Post-Partum Rehab: Cutting through the BS

I'm not sure what to call this. Is it a VLOG? Is it a VLOG within a BLOG? Do these letters stand for something and need to be capitalized, or just it just appear like I am shouting? I am intolerably ignorant to this whole world of social media, so bare with me, friends!

The intent of the video below is to send out a message to all the mamas. Sure, written text can be incredibly impactful, but sometimes you just need to hear me curse and make strange movements with my hands to get the point! All kidding aside, I hope this video serves an important purpose - which is to have an honest discussion about the (dismal) state of affairs on post-partum rehabilitation. Women need more positive and productive information about how to reconnect with their bodies. There is so much noise and non-sense about postpartum fitness and hopefully this video cuts through some of the B.S. 

I promise, I am only just getting started.....so watch out ;)

Also - please subscribe if you would like to see more of Awkward Meg :)

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No Pain, No......Pain

Woah. Two years since my last post. I suppose it is time to dust off the ol' keyboard and get back at it! My last post was written about 4 days before I found out I was pregnant with little Nevin. He is now 16 months old and is tearing up the house. I really can't even remember to a time without him. It's strange how life does that to us - when we live with someone long enough, they feel like they have always been a part of us. 

What a perfect segway....

Pain is funny like that too. When we live with dysfunction long enough, we stop remembering what our bodies felt like without it. It morphs into every movement, every breath and just becomes our barometer for "normal" - albeit a rather shitty version of normal. 

I talk about this with patients on the daily, most of the time the conversation goes something like this: 

ME: "So what brings you in today?"

THEM: "I have this pain in my (insert body part), it has become rather constant and is now at the point that it is on my mind all day long"

ME: "When did this start"

THEM: "I don't even know. I can't remember not feeling it."

They don't even know because dysfunction is sneaky. It is layered and complex and deceiving. Pain is an experience that is formulated in the brain, driven by input from the body. As a defence mechanism, our brains will start telling our bodies to subtly start moving in different ways, behave abnormally, and even diminish or increase activity to certain muscles.  I told you - it's sneaky. This is all well and good because it is what keeps us keeping on.....until it's not. Usually by the time we are experiencing more constant, nagging pain we have been dysfunctional for quite some time.

while this photo may seemingly be unrelated to everything I am currently writing about - I think we can all see the pain my little Brady is experiencing in this picture! Don't mess with this boy and his ice cream! The lesson to be learned - kids are amazing at feeling, appreciating and emoting their pain (emotional or physical). They want it addressed immediately and they lack the ability to let it fester. Although a tad dramatic, it is quite remarkable what we can learn from our littlest ones. 

Pain is our bodies telling us there is a problem. It is a alarm that starts off gentle and then starts to scream when we leave it too long. It is one of our best defences, yet we try to silence it. However, we all know that where there is smoke, there is fire. 

So, what does this all mean? I don't mean to be an alarmist (pun intended), but I do want you to perhaps think about what your body (brain) is telling you.  I want you to use pain as a signal to get help. I want you to consider treating your body as well as you treat your car. Seems obvious, right? The analogy is brilliant though because it is all the same - that screeching noise in the car isn't going to go away by turning the radio up louder. In fact, it is going to get a whole lot worse (and more expensive) the longer you leave it. You better believe the same goes for your body, but there is no trading it in for a newer model in a few years. Imagine how well you would take care of your car if it had to last you a lifetime!

I'm not saying progress is pretty, but it doesn't need to be painful. 

I challenge all of us to slow down a tad and listen to what our bodies (brains) are telling us. I don't want to oversimplify the experience of pain, and undermine the challenges of those living with chronic pain. However, don't let that ache in your shoulder or that pulling in your back continue. Don't resign to never playing (insert sport) again, or stop wrestling on the ground with your kids because you are not sure you can get back up. On the other side, don't keep doing (insert activity) and then complaining how much it hurts as though this makes you a stronger person - life is too short to spend it feeling beat up and broken. 

"No Pain, No Gain" is a silly phrase muttered by silly people. It cultivates a belief that dysfunction and pain is a badge of honour that we carry around. The busier we are, the more tired we are, the more injured we are is not something we should take pride in. I'll leave you with a much better phrase to mull over:

Take care of your body, it's the only place you have to live  - Jim Rohn

Ode to the Bod

It is a beautiful, summer morning and despite that glorious sunshine, I was a little slow to climb out of bed because my body was achy and sore. Yesterday was my first triathlon since having twins and while I felt on top of the world after finishing, I was reminded this morning how hard my poor muscles worked to get me to the finish in one piece. 

How amazing it all is -- this mass of bones and muscles, tendons and ligaments, joints, nerves and connective tissue. It carries us around through our daily tasks and even endures when we don't treat it as kindly as it deserves. What a wonderful and amazing machine. 

