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What do you think of when you hear the word recovery? In the context of exercise and fitness, you may imagine stretching, or getting a massage. While all of those can be helpful and have their place, I call those the “minors”. Often, I see people playing in the “minors” vs. the “majors”. When put that way, I think we all agree that our interest is piqued by the ability to play in the “majors”. So, what does that mean?
When it comes to managing pain and injury, exercise, and challenging our fitness goals, there are some major components we should be focusing on before we bring the minor components into play. These are things that help at a systemic level and create positive changes in our global health. In turn, we can recover better, heal more quickly from injury, and make the gains we’re yearning for. The majors involve sleep, nutrition and hydration, stress management, and movement. Notice there are no passive things here; nothing that you must have someone else do to you. No massage tools, or other expensive pieces of equipment. What it does involve is commitment and consistency – and that’s the hard part! These are integrated into your lifestyle, and things you do day in and day out. When we create those habits, recovery is part of life; and at this point, the “minors” may give you an extra boost when needed. So, what are the differences between the majors and minors? Things like massage, stretching, cupping, tape, and foam rolling can feel good. They may help decrease sensitivity or symptoms for the short term; however, what they are not doing is creating long term change. They don’t break up adhesions or tissues, they don’t prevent injury, and their effects are short-lived. This isn’t to say they don’t have a place, but it shouldn’t take up as much space as it often does. On the contrary, the majors make long-term changes. When we get adequate sleep (7-9hrs of quality sleep per night) our tissues physically recover and adapt to the stresses we’ve taken on. Our brain recovers and solidifies neural pathways we are forming or changing. When we consistently miss out on this sleep, we see detrimental long-term effects related to chronic disease and mortality risk. When we have nutrition dialed in with the right amount of caloric intake, protein, carbs, and fats while avoiding things like sugar and alcohol, our tissues have the resources to rebuild stronger than before and have the energy to perform the tasks we have in front of us. Without this, we see depleted reserves of energy, decreased tissue and bone quality, and sometimes even changes to our hormonal and adrenal function. Alongside solid nutrition, aim to drink ½ your body weight in ounces of water every day! Simply increasing your water intake can make a huge difference in how you feel and perform. We’ve talked about stress management a bit on social media and in previous blogs. Stress is a broad term and captures everything from physical stressors to non; essentially, anything that disrupts your homeostasis. Consistent and prolonged stress can have a negative impact on our body’s ability recover from stress, on tissue quality, on sleep, and on many of our own behaviors (I’m probably not the only one who reaches for those chips or ice cream when I’m feeling stressed out!). Of course, we can’t control many of the things that add stress to our lives; however, we can control how we respond, cope, and live alongside those stressors! These strategies can help control our body’s response when facing such stress, ultimately lowering the levels of stress hormones. When we’re not addressing and managing the stressors in our life, things like massage, foam rolling, or cupping are simply a band aid for the time being – kind of like the ice cream! The last major component I mentioned is movement. Movement doesn’t mean formal exercise necessarily. I often like to talk about it in the term “movement snack”. Essentially focusing on integrating frequent movement bouts into your day – whether that’s walking, a yoga flow, hopping on a bike, or stretching. Simple movement like this can be one of the best forms of recovery as it increases your heart rate enough to get blood and oxygen flowing through those recovering tissues, provides your brain with positive reward chemicals and gives it a break from attending to your work and daily tasks; and probably leaves you more productive too! This is especially important for those folks who work from a desk, and then ask their body to go all out during their morning or evening workout class! All this to say, I definitely enjoy a massage now and then, and I agree that it feels great to roll something out on a foam roller… I definitely enjoy my chips and ice cream now and again too. While these minor recovery tools can be helpful, the majority of one’s effort and time should be placed on the majors; because without these, the minors can only do so much, and are not sufficient enough to help you toward your goals, improve your health, or prevent injury or overtraining. Most folks I work with have goals related to lifelong health and longevity, and playing in the majors is what will get them there! Reflect on where your behavior stands relative to these major and minor tools. Can you make simple changes to help yourself in the long term? It’s all about the long game, and that’s the game we like to play! Let us help you do the same! Cheers, Elle Carlson, PT, DPT
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At the end of 2022 I put out a poll to my social media followers asking what they wanted to see and learn more about in 2023. I have always struggled with being on social media as a business owner and physical therapist. There is so much information out there (and misinformation), it can feel overwhelming; and I don’t like the idea of contributing to that overwhelm. So, I aim to be more intentional. With that, I’m using your feedback to drive my writing and social media content this year because I want to provide you with information that is relevant and useful!
