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.
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.
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 đ
Have you ever been told to do that? I certainly have! “Breathe deep…” that’s what instructors have told me during hard workouts as I sweat and sputter for air. I’ve had kind friends tell me to “just breathe deep!” when I’m going through a stressful moment.
This sounds like a good idea, because deep inhales calm you down, right? Well…actually no.
In fact, taking a deep breath is the last thing you want to do if you’re trying to calm down!
One of the best things you can do to calm and destress is to hold your breath.
Sounds crazy, I know! Because everyone always tells you to breathe, and we’ve all heard that breath-holding is really bad for us. That is true but also NOT True! Okay…let me break this down a bit.
Holding our breath is really unhealthy if we are unaware that we are doing it.
Disorders such as sleep apnea are harmful, unconscious forms of breath-holding. We want to avoid this for sure!
A new form of unhealthy, unconscious breath-holding is becoming more common and leading to all kinds of problems. This type of breath-holding occurs when we are constantly shifting between tasks and never focusing on one thing for a sustained period of time. Without realizing it, we forget to breathe.
Our current lifestyle promotes this scattered attention. With computers, phones, and watches pinging us all day long we can’t stay focused even if we try!
This form of unconscious breath-holding, now dubbed “email apnea” is very problematic- leading to poor digestion, increased stress hormone production, increased blood pressure, a dampened immune system, decreased ability to focus, and interrupted sleep. After months or years of this, your neck and shoulders get tight on top of everything else.
So why am I telling you that you should hold your breath? Because when you consciously hold your breath, all sorts of wonderful things happen.
Breath Holding for Clarity of Mind
Yes, it’s true, when you hold your breath you start to feel anxious, irritable, and hyper-focused on getting air in. But this momentary air hunger results in a state of peace and calm once you are finished with the technique. Over time this relaxed state becomes more and more prominent because your tolerance to carbon dioxide is increasing and your breathing patterns are becoming normalized at rest.
Yogis have been practicing breath-holding techniques for thousands of years.
At that time they already knew that there were health benefits, and now we know the science behind it.
By exposing the chemical sensors in your arteries to greater and greater levels of carbon dioxide by holding your breath, you restore normal breathing patterns that have been disrupted due to minor (or major) stressors in your life.
Yogis would often use breath-holding techniques as a way to prepare for sitting in meditation because as breathing normalizes, thinking becomes clearer.
But don’t worry! You don’t have to meditate to get all the benefits. Just doing the breathing techniques are enough.
Breath-Holding and Anxiety
Breath-holding techniques have been shown to help with anxiety and depression disorders (of which 50% of Americans will suffer one of).
The problem is, patients with anxiety have a much greater fear of holding their breath. To avoid the sensation of air hunger- which is inherently anxiety producing- they over-breathe.
Over time, their chemical sensors tolerate less and less carbon dioxide, and it becomes harder and harder to hold your breath. This cycle creates more anxiety, more over-breathing, and so on.
Slow breathing is taught to people who suffer from panic attacks because it increases carbon dioxide levels without the fear-inducing capacity of breath holding. So, if you know that you tend toward anxiety or panic attacks, try slow breathing first.
If you are feeling stressed, anxious, or panicky, your body is already increasing your oxygen levels and reducing your carbon dioxide levels. If this continues, a panic attack can occur. By increasing and maintaining higher levels of carbon dioxide, the anxiety can be prevented before it even starts.
So, instead of taking a deep breath, try holding your breath!
This will increase your carbon dioxide levels and trigger your chemoreceptors to increase your tolerance to carbon dioxide. At first, while holding your breath, you may feel MORE anxious, uncomfortable, irritable. Your body will scream at you to breathe. But AFTER you hold your breath, the opposite happens. You become relaxed, calm, clear-headed.
Precautions
A word of warning: do NOT try this technique if you are pregnant or if you have cardiac issues or heart problems. This technique is also not appropriate for children under age 12.
How to Do It:
To practice breath-holding, make sure to breathe slowly and smoothly in through the nose and out through the nose. If your breath becomes ragged or uneven, or you are feeling very anxious or panicked, reduce the time of holding until you can perform the exercise comfortably while still reaching the sense of slight urge to inhale.
