How To Breathe When Working Out And Running! Via Bodybuilding.com

Image from bodybuilding.com

There’s a great article on Bodybuilding.com entitled How To Breathe When Working Out And Running! I wanted to share it with you all it gives some great, concise information. I love how to emphasize the importance of breathing during every type of exercise. However, I wanted to give a little more information or my thoughts on some of the topics in the article.

First, most of our patients are not performing dead lifts, therefore, I DO NOT RECOMMEND using the valsalva maneuver at all. This is a tool that can be helpful as they described, but only during certain activities and only with proper training. I want to be sure that anyone who reads the article does not think it’s appropriate to performing the maneuver when lifting lighter loads like an overhead press, leg press, or something similar. As the author writes in the article, it is appropriate to exhale slowly through pursed lips during the lifting portion of those activities. 

Breathing out through pursed lips is a great technique as it creates more resistance to an exhale and effectively makes you work harder to breathe out. This sets you up to more effectively use your abs (specifically your internal obliques and transverse abdominis) when exhaling. When we exhale with these muscles, our diaphragm is in prime position to be utilized during the next inhalation. This leads to more effective inhalation, better oxygenation, and less overflow into our lower back and/or neck muscles to help us get air in quickly. 

Second, the author describes that as we exhale our ribcages shrink. This should be, but isn’t always, the case. Depending on what exercise we are doing and what position we are in, we may not allow our lower ribs in the front to fully collapse or drop down during an inhalation. When this is the case, our diaphragm is not in a good position for our next inhale and we will compensate to get air in. This can lead to shortness of breath, poor endurance, fatigue/pain at the neck or lower back, and other problems. 

When you position yourself in a supine position (lying on your back), try to keep your lower back as close to the floor as you can get it. Use your abs to pull your lower ribs toward the floor and flatten your back. Try to keep your lower back as close to the floor as possible during your activities WHILE BREATHING. If you are on a bench doing chest work, you may need to keep your feet up on the bench with you. If you need or choose to put them on the floor, be aware that it will be much more challenging to keep your abs engaged and your lower back in a safe position during your activity. Be sure to exhale through pursed lips and drop those ribs toward the floor/bench as you lift. 

Lastly, I love the idea of paced breathing with cardiovascular work. I simply want to mention that just because the author suggested breathing in for 3-4 stairs as well as out for 3-4 stairs does not mean that it is a good pace for your individual body. Because you are doing cardiovascular work, expect to be slightly short of breath during that activity, but please alter your pace if it feels like you are starved for air or that you’re panting. Also, recognize that your pace will change from day to day. If you go into your work out feeling well energized and motivated, you may notice that you are able to ascend/descend 4-5 stairs during a breath without much effort. However, you may feel sluggish at your next work out and notice that you are starving for air at 5 stairs. No problem! Slightly increase your pace of breathing so that you are comfortable again. Listen to your body and react accordingly. 

Just be sure that, no matter what you’re doing with only a few exceptions, never stop breathing and breathe at a rate that feels comfortable to you!

Written by Lesley Callaham, MPT, PRC on January 22, 2019

How to Shovel (Through a PRI Lens)

Image from www.thegentleplace.com

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

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. 

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!