Core Strengthening: The Wellness Station Way!

What is our core, what does it mean to have a strong core, and what are the best methods to achieve this?

Many of us associate the idea of having a strong core with the ability to stay active and independent as we age, maintain our balance, avoid injury, ease back pain, or perhaps maintain a trim waistline.

Although the idea of core strength is popular and highly sought after, what we are really after is core responsiveness: how efficient and with how much precision are our core muscles able to respond to the needs of our environment and our intentions. In other words, how well are our bodies able to do what we want them to do in a given situation?

This responsiveness depends on our neuromuscular system- the intricate connections between our brain, spinal cords, and muscles. It is crucial that this responsiveness includes all of the tiny muscles that connect each of our vertebrae, which are vital for dynamic stability, proprioception, and the ability to "change shapes" depending on the needs of the situation.

In the world of traditional physical therapy and fitness, the idea of core strength is often reduced to "core stability", and focuses on the ability to brace and hollow the abdomen. The general notion is that we must be able to keep our core very tight and rigid during movement, lest we injure our spines. This rigid stability utilizes the large, long muscles that travel up and down the spine, neglecting the tiny muscles in between each vertebrae. This is not how we function as human beings!

As we live in a three-dimensional world, our bodies need to be able to efficiently change shapes based on the situation we are in. By only training ourselves to keep our cores tight and thus restricting movement, we are behaving in a linear manner that is not conducive to our dynamic, three-dimensional world. Although this type of core engagement can be helpful in some situations (perhaps if a pet or a baby decided to crawl on our stomach!), far more often this approach is selling ourselves short and could actually put us at a higher risk of injury, pain, or limited function.

   Consider the example of a stack of blocks connected by elastic bands as referenced in our Ehlers Danlos blog post, illustrating the difference between segmental vs. rigid core responsiveness. The traditional approach to core stability is similar to the example in which the blocks are connected only by four long rubber bands, in which the vertebrae (like the tower of blocks) are undifferentiated and controlled using the large, long muscles of the spine. This would neglect the small muscles of the spine that allow us to move with efficiency, fluidity, and balance. Our approach at The Wellness Station reflects the example in which the tower is connected by smaller rubber bands in between each block, allowing the structure to form a variety of complex shapes and forms, representing segmental spinal responsiveness.

Our core is our spine- we need to be able to move our spine in the three dimensions. Flexion and extension, side bending, and rotation. Each of our many vertebrae are capable of movement, and our deep spinal muscles (including the transversospinales and the segmental muscles) allow this movement.

By engaging in mindful movement practices to target these muscle groups, we can strengthen our mind-body connection to these areas, thereby improving responsiveness of our core.

This is truly what core strength is- our ability to move our spines into different shapes efficiently, mindfully, and powerfully depending on our intention and the circumstance we find ourselves in.

Here are some examples of mindful movement drills that engage the body in three-dimensions, and target segmental movement of the spinal column. Enjoy!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Stairs With Sore Knees: From Struggle to Success!

Stairs can be a major stressor for those of us with sore knees. Oftentimes, older adults begin to avoid stairs as much as they can, and even choose homes that are on one level for this very reason. When stairs are the only option, there may be extra difficulty, both because of issues with the knee joints, as well as the deconditioning of muscles that may have occurred as a result of not going up and down stairs as frequently (use it or lose it). The act of choosing to continue to use stairs as we age is a great way to maintain strength in the lower body, but this will only be beneficial if we can climb stairs with ease and efficiency. Rather than making stairs the enemy, how can we begin to see stairs as a healthy challenge that will help us maintain our strength and mobility?

Biomechanics of stairs:

It may be helpful to understand a little bit of the biomechanics of stairs, or the physics of the movement. Going up stairs is a concentric action, in which the muscles shorten as they contract, creating a force that overcomes resistance. Most of the concentric action occurs about the hip and knee joint, and key muscles for going up stairs are the quadriceps (front of thighs) that act to extend the knee, and the hamstrings (back of thighs) and gluteus maximus (large buttock muscle) that shorten to extend the hip.

We also require use of our hip flexors (front of abdomen to front of hip) to lift our foot to the next step. In addition, if we learn to ascend stairs using more of our body, muscles on the sides of our bodies can also help, including our gluteus medius (side hip muscle) and quadratus lumborum (side of waist/low back). We can rely on the integrity of our skeletal structure to help direct the forces required to go upstairs, as we can send our body weight over our supporting leg, thereby requiring less overall muscular effort to go up stairs.

