Author: Dr. Derya

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Back Pain? How to Address the Root Cause

50 year old woman with back pain

Almost everyone will struggle with back pain at some point in their lives. For some it comes and goes, for others it’s a once in a while thing, and for others it becomes a part of their lives.

What’s even more concerning is that the outcomes for surgery for back pain are not that great. Several studies have shown that long term results for patients who had surgery for their back pain were the same as those who were treated with exercise and cognitive therapy.

Why doesn’t surgery work?

Our spines are complex, we humans are complex! The thinking that the source of the pain is always at the location of the pain is almost always wrong unless you had a direct trauma to that area.

This is because we compensate, and we do it really darn well.

Have you ever had to wear a cast or boot after spraining (or breaking) your ankle or your foot? Maybe you even had to use crutches. Soon, your arms, neck, and hips and probably some other body parts will start to hurt. (Don’t worry, I’ll get back to the back pain soon, stick with me here!)

But there was no direct injury to anything except your ankle! The pain in those other areas occur because you are compensating for not being able to use your foot properly.

The problem is, we all have histories of injuries that make us compensate slightly, and underlying all of that we have an asymmetrical brain and an asymmetrical body that will make us prefer to do things differently on one side than the other.

That’s not really a problem if you’re a wild human foraging for berries or climbing trees all day. But if you’re a modern human, you’re forced into positions (sitting at your desk or your car) and actions (writing, typing, opening doors) that your body will do over and over and over again on the same side.

This creates asymmetries that become ingrained, and now we have to compensate somehow.

So what does this have to do with back pain?

The Postural Restoration Institute, or PRI, clarifies how these asymmetries affect us and can cause problems. Here is a brief synopsis of why and how our asymmetrical nature impacts our lives…

We have a more stable, domed, strong diaphragm on the right accompanied by a flatter, weaker diaphragm on the left. this makes us feel much more comfortable standing over our right leg.

This orients our pelvis slightly to the right.

But nobody walks around with their body pointed to the right! No, we compensate to bring our chest back around to the left, so we can see where we’re going.

So, basically, our pelvis is pointing right, while our ribcage is pointing left. With walking and other alternating activities, we alternate by turning our pelvis to the left and ribcage to the right, but because of the strong anatomical tendencies listed above, we can lose this ability to alternate symmetrically.

Over time, or with repetitive activity, or injuries, we can become “stuck” in this twist. Some degenerative changes can occur, but the research unequivocally shows that disc degeneration or arthritis is usually NOT the cause of back pain (in studies where they scanned hundreds of people, some with back pain and some without, there was no correlation with back pain and arthritis/disc disease or other imaging findings. In fact, some people had severe pain and no findings on imaging, while others had severe degeneration, arthritis, and bulging discs, but no pain)!

The key to getting out of back pain for good is not going under the knife, but rather learning how to bring your pelvis back around to the left, and your trunk back around to the right.

To do so, breathing must become re-organized and re-balanced (remember that the diaphragm is the start of all this asymmetry!) and new movement patterns need to be established.

One very simple thing you can do to start training your body out of compensation is working on getting your left lower ribs down, in, and back. This will promote doming of the left diaphragm and bring your trunk back to a neutral position over your pelvis.

Here’s how to start re-orienting your ribcage to untwist your spine:

References:

Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983;8(2):131. 

Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976). 2009;34(10):1094-1109. doi:10.1097/BRS.0b013e3181a105fc

Brox JI, Nygaard ØP, Holm I, Keller A, Ingebrigtsen T, Reikerås O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis. 2010;69(9):1643-1648. doi:10.1136/ard.2009.108902

Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci. 2018;8:30. Published 2018 Aug 24. doi:10.4103/jcis.JCIS_16_18

Wáng YXJ, Wu AM, Ruiz Santiago F, Nogueira-Barbosa MH. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translat. 2018;15:21-34. Published 2018 Aug 27. doi:10.1016/j.jot.2018.07.009

Lateef H, Patel D. What is the role of imaging in acute low back pain?. Curr Rev Musculoskelet Med. 2009;2(2):69-73. doi:10.1007/s12178-008-9037-0

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Have a Seat: How to Sit to Support your Spine

We’ve all been told to “Sit up straight.” But what does that really even mean, anyway? This advice can be confusing, and even problematic.

The postural restoration institute (PRI) is about so much more than posture, but they have taught me a lot about how to position yourself in your daily life so that you can breathe better and reduce unnecessary tension and patterning in your body.

The Problem:

A common problem that I see when people follow the recommendation to “sit up straight” is over arching your back. Of course, it is not good to slump (picture 1). There are so many reasons why slumping like this is terrible for you, I’m sure you’ve heard them all (and can see how it just looks awful!) so I’m not going to get into that here.

But! it’s just as bad to over arch your back (picture 2).

sitting posture: examples of good posture and bad posture while sitting

This is because when you over arch your back, your abdominal muscles cannot help stabilize you and they become weak. Conversely, your back muscles become tight, short, and also weak, with extra compression in your lower back spine. 

You are forced to hold yourself up with your hip flexors, which also become short and weak!

Not to mention, you can’t breathe well sitting in an over arched position.

In the PRI world, we understand that abdominals are breathing muscles first, and in the over-arched position, your back muscles take over and abs can’t do their job.

Most of your lungs, and best area for passing oxygen from your lungs to your body, is in the ​lower back lungs. ​When you sit overly arched, this area becomes compressed and you can’t breathe well. 

Fix It!

The best way to sit is to not arch or slump, but rather to keep your ribcage neatly stacked over your pelvis (picture 3). 