Here is the trade off though -- our bodies will always search for the easy way.  Despite the beautiful complexity that is the body, it will always look for the short-cut; the path of least resistance. We can't blame it -- wouldn't you do the same? However, this is where problems start to emerge. 

As a physio, I see people in pain. Aside from acute, traumatic injuries, most of what I see are injuries due to a breakdown in the system; the "short-cuts" that start to manifest into imbalances and imbalances that start to cause tissue destruction. Therefore, rehabilitating an injury, or better yet, preventing injury is all about ensuring that we create an environment within our bodies that allows it to work efficiently, but also biomechanically. 

What does all of this physic-speak actually mean? Well, let me give you an analogy. Lets say that you are driving a car but the front left tire is low. Well, if you keep your foot on the gas you car is going to keep driving for you, but it is not working how it is designed to work. The car wants to pull to that side, so the car has to compensate. The other tires start to become warn in an unsymmetrical fashion. If the tire gets too low, the rims may start to get damaged by the increased pressure on the road. The cascade continues....

The body is much the same way. If we have weakness in key muscles, the body is wise enough to keep on trucking for us, but it starts calling on other muscles to do the job and it won't be long until the effects are noted. Therefore, it is important to gain an understanding and appreciation of this precious vessel that is your body. What are you doing to keep it in balance and running smoothly? Are you confident that the physical demands you make of it are in line with the capacity it has to do the job effectively and efficiently? Do you notice that you have common "problem areas" or perhaps even a "problem side" that consistently seems to pop-up when you turn up the heat in your training or activities? If so, you need to make friends with a good rehab provider that can get you back on track. 

I promise this is not just a shameless plug for physiotherapy or other like-minded professionals. Rather, this is a PSA that you have this incredible body - one that is so mind-blowingly intricate and amazing that you owe it all the respect and love it deserves. We have no problems investing money to dress it up and make it look fancy, yet we are hesitant to invest the time + money to make it function optimally. 

So back to my post-race sore bod that I am dragging around today. It has taught me an important lesson; it is resilient, it is strong, it does its best for me when I treat it the best. It carried me through the finish line, so today it deserves a nice stretch and some solid rest. Tomorrow we begin again. I will spend the time to strengthen the areas that fatigued first. I will pamper the parts that took an extra beating. We will continue to evolve together and I will continue to listen to what it is telling me. 

Ode to the Bod. 

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Above: Myself and my fellow podium-mates at the Gravenhurst Triathlon. Most incredibly, another twin mama took 1st!!

Give you bod some love today and everyday and get it working like the well-oiled machine it was made to be!

MMM

The Tragic Hip

Oh the hip! An area commonly upstaged by the trendiness of the core or the injury-prone, attention-seeking knee. It bears all of our weight, yet we give little love to this often disregarded joint. However, it is crafty in it's payback. It will rarely start to ache or pain in the face of neglect. No, it is more ruthless than that. It will start to slowly wreak havoc through the rest of our bodies until we find ourselves spending long nights taping feet and shedding tears over the foam roller just trying to figure out exactly what went wrong. 

Now don't get me wrong - I have mad love for the core (as evidenced by my previous three posts), however, 99% of clients I see are more apt to work on core stabilization than hip stabilization - and this is problematic. Even if you are not working the core entirely correctly, or efficiency - there is no argument that you are likely giving this area more attention then the hip stabilizers, and it is primarily because this muscle group is not given the respect it deserves!

Let me fill you in. When you are doing any activity that is weight-bearing (i.e standing, walking, running, skipping, hopping, dancing, skiing, skating, surfing, cycling, Irish jig, etc......) is imparting force through the hip (and foot and knee). The goal for efficient and productive movement is to limit the amount of force transmitted through the joints and maximize the force through the surrounding musculature. Furthermore, we have two broad groups of muscles; global moblizers and local stabilizers. The first is the big muscles that we tend to all know and exercise on a regular basis. At the hip, this would be the quadriceps, hamstrings, gluteus maximus. The local stabilizers are the muscles that are deeper, smaller and are what protect the joint from undue stress. For most, this is where the problem lies. 

Here is a basic test you can try: 

• Stand in front of a full-length mirror. Place you feet hip width apart and place your hands at your waist/top of pelvis.
• Slowly lift one foot off the ground by bending at the knee
• When you do this, what happens? Does the hip on the lifted side drop at all? Are your hands at different heights now?

If you answered yes to any of the above questions, or resemble my highly artistic, sad-faced image above, you likely have difficulty stabilizing the hip properly. What this means is that when you transmit your weight to one leg, the hip joint rather than the muscles are absorbing the additional force. Now think of how this applies to an activity with much more speed and impact - like running. If overtime your foot hits the ground you are not able to properly support your body weight, your joints and surrounding soft tissues take the toll and this is when injury manifests it's ugly face. 