We’re kicking off 2023 blogs by highlighting the peaks and valleys of physical therapy and recovery from injury. This is something that was requested as a topic because it can be so frustrating when you’re knee deep in the process, and it’s sometimes difficult to see the light at the end. With most things in life that involve making progress, we often experience setbacks, plateaus, or even failures. Ultimately, those things are what launch us to be better on the other side! We can think of recovering from an injury in the same way. As much as we wish it to be linear, it just isn’t and, truthfully, if we’re avoiding some of those setbacks or failures, we may not be challenging ourselves enough to see progress. Of course, when dealing with pain or injury there are always guidelines and considerations to help us stay the course. #1) Be patient with your rehabilitation journey! It’s not plausible to completely resolve pain in 1-2 sessions, especially if something has been around for a long time. The role of a physical therapist is to help you manage pain, modify training, and provide education so you can make informed decisions when it comes to your health. We are always working toward long-term resolutions and goals rather than quick fixes; these are focused on establishing good exercise habits, a healthy diet, and regular and sufficient sleep. #2) When experiencing a setback there are a few things to ask yourself: What was I doing that provoked this setback? Was it more than my previous level of activity? If so, that’s actually progress! You were able to do more activity before having an increase in your pain. Something you likely would not have been able to do, say, 2 months ago – Congrats! You might also ask: How much more pain am I in than usual? Is there significant swelling or mobility limitation associated with it? How long does it take me to recover from this exacerbation? These questions can give us some information on the degree of setback, or how much we may need to adjust in our rehab plan. A small to medium increase in your pain that does not greatly impact your mobility and reduces in 1-2 days after the exacerbation is okay! This is giving us information on the stressors your body can currently handle so we can manipulate those appropriately for adaptation! On the other hand, if there is a medium to large increase in pain, maybe some swelling, reduction in your everyday mobility, and it sticks around for more than a couple of days then we need to get on top of the inflammation. This may warrant a larger reduction in activity and re-evaluation of our rehab plan; however, by appropriately addressing this we can get back on track! #3) Your injury is unique to you. It can be helpful to hear stories from others about their experiences, successes, challenges, etc. However, your injury is yours and it’s not the same as your best friend’s. A physical therapist uses experience of managing similar injuries to guide treatment, but they also make sure the treatment plan and interventions are individualized to YOU. Ultimately, we can never fully predict or avoid setbacks – or injuries for that matter – we can only do our best to navigate them as they come around; and prepare ourselves to be better the next time we face a similar situation. Clear and open communication with your physical therapist is crucial for creating a plan catered to your needs, as well as working through setbacks you may experience. Additionally, continuing to participate in those activities that bring you joy, and that you love, is a huge factor in progressing through a setback – or even helping to avoid them. So, reflect on what those things might be, and the next time you experience a setback remember that it is part of the process! Need more guidance on something you’re managing? Have questions about your own process or setback? Hit the Talk With a PT Button up top to schedule your free phone consultation! Cheers, Ell Carlson, PT, DPT Over the last couple of months, we have explored the concept of pain, how it is processed and produced by our body and nervous system, and what happens when it sticks around for too long. In this final part of the series, we are discussing how we can manage this persistent pain and create a more resilient and robust body!
