. It is essential to learn proper respiration while activating the core. This not only allows the client to strengthen the abdominals, but to teach them to keep them engaged, subconsciously, while they walk, talk, and breathe throughout the day. That is fully correcting the problem and stabilizing the core. The former is simply contracting the abs for 10 minutes a day with poor mechanics.

Want more information or to learn to correctly recruit your core while breathing normally? This is a pillar in all of our treatment programs at Integrate 360 Physical Therapy. Call us at 314-733-5000 or email Lesley@integrate360pt.com or Nancy@integrate360pt.com today!