This allows for the abdominal and back muscles to work together in a balanced way, and for the natural curves of the spine to exist. It also promotes normal breathing. 

How To Do It:

Sit with knees at hip height or slightly higher. Roll your pelvis slightly under (as if you were trying to bring your belt loop closer to your belly button). Feel your sit bones in the chair (the bony points at the base of your pelvis). Exhale through your mouth and allow your lower front ribs to move down. Place a pillow behind you for additional support, putting the pillow all the way down to support your whole back (picture 4).

Ahhhh, that’s better! Your spine can decompress, your back muscles can relax, and you can breathe.  

Need more help? Here’s a video guiding you on how to fix your sitting posture!

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Do You Want To Be a Forever Runner?

“Running is bad for your joints. Stick to low impact activity.”

This is the line delivered to many of my patients by the media, the internet, and even orthopedic doctors. But the reality is that there is really no research to support that, and there is actually research to support that impact is actually better for your joints than none at all.

Of course, overdoing anything is not a great idea, and the research does show that high level athletes who demand extremely high levels of impact on their bodies do have slightly less healthy joints than recreational runners, but their joints were still healthier than those of sedentary people!

Running, walking, hiking, whatever impact activity you engage in, can be extremely beneficial for your health, and can prevent osteoporosis in the lower body joints.

A lot of people feel that they can’t run/walk/hike because of pain syndromes. Others have pain but just run through it, because running is supposed to be painful, right?

Actually…no.

Running is not meant to hurt, and not meant to be a punishment!

In fact, if you are doing anything to punish yourself, that is something to question on a deeper level.

Whatever activity you enjoy- running, hiking, walking- can and should feel good throughout your life span.

However, when we demand symmetrical right to left repetitive movement of our bodies, transitioning from one leg to the other, it is common to develop pain syndromes due to the inherent asymmetries in our body.

We are different right to left. This is an anatomical fact, and a primary tenet of the Postural Restoration Institute (PRI for short). The biggest difference is the position and shape of the diaphragm and how that diaphragm influences our pelvis.

In a nutshell, these asymmetries make us feel more comfortable standing over our right leg.

Our right abdominals become more and more strong, while our left abdominals become weak and lengthened. This has all sorts of implications for your ribcage, pelvis, hips, and everything else above and below your abs. You can read more about these asymmetries here.

This preference for our right side will drive us to create torque in all sorts of areas of our bodies in order to stay over to that side. This happens on a very subtle level but over time these patterns get deeply ingrained and we can get stuck. We can’t figure out why we have pain in our knees, hips, ankles, or neck and shoulders.

This is where PRI comes in. I have taken many courses through the Postural Restoration Institute, and I love the work they do because they acknowledge that we are different right to left. From this more accurate framework, those seemingly random aches and pains start to make sense.

We can work towards restoring balanced side to side and front to back, and pains in all areas of the body start to ease up.

If you want to be a forever runner, hiker, or walker, the key is to stay balanced so as not to overly compress certain joints and develop excess instability in others.

How can you tell if you’re balanced?

Here are some signs that you may have asymmetries present:

  • Uneven hip height
  • Leg length discrepancies
  • Knee, ankle, hip, back, shoulder, neck or jaw pain
  • one foot turning out more than the other
  • one hip tighter than the other
  • One leg more muscular than the other (especially in the front of your thigh)
  • Different wear patterns on your shoes (right vs left)

If you suspect that your asymmetries are impacting you, but you want to keep running/hiking/walking into your old age, now is the time to address these problems.

Here is a simple exercise you can do to be more balanced right to left when you hit the trails.

this exercise was created by the postural restoration institute

You can also download my FREE Guide: Top 5 Injury Prevention Tips for Runners below!

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References:

Eduard A. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. JOSPT Published Online: May 31, 2017 Volume 47 Issue 6 Pages373-390 https://www.jospt.org/doi/10.2519/jospt.2017.7137

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The Most Misunderstood Molecule, and How to Harness Its Power

Deeper, quieter, regular, slower.

Those are the general guidelines for focusing our attention on the breath. This awareness makes us feel calmer, more relaxed, and releases tension from our bodies.

But How? Why does changing our breath change our mood, and many other factors?

Research has shown that slower, deeper breathing reduces heart rate and risk for cardiovascular disease, as well as improves athletic performance. (yes, all you athletes out there, breathe slower to go faster).

The reason all these magnificent changes occur within us when we deepen our breath, especially our exhales, is because of a very special molecule that usually gets a bad rap.

I’m talking about good old carbon dioxide, CO2.

I know what you’re thinking…is she talking about the very same carbon dioxide that we are trying to reduce in our atmosphere to slow global warming? The same carbon dioxide that is considered a waste product of our bodies- something useless to to be rid of as soon as possible?

Well, yes, I am.

But what if I told you that this special little molecule was not only a useful component in improving your health, but an essential one for you to be able to thrive?

You see, for our bodies to get oxygen from our lungs to our tissues, we need carbon dioxide. To get a proper inhale, our receptors in our neck need to sense a certain amount of carbon dioxide in our bodies.

Not to mention, carbon dioxide is stored as bicarbonate in your blood stream, which is essential for maintaining the pH balance of your whole body.

Did I mention that carbon dioxide is critical in weight loss? Most of your body mass lost is due to breathing out carbon dioxide. In fact, more than 80% of weight loss is due to breathing out CO2, and only 15% or so is lost via sweat and urine.

So, if you’ve been dieting, exercising, doing all the right things and still not losing weight… you may want to look at how you’re breathing.