Before tackling this, let’s recap. Pain is 100% always created by the brain. Our brain receives signals from various parts of our body. Some of these may be related to mechanical, or thermal stimuli that can indicate a threat. The brain uses information stored within itself including memories, experiences, emotions, beliefs, etc. to decide whether this stimulus is threatening enough to elicit pain. This is meant to be protective; move yourself away from this threat or get rid of the threat itself! Due to the neurological nature of pain, there is not always tissue damage or injury present. Also because of this, there does not need to be any mechanical or thermal stimuli to elicit a painful sensation. This is where it can become very frustrating because it feels impossible to get rid of pain if there is no physical source to address. However, we CAN influence the creation of pain by working through beliefs, ways of thinking, emotions, and learning more about how pain works! These efforts address the neural circuits that contribute to the creation of a painful sensation. These circuits can become TOO GOOD at creating pain when it is present for more than a few months, and are sensitive to cognitive and neural activity including thoughts, beliefs, memories, etc. In the presence of this persistent pain, it is even more likely that there is no tissue damage or injury related to the pain. One might find that they feel more pain when they’re stressed, sleep deprived, eating poorly, or not exercising vs. when they have a better handle on those factors. So how do we improve this pain that’s not related to any tissue damage or injury? Whether there is physical tissue damage or not, we may see changes in physical abilities, strength, mobility, etc. in the presence of persistent pain. Therefore, there are likely physical deficits to address to build a more resilient self! When it comes to changing these physical deficits OR addressing the non-physical components of persistent pain, I often point to an equation that is widely used in areas like strength and conditioning. This equation is stress + recovery = adaptation Our bodies are geared toward adapting to stressors to better handle those in the future. It uses the information of stress to learn, evaluate, and adapt so it can be better prepared the next time. This can be applied to performing a bicep curl and becoming stronger over time or speaking in public for the first time and eventually becoming comfortable and confident with this. The thing about the stress component of this equation is that our body can’t tell the difference between types of stressors. It may be stress of work, family, finances; or it could be an intense workout, doing too much too soon, or lack of sleep. To our body, and our nervous system, these all just equal stress; it can’t decipher which is more impactful than the other. It’s the body’s goal to adapt to these and become more resilient to them; however, if the cumulative stress is too great, and recovery doesn’t match it, it will fail to adapt. Even more, it may show maladaptive signs including pain, fatigue, or potential injury. Our job is to evaluate stressors of all kinds: physical, emotional, psychological, social, etc., and to assess the cumulative impact these are having relative to your ability to recover. If we can manipulate stressors to assure an adequate dosage of not too much or too little, while focusing on recovery strategies and joyful activities, we will see adaptation take place and a resulting body that is able to handle more! I like to refer to a cup analogy I’ve learned from various mentors in the field. Imagine you, your body, and your brain are a cup. (I include all of these because we’ve learned that they all play a role in pain, right??). This cup is filled with water, and your life stressors are objects that are placed into the water – remember these stressors include anything and everything that disrupts your homeostasis (physical or non). As more of these objects are placed in the water, the water level rises. When it gets to the point of overflowing, we have met the capacity of the cup. In your life, when this happens, you may experience an exacerbation of your symptoms (more pain/stiffness, increased fatigue, decreased performance in your workouts or life, etc.). What can we do about this?? Our goal is to remove or modify the objects (stressors), that we can, from the water so the level lowers, while assessing and addressing recovery efforts. In doing this we see adaptation and the development of a bigger cup over time! A bigger cup means you can take on more before overflowing = greater resiliency! It may sound like a simple concept, but simple does not always mean easy, right? If it sounds like some of this applies to you (and it does to all of us to some extent!), a great place to start is to reflect on what stressors may be in your life, and how you cope (recover) with those. Do you make time for joyful activities with people you love? Do you prioritize healthy food, water, and adequate sleep? Do you move your body regularly? These foundations are key to health & wellness, but even more so to combating persistent pain and keeping yourself feeling good and moving well! Whether you want to chat more about these concepts surrounding pain or want guidance on how to start your journey of building a bigger cup, we’re here for you! Hit the Talk with a PT button at the top of the page to start your journey toward becoming more resilient! Cheers, Elle Carlson, PT, DPT Last month we laid out the basics of pain. Talked about what it is, what it is not, why we experience it, and a bit about how it works. We ended with a teaser about what happens when it becomes persistent. That’s what we’ll be covering today!
