Walk Better: Five Simple Tips

Part One: Free Your Arms

Other than just getting you from point A to point B, walking is a great way to get exercise, relax your mind, and restore alternating rhythm in your body.

But how do you know you are walking well? And what can you do to get all these benefits mentioned above?

In this series of posts, I will go through five simple steps on how you can be a better walker, and by doing so restore freedom and flow in your body with every step.

Before we get into what you can do to walk better, let’s consider why you would even want to pay attention to how you walk.

Asymmetries Become Magnified

Walking is a symmetrical activity, but the body that does the walking is inherently asymmetrical.

We are asymmetrical in our internal anatomy but also in how we use our bodies. For example, we may always use the same hand to reach for something, always kick with the same leg, always read from left to right.

When we do a symmetrical activity like walking with an asymmetrical body, any asymmetries become magnified.

Inevitably, one leg will be more flexible or stronger, one arm will swing further or stay closer to your body (and yes your arms are involved in walking), and your brain will perceive the right and left sides of your world differently.

Soon we are no longer walking efficiently, no longer pumping air in and out evenly, and we start to create harmful torque on joints and tissues.

So what can you do to walk better?

Free Your Arms

You can start with liberating your arms!

Arms are very important for walking. They provide a counter force and counter balance to the legs, and more importantly your shoulder blade on your ribcage provides a compressive downward force on the opposite leg as the arm swings back, providing your brain with an increased sense and awareness of the ground beneath you.

This tells your brain that you are safe and your whole body can relax into the flow of walking.

One simple thing you can do to walk better is to let your arms just do their thing. Of course you have to carry things sometimes, but try to walk a little bit each day without carrying anything.

Let your arms swing naturally.

That means no dog leashes, no groceries, etc. If you walk to work or school, consider wearing a well fitting backpack instead of a shoulder bag.

Walking GIF — ummm, can we see a little arm swing please?

Make sure your hands are open (not clenched or in a fist). Don’t force your arms to swing, just let them move naturally with the rotation of your trunk.

What’s this about trunk rotation? Your trunk (i.e. ribcage) and pelvis rotate in opposite directions as we walk. While walking, the arms literally just hang off our torso. The arm swing is actually just a pendular motion of relaxed arms as the trunk rotates side to side.

So it’s not helpful to “make” your arms swing. Let them do what they do naturally, but make sure your trunk/torso is moving well.

night arm GIF — I mean, that’s a little excessive, but you get the idea.

This takes us to our next tip for walking better…

Twist your torso!

Stay tuned for how appropriate torso movement improves your walking.

Make sure you subscribe to the blog to get the next post with the second tip on walking better as soon as it is published 🙂

July 5, 2021August 28, 2021

A Better Plank

Simple Corrections for a Common Exercise

Ruth has been working out off and on for pretty much her whole life, and she is no stranger to planks. She’s had lots of different people tell her all sorts of different things about how to do a good plank. “Keep your butt low!” a coach once yelled to her during warm ups. A friend at the gym reminds her to “keep her back straight.” So she works diligently on these things and feels like she has a pretty good plank. She also has some neck and shoulder pain but doesn’t attribute it to her planks because she’s doing everything right…right?Planks are a great way to strengthen your shoulders and abdominals, and lots of people do planks in different ways. So which way is best? In order to do a plank that is most supportive for health and longevity, it’s important to understand a little anatomy first.

1. Your ribcage is supposed to be “egg-shaped.” Not flat. So trying to have a flat back flattens the back of your rib cage, smushing one side of your “egg.” Most of your lung field is in the back of your ribcage! So when you flatten your back, your breathing is compromised.

2. Shoulder blades are designed to sit on an egg-shaped rib cage. When backs become flat, shoulder blades don’t know what to do, and the muscles that attach to shoulder blades get tense and sore.

3. There are practically no joints attaching your shoulder blades to the rest of your body. They are just free floating in muscle. So when those muscles get sore, shoulders get sore. Also, many shoulder blade muscles attach to your neck, so when shoulder blades are confused by flat backs, necks hurt!

4. your abdominals are breathing muscles first. This means that they attach to your ribs and help pull them down in the front to support that nice egg shape. So if your ribcage is lowering to the floor, abs get confused! because they are not designed to work in ribs that poke forward in the front. When this happens, your lower back also arches, and after a while…it hurts.

