Tight Calves And The Pelvic Floor

For over a year now I’ve been studying with the Restorative Exericse Institute. Before I decided to go for the Whole Body Alignment course this Spring, I took the NoMoreKegels course which is all about pelvic floor health. I learned about the effect of our footwear and posture on the alignment of the pelvis and how this in turn effects the pelvic floor muscles. I also learned specific exercises to restore pelvic floor function. And one of the most fundamental of those restorative exercises is the calf stretch.

The CALF STRETCH? For my PELVIC FLOOR? Yep. It all begins with tight calf muscles. (Well, it all begins in the feet but that shall be another blog post.)

The calf muscle group is made up of the gastrocnemius, soleus and the plantaris. They all attach to the heel of our foot. The soleus attaches below the knee at the tibia. And the large gastrocnemius and the much much smaller, but oh so sensitive, plantaris attach above the knee at the femur.
Muscle always contracts from attachment point to attachment point. Which means that what goes on with the attachment points, i.e. how the bones are aligned, matters a great deal to what goes on with the muscle.

For example, when I wear a shoe with a positive heel, the natural heel of my foot where my calf muscles are attached to, is brought closer to the knee.
As a result the muscle is put in a shortened position. If the muscles are chronically held in this position because I’m in my positive heeled shoes all day, well, then they stay in this shortened position.

A chronically shortened muscle is a tight muscle. And a tight muscle isn’t very good at receiving or pumping blood and lymph and also doesn’t communicate well with the spinal cord. In short, a tight muscle isn‘t a strong, force generating muscle.

Another example is the posture of constant knee flexion. Check out any person running or walking on the street. They all have their knees bent. And then look at all the people sitting around. They also have their knees bent (surprise!).

Because the gastrocnemius and plantaris muscle attach above the knee, any kind of knee bending action puts slack in those muscles. Muscles can’t stay slack because then they have no force generating power so the muscle fibers simply adjust and shorten themselves. Now they can work again.  But because the knees are in flexion all day long (sitting, sleeping, walking with bent knees) the calf muscle is chronically shortened. And a short muscle is a tight muscle is a weak muscle  …

This constant knee flexion is one culprit for the pelvic floor problem. But to understand this, we have to welcome the hamstring group into the discussion.

The hamstring muscles all attach to the lower leg bones (tibia and fibula) as well as to the pelvis. Knee flexion causes slack in the hamstring muscles. The hamstring muscles get short and tight. And these shortened hamstring muscles are pulling and tucking on the pelvis causing the pelvis to be out of neutral (posterior pelvic tilt). Which then in turn puts slack in all the pelvic floor muscles causing the pelvic floor muscle to adjust and shorten.

And a short, tight, weak pelvic floor muscle isn’t very good at holding up the pelvic organs. A short, tight, weak pelvic floor muscle is also not very good at expelling babies. WOW!

Soooooooooo, if you have plantar fasciitis or heel pain or crampy, tingly, tired legs or knee pain or pelvic pain or if  you are leaking urine when doing jumping jacks or you have back pain or you were told you have have a hypertonic pelvic floor or prolapse or prostate problems, there are many things you can do right now to get better. Here are a few suggestions:

1) Stretch your calves and click this to read and see how.
2) Assess your shoe wear. If you wear really high heels, get into a smaller heel. And if you wear running shoes with a bit of a heel, consider getting a truly zero heel shoe. (Here is a list for minimal or ‚barefoot‘ shoes)
3)Increase barefoot time
4)Get out of the chair every 20 minutes and stretch your calves.
5)Get the Every Woman's Essential Body kit from the Restorative Exercise Institute (and I don't benefit from this recommendation in any way other than the fact that I was the source that led you to some amazing and cheap self help tools and knowledge)
6)You could even take the NoMoreKegels course yourself.
8)If you are in Ottawa, come to class or book a private session

PS: I can't let you go without saying this:
The abdominal muscles attach to the pelvis .... calf stretch anyone?