Going down stairs is actually more difficult for many people, especially those of us with knee issues. The skeletal system of our bodies is extremely important for supporting and directing forces. Going upstairs, we are able to rely on our skeletal structure more reliably, whereas going downstairs requires the supporting knee to be very bent, which makes the muscles in the front of the thigh have to work much harder. Going down is an eccentric action, which means muscles have to lengthen while contracting, as they control against the force of gravity. In other words, eccentric contractions are kind of like controlled falling. These types of contractions are actually more difficult for our muscles, which is why eccentric training is an excellent way to improve tissue strength and resilience. However, if our muscles lack the strength to control our movement during gravity, we might notice going down stairs, sitting down into a chair or toilet, or lowering ourselves to the floor may turn into more of a “plop” than a smooth motion. This indicates that our muscles lack eccentric strength, and our joint tissues may be taking a great deal of strain as we do these activities. 

Another reason why going down stairs might be more difficult for some is that it tends to isolate the knee joint more than going up stairs. As described above, going up stairs can make great use of the muscles of the hips and core. In going down stairs, notice that the knee might travel far over the toes, and very little movement actually happens in our hip. As the knee travels over the toes and the quadriceps contract eccentrically, pressure builds up in our knee which can be an irritating factor, especially if we lack eccentric control or if there are other factors at play that are impacting our movement efficiency.

Strategies for a “bad day”:

Although practicing stairs is a great way to get better at stairs, sometimes we have to modify how we do it based on pain and discomfort. Think about an early morning. In the winter. Perhaps you “overdid it” yesterday, and your knee is speaking to you. Or perhaps, you had a knee replacement surgery not so long ago and your knee simply is not in shape to do stairs normally. If this is the case, here are some strategies for bringing more ease into your life:

1) Up with the strong, down with the sore:

This popular adage is well known for anyone who has had a knee replacement. Many will say “up with the good, down with the bad”, but why the negative self-talk if we could just say sore? This advice simply means to go up and down stairs one at a time, rather than your leg traveling past your other leg to the next step. Also, when going up, lead with the leg that is stronger, not experiencing as much discomfort, etc. And when going down, lead with the sore leg. This will make sure the strong leg is doing both the concentric and eccentric action to give the sore leg a break.

2) Try backwards, or sideways:

This tip is mainly for going down stairs. If one were to go down stairs backwards, mechanically, it would look a bit more like going up stairs in which we can use our hips a bit more rather than isolating the knee. For safety reasons, it is extremely necessary to practice this first before gallivanting down the stairs backwards. Try standing on the bottom step, holding on to the railing. Then slowly lower one foot down to the ground, followed by the other foot. Then come back up, practicing several times to get the hang of it. Similarly, when going down sideways, the knee does not have to travel so far over the toes. We are able to bend at the hip more to lower down to the next step. Going down sideways will also make it possible to hold on to a railing with both hands. On a bad day, consider going down backwards or sideways leading with the sore leg, just as described in the previous strategy.

Strategies for optimizing movement and preventing issues:

On a typical day perhaps if our knees are not a bother, and we would like to embrace the healthy challenge of doing stairs in an efficient and strain-free way, consider the following recommendations:

1) Root your heel to rise, bend side to side:

Rooting to rise means to take advantage of the force that the ground gives you, known as the ground reaction force. As we might remember from Sir Isaac Newton, every force has an equal and opposite reaction. When we put weight into the ground, the ground exerts an equal and opposite force back up into our skeleton, allowing our bodies to move. By focusing attention on our ability to harness ground forces, we might be able to navigate stairs and other movements with a greater sense of clarity. By placing our heel completely on the step when going up, we can actually push down through our heel as our body leans forward over our foot. By pushing down through our heel, we will rise up to the next step, thereby rooting down to rise up. The muscle that pushes our heel down is the same muscle that extends our thigh back, which is our gluteus maximus, the strongest muscle in our body. If our heel is dangling off the step, we cannot make as efficient use of ground force, and more force may be required from our knees.

When going up stairs, we can train ourselves to move partially in the lateral plane, rather than only the sagittal plane to take further stress off the knees. Put simply, we can let our body side bend help us ascend to the next step. This is a difficult concept to describe that must be felt in the body to understand. One way to think about it is relating the action to pushing down on a trash can pedal to lift the trash can lid. If the right foot presses down on the step, the left side of the pelvis will lift up, bringing the left leg to the next step. In this case, the right foot would be pressing on the imaginary trash can pedal and the left side of the pelvis would be the lid.
This action is accomplished mainly by the gluteus medius as well as the quadratus lumborum, which are muscles on the side of the pelvis and abdomen.  

One way to practice this feeling before doing it on the stairs is to try a slow march standing in place. Place hands on the sides of your waist. Begin to lift your left thigh up, thinking about pressing down into the ground through the right foot. Notice that the left side of your waist would get shorter, and the right side of your waist would get longer. Continue in a slow march, paying attention to the changing length of your side body. Imagine that the leg that is holding your weight is pressing down into the trash can pedal, and the side that is coming up is the lid.