5. Hamstrings are pelvis stabilizers first. And their job is to pull the base of your pelvis down in the back, effectively “tucking” your tailbone under. When your butt pokes up (and your back arches) hamstrings get confused! And hamstrings, hips and knees, you guessed it, start to hurt.

So how should you do a plank to avoid all these issues?

1. Keep your back/rib cage “egg-shaped.” Push into the floor with your elbows to broaden and lift the space between your shoulder blades.

keep upper back rounded by pushing through elbows and broadening shoulderblades. Keep lower front ribs tucked in, and tuck tailbone under slightly.

2. Keep your pelvis slightly tucked. Instead of letting your back arch, tuck your tail under slightly- think of bringing your (imaginary) belt buckle up towards your belly button. You will feel your abs really working, and you’ll probably shake a little (or a lot!)

For extra credit- shift your weight slightly forward, but make sure you didn’t lose the tuck of your pelvis or the roundness of your back. (If you are losing it, work on the first variation for a while until you can maintain it with the shift).

Shifting forward while keeping the “lift” between your shoulderblades and the tuck of your pelvis creates an extra challenge for your abdominals.

After doing a plank this way, Ruth was surprised to find that her neck and shoulders weren’t sore after, and in fact doing the plank had reduced her pain! She felt more grounded, strong and free in her body upon standing.

Try a plank this way and see if you also find some more freedom and flow in your body when you’re done.

August 4, 2020June 23, 2021

Back Pain? How to Address the Root Cause

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

July 31, 2020June 24, 2021

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!

July 8, 2020June 24, 2021

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.

June 2, 2020June 4, 2020

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.

May 7, 2020August 19, 2020

How Do I Keep My Lungs Healthy? Two Simple Techniques

If you have ever come to see me as a patient, you have heard me talk about the importance of breathing. Not just for lung health, but for the health of your whole body.

That’s why I’m so glad that Ron Hruska, founder of the Postural Restoration Institute, was kind enough to put together two exercises that will preserve your lung health, and that almost anyone can do!

He created a video explaining the importance of compliance in our bodies especially in relation to our lungs, which I will summarize in this post. You can view the full video here.

So what the heck is compliance?

In terms of our bodies, it is essentially how mobile or flexible an area of your body is or isn’t. If an area is more stiff, it has less compliance, and if an area is more stretchy, it has more compliance.

In our bodies, there are areas that are anatomically stiffer and others that are stretchier. That’s just the way we’re made.

For example, your back has lots of layers of thick muscle and fascia, which makes that area more stiff. Conversely, the front of our body, including our abdomen, has much thinner, fewer layers of tissue, so this area is more stretchy (and also why you should not belly breathe! It makes the stretchy parts stretchier, and the stiff parts stiffer! More on that here).

Similarly, our left lung and surrounding tissues tend to be stiffer because the heart takes up a lot of space on the left side. The right side tends to be stretchier (unless we end up compensating, but I won’t get into all that here).

So, in general, the LEFT BACK area around the lungs tends to be more stiff, and the abdominal region a little too stretchy. This stiffness works its way down the chain to the left back pelvis because your pelvis motion is intimately correlated with your ribcage motion.

Why should we care about stiffness and stretchiness?

In the video, Ron shares an article about how a transplanted liver can last hours longer in transit if it is placed on a balloon-like structure instead of a block.

In this scenario, the balloon is your diaphragm.

The liver, just like all your other organs, needs to be massaged and moved around to be healthy. Your diaphragm, when working correctly, is constantly massaging your organs via your breath.

Furthermore, your lungs have many different nooks and crannys that need to be cleaned out by the right to left, front to back, and top to bottom pumping action we get through breathing and moving.

So the best thing you can do to stay healthy is to breathe well and stay moving! Climb stairs, get up and down from your chair, go for walks, etc.

But we need to give our lungs special attention, because of the anatomical differences we discussed earlier.

How does this relate to COVID-19?

Ron also cites an article from CNN, which discusses how healthcare providers are making it a point to place more severe patients on their stomach, and rotate them at certain time intervals throughout the day. This helps patients who are ventilated recover from COVID-19 infection.

The reason that positioning helps these patients is that lying on their stomach creates more stiffness in their abdominal region (from the pressure of the surface), and more stretchiness in the back. It also drains the back lung area of any infection, fluids, and stale air so that it can fill again with fresh clean air. Similarly, when the patients lie on their right side, the left side drains so that it can refill, and so on.