Persistent pain is pain that lasts beyond the healing norms; most injuries heal within 3-6 months. It can be related to an initial injury but lingers even after we know that injury is healed. Some common complaints that come with persistent pain include feeling like it spreads or moves around; noticing that it increases with stress or decreases when you’re feeling good; and it often affects your ability to sleep. People with persistent pain may also notice that tests don’t always explain their symptoms, medication doesn’t totally control it, or people disregard the pain as not being real. This is when the pain is no longer associated with an obvious “tissue issue”. It can make it very frustrating to understand, as well as to control if we only target the tissues that appear painful. Acute pain related to an injury can become persistent as our nervous system adapts to the presence of pain and begins building neural connections within this ‘new normal’. We mentioned last month that pain is produced from the brain using information from your body. When pain is persistent, your brain forms more and more of these pathways that can create the sensation of pain. It ultimately becomes really good at sensing pain; something we might describe as being hypersensitive. The pathways and creation of pain are influenced by information stored and sent to the brain. Things that might worsen this sensation of persistent pain include worry, decreased activity level, stress, anxiety, depression, injuries, or disease. This may sound overwhelming and complicated. Pain is influenced by so much going on within the brain, how can we go about changing that?! Just as those listed above can make persistent pain worse, there are many things that can make it better; lots of which are in our control! These include knowledge of pain, restful sleep, fun activities, friends/family, healthy food, and positive thinking. Bringing these into our lives can decrease the sensitivity of those neural pathways, resulting in less pain overall – without even addressing anything tissue related! Not only can this improve pain but think about how those bolded items above can positively influence many aspects of our lives! Persistent pain my not be directly related to tissue damage, but we can see decreased tissue tolerance in the presence of persistent pain. This can happen due to activity avoidance related to the pain, decreased activity levels overall, and deconditioning related to this. When we work with the knowledge we’ve discussed surrounding stress, education, diet, positive thinking etc. we can decrease pain activity and the sensitivity of those neural circuits; however, this doesn’t always mean we can hop right back into our previous workout routine, activity, or sport. Our tissues may still be sensitive to this because it’s been a while since they’ve participated, and they may have lost some of their capacity to do so! To totally complete the picture, we also need to address these developed deficits in strength, mobility, or motor control. That’s where the combination of education and addressing life factors discussed above, PLUS specific movement and exercise prescription can be the magic bullet! Next month, to round out our 3-part series, we’ll be talking about how to get back into those activities you love, while working to calm your persistent pain at the same time! If you experience persistent pain yourself, or this information resonates with, check out the resources here: https://www.oregonpainguidance.org/paineducationtoolkit/ Cheers, Dr. Elle Carlson, PT, DPT What is pain?
When it comes down to it, pain is a safety mechanism. It’s meant to detect potential threat and alert our brain to that threat, so that we do something about it. “Hey, your hand is burning, take it off the stovetop now!”. It’s hugely important for safety, survival, and preventing or stopping injury from becoming worse; and as much of a literal and figurative pain it can be, we’re far better off being able to experience pain than not. It helps us address a dangerous situation that may be threatening to life or limb, alerts us when we’re ill, tells us to change position to protect our body, and motivates us to stay away from things we’ve learned to be threatening and painful in the past. We can’t survive for long without pain – let alone thrive – no matter how much of a nuisance it can be. How does pain work? Pain is completely, 100%, created by the brain. Yes, we have nerves that send messages from different parts of our body to the spinal cord, and eventually to the brain. However, the information they send doesn’t state ‘pain’ or ‘no pain’. It is simply a message that we’re feeling something; but nerves cannot interpret what that is. Our brain receives this info, processes it, and ultimately creates the final sensation that we experience consciously and deem ‘pain’. This processing happens so very quickly, which I’m sure you can all relate too; however, in that split instance, the brain considers so many different things in making that decision. These factors include your immediate environment during the painful experience. Is their danger? Are you embarrassed? Is a crowd around, or are you alone? How about blood, is there blood? Am I supposed to be hurt right now? How do people usually respond when something like this happens? It also considers past experiences. Has this happened before? What was it like last time? Did I make it out okay, or was that experience terrible? I’ve broken my wrist before; did I do that again? It may also consider your current state. Are you hungry? Did you sleep well last night? How about water? Are you feeling stressed about something in your life? The above are just a few of the components considered in this decision-making process of the brain; but ultimately the brain decides something is threatening enough to be painful. This sensation of pain will motivate us to address the situation whether that be removing ourselves or removing the stimulus. What is pain not? Pain is not always an indicator of tissue damage. Neither the presence of pain, nor the intensity or amount is correlated with the presence of tissue damage. Someone can experience pain without having any sign of injury or tissue damage, while the next person can have a significant injury and feel very little pain. All the factors described above, and more, play a role in how that pans out. Pain is a signal that we need to listen to. But we also need to consider so many other variables to determine whether that pain equates to damage, whether we are safe, and how we might best address it. Pain is a large problem for many individuals, and a massive problem for our healthcare system with nearly 20million people managing chronic pain in the United States alone. We can’t ignore it, and it is not “all in your head”; however, we need to approach it differently than “fix the tissue issue” because often there isn’t one. This is the first blog of a 3-part series about pain. Follow along next month when we discuss what happens within the nervous system when pain becomes persistent! Cheers! Elle Carlson, PT, DPT What can we learn from pain and the color red? It’s not so much about this specific color, as it is about context; and, how the context of a situation can change how we experience pain.