I don't want to get into "hip exercises" that you should do - because to be honest, each of us have different deficits, compensation patterns and general wonkiness that needs proper assessment. There is no "one size fits all" to strengthening. Take the time to get evaluated by a trained practitioner and understand what will be of most benefit for you. I promise that Benji Franklin was on to something when he said, "an ounce of prevention is worth a pound of cure". True story. 

If you want to see the ultimate "hipster" ever, take a looksie at my biggest patient challenge and greatest life inspiration in the video below. Your own strengthening goals will seem like peanuts after this......

Jen has some other pretty awesome videos, so check out her youtube channel here 

Feeling inspired? 

MMM

Hardcore Series Part III: Breathing

I would hazard a guess that most people out there don't get super jazzed to read about/practice breathing when they decide they are ready to do core exercise. Like most, I am also guilty of wanting to jump right into "the exercises", dismissing what seems like the fluff work - breathing. Even more, I often see breathing go completely out the window with core exercises, as we all have a tendency to hold our breath when trying to focus on an exercise or movement. However, effective breathing is just as paramount to proper core training as any other movement or muscle activation you will do. As mentioned in part I, the diaphragm is an integral part of the core unit. When you focus on your breathing and the movement of your rib cage and diaphragm it will actually be a much easier and effective way to engage and relax the proper muscles. 

Although breathing is the most natural activity we do, I would argue that most have very poor breathing habits. We have the luxury of not needing to think about breathing for it to occur, but that doesn't mean we always have good form. There are many ways to analyze breathing patterns and there are just as many categories of breathing to evaluate. For simplicity, I have broken breathing "styles" into three groups. 

Apical or clavicular breathing refers breathing into the upper part of the lungs. When used properly it is only to be done as a mode to get the maximal expansion of the lungs with exercise or excursion, as it requires the muscles of the neck to work in lifting the collarbones and create room for the top of the lungs to expand. However, those [ahem, most of us] that carry a lot of tension in our necks/shoulders can default to this pattern. It ends up creating a very shallow breath with very little excursion of the diaphragm and lower ribs and increases the muscle activity in our upper backs/necks. By far, this is the most common pattern I see when I tell someone to take a deep breath - they end up shrugging their shoulders and filling the top of their lungs and defeating the purpose of using deep breaths to relax those tense areas. 

Diaphragmatic breathing refers to breathe with a conscious focus on proper movement of the diaphragm with every inhale/exhale. It is also referred to as "belly breathing". When "breathing from the diaphragm", you will see the belly expand with every inhale, and retract with every exhale. The shoulders and chest do not demonstrate much movement at all. This breathing pattern is used to slow down the respiratory rate and to increase the air volume in the lungs. It is common to use this pattern for relaxation and meditation. It is also beneficial for facilitating core recruitment and to bring more awareness to the process of breathing. 

Lateral costal breathing refers to side-to-side excursion of the ribcage with each inhale. When speaking of the mechanics of the ribs during breathing, we often discuss the lower ribs moving like a bucket handle - when you inhale, the lower ribs swing out on either side, much like the handle of a bucket. Those with a stiff mid back/rib cage often demonstrate very little movement of their ribs with breathing. Conversely, using breathing as a technique to mobilize the mid back and rib cage can be an effective way to restore mobility to this area. 

The video below is a great 3-dimensional representation of how the diaphragm and rib cage move with a deep, effective breath. 

I know you have all heard countless times how important it is to become aware of your breath. I'm not telling you anything new. But why is it that so few actually use breath to guide their exercises? I don't have a great answer for you. What I will say, is that once I start to work on breathing with a client, they tend to over-complicate/over-think when to inhale/exhale and this (paradoxically) creates more tension and less fluidity to their exercises. Most importantly, just remember to breathe! Start each exercise session with just a few, simple breaths that expand the rib-cage in all directions. To take these big breaths, you will notice you have to shift to a nice, tall posture. You will also (hopefully) start to feel the connection between your diaphragm and core as you continue to inhale/exhale in a thoughtful way. This, my friends, is doing more for you than most "core exercises" than you might previously have been doing. Try for yourself! Below is a simple routine adapted from STOTT® Pilates basic principles (you can find link here)

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BREATHING PRINCIPLE EXERCISES

1. Notice Natural Breath Pattern

• Lying on back, breathe smoothly and notice your natural breath pattern
• Is breath going into abdomen, upper chest, sides of rib cage or back of rib cage?

2. Breathing Flexed Forward

• This exercise encourages breathing into the sides and back of rib cage. 
• Sit in an upright position, arms relaxed, knees bent
• INHALE to prepare
• EXHALE and initiating from the top of your head, curve forward and relax over legs
• while forward flexed, INHALE through nose, feeling sides and back of rib cage expand
• EXHALE through pursed lips, allowing rib cage to close
• repeat 3-5 repetitions
• on last EXHALE, initiating from tailbone, roll up back to starting position

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Homework doesn't get much easier than this! Just breathe in that sweet, spring air and get ready for Part IV: The Pelvic Floor!.......

MMM