Let’s explore some of these in a little detail…

Firstly, how the heck does carbon dioxide help your body get more oxygen?

Think of carbon dioxide as the Fedex guy, and oxygen as your packages. When outside air hits your lungs, it makes it’s way down to alveoli, the tiny air sacs that interface with the blood stream. The oxygen molecules (packages) get loaded from the alveoli onto the red blood cell, which in this analogy is the Fedex truck.

The truck travels all over the body, delivering oxygen to all the cells as they all need oxygen to survive and flourish. When exercising, certain muscles need even more oxygen more quickly.

This is where our good buddy carbon dioxide comes in.

Oxygen cannot get off the truck unless there is a carbon dioxide molecule there to unload it.

When the oxygen gets to its destination, the carbon dioxide triggers the packages (oxygen) to be unloaded off the Fedex Truck (red blood cell), and be delivered to the cells (your mailbox).

The more carbon dioxide present, the more efficiently the oxygen can be offloaded to cells.

So, when you’re exercising and you really need to get oxygen to those tissues, perhaps try breathing slower instead of faster.

Why does the amount of CO2 in your body determine how you inhale?

I’m constantly telling my patients, don’t worry about the inhale! If you get a good exhale, the inhale will just come.

This is for two reasons, the first of which is purely mechanical.

When you exhale completely, the lungs become essentially “empty” of air, which creates a vacuum. New air has to flow in. It must follow the laws of nature! It must flow from the higher pressure (outside your body) to the lower pressure (inside your lungs). You don’t have to use your accessory muscles (aka your neck) to pull air in, it just goes in! Easy.

The second reason is neurological.

Deep in the reptilian brain, the most primal part of our brain that was present when the first creature crawled out of the primordial goo and decided to walk on land, there is a simple neural network that says, “breathe.”

This network senses levels of oxygen and CO2 in your body to decide when to inhale or exhale. Basically, when your body senses a certain level of oxygen in your body, that circuit makes you exhale. Similarly, when a certain level of CO2 is sensed, the circuit makes your body inhale.

Unfortunately, for many of us, this circuit gets messed up.

We breathe shallowly because we are less active, or stressed, or both, and we do this so much that we end up overriding the part of the circuit that senses CO2 and tells you to inhale.

We get stuck in this cycle of inhaling without ever getting to the bottom of our breath; we lose that primal trigger to inhale, so our inhales get all wonky, a.k.a. you end up pulling your ribcage up with your neck.

In addition to all these important factors, carbon dioxide is the main reason that you feel relaxed with deeper breathing.

Carbon dioxide makes you chill out.

Think about it. What do they tell you to do when you’re having a panic attack? Breathe into a paper bag. You’re breathing back in the CO2 you exhaled. Get that CO2 flowin’ baby!

Carbon dioxide relaxes you by causing your blood vessels to relax, which allows blood to deliver oxygen to all your tissues more easily.

Also, as mentioned above, CO2 lets your body unload oxygen from red blood cells to tissues.

These two factors together mean that your brain gets more oxygen and blood flow. This tells your body that you are safe, and you feel calmer and, well, more chill!

So how to insure that you get more CO2, but not too much?

The answer is simple, and I think you know what I’m going to say.

Breathe deeper, quieter, regular, slower.

5-6 seconds for each inhale and exhale, resulting in about 5-6 breaths per minute, is the ideal for balancing the CO2 and O2 in your body.

Below is a short video on how to do just that and harness the power of this special molecule.

Are you ready to breathe better to move better, to improve the health and resiliency of your lungs without any medication or procedures? Click the button below to find out if will benefit from working with Dr. Derya.

Book a FREE WellBody Screening Session

References

Aakash K. Patel; Andrew Benner; Jeffrey S. Cooper. Physiology, Bohr Effect.
https://www.ncbi.nlm.nih.gov/books/NBK526028/

Anders Olsson Blog https://www.consciousbreathing.com/anders-olsson/carbon-dioxide-training-extremely-harmonious/

Nestor, James. Breath: The New Science of a Lost Art. May 14, 2020 http://www.pathwaymedicine.org/control-of-respiration

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The Revolutionary Bone that No One Talks About

It was a beautiful sunny day, not too hot with a nice cool breeze. As I jogged along the trail that passes through the meadow by my house, taking in the thousands of bright blue chicory flowers, I reflected on how lucky I am to live in such a beautiful place, to have a healthy body…. OUCH!

My knee was bugging me again, as it sometimes does when I’ve been running a lot without much cross training. Not that long ago I may have endured it, knowing that I would do some manual therapy or soft tissue work when I got home to try and coax my body back into a better alignment. Maybe I would have checked out my running form-making sure my core was engaged, and that my cadence was just right.

But today I know more. Thanks to the postural restoration institute, or PRI for short, I have such a deeper understanding of how so many things affect our movement and anatomy. I knew that the best thing I could do was just be more aware of the left side of the trail as it whizzed past. As I did that, my knee instantly felt much better.

Wait whaaaat??? Yup. Seriously. I simply became more aware of my left peripheral vision, which made my knee feel better.

Little disclaimer here…this is not to say that everyone who goes running will instantly be painfree by looking to the left, everyone has unique needs and nuances.

That said… it is a good idea to be aware of your peripheral vision when running and in general…more on that later.

But WHY??? Why would what I’m doing with my eyes affect my knee pain?

It’s all because of this special bone at the center of our head called the sphenoid.

Before we get into what this could possibly have to do with my knee, we should first ask ourselves…

Why Is the Sphenoid Bone So Special?