Here’s what to do:
Slowly inhale to the count of four.
Exhale fully but slowly also to the count of four.
Hold your breath when you are done exhaling for a count of four.
Repeat this breath cycle for 1-2 minutes.
You can increase or decrease the count depending on if it feels easy or too challenging, for example holding each stage for only 2 seconds if it feels very hard, or 5 seconds if it feels easy.
*Aim to hold the breath for the same duration as the inhalation and the exhalation. This is a goal to work toward if holding your breath is hard initially.
A few things to keep in mind:
Don’t over-effort to hold your breath, work within your range of sensing some air hunger but not over doing it.
Practice this technique sitting or laying down. Do not do this technique while standing.
Keep your mouth closed and breathe through your nose as much as possible.
Practice this breathing technique on an empty stomach if possible.
Potential Health Benefits:
Improved diaphragm function.
Increased lung capacity.
Cleared out residual, dead air from the lungs.
Restored function of the respiratory center in the brain (due to the increase in carbon dioxide during breath-holding).
Increased oxygen off-loading to tissues, resulting in improved breathing efficiency and endurance.
Reduced stress and anxiety.
Clearer thinking.
Improved circulation.
May help with relieve digestive problems, allergies, asthma, and auto-immune disorders.
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 severedegeneration, 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 ĂP, Holm I, Keller A, Ingebrigtsen T, ReikerĂ„s 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
WĂĄng 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
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 đ ). 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.
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 âsucking wind.â
It just felt like I couldnât 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 didnât 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, âthere must be something wrong with me.â
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 couldnât breathe. I thought I might die. âIs this asthma?â I thought.
These days, I am the one zooming up the trail.
I surprise myself at how sometimes, even after I havenât 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 werenât moving well, which didnât allow me to exchange enough oxygen into my blood stream.
So, even though I was constantly exercising, my tissues werenât 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 werenât 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 didnât 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 itâs 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 thereâs no room for feeling, because before our feelings were so terrifying and painful that we donât want to risk going there again.
Trauma lives in our bodies, not in our thoughts.
We canât 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 donât 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.
“…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 donât breathe, we donât shift. When we donât 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 didnât 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 donât exhale all the way, your lungs and ribcage donât 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 youâre 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 didnât say FORCING air out (which is what most of us tend to do). Itâs 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 youâre 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, âahhhhhh.â
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, Iâve 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.
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 sadnessassociated 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.
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.
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, andthat 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!
We all have them, the big broad bones that fold onto the back of your ribcage like wings. But what do we really know about them?
To understand the function of the shoulderblade, or âscapula,â we must first understand their form.
1. The only bone to bone attachment of the scapula to your trunk is a tiny joint where your collarbone meets the top tip of the scapula.
This joint, called the acromioclavicular joint, or AC joint, is about as secure as if you put the tips of your two index fingers together head on, i.e. itâs pretty flimsy.
The joint between your shoulderblade and the rest of your body is about as secure as the joining of two fingertips.
The crazy thing is that the arm bone attaches to the scapula bone via a shallow concavity, and the scapula is attached to the rest of your body via the above mentioned AC joint. Literally the only bony attachment of your arm to your torso is via a tiny, flimsy joint.
The acromio-clavicular joint, or AC joint, is the only connection between the scapula and the rest of your torso.
So, youâre probably wondering at this point, âhow is my arm not falling off?â It is pretty amazing that our arms not only stay attached, but that we are able to climb, crawl, draw, reach, swim, etc with such precision and stability.
2. It is mostly muscle that holds our arm onto the rest of our body.
This is an amazing design because it allows for a huge degree of mobility in the shoulder, which is necessary to do all the precise tasks and vast ranges of motion required of our arms.
However, this can also create a lot of problems. Muscles change their function based on their position, and repetitive, habitual movement patterns can place muscles in suboptimal positions. If we always sit at the same desk, with our phone on the same side, or we always sit the same way in the car, or always throw a ball with one hand, we are slowly but surely ingraining one-sided patterns into our bodies.
When this occurs in the shoulder and shoulderblade regions it is especially impactful due to the heavy reliance of the shoulder on muscles for stability. This is why shoulder injuries often have little to do with the shoulder, unless it was due to a direct trauma. Usually it is a muscle imbalance or aberrant positioning around the scapula that is the issue, even if the pain is felt in the shoulder.