What is so amazing to me is that Ron and the Postural Restoration Institute created simple techniques that place your body in a position that drains all the right parts of your lungs, but in a functional, physically active way. Patients in the hospital on ventilators can’t do this because they are too weak, but you can!

Why would you want to do these exercises?

It’s so important right now to keep your lungs healthy. And if your lungs are draining and refilling well BEFORE you get sick, the severity and duration of your illness will be much less. So, hopefully you DON’T get sick, but if you do it will be good to have your body as prepared as possible to combat the virus.

Having good stretchiness/stiffness ratios in your body and lungs helps with so many other issues!

Allergies, airway issues, pain syndromes, there are so many benefits to these techniques.

I hope you try them, you will benefit from doing one or both of these every day. And at the very least, get up and move, whenever you can!

A simple technique to keep lungs healthy!

Another exercise to keep lungs healthy!

March 16, 2020May 1, 2020

5 Tips for Choosing Shoes

Most of the patients I work with benefit from wearing a shoe that not only supports your foot, but also provides neurosensory feedback that allows your ankles, hips, ribcage, and neck to move better. The right shoe is like a circuit breaker that gets you out of old patterns so you can rehab better and faster.

These shoe recommendations are not forever, but certainly while you are going through the rehabilitation process a good pair of shoes is essential to progressing and maintaining gains. Every year, the Hruska Clinic, created by Ron Hruska and the Postural Restoration Institute, provide a “shoe list” with the year’s best shoes based on appropriate stability and neurosensory prinicipals. This is a good place to start when selecting shoes. See the current shoe list HERE.

Once you are done with your course of physical therapy, you can certainly wear whatever shoes or boots you like to go out to dinner, the movies, etc. I still recommend that if you will be on your feet all day, when running, or if you are going on vacation and will be walking a lot, wear shoes that provide appropriate support and neurosensory feedback. This will keep you feeling good.

A lot of my patients ask me about dress or casual shoes that they can wear while they are still in their rehabilitation process, as they cannot wear tennis shoes to work.

While the shoes on the Hruska Clinic List will be the best during rehabilitation, here are some general concepts that you can apply to any shoe.

1. No Heels

Heeled shoes push you onto the balls of your feet, making your back arch and front ribs move up. In order to find a neutral position in our bodies, we have to be able to sense the ground through our heels. When we are forced into an extended position, this can cause issues all the way up the chain, from your feet to your neck and head.

2. Shoe Structure

Mary Jane strap shoes or shoes that lace up are best. Slip on shoes or flip flops provide a sense of instability to your body, causing your ankles, pelvis and neck to stiffen in an attempt to stabilize. This leads to compensations and pain.

3. Heel Stability

Not only do you have to sense the base of your heel through your shoe, but it is also important to feel a “hug” around the base of your ankle, just below the achilles tendon. This support allows your ankles the freedom to “wobble” in and out. This wobble allows our foot to transition between pronation and supination, which are essential for normal walking.

4. Sense Your Foot.

Feeling your heels is important, but the shoe should allow you to feel your whole foot. Try this technique to see if you feel your whole foot in your shoe:

Stand with your right foot slightly in front of left, left arm forward, right arm back (as if you are in the middle of taking a step while walking).
See if you feel your left heel, arch, and big toe.
Slightly lift your right foot off the ground, and see if you still feel left heel, arch, and big toe.
Repeat on the other side (right foot slightly behind left, right arm forward).

If you don’t feel your arch or big toe in this position, this is not the shoe for you. Or, if you only feel your arch and it is painful or you don’t feel the other parts of your foot (heel and big toe), then the arches in the shoe are too high.

5. The Shoe Should Feel Good Right Away!

You should not have to feel like you have to break in a shoe. It should feel comfortable when you try it on in the store. Your body will let you know when you have found a good shoe.

Everyone is different and some people need individualized advice on finding the right shoe. However, if you find a shoe that meets all these criteria, you are likely going to have good success with that shoe.

March 2, 2020August 5, 2020

Balancing Two Sides of One Body

Most of our movements- the way we sit, stand, eat- are happening subconsciously. Furthermore, we all have preferences for doing things on one side or the other, and in one way or another. While handedness plays a role in this, our neurology and the way our brains are wired play a much larger role.

