​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

The idea that strengthening muscles makes them more stiff or less flexible is one of the past; as is the thought that a long and flexible muscle is weaker. Both mobility and strength are necessary for performance and injury prevention, and it’s hard to improve one without the other. 
 
Why not static stretching like we’ve done our whole lives? Although this can feel good, and can improve mobility in the short term, it doesn’t produce long-term change like we used to believe. Static stretching can dampen the nervous system response to a stretch so that it feels easier to move into this position for some time; however, this is short lived. Permanent changes in tissue length at the muscular and cellular level are not seen, so true length changes throughout the muscle don’t happen.  We’ve learned in recent years that the best way to improve a muscle’s flexibility may be to load that muscle as it is stretched.  
 
In the world of exercise this is called an eccentric activity. When thinking of how a muscle contracts there are three primary methods: isometric, concentric, and eccentric. Isometric occurs when there is no motion, i.e., arm wrestling against someone who’s an even match. Concentric involves shortening of the muscle as it moves against a load, i.e., the part of a bicep curl that brings the weight closer to your shoulder. Finally, eccentric involves lengthening the muscle while it lowers a load, i.e., the part of a bicep curl when you lower the weight to your side. 
 
This eccentric load has been shown to create long term changes within the muscle that improve mobility around a joint and flexibility of that muscle, while simultaneously strengthening within that range. It does so by breaking down the tissue under a heavy load during the exercise. During recovery the muscle remodels to withstand this stretch better the next time it comes around. Just as you break down your hammies during a deadlift and can go heavier over time. This can be especially effective at the hamstrings or hip flexors, but really many muscle groups can benefit from this training as we use eccentric motions throughout our life! Bending over to pick something up, lowering our body weight off a step, lowering an object from a high shelf, etc.
 
What do these exercises look like? Think about the position you’re in when that muscle is in a big stretch. This is the motion you want to create through the exercise, simply adding a load. Some examples might include psoas lower, reverse Nordic curl, and a dropped heel raise. 
 
Research and evidence are ever evolving. So much so that it seems hard to keep up! Our current body of evidence suggests this approach of eccentric loading may make more impact than static stretching, and that static stretching maybe doesn’t do what we once thought. Even so, it’s always best to analyze what your body needs, and what works well for YOU! 
 
If you need guidance on where to start, or what approach suits your needs, head to our website to chat with a PT! 
 
Cheers! 
 
Elle Carlson, PT, DPT