Here are just a few reasons…

  • The sphenoid bone attaches to our jaw, our eyes, and our ears.
  • The nerves that tell us to rest or digest or fight or flee or freeze pass through this bone.
  • The main arteries that supply blood flow to your brain pass through this bone.
  • The position of this bone determines the amount of pressure on your brainstem, which contains the apparatus to help your body organize movement.
  • The pituitary gland, which performs life-sustaining functions, nestles nicely into a tiny protective saddle in the sphenoid bone.

I could keep going, but I think you get the point. This bone is responsible for a lot of important stuff!

Even just a tiny tweak in the position of the sphenoid could cause all sorts of repurcussions, many of which seem completely unrelated.

What Might Tweak a Sphenoid’s Position?

  • The way your teeth touch matters big time to your sphenoid.
    • The sphenoid interacts with your top and bottom teeth via muscles and nerve endings, but even the bony position of your jaw and maxilla (the bone that holds your top teeth) push against the sphenoid in certain ways. Not to mention, the periodontal ligament is HIGHLY sensitive to pressure and gives you lots of reference as to where you are in space. This neural information is then processed by your BRAINSTEM (remember that guy?) And what’s between your teeth and your brainstem? The sphenoid.
    • Have you ever had dental work done and had the position of your tooth end up just a little higher or lower? If you have, you know it. Your body knows it. Everything feels off, you can’t relax until that tooth is back to where you like it! That’s the sensitivity of the periodontal ligament and the sphenoid position at play.
  • Head injuries and concussions.
    • I don’t think I really need to explain why a blow to the head can affect sphenoid position and surrounding function. But what most people don’t realize is that you don’t have to hit your head to get a concussion. Whiplash, blast exposure, falls, all these things can result in jostling the contents of the skull.
  • How you use your eyes.
    • Remember, the muscles that move your eyes around attach to your sphenoid. If you use your eyes the same way most of the time (like staring at a screen, for example), this can pull on the sphenoid.
  • The neck.
    • The poor head is at the whim of what the neck is doing. And the neck is at the whim of what the body is doing underneath it! Think of a house that is built on clay. When first built, everything is nice and level. But then, after a big rainstorm, different parts of the clay expand at different rates due to the moisture, and the foundation starts to shift and become unlevel. Of course everything above the foundation will also become unlevel. Similarly, if your body is imbalanced below your sphenoid, you will likely also have imbalance above.

Of course there are other situations where certain visual or dental changes (surgical or otherwise) can affect how you hold your body below, because, unlike a house, the body’s roof (the cranium) has just as much of an effect of where the foundation (rest of the body) sits due to all the sensory input we get from our head telling us where we are in space.

Don’t believe me? try standing on one foot. Got it? Good. Now try doing that with your eyes closed. Little harder? That’s because you’re getting information about where you are relative to the ground from your eyes, not just your feet.

Also, I have to say that if you had a head injury or dental work or vision work, this does not doom you to a life of a crooked sphenoid! It can certainly have an effect, but in most people it is manageable with the right program of manual therapy and movement techniques.

So back to my knee. Why did being aware of my left visual field help my knee?

At a purely structural level, there is some effect of letting my eye position change to pull on my sphenoid in a different way.

On a deeper, subtler, neurological level, being aware of the left does several powerful things.

Firstly, it reminds my body to become centered instead of pulling to the right, which I do (and most people do) because of our anatomy and the way our brains are wired. This is especially important for me since I have had a head injury which included broken facial bones.

Secondly, it opens up my left peripheral vision, which creates a sense of expansiveness in my body, thus allowing the sphenoid and surrounding bones to spread and widen. This takes pressure off of all those neural and vascular structures, and lets my body relax out of a state of tension.

When our bodies are held in a tense and protective state, we can’t rotate well through our torso. A side to side alternating activity like running absolutely requires the ability to rotate. If you can’t rotate at your trunk, your body will do it somewhere else. For me, it was my knee.

As soon as I let my left visual field soften and open, my body got a signal (or many signals, rather) to reposition itself into a more optimal position, subconsciously. I could rotate better, breathe better, and didn’t need to put any extra torque on my knee.

Well, I know this is a pretty heady conversation (get it? Heady? Skull? Ok I know, too punny) but it is one worth having.

Because sometimes you do all the right things and still aren’t feeling better or where you want to be with your sport, your breathing, your health, or your ability to do the things you want to do.

When that’s happening, it’s time to look at what’s happening from the neck up to determine if something there could be inhibiting your progress.

Here’s a simple but powerful technique to try that will help with restoring sphenoid position.

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Why Is It So Important to Learn to Exhale?

Wait a minute, I already know how to exhale. I do it hundreds of times a day, without even realizing it! Why would I need to learn how to exhale?

Good question.

As I work with my patients, the comment I often get is, “wow, I didn’t realize that I was never really exhaling!”

But how can that be? Read onwards, my friend, and I’ll explain it all.

When we breathe, we have many degrees to which we can move air in and out. There is simple survival breathing, which is just enough air to keep us alive, some may call this a “shallow breath.” This is how many of us breathe when we are still and not moving.

If we spend a lot of time still and not moving, or if we have life events that put our nervous system in a state that tells us we are not safe, and we should be as still as possible as a survival mechanism, we can get stuck in a shallow breath.

“Form follows function and function follows form” is a tenet of how our physical structure adapts to our environment. When we don’t breathe deeply, our ribs and surrounding structures don’t move. When our ribs don’t move, it’s harder to breathe well.

Oh, well the solution to that is easy, just breathe deeper!

For some reason, our common societal belief is that to breathe deeper, we need to take more air in.