What do you think of when you imagine red? Heat, danger, fire, etc. What about when you imaging blue? Cold, calm, water, etc. When you go to turn on a faucet or the shower, blue means cold, red means hot… right? This is done deliberately because of the associations made with those colors, and the likelihood that people will turn the faucet in the correct direction pending their ability to see those colors. An interesting experiment was conducted in which a very cold piece of metal was put in people’s hands. While people touched this piece of metal, they saw a blue light. They weren’t told anything about this light, but the timing was such that they saw blue at the same time that they touched this cold object. Afterwards, they were asked to rate the pain they felt out of 10. This was repeated with the same people, and the same cold piece of metal; however, this time a red light was displayed vs. blue. Again, they were asked to rate pain out of 10. What do you think happened? While some people reported no difference, many of the individuals reported a higher rating of pain when the red light shone despite the metal object being exactly the same. It was even as significant as some people reporting no pain with the blue light, and 8 out of 10 with the red light! So, what? It doesn’t seem like your back or knee pain is related to the color of lights around you, right? Maybe. BUT it is largely related to context and how we perceive that context. This experiment showed us that the only thing that needed to change in order to increase someone’s perceived pain was the color of the light – the context! This is a hugely important factor when dealing with pain. Especially pain which has been around for a long time. The cool part? We can often change or have some amount of control over our context… we can definitely control a lot of the thoughts and beliefs we tell ourselves which is where a lot of this starts! (i.e., the belief that red = hot) How might context be affecting your pain experience? Is some of this in control? If you’re feeling lost about how to begin managing your pain or injury and getting back to what you love, head to the Talk with a PT page on our website! Cheers! Elle Carlson, PT, DPT Do you every experience nagging hip pain? Maybe it feels achy along the outside of your hip and maybe even moves toward your tailbone, or into your low back? This can sometimes be related to pelvic floor muscles, believe it or not!
The pelvic floor is made of a sling of muscles that travels from the pubic bone to the tailbone. They work to help support pelvic organs, and play a role in things like continence, sexual function, and stability. Some of these deep pelvic floor muscles act on the hip to help rotate it in and out; think of the motion you might do when performing a fire hydrant exercise or kicking a hacky sack (do kids still play with those?). Because of the relationship with the pelvic floor, hip pain that we believe to be related to the hip joint, may in fact be related to these pelvic floor muscles that double as hip rotators. If you’ve been following along in this blog or on social media, you’ve heard me describe some of the tension or guarding that can be seen in the pelvic floor muscles. This can sometimes contribute to pain and dysfunction, and it may manifest as hip pain with or without the symptoms we typically relate to pelvic floor dysfunction. So, how can we address this? Just like any other muscle, the muscles of the pelvic floor need to be exercised through their available range and placed under the appropriate stress to meet the demands of life and activities. These hip rotators that we’re highlighting today are not always trained into this rotation movement, so may not have the opportunity to move through this range as often as we’d like. They play a huge role in singe leg stability, pelvic control, and low back support! Therefore, giving them a little TLC can help not only improve function of the pelvic floor, but in turn, support the hips, pelvis, and low back more effectively! Here are some of my go-to movements for improving mobility here and progressing toward strength! YouTube playlist. Give these a go, see how they treat you, and reach out with questions! Cheers, Elle Carlson, PT, DPT P.S. This will be the last blog for a few weeks as we jet of to Croatia this weekend! See you soon! When we feel tightness, stiffness, or pain in a certain area, we often think we need to just stretch it away! Stretching can feel great and can provide relief to pain; but it’s important to note that this is short lived.