Belly Blues And What To Do About It

For many women the belly is a problem zone laden with negative emotions. Maybe you feel totally disconnected from this area of your body. Maybe the look of your belly in the mirror triggers a sense of hopelessness and depression.

So what do you do? You suck it in. You might suck it in to hide it. You might suck it in because you think this is what „engaging the core“ is all about. Well, sucking in your belly is disrupting the normal pressure in your abdomen  and has nothing to do with contracting your deepest abdominal muscles.

You CAN re-connect with your belly again. Over time you can even flatten it so you like looking in the mirror again.  All you need to do is get the muscles to work again. And the first step is letting it go!  Release your belly. Let it be as big as it wants to be. The hardest thing of all. But now the muscle isn’t “stuck“ anymore and it can actually contract.

Getting ready to contract the deep abdominal muscle (transversus abdominis aka TvA) correctly

How you position your pelvis and rib cage really matters to the proper functioning of your TvA  – after all the muscle attaches to large portions of both. Check it out on this image from Gray's Anatomy.

How should the pelvis be aligned?
Your ASIS (Anterior Superior Iliac Spine) and your pubic bone should be in a vertical line when standing or sitting. It will give you a nice curvature in your lower back. To find your ASIS you can just put your hands in your groin area and then walk them up until you can palpate the part of your iliac spine that most protrudes. Or maybe it makes more sense if I tell you to put your hands on your hips and find the point that protrudes in front.

So when you are sitting it should look like this.

Now that you are sitting in neutral pelvis, relax your belly and check in with your rib cage. Do you feel a strain in your upper back? Are you thrusting your rib cage forward? Try to relax your rib cage back and lower it down so it starts to align with your neutral pelvis. Relax your belly again. And breathe.

Some cues for you:
Take air in through your nose and let the air fill your rib cage.
If you notice your shoulders coming up to your ears when breathing, focus on sending the breath into the lower half of your rib cage.
Exhale through your mouth.
Take your time.
Your belly stays relaxed the whole time.

Once you get the hang of it and this feels natural, you can start doing some TvA contraction exercises.

Contracting the TvA
The TvA wraps around our waist like a girdle and contracts like one. Pretty cool.

So.... inhale again and now as you exhale through your mouth you draw your belly button towards the spine. Maintain the neutral position of your pelvis as you do this.
Also make sure that your rib cage is not thrusting forward.
Let your belly relax after each contraction and check in with your pelvis and rib cage and re-set if necessary.

How many? It's up to you. More doesn't necessarily mean faster results. Focus on maintaining neutral pelvis and dropping the rib cage as you go throughout the day and when doing the exercise. And ... relax your belly. Now that you know how to contract the TvA properly you can hopefully see that your habit of sucking in your belly has nothing to do with contracting your abdominals.

PS: One day you don't even have to think about contracting your abs, they will do it for you. Like they are supposed to. If only we used our bodies the way we should. Our habit of excessive sitting is not exactly helping. The exercise shown is a good starting point - since we sit all the time, we might as well sit properly and wake up our core. When you're done with it, get out of the chair, do a calf stretch, put a pair of really flat and comfy shoes on and go for a walk. It will help with the belly blues!

PSS: A quote from Katy Bowman, biomechanist, about core strength.
Core strength does not mean abdominal exercises! It is the ability to stabilize the bones in the upper body, rotate the torso with proper spinal curvature, and maintain pelvic position while sitting, standing, and exercising! It’s the ability to control the bladder, stabilize the ligaments of the knees with the lower abdominal wall, and breathe correctly while doing all of these!

Oh, The Sarcasm Of My Last Post and A Contest

Last Thursday I wrote a post with the title 'Fall Into A Habit Of Walking'. I thought it was a funny game with words since its fall and falling into a habit of walking sounded like a really witty title. I wasn't laughing the next day. I did walk on Friday morning like I said I would. But I also did the falling part. No, not that kind of falling. But the literal Falling Down The Stairs.