While this is true for some people, it’s definitely not true for many. And, almost EVERYONE needs to first get air OUT before you can effectively get air back in.

This Ribcage is Too Big!

Some ribcages are “hyperinflated.” Barrel-chested, military posture, ribs pushed up in the front, all these positions indicate that there is some dead air hanging out in those lungs, for who knows how many years.

How are you supposed to get new fresh air in if your lungs are already full of dead air?

These people can’t get air OUT.

Think of it this way. Your lungs are a balloon (this is a gross analogy, but just go with it 🙂 ). You fill the balloon with air (inhale), then let a tiny bit out (exhale). Next breath, you need to fill the balloon with air again because you need oxygen to survive. But still, you let out just a little. Over time, that balloon will get bigger and bigger, despite feeling like you need more and more air!

Of course it would feel like you need to inhale, because each breath in is so small since those lungs are already packed full. But what you really need to do is get that dead air out!

Getting a complete exhale, all the way to the bottom, gets that dead air out. For these individuals, when they feel that they have exhaled completely, they are often surprised to find that there was still more air in there to exhale.

Once that dead air is out, the ribcage and diaphragm positions can return to normal, and functional breathing can be restored.

This Ribcage is Too Small!

Some ribcages become rigid and small, collapsed in on themselves. They can’t get air in OR out. Their diaphragms can’t do the magnificent action they were designed to do, simply because there is no room to do it.

People with this kind of ribcage absolutely need to invite some expansion into their lives, but in order to do that, a diaphragm needs to be awakened and revitalized.

Achieving a complete, relaxed exhale triggers the reptilian brain to restore the breathing pattern that is primally wired within each of us.

Getting all your air out in a relaxed way is like a reset button for your nervous system.

When you reset in this way, you don’t need to try to get air in, it just flows in! You may need to do some specific exercises to open and expand your chest wall and lungs and bronchi (in certain places and directions, but I won’t get into all that here), but by simply getting your air out, you’ve already done an amazing thing for your whole system.

How does air just “flow in” after a complete exhale?

When you exhale completely, you let all the air out of your lungs. This creates a vacuum- air HAS to flow into that space due to the laws of physics- air will flow from an area of higher pressure to lower pressure.

It’s like when you open a hot oven and all the heat blasts out- the high pressure hot air must flow into the lower pressure cooler room. You don’t have to do anything the make the hot air flow out, you can’t even stop it flowing out! It just happens.

When we try to actively pull air in, we end up using accessory muscles, i.e. your neck. Just trust me on this one, you don’t want to breathe with your neck. Your neck has enough work to do already managing your head on the rest of your body. Using your ribcage to breathe is a much better way to go.

This Ribcage is Juuuust Right.

The human body is an amazing design! Sometimes it’s just hard to get out of our own way and let it do what it needs to do.

Allowing air to move out completely has so many more benefits than simply restoring ribcage and diaphragm position (although the restoration of those contributes to all these other factors I will share with you).

Benefits of Exhaling Well

  • Decreased heart rate (by stimulating “rest and digest” nerve fibers).
  • A more balanced inhale to exhale ratio, which reduces stress levels.
  • Reduced states of hyperinflation.
  • Improved digestive action of the gut.

So the question is, why wouldn’t you wan to exhale well?

Remember, exhaling is about softening, releasing, and letting go. Sometimes (or a lot of the time?) this can be harder to do than tensing, clinging, and holding on. So give yourself some patience and grace as you work towards a fuller exhale, and eventually a more expansive breath (and life!) as a result.

Here is a short video on how to get some air out, based on the primary breathing method from the Postural Restoration Institute, or PRI for short.

Be well, my friend!

Kindly,

Dr. Derya

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“Be Balanced” FREE Summer Challenge: 3 Weeks to a Calmer, Happier You

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Summer is fast approaching and what a whirlwind of a year 2020 has been already. There has been so much going on, viruses, economic downturns, political uprisings, and to top it all off…murder hornets!

No matter who you are, I am sure you have been affected in some way. And it is healthy to feel the icky feelings, because they encourage us to take action and make changes.

With so much going on, it is also helpful to have some strategies to find some balance emotionally, mentally and physically, especially when so many impactful events occur in close succession.

That’s why I decided to challenge myself to be more balanced this summer. Will you join me?

Each week for three weeks, I am going to put some energy and awareness into being just a little more present and a bit more in my body.

But the key to making it work, for me anyway, is that it has to be super simple! Because if it’s an elaborate 20 minute process each day, I’m probably not going to do it.

What I need are some things that I can quickly do throughout my day. And, in my experience, the little things we do all day are much more impactful than doing a big chunk of something now and then.

It’s like learning a language…

Usually, when learning a new language, you spend a few hours several times a week in focused study. But you quickly forget what you learned in that hour chunk of time and have to keep coming back and reviewing. This way, you will learn the language, but it will be slow and hard to apply.

But what if you were suddenly living in a country where they only spoke the language you were trying to learn? Over three weeks, you would learn the language much faster and in a much more practical way than you would if you were studying a book or taking a class a few times a week.

You are immersed in it, so you get it better and faster.

That is what I hope to do with this challenge! Each technique, one per week, will be simple, quick, and applicable throughout your day. You’ll be doing little bits all the time – it’s a DIY balanced lifestyle immersion.

It’s never a bad idea to learn how to be more in your body, and more at peace with your world. Especially now, the world could use a few more people who are acting from a place of calm and groundedness.

So, will you join me?

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I’ll see you on the other side!