Most of us have heard that we have different functions for the right and left sides of the brain. As far as physical function, the right brain controls the left side of the body, and the left brain controls the right side of the body.

The perception of the two sides of the brain is a bit more nuanced. The right brain manages sustained, broad, and vigilant alertness. Conversely, the left brain has a narrow, sharp, and focused attention to detail. The right brain is more focused on the big picture, the surroundings, what’s going on in the background. The left brain is more alert to what’s right in front of us, the immediate task at hand, what’s next on the agenda, etc.

An example of how the two sides of the brain work together is driving a car. In this situation your left brain has focused attention on the road in front of you. While this is very important, it is also important to be aware of your surroundings. Your right brain is broadly scanning the environment for potential threats such as other cars, pedestrians, hazards, and so on.

sculpture of a head showing different functions of the left brain — Different sides of the brain have different functionality

The left brain contains the centers for speech and language. Since the left brain controls the right side of the body, the right arm becomes prominent in communication, growth, and development. Even in left handed people, there is a tendency for the right shoulder complex to be tipped forward and down as a physical representation of the interactive quality of the right side. This is because even though handedness is a strong driver of pattern, the brain and nervous system are far stronger.

This normal and natural asymmetry can be problematic when it is not balanced with left arm neurological and muscular activity, so in clinic we work on changing movement patterns at the level of the nervous system. My patients often tell me that when they do their exercises at home, they are not sure if they are doing it right and it feels hard to keep track of all the movements in the exercise. I always tell them this is exactly what we want, because we are trying to change a movement pattern, not just get stronger. You can go to the gym by yourself and lift weights if your goal is muscle mass. What you need from physical therapy is to learn how to change the wiring of brain and body, to become better balanced right to left in three dimensions. For this to occur, it will probably feel like your brain is working just as hard, if not harder, than your body when you do your home program.

Learning to change a movement pattern is like learning to drive a car. At your first driving lesson, there was an overwhelming amount to pay attention to: hands on the wheel, gas, brake, checking mirrors, road signs, and if you had a clutch then that’s a whole different animal. But now, you drive somewhere and think, “wow, I don’t even remember driving here, I’m just here!” That’s because the neurological and muscular systems have become automatic through repetition, but you had to start with a very “thinking heavy” process to get there. You had to pay attention in the beginning, and now it just happens naturally.

That is how we bring our body into balance, by literally re-wiring the neurological and muscular patterns in the body. We use conscious effort until it becomes unconscious. Because the reality is that so much of what we do in our day is unconscious; but if those daily patterns are not regulated by transitioning well from right to left and back again, we develop strong patterns that create structural weaknesses, instabilities, and pain syndromes like fibromyalgia.

One simple way to balance the left and right sides of the body is through a breathing technique called “nadi shodhana” in sanskrit, which we can loosely translate as “alternate nostril breathing.” This technique is simple and very soothing to the nervous system as it creates a deep sense of balance in the body at a neural and respiratory level. See the video below to try it out.

https://youtu.be/c6ay8f6bJHk

Alternate nostril Breathing for Body and Brain Balancing

December 18, 2019June 24, 2021

The Illusion of Symmetry

From the outside we look symmetrical. Left to right, it seems that if you drew a line down our center we would get two equal parts. Most anatomical drawings present the human body in this way.

When we dig a little deeper, it turns out that right to left we are quite different, and these differences can have a profound effect on our physical functioning.

Often I have patients ask questions like, “why is it that only my right knee hurts with running?”

Good question! Some may say that this is due to handedness, with most of us being right handed. But have we ever stopped to ask why it is that most of us end up being naturally right handed? I don’t intend to get into a debate about handedness, but it certainly hints that there is something else at play, some asymmetry inherently present in all of us. These asymmetries are normal and natural. However, these asymmetries can become problematic when they become unbalanced.

This can occur due to external or internal circumstances. For example, your life requires that you do repetitive tasks to one side only, like reaching for the phone on the right, or getting in and out of the driver’s side of your car. It may also be something intrinsic to you, such as an injury. If you had an injury to your left leg, you felt more stable on your right leg as you were healing. That is helpful while you heal, but that patterning of preferring the right leg to stand on can remain long after the tissues have healed.