I thought I got to the end of the stair case and wanted to keep walking but there was another step left and I stepped into the air and then fell and twisted my foot. I can't tell you how dumb I felt. And how painful it was. This is what my foot looked like on Friday:

 See the bump on the outside of my foot. OUCH.

I became a certified Healthy Foot Practionioner in September and know what a delicate and complex structure our feet are. Leonardo da Vinci called the foot 'a masterpiece of engineering and a work of art'. Since my feet are a good example of what our shoewearing lifestyle does to this masterpiece (think crooked toes and bunions in my case and fallen arches, plantar fascitis and calluses maybe in your case), I felt extra angry that this had to happen to me.

So even more work for me. Why more work? Because my feet were in my very own rehab even before the stupid fall. Our feet are the foundation we stand on and since I don't want to have chronic back pain and a knee replacement when I'm older, I want it to be a good foundation.

Here are a couple of exercises that I do with my injured foot to get the blood flowing and the lymph draining in there. The exerices also innervate the many small and completely underused muscles inside the foot. And these exercises are key to healthy feet in any case - acute injury or not.

I lift my big toe keeping the others on the floor. With the swelling in my foot, this is hard work. I am taking it easy.

The swelling somehow causes my big toe to adduct (turn in). Like the beginnings of a bunion.Maybe your toes looks like that?

So I spread my big toe out (abduction).

See if you can lift your big toe while keeping the other toes connected with the ground. If you can, work on lifting up the other toes one by one. If not, keep practising. For the health of your feet and your whole body. Because 'the foot bone is connected to the leg bone and the leg bone is connected with the hip bone and the hipbone is connected with your spine' and so on.

Book recommendation:
Katy Bowman (2011) Every Woman's Guide To Foot Pain Relief   
DVD recommendation: 
https://www.alignedandwell.com/shop/fix-your-feet/

Contest:

The first person who can tell me how many joints are located in each foot, wins the book. (I got some copies as part of my training so I might as well make use of them and hand them out.)

 




 

Fall Into A Habit Of Walking

This morning I had some unscheduled time. So after my husband and I got the kids fed, dressed, packed and walked to day care and after I responded to some emails, I was faced with the following choices:
a) do some bookkeeping
b) get some study time in for my Whole Body Alignment course so I get closer to my goal of being a Restorative Exercise Specialist
c) write a blog post to share a bit of what I'm learning in the just mentionned course
d) walk to the store to buy new woodchips for our guinnea pig so he can get a fresh house today

Bookkeeping is boring. So this was out from the start. Since the pig's house was in a stinky state and the sun was shining and walking is so good and walking in alignment practice is part of my course, I decided to put my shoes and backpack on and go for a little walk. Mind you the store is only 800m away from our house. So walking back and forth is a mere 1,6km. With our morning walk of 2km to and from day care I'm at a whopping 3,6km. Plus 2 more km when we pick up the kids later this afternoon. 5,6km. 3 miles. Not all that bad. And good decision making, right!

Walking the way we are biologically supposed to, i.e. in alignment involves half of the over 600 muscles in our body. And the more muscle we use, the more blood those muscles can pump into more areas of our body and thus the more cell regeneration occurs. More cell regeneration = more health. And we really are supposed to use our body in a way that gives us the most chance of survival, i.e. health.  (In the past, I wrote a little bit out what our sedentary life style does to our immune system).
 
So what is walking in alignment? This is what I'm learning from Katy Bowman, biomechanist, in the course I am taking. It should not involve bent knees or bouncing hips or powerwalking arms (read an article from Katy herself). Natural walking should also not involve shoes with a positive heel. Even the regular running shoe has a positive heel, i.e. inside the shoe the natural heel of your foot sits higher than the ball of your foot (read a rather lengthy scientific essay by Dr Rossi about why shoes make proper gait impossible). So for us shoe-wearing, chair lounging and asphalt walking people, it's actually really really really difficult to walk naturally. And I'm nowhere near it.

