Why Aren't My Abdominal Exercises Working?

There are a few reasons why your many hours at the gym don't feel as though they're paying off when you look in the mirror.

1) Too much tissue. No matter how much muscle mass you have, you'll never see defined abs like in the picture above if they're covered by a large amount of adipose tissue or fat. Try to be patient. Stick to your healthy eating and exercise regimen and you'll notice results over time.  Remember, it is unhealthy to lose more than 2 pounds a week. Additionally, if your eating healthier and exercising at the same time, you may not see the number on the scale change at all. This doesn't mean that your hard work isn't effective, it simply means that you're replacing your fat weight with muscle weight. You're well on your way to a more defined body. Handy tip: you may find it motivating to take pictures of yourself each month. This way, when you compare the photos the changes your body has undergone will be much more noticeable.

2) You may be doing the wrong exercises. Many popular gym exercises like the roman chair, leg lifts, and sit ups aren't actually working your lower abs, they're working your hip flexors! Any exercise in which you are bringing your legs and chest closer together is one in which the hip flexors will likely dominate the exercise.  

3) Perform more effective exercises. Activities like the forward and side plank, and bird dog typically utilize more of the abdominal muscles than the activities mentioned above. They use either a neutral spine with a neutral or extended hip, or flex the spine. The job of the lower abs and rectus abdominis ("six pack muscle") are to flex the spine forward, not bend the hip, so these exercises are able to target them better.

4) Use correct form. In our clinic, a majority of our patients present with an anterior pelvic tilt and arched lower back (see picture below). This posture is not normal and can lead to a lot of different pain problems, but it's terrible for performing abdominal and core work. One reason why is that the positioning of the skeleton elongates and inactivates the abdominals while it shortens and strengthens the hip flexors. You're literally in a faulty foundation for your gym routine. In order to perform any activity, not just abdominal ones, more effectively and with a truly "set core", you need to assume a neutral spine and pelvic position. If your exercises, including bringing your chest and legs closer together, be sure to engage your lower abs by flexing in your lower back before moving your legs or head. If your back is either on the floor or against a wall or piece of equipment during the movement, be sure your low back never pulls away from, or extends, from that support. If it does, you have lost the use of your abs. Stop the movement just short of that point in future repetitions.

Have no idea how to assume a neutral spine? Or have you tried the above recommendations and you still don't feel your abs activate? It's time for an assessment with us at Integrate 360. Let us help you understand how to assume this position and what it feels like to do your exercises correctly. Then you'll be all set to keep going with your exercises and feel confident that, with patience and consistency, you'll see your desired results!

Breathing- What's The Big Deal?

Whether it was from our choir director, yoga instructor, or a news article, we've all the heard the term "diaphragmatic breathing".  But what does that really mean?

When we are breathing correctly, or breathing diaphragmatically, the diaphragm does all of the work. The diaphragm is our primary muscle of inspiration, attaches to the inner sides of our ribs as well as the front of the bones in our lower back, and separates the chest cavity from the abdomen. When we breathe, the diaphragm moves down pulling air into our lungs and inflating them. We should see our ribcage move out toward the side and our upper chest inflate. When we breathe out, the diaphragm will passively dome back up into the chest cavity, pushing air out of our lungs and our ribcage will narrow and fall. Check out the video below for a visual.

Seems simple enough, right? Well our bodies are really good at finding out different ways to breathe which can cause problems down the road.

One way our bodies compensate is to breathe with our neck muscles. These muscles are called secondary respiratory muscles because they are meant to only help us breathe when we are running or panicking and need to draw a lot of air in per breath. They should not be used all the time. These muscles typically become overused when there is any kind of obstruction to our breathing- such as respiratory disorders, sinus congestion (especially chronic), severely deviated septum (bone between our nostrils), or even anxiety issues. When the relatively passive diaphragmatic actions cannot provide us with enough air, our bodies will instinctively begin to utilize our neck muscles to help draw additional air in. While this is fine in the short term, say during a head cold or sinus infection, prolonged overuse of these muscle and dysfunctional respiratory patterns can/will cause neck and shoulder tension as well as headaches.