With love,

Derya

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What you Need to Know About Creating a Vibrant Life: How to Contract and Expand

Last year I was dealing with some health issues, and I felt that working long days was contributing to my symptoms. After much deliberation, I reduced my hours in hopes of finding some relief and more time for rest. At first it was great. I had more time to nap, rest, and do other things that felt restorative to me.

But it wasn’t long before I started filling that free time with more “stuff.”

Before I knew it, I had eaten up all that time with classes, volunteer work, and self-imposed deadlines and projects. I was just as busy (if not more so!) than before I reduced my hours!

Bewildered, I asked myself, “how did this happen?”

It was as if part of me could not STAND having time to be quiet and relax. There was an inherent guilt to resting, to having time that wasn’t “productive.”

All over again, I ended up giving away all of myself, to the point where it wasn’t sustainable.

It wasn’t my job that was draining me, it was my own inability to save a little of my power for ME.

You could even say that I was opening my heart TOO MUCH.

My life was missing a natural oscillation that is present in all of nature, that play of intensity and calm, of effort and ease.

It was seeming to me that my whole life, and the messages I was getting from the society around me, was all about effort and opening; doing as much as you possibly can…

without the bit about quieting, softening, and going inward.

Peter Levine, an industry leader in studying and treating trauma, describes this process as “pendulation.”

He believes that rediscovering expansion and contraction is the key to living a full and abundant life, with the ultimate goal of living a more expanded life.

Too much contraction is undesirable, this is established. Thinking too much, worry, fear, over planning, narrow focus (staring at a computer)… this creates a contracted state.

You can feel that contraction in your body- your neck, shoulders, face and maybe lower back become tense.

On the other hand, expansion is always desirable, and always the goal. This happens when you consciously relax your body, get a wider view (look out a window for 30 seconds and notice how your body changes), and settling into the present moment by noticing your breath and bodily sensations.

However, there is a trap that I call “FAKE expansion,” which is also undesirable and can even be harmful.

So what is “fake expansion?”

Over filling your life with STUFF and convincing yourself that it’s REALLY important (cringe, yup, that’s me!) at the expense of your own wellbeing.

Fake expansion is “opening your heart” in a situation where you feel exhausted and unbalanced.

It’s saying yes to so many things that you don’t leave any room to take care of yourself. It’s giving more than you have to give.

We do this ALL THE TIME. Sorry ladies, but women do this more than men, but the guys definitely do their fair share.

And maybe instead of asking how you can open your heart more, you should be asking “can you make space inside your heart for YOU before opening it up to everyone else?”

A.k.a. how do you keep some of that loving care and attention for yourself, so that when you give to and care for others, you can do it from a place of love and joy instead of burnout and martyrdom?

One way you can make space for your own heart is by physically changing the shape of your body to encourage more space in the BACK of the heart area.

Interestingly, as we open the back of our hearts physically, our decisions tend to reflect this and become more in support of self nurturing instead of over reaching.

Breathe into your Back

Our bodies are so fascinating. The sympathetic nerve ganglia, which is a fancy way of describing the nerves that make you feel anxious, stressed, worried, angry…generally amped up…live between the vertebrae in your upper back spine. So, if you are always “opening your heart” by pushing your chest up and trying to stand or sit up really straight and never going the other way (rounding your back) you’re going to have a heck of a time getting your brain and body to relax.

Not to worry! You can do a simple exercise to expand the back of your heart. Here’s how to open your upper back:

Re-Establish Physical Boundaries:

Another way to encourage healthy expansion is by re-discovering the boundaries of your physical body, which reminds the mind to keep a little of that loving energy for yourself.

By re-establishing the boundaries of our bodies, we learn to expand. Here are some ways to develop and be aware of the boundaries in your body. This embodiment of where you end and the rest of the world begins teaches your nervous system how to create healthy boundaries in your life.

Here’s how to establish the boundaries of your body:

Are you are needing to create a little (or a lot) more space in your heart for you, so that you can give from a whole and rested place? Or do you need to remind your nervous system what it means to have meaningful boundaries? Or perhaps you’re like me, and you really needed both.

Whatever the case, the fact is that our society drives us to do more, push harder, be better, all the time. And that doesn’t honor the law of nature, it doesn’t honor pendulation.

Try introducing a little more space for you into your life, and see if that allows you to expand a little more. We not only deserve some space for ourselves, we need it to be sustainable.

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Improve Your Breath to Improve Your Life

I used to hate hiking and running. I was always the slowest one, gasping for air, my neck and shoulders for some reason aching and killing me. I could really relate to the term “sucking wind.”

It just felt like I couldn’t get enough air.

Even when I would diligently hike and run more often, I never got a sense that I could breathe better. I was getting better conditioned, but it always felt very hard. I didn’t understand why, even though I trained regularly, friends of mine who hardly ran or hiked at all would zoom past me up the trail.

I thought, “there must be something wrong with me.”

After I had a pretty severe bike accident, my symptoms became much worse. Instead of just feeling out of breath, when I got left behind in the group my lungs would literally close up. I couldn’t breathe. I thought I might die. “Is this asthma?” I thought.

These days, I am the one zooming up the trail.

I surprise myself at how sometimes, even after I haven’t been training at all, I can easily hike or run without getting out of breath. I never get that feeling of my lungs closing up. Now it’s way more enjoyable to run and hike, and I look forward to it! I feel that I am getting fitter and can go further each week.

So what was going on with me?

Two things. The first was poor lung compliance and perfusion, a.k.a. my ribcage and therefore my lungs weren’t moving well, which didn’t allow me to exchange enough oxygen into my blood stream.

So, even though I was constantly exercising, my tissues weren’t getting the oxygen they needed. No wonder I always felt out of breath!