I want you to start appreciating a walk and encourage you to start walking on a regular basis. And to walk with your kids. Our kids are now 3 and 4,5 years old. We always walked the 1km to our day care but finally banned the stroller this spring. The first day was tough and maybe the second too. I don't remember actually. There probably was some whining. And it might have taken us 45min to get to day care. But we made it a priority. And now it's a habit. We all walk in the morning and in the afternoon and its fun and sometimes its not and it often takes much longer than I'd want.

And maybe you think 'Ha, I wish I had time to walk my kids to day care, school, activities!' - and I will just tell you to Make Time! Because walking is the one movement we absolutely NEED to do every day for optimal health. And children need it for their healthy development. When I was a kid I walked to school every day. 1,9km one way. I google-earthed it. When did your 6 year old kid last walk 1,9km?

And if you are a new mom with only a baby and no toddlers ... well ... you can get out first thing in the morning tomorrow. (after you packed the diaper bag and put yourself some clothes on and waited for baby to wake up and nursed and changed the baby, ect. - I remember it well!)

And just in case you want to think about your alignment when walking, here are some first main pointers:

1) Keep your feet straight. Align the outside edge of your foot with a straight line. If the feet are not pointing forward when walking, the muscles of the legs and the muscles around the pelvis don't work properly. And those muscles are kind of like your engine for proper walking and also ensure that your pelvis is in its neutral position and the spine isn't overly taxed from walking with your tailbone between your legs.  

notice turned out feet - no lateral hip and gluteus involvement

that is better 

When you try this and you feel pigeon toed and your knees turn in, it means that you need to practice externally rotating your thigh.

2) Find a shoe with a truly flat sole. If you are a high heel wearer, get a smaller heel and come closer to the ground over time. In addition to a zero heel, the shoe should have a flexible sole and your toes should have lots of space to wiggle around. The same applies to your baby's or your child's shoe. Keep your kid in soft soled, roomy shoes as long as possible. Robeez and Soft Start Shoes are great choices for kids. Katy Bowman recently compiled a comprehensive list of minimal shoe brands for kids and adults.

3) When you can, keep your arms free and start swinging your arms. Not pumping forward with the elbow in a 90° angle! Let your arms hang. Swing back actively and let the arm swing forward passively.
If you push a stroller, push it with one arm only and swing the other arm. It will prevent you from using the stroller as a crutch as a nice side effect :) The arm swing is there to make walking a symmetrical activity. One leg goes forward, the oppostite arm swings back. It minimizes any twisting of the pelvis and spine when walking. It also allows the lymph in your armpit to flow and this is good news for breast health in general and nursing mothers in particluar.

And, btw, during my little walk to the store this morning I was so busy checking in with my feet and butt muscles that I completely forgot about the arms.

Happy Walking!

Ps: And here the picture my husband took of me and the kids walking home this afternoon. It was cold and started to rain. And the 3 year old didn't want to walk because she was too cold but didn't want to wear all the extra clothes we brought..... So I carried her. What can you do? It wasn't much fun and walking in alignment with a 3 year old is well ... another story. But we walked. And we will walk tomorrow.

Women Hold Up Half The Sky

‚The Freedom in a country can be measured by the freedom of birth.‘Agnes Gereb

Last night I went to see the world wide premier of ‚Freedom Of Birth‘ – a movie that any woman and man supporting a woman in childbirth should watch. A movie that slaps it right into your face that childbirth is a human rights issue. And after it has slapped you in the face, it stabs you into your heart. At least this is what happened to me.

Meet Agnes Gereb - the subject of the documentary. She is a Hungarian obsetrician and midwife and international homebirth expert. She was taken into custody Oct 5, 2010 after a woman had gone into unexpected labor at Agnes' birth centre. As I understand it, Agnes had advised this woman to give birth in hospital but the woman rejected the idea and happened to go into labor during a class at Agnes' birth centre. There must have been some trouble because Agnes immediately and rightly decided to call an ambulance. With the ambulance that took the labouring woman to hospital, the police came to arrest Agnes. The reason? Reckless endangerment of life committed in the line of duty. The woman gave birth to a healthy baby and was soon discharged from hospital.