The Postural Restoration Institute has a deep understanding of these asymmetries and how they affect us. This institute is unique in that it addresses these complexities of being a human when creating a treatment plan, which I have not seen in literally any other course or training for physical therapists, even when I was in my doctorate program this was glossed over at best.

Let’s Talk Asymmetries.

The primary source of these asymmetries is the center of our body, the trunk. It is the generator of motion in our limbs and it is our center of stability. At the center of our trunk (the “core of the core,” if you will) lies the diaphragm, which is dramatically impacted by the asymmetries of our organ and lung placement.

The diaphragm on the right tends to be more domed due to:

lower attachments of the diaphragm onto the right side of the spine compared to the left.
The central tendon (which makes the dome of the diaphragm) is thicker and stronger on the right than the left.
The right diaphragm has the support of the liver underneath.
The presence of three lung lobes on the right and only two on the left to make space for the heart.

Radiograph showing the right diaphragm (left side of picture) being higher than the left. This is normal human patterning.

All these things cause the right rib cage to be in an “exhale” position with the ribs dropping down and into the body, and the ribs on the left to be in an “inhale,” an elevated and expanded position. Think of the left lung as a big balloon pushing on the smaller balloon on the right. This causes an orientation of our ribcage to the left. The attachments of the diaphragm on the spine cause the spine to turn right.

The Postural Restoration Institute has recognized this natural asymmetry and incorporates this anatomical variance into their training of physical therapists and therefore the treatment of our patients. When I first heard that everyone is biased one way, it was news to me. When I was in my doctoral physical therapy program, we learned all the asymmetries of the vital organs, however the influence of this asymmetry was not applied to physical function. Furthermore, the asymmetrical structure and pull of the diaphragm was hardly mentioned, if at all. I find this surprising now as the diaphragm is a muscle that we use all day, every day, and it has profound impacts on how we move and interact with our world.

So what’s the big deal about the diaphragm?

The diaphragm is huge! It attaches to our lower back spine and interfaces with our abdominals, low back muscles, and hip flexors. After I took my first postural restoration course, I was pleasantly surprised at the emphasis on diaphragmatic function and it’s role as a driver of human movement. I was also surprised at how “belly breathing,” which I taught and practiced myself, was actually detrimental to harnessing the power of the diaphragm. The inherent asymmetries within our diaphragm drive the initiation of human movement, specifically walking. Essentially, the stability of the right diaphragm supports right stance phase of gait (standing on your right leg and left leg swinging).

walking still shot in Right stance phase with left swing phase

The problem occurs when we go to stand on our left leg, but we are still in right stance with our supporting muscles. The left diaphragm is not able to support our body in this position, and our right leg does not adequately recruit muscles to swing the right leg. This occurs not just in walking but also during day to day tasks. This can create all kinds of issues, knee pain on one side being just one of them. Fortunately, this asymmetry can be addressed with specific exercise that is asymmetrical, and therefore corrective. These exercises incorporate the breath to achieve diaphragm function.

Once again, I want to reiterate that this asymmetry is not a bad thing inherently. It is in fact a wonderful thing as it initiates the walking cycle and allows us to begin rotating through our trunk and pelvis. Asymmetry becomes a problem when we get stuck on one side, and are not able to get over to the other side. Relearning how to transition from right to left, and then back from left to right, is how we get balanced again.

Are you transitioning well from right to left stance?

You may have difficulty transitioning from side to side if you:

Tend to always have tightness in one hip more than the other
Always cross one leg over the other (usually the left one over the right)
One leg feels longer than the other
You notice different wear patterns on your shoes or bike saddle

Try this simple exercise to test your asymmetry:

Stand with toes pointed straight forward (feet not turned in or out). Keep this foot alignment as you transition to standing on one leg. You can touch a counter in front for support. Now, turn your pelvis so that the zipper of your pants comes over your right big toe. Try the same thing standing on the left leg, toes pointed forward, knee slightly bent. This time, try to turn the zipper over your left big toe. Notice if you can do this on one side, but not the other.

If you find one side to be challenging, but not the other, that indicates you may have trouble shifting to one side. Because of our natural human pattern, it is usually harder to do this standing on the left leg. That doesn’t mean you can’t stand on that leg at all, but it means that when you are standing you aren’t using the correct chains of muscles, which results in pain and dysfunction. To address this issue, come see me or a PRI trained therapist near you to get properly screened and the tools to find better ease and balance in your body.