Another way our bodies compensate to breathe is with our lower back muscles. This typically happens with people that have limited ribcage mobility because they are either holding their ribcage rigid during activities, they have a sway back posture (arched lower back and generally "leaned back" position of the upper body) or because of a disease process. For these individuals, it is either easier for them to use their low back muscles to compensate than their neck because either their low back muscles are in a better position to compensate or because their neck muscles are not strong enough to draw enough air in on inhalation. This happens by the person gently leaning back or extending as they breathe in. This opens up their ribcage, allowing their lungs to inflate, by letting the lower ribs move up and away from the abdomen. This, again, can be successfully used in the short term but over time will lead to lower back pain.

A person may also use a combination of these strategies to breathe. If these poor breathing patterns continue without rehabilitation, one can not only develop pain as we mentioned earlier, but it can also morph into shoulder, rib, hip, sacroiliac (SI) joint, knee pain, and many other ailments.

Traditional physical therapy does not address respiratory patterns when they are assessing, diagnosing, and treating your pain problem. What does that typically mean for the patient? As long as they do their exercises 2-3 times a day for the rest of their lives, they'll likely feel better. Are you looking for a better way? Let Integrate 360 give you a more complete rehab program to retrain your body how to breathe correctly so that you are able to overcome the weaknesses associated with your pain and allow you to live a pain-free life!

Why work harder for incomplete results? Call us at 314-733-5000 to schedule an appointment today.

Can Sport Specialization Be Bad For Our Kids?

Sports are great for kids, right? It promotes exercise, team work, discipline, and self confidence. Children are specializing in their sport at much younger ages than in years past for many reasons - the child gravitates to a certain sport, the parent is a fan of or participated in that sport when they were young, associated costs, and/or potential scholarship money in the future. But can this early specialization actually be hurting our kids?

According to Greg Schaible in "Early Sport Specialization Is Killing The Health of Our Kids" (find article here: https://drjohnrusin.com/early-sport-specialization-is-killing-the-health-of-our-kids/), the answer is yes. Kids who specialize in a sport experience more injuries which can possibly hinder their overall athletic development. They may develop a nagging injury that keeps them from achieving their maximum potential, or they may be injured during a moment of great potential growth and skill acquisition.

Playing multiple sports has many benefits, one of which is allowing that child's body to move, strengthen, and absorb stresses in different ways. What if, for whatever reason, you or your child don't want to get involved with other sports? It's important to be sure that their body doesn't overdevelop certain muscles, motions, and/or movement patterns while lagging behind in others.

At Integrate 360, assessing and treating movement and strength deficits is our speciality. Even if you aren't experiencing pain (yet), let us show you some activities to keep your body moving correctly in all planes and ranges of motions. This will help to prevent injury and help you or your child to become the finest athlete they can be! Call us at 314-733-5000.

Is Diet Soda a Better Option Than Regular?

It's that time again. The holidays are getting closer and we know we will soon be forced to make New Year's resolutions. For most of us, this usually includes improving our health in some way, typically by making healthier food and drink choices.

The world as a whole has gotten away from the nutritious or healthful drinks of the past. Years ago children drank water, milk, and some juice. Adults would stick with water, coffee/tea, and occasionally a sugary drink like sweet tea or a soda. Unfortunately, as packaging changed and options incresed, we became much too comfortable with grabbing a sugary drink like a soda or Kool-Aid instead of water.

Once the idea of the obesity epidemic started to take hold, people began to look for other options to quench our thirsts that wouldn't effect our waist line quite as much. From that point, diet soda exploded in popularity. In recent years, there has been a lot of evidence that these diet sodas (or really any low calorie sweetened drinks) are actually a terrible choice for us for many reasons. CNN.com has written a wonderful article on the topic that you can find here: http://www.cnn.com/2016/10/10/health/diet-soda-may-do-more-harm-than-good/?iid=ob_homepage_deskrecommended_pool

So when it comes to making a healthier choice for your drink- just choose water, herbal tea, or even, albeit sparingly, a regular soda.