At Mobility Innovated, we see strength training as the best long-term approach to this sensation of tightness. It may be that the tightness you’re experiencing is in fact telling you those muscles need some strength! Here are some common myths about stretching to discuss this week. #1: Stretching should be part of a warm-up routine Static stretching – which involves holding a stretch for a period – has been used as part of warmups for decades. Recent research has suggested that warmups may not be the best time to incorporate this static stretching. Of course, this depends on the type of workout you’re doing. We believe that a warmup should support you as you head into a workout for both performance and safety. Current research points toward static stretching potentially doing more harm than good when it comes to strength and performance during the chosen activity. Perhaps instead of static stretching as part of a warmup, the warmup should consist of a gradual progression of intensity that mimics the coming workout and elevates the body temperature. Static stretching does neither of these things as it does not mimic the workout movements, and typically does not increase body temperature due to the static nature. Dynamic stretching can be a great alternative that increases the body temperature and increases blood flow to the muscles that you are about to use. Some of our favorites include squats, lunges, skips, inchworms, or anything that elevates the heart rate and targets the muscle groups about to be used. #2: Stretching improves sport performance: As we alluded to above, studies have shown that static stretching can decrease performance, especially when it comes to power, strength, and speed. It’s unclear what exactly contributes to this decreased production of power and strength. This is not to say that stretching cannot be helpful at other times during the day, but it may be best to find time other than right before a workout or activity in which performance is important to you. #3: Stretching makes muscles longer: This is a tricky one to debunk because it seems to engrain in our brains – to get longer muscles we need to stretch more! As we learn more and more about the human body and how it functions, it appears that although there is an increase in range of motion with stretching, it is not due to an actual change in the muscle length! Rather, we see changes due to a neurological adaptation and improved tolerance to the tissues being placed on stretch. Simply put, our brain becomes more willing to move through a range of motion because it is less sensitive to that stretch; the muscle itself has not changed. So, what to do instead of stretch? At Mobility Innovated, we’re big fans of strength training! It’s a lot easier to create changes through tissues via resistance training than static stretches. Of course – just like anything of benefit – strength training requires time and consistency; however, the payoff is far greater than stretching, plus you get stronger while doing it! The effects of resistance training have been researched extensively, and its effectiveness proven. Stretching lacks this evidence to back it up. An example of an exercise that works on both strength and length is the RDL, or Romanian Deadlift. If you’re unfamiliar, this exercise involves a hinge at the hips while keeping knees as straight as possible. This movement takes the hamstrings through their full range for a lot of folks, moving through an ‘eccentrically’ controlled range of motion. This movement simulates a passive stretch of the hamstrings as if you were touching your toes, while at the same time requiring the muscle fibers to adapt to the added load of strength training. All this to say, it’s not BAD to stretch: If stretching feels good to you, go for it! We’re all about making sure you feel great and enjoy what you’re doing when it comes to exercise and movement. With static stretching, you may see a slight increase in joint range of motion, but it’s important to recognize that this will be transient; and that perceived tightness of a muscle is likely just weakness of the muscle. “Most stiffness is a sensation, a symptom, a kind of mild pain with movement rather than an actual limitation of movement” (Ingraham 2020). tl;dr
You know your body better than anyone else, so if stretching makes you feel like you can move better, or relieves some soreness, do it! Stretching and modalities like myofascial release, foam rolling, etc. can still have their place in warmups, cooldowns, and for recovery. Cheers! Elle Carlson, PT, DPT Bracing is a strategy used in many aspects of life. Definitely by those who do heavy lifting in the gym whether it be CrossFit, power lifting, or traditional strength training; but also, in everyday life when lifting something from the floor, or moving a heavy object. When I say bracing, I mean the tension and pressure created through the abdomen upon lifting. This is generated by core musculature and influenced by bracing and breathing strategies. Do you hold your breath when you lift, breathe out with the greatest effort, or allow yourself to breathe however feels comfortable?