2) Practice Step Ups and Downs:

As we learned, eccentric strength is necessary to go down stairs with ease, and concentric strength is necessary to go up stairs. A great way to improve this strength is to practice step ups and downs. On the bottom step or perhaps using a stool as well as something to hold on to as needed, place heel up onto the step and practice driving down through the heel to step up. Keep the same heel on the step, and lower down backwards with control until your other foot touches the ground. Repeat several times, noticing the activation of your thigh, glutes, and side body muscles.

For a more challenging exercise, practice going down a step facing forward. We have learned, this is the most difficult and likely to elicit discomfort of the knee. For this reason, it is important to start practicing by holding on to something, as well as starting with a partial range if you are having difficulty controlling this motion. Start standing on the bottom step, keep one foot where it is, and begin to lower the other foot towards the ground, but only a couple of inches. Then return to the starting position. The key is to lower down very slowly, to ensure you are maintaining eccentric control. Try a few more times, perhaps each time letting the foot travel a little closer to the ground as your other knee bends. Notice the tracking of your standing knee on the leg that is holding your weight as you lower down. Does your knee bend straight forward over your toes? Does it drop in towards the big toe side, or out to the pinky toe side? Does making a change to where your knee tracks impact the comfort and ease of this motion? Spending a little time each day practicing these movements will condition your body and your mind to be primed and ready for the next time you encounter stairs.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Osteoporosis and Osteopenia: A Healthy Movement Practice

Are there any special considerations for a movement practice for someone who may be at risk of osteopenia or osteoporosis, or perhaps is already diagnosed with a condition of impaired bone density? 

Absolutely! One size does not fit all when it comes to movement, especially when it comes to protecting the integrity of our bones. At the Wellness Station with our Feldenkrais-inspired approach, it is our job to address osteoporosis and osteopenia with individually-crafted lessons that are unique for every individual. Factors that are important to consider throughout therapy are how to maintain and increase bone density, improve muscular strength and responsiveness, body awareness, and help prevent the risk of a fall or compression fracture.

Here are some key considerations when engaging in yoga or any movement if you are aware that you have decreased bone mineral density:

1. Communicate effectively with your body: 

When we move, we are engaging in a dialogue with our body. We initiate the movement, and it is our job to listen to how our body responds, and modulate our movement based on that response! In other words, what are the subtle signs that we can pick up when we are putting our body through strain? Do we notice when we are doing a forward fold that we feel uncomfortable pressure in our abdomen? Do we notice that the way we pick up a heavy object from the floor causes us to hold our breath and feel a sense of distress? If so, we have to change the way we are moving.

2. Modify movements that put excessive load on the front of the spine or neck of femur: 

The most common osteoporotic fractures are of the front vertebral bones in the low or mid back. Notice in this image the location of the compression fracture is in the front of the spinal bone towards the middle of the back. There are many types of movements that increase load on these bones, such as bending forward at the waist, as well as twisting and turning the body when bent at the waist. When engaging in movement that involves compression of the front spine, consider the load that is going through these bones, and be careful not to push or strain if any discomfort is felt.

Consider a forward fold. Especially if the hamstrings are tight, the spine may become very rounded in this pose, which can put extra load through the front vertebral bodies, especially if we are straining to try to get the hands to the ground.

When modifying your movement practice, consider the intention of the movement, and modify to match the intention but in a safer and more effective way.

The intention of a forward fold is to experience lengthening and relaxation throughout the back of the body, including the hamstrings, gluteals, and muscles of the low back, and the fascia (connective tissue) that runs down the back of our body.

Notice that in this movement sequence, these same intentions are met, but the spine is fully supported by the ground and we are able to move dynamically without increasing the load on the vertebral bodies.

The neck of the femur just below the hip joint is also a common fracture area. Be cautious about poses such as pigeon, as this position subjects that bone to a high amount of load. Many people practice pigeon in a very passive way, which is not helpful for strengthening the bones and the surrounding hip musculature.

Consider these hands and knees variations of pigeon pose. Notice that by performing this “wagging the tail” movement, we are bringing suppleness into the whole spine, and also challenging the weight-bearing leg (the leg that is down on the ground). Notice that “sitting back” into the weight-bearing leg is very similar to the “pigeon” position, but it is a dynamic rather than a passive movement. This challenge can stimulate bone density as well as improve strength and responsiveness of the supportive hip muscles including the gluteals and piriformis.

After you get the hang of wagging your tail, try to make circles! Notice the engagement of the entire body with this dynamic movement pattern.