Movement and Sensory Information Directly Effects Stress Levels per The Atlantic

““Something about axial control has an impact on stress responses,” Strick reasons. “There’s all this evidence that core strengthening has an impact on stress. And when you see somebody that’s depressed or stressed out, you notice changes in their posture. When you stand up straight, it has an effect on how you project yourself and how you feel. Well, lo and behold, core muscles have an impact on stress. And I suspect that if you activate core muscles inappropriately with poor posture, that’s going to have an impact on stress.””

James Hamblin from The Atlantic has written a great article breaking down why and how movement and sensory experiences can effect our stress levels. Please read it here: http://www.theatlantic.com/science/archive/2016/08/cortical-adrenal-orchestra/496679/

As discussed in previous blogs, we find that most people move slightly asymmetrically. This can do a number of things, one of which is give our brains faulty sensory information. If we tend to spend more time on our right foot and get a better heel strike on that side, it can make our system feel out of balance which, according to the above article, could potentially negatively effect our stress levels.

Additionally, these asymmetrical patterns cause our bodies to move in compensated ways. One major example of this that our patients constantly report is that they will do a lot of "core work" at the gym, but feel no benefits. If our bodies are not in the right position, a lot of that lower abdominal strengthening will actually strengthen our hip flexors which can cause low back pain potentially, again via the article above, negatively effect our stress levels.

Let us help you get the most out of your body. Whether it's sporting or athletic performance, decreasing pain, improving stability and/or flexibility, or decreasing stress, we can help maximize the benefit from the activities you are actually doing.

Now get outside and take a walk!. It utilizes your core more than sitting at the computer or watching TV, and stimulates your sensory system with all of the sites, noises, and temperatures. 

Incontinence - Truths and Myths

Incontinence is an issue that affects everyone! If it does not affect you personally, than certainly a friend or loved one you know changes their routines or activities due to it. Think you know a thing or two about it? Let's find out.

1) Incontinence is when I leak urine when I laugh or sneeze.

-That is mostly true. First of all, one can be incontinent of urine, gas, feces, or a combination of these. Additionally, leaking when you laugh or cough is called stress incontinence. You can also experience urge (leaking as soon as or soon after you feel the need to go to the bathroom) or overflow incontinence (leaking when you feel like your bladder is completely or overly full).

Google image for "urinary incontinence"

2) All women experience incontinence. It's a normal part of aging.

-There is nothing about this statement that is true! Incontinence, no matter what form, is NEVER normal. It's our body's way of letting us know that one of our muscular systems is failing us for some reason. We need to figure out why this is happening and rectify it immediately to keep it from getting worse. Additionally, INCONTINENCE EFFECTS BOTH MEN AND WOMEN. Everyone has a pelvic floor and everyone has the potential for that pelvic floor to give them trouble and lead to symptoms.

3) I've already been to the doctor and had physical therapy although I still have symptoms. Isn't this as good as it's going to get?

-Not necessarily. A lot of the time when you go to physical therapy, you will see a "women's health specialist." They will spend a lot of time looking at and assessing the health and function of your pelvic floor. This may include internal examinations, biofeedback work, strength measurements, etc. However, some of the time, these clinicians can get so caught up in assessing the pelvic floor that they lose site of more global influences on the pelvic floor musculature. At Integrate 360, we have specialized tools and assessment techniques to not only assess the structure and stability of the skeletal foundation that the pelvic floor muscles work off of, but we can also assess what position the pelvic floor starts in.

The pelvic floor has to be able to ascend and descend in the pelvic ring in order to perform all of its' duties. If you're pelvic floor is chronically ascended or descended, your physical therapy will not be able to fully reverse the dysfunction and you may be left with symptoms. This musculature must be restored to a normal resting position before the muscles can achieve proper tone to perform whatever duties are needed at the time.

4) Where can I get the help I need?

-At Integrate 360 Physical Therapy, both Nancy and Lesley are well versed in Postural Restoration assessment and treatment. This is the aspect of your treatment that will assess the position of your pelvic floor and, if necessary, restore it to a "neutral" position and tone through exercise. Lesley has additional training in incontinence, pelvic pain, interstitial cystitis, and other issues of the pelvic floor if you need further therapy beyond restoring your muscles to neutral. She is able to perform internal assessments and techniques or manual therapy.

