Category: Anatomy

Learn more about your anatomy and incorporate this knowledge to achieve better movement.

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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. 

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Free Your Hands to Create

And Release Patterned Tension

Our hands are meant to create. We do the intricate activities of life such as building, writing, painting, carrying, feeling and so much more with our hands.

However, due to anatomical and neurological asymmetries in the body, our creativity is stifled by a more basic need, stability.

The postural restoration institute, or PRI for short, recognizes these asymmetries in the body and helps us correct these patterns in our body so that we can experience freedom and flow.

Due to the natural asymmetries that exist in all of us, we have a bias to center our mass over our right leg.

This preference is deeply rooted in the position of our internal organs, our diaphragm size and position, and a variety of neurological factors such as where certain functions are located within the brain, such as speech or motor control.

If something happens in our lives that makes us feel insecure, such as a physical injury or emotional trauma (and often physical injuries are emotionally traumatic), we will shift our mass into our right side because this feels “safe.”

This is not problematic, unless it persists and we forget how to get back to our left side.

When this happens, the right hand can no longer create, because now it is a splint, keeping you over to the right side.

If you were to step out onto your street right now and watch people walk, you’ll notice that many of them do not move their right arm as much as their left. This is because they are literally stabilizing themselves with that arm so they can stay centered on the right side.

This continued right side preference and “gluing” of the right arm to the side results in other changes over time.

Specifically, the right shoulder will tend to drop as the right abdominal wall becomes stronger and more tense, while the left abdominal wall becomes weak and lengthened.

The intercostal muscles (that live between the ribs) get short and tight on the right side, along with the fascia surrounding them. The right latissimus muscle becomes hypertonic, because he is a primary muscle that glues arms to sides.

So How Do We Free Our Hands (especially the right)?

Any activity that gets your right arm away from your body is helpful. When was the last time you raised your arms overhead? We don’t do varied motions like this often enough.

Opening up your right side ribs also helps immensely. Try leaning on your right arm with your legs in front of you, as shown in this picture below, based on an exercise from the Postural Restoration Institute.

Most people find this position (right leg in front, left leg in back and right ribs opening up) to feel more unfamiliar than the other side (propped on left arm) because of the anatomical and neurological biases discussed earlier. So do a version that feels comfortable for you, as it will likely feel unusual. There should be no pain in this position.

By simply being, existing and breathing in positions that are the opposite of the patterns that you typically and unconsciously are doing all the time, your brain and body start to restore alternation, freedom, and flow.

Instead of holding you up, your hands (and mind) are free to create instead of just stay upright somehow.

Another way to free up arms and hands is by getting more alternating activity into your life. Walking, climbing, crawling, anything you can think of to get those arms and legs moving in opposite directions is helpful. Watch children, they have this pretty well dialed in.

Try these tips and let your arms and hands be free and creative again.

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Back Pain? How to Address the Root Cause

50 year old woman with back pain

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

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

Why doesn’t surgery work?

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

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

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

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

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

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

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

So what does this have to do with back pain?

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

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

This orients our pelvis slightly to the right.

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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Have a Seat: How to Sit to Support your Spine

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

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

The Problem:

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

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

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

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

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

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

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

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

Fix It!

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

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

How To Do It:

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

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

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

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Do You Want To Be a Forever Runner?

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

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

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

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

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

Actually…no.

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

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

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

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

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

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

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

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

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

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

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

How can you tell if you’re balanced?

Here are some signs that you may have asymmetries present:

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

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

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

this exercise was created by the postural restoration institute

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

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References:

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

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The Revolutionary Bone that No One Talks About

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

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

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

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

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

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

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

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

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

Why Is the Sphenoid Bone So Special?

Here are just a few reasons…

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

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

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

What Might Tweak a Sphenoid’s Position?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Why Is It So Important to Learn to Exhale?

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

Good question.

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

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

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

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

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

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

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

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

This Ribcage is Too Big!

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

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

These people can’t get air OUT.

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

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

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

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

This Ribcage is Too Small!

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

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

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

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

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

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

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

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

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

This Ribcage is Juuuust Right.

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

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

Benefits of Exhaling Well

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

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

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

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

Be well, my friend!

Kindly,

Dr. Derya

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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!
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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.

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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.

Alternate nostril Breathing for Body and Brain Balancing

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