Three months after Agnes was jailed the European Court of Human Rights established under Article 8 (right to private and family life) of the European Convention that any woman has the right to choose where to give birth. (case of TERNOVSZKY v. HUNGARY) Agnes Gereb was freed but is still under house arrest!

This is Hungary! In the year 2012! A member country of the European Union since 2004! REALLY!!!

I deeply care about women's rights in childbirth. And it pains me that I don't see enough women really care about it. Or don't realize they should care. Or at least don't show that they care.

I'll quote Dr Nancy Salgueiro - the Ottawa woman who you might have seen give birth live on camera 11months ago. She is also a childbirth educator and women's advocate (and chiropractor). In her talks with women she finds that:

Women are given misleading information making them feel as if procedures are necessary when they are not. - Induction or Oxytocin anyone?

Women are being told they are incapable of birthing their own baby and must trust in a system that does not support normal birth. - Ever been told during check-ups that your baby is large, maybe too large for you to birth vaginally?  I hear stories like that ALL THE TIME.

Women are being forced to birth in institutions because of lack of access to birth attendants outside hospitals. -We are lucky in Gatineau to have the Maison de Naissance but I felt like I won the lottery when I landed a midwife there to give birth to Elise outside the hospital. Ottawa residents are lucky to have quite a few midwifes and many homebirths. But not enough! Ontario is going to get 2 birth centres though. So there is a shift happening. Slowly but surely.


Women are abused and assaulted by procedures done to their bodies without consent and even after consent is withdrawn - Too many nurses, doctors and student nurses check how dilated you are? You just accepted it and realized later how much you disliked that? I gave birth in a Ottawa hospital to Joshua. It was an easy birth without any intervention and I didn't have a single tear. My vagina felt pretty good actually. Yet, I remember having to turn my naked butt to at least two nurses (one was a student, I believe) who checked for hemorrhoids. I felt uncomfortable to say the least. And 5 years later I still think about it. So, yes, I feel kind of violated! My midwife who cared for me after Elise's birth in Gatineau never felt the need to look at my perineum because she knew from the birth that I didn’t have tearing and she knew I would tell her if I had some trouble down there. After all I know my body best. Not to mention the fact that most women are automatically supplied with oxytocin at Ottawa hospitals. I didn't believe it but an ex-hospital nurse at last night's talk said that she cannot think of a single case under her watch where oxytocin was not given - with or without consent. I still find it hard to believe actually.
 
Women are being told they have no choices and must comply with medical orders or be threatened that their child may be taken from them. - I don’t know about a case in Ottawa but looks like Nancy does.


So women here in Ottawa are being violated and discriminated against under the Article 8 of the European Convention of Human Rights. We just have to start owning this! This room last night was half-full. It should have been packed! Too many women do not know the facts about the effects of interventions on the outcomes of childbirth. Too many women do not know that a C-section is major surgery and does come with risks. We can't just wait for the system to change and hope that one day doctors will give us truly informed choice. I totally believe that change has to come from the top. But I believe just as much that change has to be iniated by you and me first. After all, Women Hold Up Half The Sky!

Check out the Informed Choice Coalition and come to the next screening on October 12.

If you had a traumatic birth experience and feel ready to work through it, there is the amazing Julie Keon with her Making Peace With Your Birth workshops.

Tough Workout or Whole Body Movement?

I have a love-hate relationship with facebook. I love it when I see a link to really cute minimal shoes like these ones. But I get rather turbulent flow in my blood vessels when I come across people saying stuff like:
'I had an awesome leg workout. I had to take the elevator down because my legs were so sore.'
or 'Great workout. I hobbled home'. Haha.

It stresses me out big time. Why on earth do people think this crazy pain is good? I'm not talking about a bit of muscle soreness that we get from using a muscle that we haven't really been using before. I mean the 'I can't walk anymore' kind of muscle soreness. This is just our body saying This-Is-Enough loud and clear. And the way I see it, it is just not natural behaviour to feel happy and proud when our body is saying NO. Or am I alone here?