We try to keep the rehab process as exercise based and hands off as possible so that you are in full control and able to "fix" yourself. However, we will certainly perform whatever manual techniques are necessary for us to restore your health as fully as possible. We try to save internal manual assessments and techniques as a last resort , but we are well versed in this area and, again, are willing to incorporate whatever techniques are needed to move you forward in your journey to laughing (without leaking) again!

5) So, what's your point?

-If you're having symptoms, get help with them as soon as possible in order to have the best odds at completely reversing them. Even if you've been to other facilities, let our unique assessment style find the link that's been missing from your rehab process.

The Treadmill - Love it or Leave it?

Image from google images.

Treadmills are very popular pieces of equipment, especially as the weather starts to get cooler. In fact, most people think of the treadmill as one of their "go-to" cardiovascular activities. But should it be?

Treadmill walking/running is very different, biomechanically, from walking/running on a track or outside. When we are on solid ground, we must utilize our hamstrings to help pull ourselves forward when our foot first hits the ground and our gluts to propel our body forward when our leg is behind us. Our arms are also free to swing which helps us to utilize momentum while moving.

A treadmill changes these mechanics. Instead of pulling and pushing our bodies off of a stable surface, we are essentially trying not to fall forward as the ground is pulled out from underneath us. This makes the effort of walking much more passive. We will not need to utilize our hamstrings, gluts, or core muscles as much due to the machine doing a greater amount of the work. When our locomotive and stabilizing muscles are not fully functioning, we may overextend certain joints, our low back or knees, for example. It also teaches us poor walking mechanics that can carry over into walking on flat surfaces.

Additionally, as we increase our speed, we tend to hang on the handrails and not swing our arms. Not only does this make the activity even more passive, but the rotational forces and stresses on our bodies are not able to be distributed throughout our joints to be absorbed adequately. This can cause back or leg pain, as well as malposition/malalignment of the spine and/or pelvis.

Walking outdoors is the best option. Not only does this restore our natural mechanics, but it offers a natural interval training - hills! We're also able to look around at the sites around us which is relaxing for the neurological system.

Walking on a track is a close second as proper mechanics are still intact, but it becomes harder to visually appreciate the world around you. Also, if you always walk counterclockwise, you'll be using your joints and muscles asymmetrically as you walk around in a continuous circle.

If you have to walk on the treadmill, try increasing the incline to 1-2%. This will help restore the push/pull mechanics that are missing from walking on a flat treadmill. Be sure not to make the incline so steep that you'll need to hang on to the handrail which, as mentioned before, is not a good plan. It is also easy to stare at one object - a book, TV, calorie counter, etc. Be sure to look around to keep your visual system relaxed and active. If you're going to use a treadmill, it's best to place it in front of a window so you can still be aware of the world around you.

No matter what form you choose - get out there and get active!

Are Standing Desks All They're Cracked Up To Be?

Image from Google Images "standing desk"

Lately there has been a lot of information that sitting all day puts us at a much higher risk for obesity, diabetes, pain, and other potentially life-limiting issues. Therefore, one would think that standing for a portion of the work day would be a great way to combat this, right?

Although merely changing your position and burning a few more calories while standing are good things, the standing desk may not help with low back pain or sciatica that you've been feeling after a few hours at work.

If you are planning on getting a standing desk to help with pain you may be experiencing, keep in mind that simply standing up may not be enough to ease your discomfort. Most of us, pain or no pain, have postural abnormalities. Chances are, if you do experience pain, yours are a little worse than most. In order to make the most out of standing at work, you need to be sure you do so without falling into these postural problems.

When we stand, most people tend to have too much arch in their lower back, a forwardly tipped pelvis, and stand with our weight on our toes (especially if you're wearing heels, ladies!). These issues cause our weight to be put onto our lower backs causing low back pain. When this happens, our stabilizing muscles are not able to work efficiently and we must compensate with others, such as our piriformis, causing possible sciatica and other discomfort.

How can you make the most out of your standing time?

Shift your weight- When we try to stand "correctly," with equal weight on both feet and standing erect, we tend to fall into the pattern described above. Try shifting your weight from side to side throughout your standing time, but be sure to share time between legs as most of us will "pick a leg" and stand on just that side for a majority of the time. Let's say you pick your left leg to stand on: pretend you have a quarter under your left heel and try to center your body weight over it. Placing your right foot slightly ahead of your left, with your toes pointed forward, will help accomplish this. If you're doing this correctly, you'll notice your pant zipper is aligned over your left big toe. This will keep your weight on your heel and your back in a more neutral position.