Turns out the reason my neck and shoulders hurt while hiking and running was because I was trying to pull air in with my neck! My ribcage, lungs and diaphragm weren’t working well together to pump air efficiently in and out, so my neck and shoulders decided to take over.

The second thing holding me back was trauma.

Since my bike accident, if I exerted myself too much, especially with other people around, my body would go into a state of “freeze.” I would check out mentally, close off socially, my lungs would seize up and I would have to sit on the floor and gasp until I could get up again. I think some people might call this a panic attack.

I know now that my ribcage mobility and my trauma were related.

Because I didn’t breathe well in the first place, it was harder for me to breathe and sense the fluctuating rhythms in my body.

Through a lot of trial and error, I eventually found that PRI techniques, in addition to working with a skilled somatic therapist, I was able to overcome both of these obstacles. And because of the huge impact it has had on my life, I now I help others do the same.

The way our bodies work is NOT like a mechanical machine.

We can’t pretend that a breathing issue only affects our lungs. We are constantly affected by what’s going on inside of us and around us, both physically and mentally. We need to be able to shift side to side in our lungs, our bodies, our minds, and our spirits. Stuck ribcages prevent lungs shifting. Stuck mindsets prevent bodies shifting. Stuck beliefs and trauma prevent our spirits from shifting.

The reason overcoming stuck patterns in the body and mind is difficult is because it’s about softening and letting go.

This means allowing air in and out instead of forcing our bodies to breathe a certain way. Releasing tension instead of holding on.

So many of my patients struggle with softening and letting go (myself included).

If I tell someone to tense a muscle, they can almost always do that. But if I ask them to soften and relax a muscle, it is much harder.

Similar to how our muscles become rigid, our minds can do the same thing. Here’s an example:

Someone asks you about an issue that you are strongly against. Very likely, you get worked up and talk fervently about all the reasons you think it is wrong. But if you are asked to see where the other person is coming from, and why they might feel the way they do, it will probably be much harder for you to give an answer.

This is just one way we become rigid- with our beliefs. It’s much harder to change the way we think about something than it is to keep thinking what we always have.

Can changing the way our lungs move help us overcome trauma?

Trauma is a state of being disconnected from our bodies. It’s a survival mode where there’s no room for feeling, because before our feelings were so terrifying and painful that we don’t want to risk going there again.

Trauma lives in our bodies, not in our thoughts.

We can’t think our way out of trauma. But we most certainly can feel our way out.

Sensing the breath is one way to sense our bodies again, which is the first step to overcoming trauma. We must learn to sense the ever-changing flow that is always occurring in our bodies. And at the center of our bodies lie our lungs, whose function is to manage flow. Flow of air in and out, flow of oxygen to our tissues, flow of byproducts back out into the world.

*Please note that sensing the breath is not appropriate for everyone who is working with trauma. So, if you find that noticing your breath feels uncomfortable for any reason, take a break for now and consult with a provider to help guide you in this process.

Our lungs remind us of how connected we are to everyone and everything around us.

We use our lungs to create air for our voice so that we can communicate with others. The carbon dioxide that we don’t need is expelled by the lungs to provide nourishment to trees and plants. And those very plants provide oxygen back to the bronchial trees within us.

As Pocahontas said,

“…we are all connected to each other
In a circle, in a hoop that never ends”

(Sorry, couldn’t resist the Disney reference!)

Do You Find Yourself Holding Your Breath?

When we don’t breathe, we don’t shift. When we don’t let go, we become rigid. Letting air out is an excellent way to start bringing flow back into your body via the breath.

Most people think of the inhale as the main part of the breath. But an inhale is only as good as the exhale before it.

Think of it this way. If you didn’t get all your air out, your next inhale will not bring in much fresh oxygen! There’s just not enough room with the lungs partially full of old air.

Furthermore, if you don’t exhale all the way, your lungs and ribcage don’t get to move through their full range of motion. Now you are working towards rigidity in a pattern of half full lungs, and you are reducing the amount of flow in your body.

The less your ribs move, the less your diaphragm moves, the less massaged your gut organs get by the movement of your diaphragm, and you become more rigid in your digestion.

The less air you get out, the more your body shifts into a state of fear and tension.

Think of your lungs as a balloon. If you never exhale completely, that balloon keeps getting more and more filled with air, and you feel like you’re floating away from the ground. We need a sense of the ground to feel stable, supported, and, well, grounded!

One way to start creating more flow and learning to let go is by letting air out.

Notice that I didn’t say FORCING air out (which is what most of us tend to do). It’s about allowing the lower front ribs to soften down instead of cramming them down.

Here is a short video on how to find an exhale breath that will get your ribs and lungs moving again.

Think of this breath as a sigh. Like you’re getting into a hot bath, or arriving home after a long day and sinking into a nice soft couch. “ahhhhhhh.” After that first delicious sip of an ice cold drink on a hot summer day, “ahhhhhh.”

If you like, take note of how you feel before and after doing this breath for about 5 rounds of 5 breaths. Has the quality of your breath changed? How about the quality of your mind? Your mood? You may be surprised by the results.

To take this a step further and work on sensing your body in addition to sensing your breath, practice also feeling the places where your body touches the chair, and/or where your feet touch the floor. Notice if you’re tensing your shoulders or your face, and see if you can soften there.

More and more throughout your day, be aware of what’s happening in your breath and your body.

Just noticing your breath, and not even trying to change it at all, is an incredibly powerful technique. You can watch your body find it’s rhythm again.