Unbeknownst to many, the strategy being used can largely impact the pelvic floor; and it may be important to evaluate this if you experience stress incontinence, have a prolapse or suspected prolapse, are currently pregnant, or are recovering from labor and delivery. Depending on the strategy, the pressure changes within the abdomen and therefore through the pelvic floor. So, what do these strategies look like? Strategies that reduce pressure through the pelvic floor include breathing in and out throughout the movement or breathing out during the most difficult aspect of the movement. If relating this to a full balloon under pressure, releasing some of this pressure through the opening of the balloon can reduce pressure throughout the balloon, creating a better tolerance to load. If this breath is held, pressure may escape elsewhere – commonly through the path of least resistance. Sometimes this is the pelvic floor, which can lead to leakage or affect a current prolapse. This can also be a diastasis or separation through abdominal muscles. Strategies that can increase pressure through the pelvic floor include Valsalva or wearing a weightlifting belt. We’ve talked about increasing pressure through the pelvic floor, and how this can sometimes have a negative impact; but is this always bad? This isn’t bad in and of itself. It’s a matter of whether the pelvic floor is strong enough! These strategies can be great for increasing effectiveness and strength through a lift and allowing for one to lift heavier! However, if one’s pelvic floor is not ready for this increased pressure, the previous strategies are likely a better place to start. A Valsalva maneuver involves taking a deep breath in and then sealing escape routes including the nose and mouth; this is done by keeping the mouth closed as well as closing the glottis, so air doesn’t escape through the nose. Because the escape routes are closed, pressure increases throughout the abdomen and pelvic floor. You might imagine a balloon that does not allow air out through the top. However, when imaging this balloon as the abdomen, upon bracing and breath holding you want to draw your abdomen in vs. pushing it out. Pushing out can send the pressure down toward your pelvic floor and focus it here rather than distributing it more evenly through the abdomen and pelvic cavity. Wearing a weightlifting belt creates the most pressure through the pelvic floor, but again, this is not inherently a bad thing! It’s important to remember that when wearing a belt, pushing out against the belt is going to create the most pressure distributed toward the pelvic floor. Instead, we want to think about drawing in away from the belt as if assisting it in keeping everything sinched in. This will reduce pressure through the pelvic floor and create better efficiency in bracing over all! Who knew such a small thing like bracing can influence the pelvic floor so much?! It seems simple but can have a great impact; but because of that simplicity and impact, we can also make small changes that will make a large difference in pelvic floor symptoms when lifting or working out! If you or someone you know has trouble with leakage, pressure, or pain when lifting; or they are working to get back into the gym and to those activities, we encourage you to work with someone who has experience in pelvic floor training! Cheers! Elle Carlson, PT, DPT If you follow along on social media, I had a post last week discussing relative vs. absolute increase when it comes to running progression; and particularly when returning after baby. This can be a difficult concept to grasp, especially when navigating this for the first time, so we’ll dive in more this week!
Typically, when someone wants to increase their running distance or time; or they’re training for a race that is further than they typically run; or they are training for performance… the recommendation is to increase their distance/time running by no more than 10% from week to week. A number is placed on this to safely, effectively, and efficiently have them move through their training regimen and see the results they’re after. Too large of an increase too quickly may expose tissues throughout the body to an intensity they’re not yet prepared for; too little an increase, and we’re not going to overload the body enough to trigger adequate adaptation – it can be a tricky balance! When returning to running post-partum, the problem with this 10% increase is that it can be really small relative to where one is starting; and this can potentially take away from progress or effectiveness of training. When someone is returning to running after baby, and when ready individually, a walk-run progression is commonly recommended; and this goes for returning from a variety of injuries as well! With this walk-run progression, one might start out running/jogging only 1-2min at a time, followed by walking for 60-90sec, repeated for a set duration. Of course, this can vary by individual as well. When considering a 10% increase from starting here this week, to next, that is only adding 6sec to 60sec of running! You can imagine that this strategy might make for a long road to recovery. This is where the difference of relative increase vs. absolute increase comes into play. Relative increase is that 10% or associated number – the percent increase this week relative to last week. Absolute increase is how much distance or time was actually added from week to week. 60sec this week to 66sec next week is a 10% relative increase, and a 6sec absolute increase. In the situation where the time or distance spent running may be small (for now!), it can be helpful to have a large relative increase. Sometimes upwards of 50%. With this, we can increase by 50%, but add 30sec to next week’s running time. This allows for an appropriate progression to keep your body adapting, while still providing guidelines to assure a safe progression. So, although the 10% increase is a good rule of thumb, once you have more miles and time consistently under those tennies, there is plenty of wiggle room in those early stages to keep you progressing, improving, and working toward those running goals! Need some guidance on getting back to those miles? Hit the “Talk with a PT” button above to get started! We would love to meet you! Cheers! Elle Carlson, PT, DPT |
AuthorElle Morgan, PT, DPT Archives
February 2023
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