3. Our shoulderblades are concave in shape
Even though at first glance it seems that are shoulderblades are flat, they actually have a concave shape. This allows for the shoulderblade to sit on the ribcage, which is egg-shaped.
Side view of a shoulderblade showing the concave surface that touches the ribcage.
However, many of us tend to change the shape of our ribcage by changing the way we breathe. For example, a common pathological breathing pattern is pushing the front lower ribs up in order to get air in without completely exhaling. This is a common breathing pattern when we are stressed- it is a shallow, more rapid breath. If we are a little stressed most of the time, our breathing will reflect that, and over time the shape of our ribcage will reflect that as well.
What this “stress breathing” pattern does is create a flattened ribcage in the back, so now we have a concave shoulderblade trying to sit on a flat surface. At this point the muscle activity cannot be restored because it is the structure underneath that is the issue, and must be corrected before the shoulder can start to move better and feel better.
The shoulderblade is often overlooked when we think about how we move our bodies, but its position and function is vital to our arms being able to move well and without pain. Keeping the muscles around your shoulderblade strong and in an optimal position, as well as keeping your ribcage well positioned with proper breathing, will preserve the life of your shoulders and make for a much happier and painfree shoulder complex.
With the exponential growth of yoga in the last few years, class sizes are getting bigger, and the content more imaginative. It is wonderful that more people are exposed to yoga. As a physical therapist, what concerns me is the lack of emphasis on internal stabilization. This stability comes from deep muscle activation, in sanskrit called bandha, which translates to âLock.â
In our fast-paced lifestyle, we are often tempted to put ourselves in a position of compromise to “just get things done.” We skip the part where we find our sense of center, and we forget to return to it repeatedly. This is what the practice of bandha teaches us. Developing the bandhas takes effort to build strength, vigilance to maintain, and patience to master. However, once the bandhas are in place, all the other aspects of yoga practice become more accessible, fluid, and enjoyable.
Bandhas stabilize the body during dynamic movement. Some yoga postures can even be damaging if done repeatedly without this awareness. Sure, a teacher might now and then mention a bandha, or advise students to âengage the pelvic floor.â . The problem is that many people have never been taught how to access the bandhas in the first place.
Yoga and the bandhas can apply to every day life.
What are bandhas, and how do we access them?
In yoga there are essentially three bandhas in the body. The
main two we will discuss today are âmula bandhaâ and âuddhiyana bandha,â which
represent the pelvic floor muscles and the transversus abdominus muscle, respectively.
These are the deep stabilizers of the trunk and pelvis. The third bandha is
âjhalandara bandha,â which involves the core muscles of the neck and head known
as the deep neck flexors (longus colli and longus capitus muscles).
Mula Bandha (Pelvic Lock)
Letâs start with mula bandha, the root lock, or the pelvic floor. In physical therapy practice we often teach patients to engage their pelvic floor if they have hip, back, and leg pain. I even now teach pelvic floor exercises to help patients who have neck pain, because the pelvic floor is the “foundation of the house.” If the head and neck are the roof of the house, you can imagine how a poor foundation would result in an unstable roof.
In my experience working with patients, these muscles are inherently difficult to engage for several reasons. The first is that they are âpostural muscles.â Unlike big mover muscles, like the thigh muscles that bend the knee, the postural muscles are under subconscious control. This makes it difficult to fire them at will, and they are harder to feel. The thing that makes pelvic floor muscles really hard to access is the fact that we canât see them, and many people have never even heard of them.
How to access Mula bandha
As mentioned
above the pelvic floor is hard to access, but visualization can be helpful.
Sit on a firm chair with knees and hips at 90 degrees and feet flat on the floor.
Sitting up straight, hinge forward and back from the pelvis until to feel ventered on your sit bones (the boney protrusions at the base of the pelvis).
From here, draw the sit bones closer together, without tightening your gluteal muscles.
Keep this as you visualize the sit bones pressing down into the chair, as the space between them moves up (this is the doming up/activation of the pelvic floor muscles that make mula banda).