*Again, If doing this makes you feel anxious or uncomfortable, consult with a provider who can help you work through the process of getting back in touch with your body.

So if you’re like me, and you’ve been trying really hard to get better but things still don’t feel right, breathing and sensing might be the missing link.

Don’t underestimate the power of finding the flow in your lungs, your mind, your spirit. Trust me, I’ve been there, and I’ve made it to the other side. And I know that if I can do it, so can you!

If you want to work with me on this or just have questions on next steps, feel free to send me an email or leave a comment below. Derya@MyEssentalPT.com.

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How to Get Unstuck

You know that feeling you get when a moment is so perfect you just want to capture it forever? And then there’s that sadness when you realize that the reason the moment is so perfect is because of its impermanence, and ironically any attempts to capture it would suck out all the specialness of the situation.

This is the inherent, beautiful sadness associated with the understanding of impermanence.

I had this feeling earlier today, just now actually, driving home from work. It was a warm, hazy afternoon and everyone on the road had their windows rolled down including me. As I came upon a view of the mountains, the perfect moody, twangy, blues-ey cowboy song came on the radio and I so badly wanted to capture that moment. My inclination was to pull over and look up the song so that I could add it to a playlist and listen to this song and have this feeling over and over…

But that’s not how it works. So, instead of wasting this perfect moment searching on my phone, I turned up the volume and cruised.

I feel this same kind of sadness when I’m walking my dog, Hazel, and see hundreds of flowers popping up in unexpected places. Initially, this makes me so happy, and then I feel sad because they’re all going to go away as the seasons change, and part of me wants them to just stay. But I also know that if they were around forever, they wouldn’t be nearly as delightful.

It’s at these moments that I recall the core teaching of the buddha: everything is impermanent, and constantly changing.

By understanding impermanence, I can let go of wanting things to stay a certain way, because I know that it’s not the true nature of things. And by embracing change, we can smile when the flowers come, and also smile knowing that they will go. Because red and golden fall leaves and later pristine white blankets of snow will take their place. Instead of fretting about missing a moment, I can simply enjoy it.

Embracing change is not something that comes instinctively to us, and something we have to work on.

That’s because change means uncertainty, and uncertainty is scary. But, when you really think about it, nothing is certain. And pretending that we can be certain only breeds attachment and fear.

How Fear of Change Manifests in the Body

Our bodies were designed to oscillate and reciprocate, they were meant to shift from right to left and left to right, from front to back and top to bottom, and twist and turn in all different directions.

However, most of us get stuck in patterns that come from the way we always do things, and (maybe more so) the way we always think things. We assume what the next day will be like based on the days before, and if there has been the same thoughts, movements and emotions in the previous days, the brain and body will expect more of the same. And if something is different, we become fearful, worried, frustrated or angry.

Take for example your commute to work. Everyday you drive to work, and you expect your car to run the way it did the day before. But if for some reason your car breaks down or doesn’t start, this is extremely upsetting! It ruins your day, because it’s not what you had planned, what you predicted, what your brain and body is comfortable with.

Think about all the things you do in your day the same way. Always crossing one leg over the other. Always crossing one arm over the other. Mousing with the same hand at the computer. Driving the same route to work everyday. Feeling stressed about the same things at work. Getting in the same arguments with your significant other.

All of these actions pattern us physically, mentally, emotionally.

The more patterned we become, the more resistant we are to change. The more resistant we are to change, the more we suffer when something unexpected happens. And the more our bodies become hardened into certain patterns that don’t allow us to alternate and reciprocate, the more we get stuck. Stuckness creates imbalance, disease, and pain.

So How do I Get “Unstuck?”

Well, that’s “easy.” Easy because the changes aren’t that hard to do physically, but the quotes are there because change is hard! Everything about the way your brain and body are wired is designed to resist change. Your brain wants to keep you “safe,” and patterns feel nice and secure.

To get yourself unstuck, try doing things you usually wouldn’t do! Sleep on the other side of the bed. Cross the opposite arm in front. Take a different route to work. Cook something different for dinner. Stay up later. Wake up earlier. Put your watch on the other wrist. Get creative and find ways to mix it up.

The main source of where we get stuck is through our ribcage and lung field. By shifting the way we stand and move, we shift the way we breathe, so doing any of the above helps with that. You can also help create more mobility, shifting, and alternating in your life by doing specific exercises for your lungs.

That said, don’t disregard the power of inviting more change into your life. It is a simple way to create new patterns and break up old ones. You learn to be more comfortable with change, and maybe even enjoy and invite it into your life. It’s pretty amazing how when you let go of how you expect things to be, you see all the ways that things can be.

Noticing Change Through the Body

The body is the gateway to observing the changing nature of our existence. Your breath is always in flux, inhale to exhale. The heart is always beating, sensations are always changing (even though it seems that a sensation stays the same, when you pay close attention you will notice that it is indeed changing in subtle ways). When we can observe change in our body carefully and thoroughly, we start to understand impermanence on a visceral level, which is where the real change takes place. Just understanding impermanence on a cognitive, theoretical level is helpful, but it is not enough to shift your body into a new state of freedom and flow. To incite real and lasting change, we must experience at the physical level, at the level of the body.

Noticing change in the body is called “interoception.”

This 5 minute guided meditation will help you notice change in your body by practicing interoception.

So next time you find yourself feeling frustrated that something didn’t go the way you wanted, or sad that something won’t stay the way it is or was, remember that this moment can change you from the inside out if you let it. And to ease the pain of those moments, start making changes now! Try to switching up your routine whenever you can. Try something new and mix it up.

Your brain and body will thank you.

Call Dr. Derya