Imagine you are a paleolithic person and you live fully in tune with your body because listening to your body's signals means the difference between life and death. Imagine one day you feel that all this natural living stuff stinks and you want to have a bit of fun and show everybody how cool/strong/able you are by doing something nobody has ever done:  You climb up and down 15 trees as fast as you can followed by lifting 5 big rocks and a 30minute chase after a mammut (or whatever). Imagine you made it and everybody is cheering. You feel the rush of adrenaline. It feels great. You also feel sore and have to lie down. Not so great. You actually feel too weak to embark on the 5mile trek to the next food source. Not great at all. You are left behind. The End.

Had the paleolithic people and the people after that been abusing their body like this, well, we wouldn't be here. Humans survived and evolved because they spent their days doing whole body movements like walking and carrying their children (or dead animals.) And then they rested. No CrossFit or treadmills or crazy leg workouts needed to live and thrive. Just walking and carrying stuff in their arms. And maybe the occasional climb up a tree or fight with an animal. And then a period of rest.

What happened to us? This big fitness boom. It's only been around for the last 40 or so years. Before that people just moved more throughout the day. They didn't need to work out. Now we sit on our butts for most of the day. Most of us don't even wash the floor on hands and knees anymore. (I do! I do!) And because we know we are so deconditioned, we take our completely underused body with its 600+ muscles (most of them way too tight) into a gym and give it a tough workout. Then it makes us feel great. But, really, for our body it's only stress. On every level. Muscles, tendons, ligaments, connective tissues, organs, blood vessels. Each and every cell really. And it shows. Foot, knee, hip, back, neck and shoulder pain anyone? Feeling tight? Not able to walk up or down the stairs? Needing to take the elevator after a workout???????? It just doesn't make sense to me!
...

Oh, and at the end a little help for all of you out there with tight calves from a tough workout, from wearing heels or from sitting too much: THE calf stretch. A rolled up towel will do too.

Sucking in your belly - Good or Bad?

BAD. Very bad. Very, very bad. And before you say 'hang on a minute, I was told to pull my belly in', let me explain:

Your deepest abdominal muscle (the TvA) contracts when you pull it towards your spine with the pelvis and rib cage in their neutral alignment. When you carry your pelvis and rib cage outside of where they should be, you don't work your core. But this is another blog post (If you can't wait, click here and here). Getting your TvA muscle closer to optimal functionning is absolutely crucial for the health of your spine, pelvic floor, cardiovascular, digestive and reproductive systems. Not to mention the good looks we are all after. 

Sucking in your belly has nothing to do with contracting your TvA. I have seen and talked to so many women who want to get their bellies in shape. And they all do it: They suck in their bellies. Even men suck in their bellies. And you suck in your belly propably right now. I know it. Because even I suck in my belly. Especially yesterday. And when I do it, you do it, too. (Very good reasoning on my part!)

When we suck in our bellies, the motion is up under the rib cage and not at all back towards the spine. Feel the pressure just under your ribs? This habit of sucking in our belly doesn't make the belly smaller because the abdominal muscles just aren't innervated. Instead we create unwanted pressure in our thoracic area - especially at the diaphragm. So much for healthy breathing! We need the diaphragm for expelling stuff (think vomiting or coughing). Not for pressing the contents of our abdomen against it. When we are so busy sucking it all in and up, then our bodies have a much harder time with all these very necessary downward motions like birthing babies or pooping or menstruating.

If you want to get your abdominals to work and if you want to breathe, oxygenate, digest, poop and birth freely and get a flatter belly as a bonus, you have to start with this: let your belly relax.

Let it hang. All of it. Breathe. And let it hang. The best position for releasing it is on hands and knees. (click here for pictures) Then you can start working on your TvA - with the ribs and pelvis in neutral!

We were just not made to suck in our bellies. Just think of how happy this pig must be. (Though it might be time for pig to learn some TvA contractions. He doesn't even have a lumbar curve. Oh well. Maybe not so happy after all...)