3. Prioritize extension postures rather than flexion postures

Flexion-based movements such as forward folds are when the spine is bending forward, which puts more compression on the front of the vertebrae. Extension-based movements do the opposite. Also known as backbends in yoga, extension-based postures are very safe for those with bone density loss. Spinal extension helps to reverse the compression on the front of the body, and helps to strengthen the muscles that promote healthy posturing. 

Notice these extension-based movements performed while lying on the belly. This is an excellent way to build strength and awareness of the back side of the body. Notice the balance and stability that is created by performing these diagonal movement patterns  in which the right upper body moves with the left lower body, and vice versa.

4. Challenge your balance with ease and support 

Yoga can be an excellent tool for improving balance, but it is important to be able to maintain stability and ease throughout your standing practice. There is no point in practicing feeling unbalanced, so modify your practice to meet yourself where you are. If you are feeling too challenged and at risk of falling, then this is not doing you any favors. Maintain stability and ease by modifying and using props. My favorite props for balancing poses are the wall, chairs, and even the kitchen counter. By gently contacting one of these props with a hand, we can maintain groundedness, and correct ourselves more easily if we begin to lose our balance.

Notice the use of the wall as a prop to perform this standing side bending and circular movements. This sequence is the same as what we did on hands and knees, but now in a standing position. As balance is a dynamic process, adding movement is more helpful for improving balance compared to holding a static position such as tree pose. Additionally, the weight-bearing leg is being stimulated in a way that will help improve bone density and strength. This is also a great way to warm up the body before further activity such as going on a jog.  

At The Wellness Station, we will help you become aware of habitual movement patterns, yoga poses, and lifestyle factors that may be affecting your bone density and risk of fractures. We will help you develop or modify your movement practice with considerations of your individual needs, medical history, and goals. Every day is an opportunity to get to know your body on a deeper level in order to stay active, healthy, and strong, even with osteoporosis.

Core Strengthening: The Wellness Station Way!

What is our core, what does it mean to have a strong core, and what are the best methods to achieve this?

Many of us associate the idea of having a strong core with the ability to stay active and independent as we age, maintain our balance, avoid injury, ease back pain, or perhaps maintain a trim waistline.

Although the idea of core strength is popular and highly sought after, what we are really after is core responsiveness: how efficient and with how much precision are our core muscles able to respond to the needs of our environment and our intentions. In other words, how well are our bodies able to do what we want them to do in a given situation?

This responsiveness depends on our neuromuscular system- the intricate connections between our brain, spinal cords, and muscles. It is crucial that this responsiveness includes all of the tiny muscles that connect each of our vertebrae, which are vital for dynamic stability, proprioception, and the ability to "change shapes" depending on the needs of the situation.

In the world of traditional physical therapy and fitness, the idea of core strength is often reduced to "core stability", and focuses on the ability to brace and hollow the abdomen. The general notion is that we must be able to keep our core very tight and rigid during movement, lest we injure our spines. This rigid stability utilizes the large, long muscles that travel up and down the spine, neglecting the tiny muscles in between each vertebrae. This is not how we function as human beings!

As we live in a three-dimensional world, our bodies need to be able to efficiently change shapes based on the situation we are in. By only training ourselves to keep our cores tight and thus restricting movement, we are behaving in a linear manner that is not conducive to our dynamic, three-dimensional world. Although this type of core engagement can be helpful in some situations (perhaps if a pet or a baby decided to crawl on our stomach!), far more often this approach is selling ourselves short and could actually put us at a higher risk of injury, pain, or limited function.

   Consider the example of a stack of blocks connected by elastic bands as referenced in our Ehlers Danlos blog post, illustrating the difference between segmental vs. rigid core responsiveness. The traditional approach to core stability is similar to the example in which the blocks are connected only by four long rubber bands, in which the vertebrae (like the tower of blocks) are undifferentiated and controlled using the large, long muscles of the spine. This would neglect the small muscles of the spine that allow us to move with efficiency, fluidity, and balance. Our approach at The Wellness Station reflects the example in which the tower is connected by smaller rubber bands in between each block, allowing the structure to form a variety of complex shapes and forms, representing segmental spinal responsiveness.

Our core is our spine- we need to be able to move our spine in the three dimensions. Flexion and extension, side bending, and rotation. Each of our many vertebrae are capable of movement, and our deep spinal muscles (including the transversospinales and the segmental muscles) allow this movement.

By engaging in mindful movement practices to target these muscle groups, we can strengthen our mind-body connection to these areas, thereby improving responsiveness of our core.

This is truly what core strength is- our ability to move our spines into different shapes efficiently, mindfully, and powerfully depending on our intention and the circumstance we find ourselves in.

Here are some examples of mindful movement drills that engage the body in three-dimensions, and target segmental movement of the spinal column. Enjoy!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team