If you can achieve this lifting sensation, you can try maintaining that while visualizing your coccyx (the tailbone) and the pubic symphysis (the very front of your pelvis) also moving towards each other.
These four points (the sits bones, coccyx, and pubic symphysis) all are moving towards a central point.
Even if you feel nothing initially, with continued visualization you will begin to feel something. It is a process.
Uddhiyana Bandha (Navel Lock)
Also known as âflying upâ bandha, this is the place between your navel and your pubic bone that wraps around your waist. It creates lightness and lift, and stabilizes the trunk and pelvis during movement and during static standing and sitting. A long, flat sheath of muscle, this bandha is made up primarily by the transversus abdominus and the internal oblique muscles.
The transversus abdominus muscles that make up uddhiyana bhanda.
How to access Uddhiyana Bandha
One accessible way to feel uddhiyana bandha is by activating the leg muscles strongly.
Stand with your feet hip width apart, feet parallel.
Draw up through the inner arches of the feet, while rooting the base of the big toe, base of the pinky toe, and straight down through the heel. You may feel something light up in your core with just this! If not, no worries, keep going.
Imagine you are drawing all the musculature of your legs up towards your pelvis.
Maintain that as you tighten the front and back of the thighs simultaneously.
At this point you should feel the area below your navel turning on. That is uddhiyana bandha.
Now see if you can relax your legs somewhat while keeping the activation in your abdomen.
Jalandhara bandha (Throat Lock)
While the full expression of Jalandhara Bandha is more
applicable during breathwork, a sense of this lock can help with asana practice
as well.
Due to our lifestyle that now frequently involves sitting,
the head tends to come forward with the chin protruding. Then, when it comes
time to practice yoga on the mat, we carry this poor posture with us.
Jalandhara bhanda can mitigate this effect by teaching us to draw the head back over our spine. In the full expression of the bhanda, the chin is nestled in the nook of the breast bone between the collar bones, called the sternal notch. This can be a good release of the fascia along the back of the neck, but is impractical for asana practice and may cause strain for some individuals.
A lighter version of Jalandhara bhanda can help us find a neutral and stable position of the head and neck by recruiting the muscles that make the âcore of the throat.â These deep muscles return the head to a neutral position.
How to access Jalandhara bandha (throat lock)
Sit in a firm chair, feeling your sit bones.
Exhale completely through your mouth as you let your neck and shoulders relax and your front lower ribs move down and in (for more info about the importance of the ribs here, see my other post âthe posture mythâ)
Now, draw your head straight back so that it sits atop the rest of your spine.
Maintain a relaxed posture of your neck and shoulders as you draw slightly nod your head down as if you are holding a small orange between your chin and the space between your collarbones.
Imagine the base of your skull floating up as your chin drops slightly, lengthening the back of your neck.
Check to see that your shoulders are still relaxed. If not, take another exhale and let them drop.
Stay here a few breaths, inhaling to lengthen through the back of the neck, exhaling to settle the shoulders and the front lower ribs.
Yoga and Injury
As a physical therapist, the most common yoga injuries I see are in people who are naturally flexible (usually young to middle-aged women, which happens to be the largest demographic of yoga practitioners). These individuals can put themselves in many challenging postures but lack the deep stabilization of the bandhas. I also see stronger men and women who are able to muscle through arm balances but end up with neck and shoulder pain because really it is the deep connections of the bandhas that create a sense of levity in arm balances, not the arms. Practicing poses with correct activation of the deep stabilizing muscles may mean that you have to approach the pose in a new way, and you may not be able to make the pose look as good initially. This is where the yoga really happens- when we shift our focus from what the pose looks like to what it feels like, when we move from place of integrity and patience.
It can take time to develop a keen awareness of the bandhas and to incorporate them into practice. However, by learning to engage the bandhas, yoga injuries can be prevented and healed by practicing with increased awareness, intention, and patience.
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, âwhy is it that only my right knee hurts with running?â
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 donât 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 âcore of the core,â 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 âexhaleâ position with the ribs dropping down and into the body, and the ribs on the left to be in an âinhale,â 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 whatâs 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 itâs role as a driver of human movement. I was also surprised at how âbelly breathing,â 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).
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.