Pick the right shoes- Sure, many of us have certain dress codes we have to meet which usually means uncomfortable dress shoes for men and heels for women. No one said you have to wear them every minute of every day. Either bring a pair of tennis shoes to work, or buy a pair that you keep under your desk. When you want to stand, switch your shoes. This will not only make your feet more comfortable, it will help keep your weight on your heels appropriately.

Don't do it too long- Our bodies were just not made to hold a static position for more than 20 minutes. Even if you're shifting your weight from side to side, try to take a break every 30 minutes and walk a few steps around your office/cube, go to the bathroom, or refill that cup of coffee. No amount of will (or stubbornness) can beat anatomical and biomechanical design.

Change it up- Whether you're sitting or standing, we tend to set up our desks/work stations and leave them that way permanently. This is a problem because you are causing repetitive movements to take place which cause microtraumas to our tissues as well as possibly feed into our poor postural habits. Try moving your water or coffee to the left of the computer and the stapler to the right this week. Keep things interesting for your body so it doesn't begin to wear out!

How to Survive Your Thanksgiving Cooking

Image via google images

Unfortunately, we can’t help you tolerate your mother-in-law’s endless “opinions” about your recipe choices and cooking techniques, but we have some tips that will help ease the back or knee pain that so many of us experience after cooking for a length of time.  

Many of us tend to stand with one, or several of the following: knees locked back or hyperextended, pelvis tipped forward, exaggerated arch in the low back, weight on our toes versus our heels. This posture may not seemingly create much, if any, pain when only standing for short durations, but can really start to become problematic when we stay in this posture for too long or are lifting heavy pots and pans with this faulty alignment. Here are some quick ways to keep that pain at bay for as long as possible:

1. Take breaks. So many of us become focused on getting the task done as fast as possible, we “tune out” our bodies. Our bodies are not meant to stand for more than 30 minutes at a time and when we aren’t listening to its subtle cues, our pain levels can easily escalate before we realize there’s a problem. Try setting an egg timer for every 20-30 minutes. When the timer goes off, sit down, walk around, just do something other than standing in place. Feel like you can’t stop mid-recipe? Set up a card table with a chair and sit when you’re prepping ingredients.

2.  Wear comfortable shoes. You’re likely going to change into some nicer attire, or freshen up to get the onion smell off of you, before your guests come over. Therefore, you may as well wear the most appropriate things while cooking. Although flats and minimalist running shoes may feel comfortable on your feet, they allow your heel bones to rotate and arches to fall. When your feet aren’t able to support the weight of your body appropriately, you will find “easy,” or compensatory, ways to try to give your body that support. We usually “hang on our ligaments” or “lock our bodies out” to do this, i.e. locking our knees or arching our backs.

3. Don’t lean. When our postural muscles that help hold us upright get tired, we’ll find other ways to hold ourselves up. It’s very common to arch our backs, rotate our pelvis forward, and lean our hips against the countertop or kitchen sink. This puts a majority of our body weight directly onto our lumbar spines (low back) and forces us to lock our knees out.

4. Avoid twisting. Not everyone has a gourmet kitchen with ample room. Often, we’re cooking in a small space because of the kitchen size and/or the family standing over our shoulders trying to sneak a taste before dinner time. With that, we tend to twist our upper bodies and back as we reach to another spoon, pot, etc. Instead, move your feet. Our feet should always be below our hips, hip width apart, with our toes forward. So as you reach over to get that colander, take some steps to get there instead of just twisting your body or overreaching.

5. Make someone else do the dishes. For goodness sakes, if you just did enough cooking to need to read this article, you deserve a break!

Image via google images

Video: What is Postural Restoration: Your PRI Questions Answered (Part 2)

Here is the follow up to our first video explaining postural restoration. We hope this gives you a much better understanding of how PRI can make a difference in your life. Questions? Just give us a call at 314.733.5000 or send us a note. We'd love to discuss your needs.