Have Kids Ruined Your Core?

If Your Back Constantly Aches, Your Hips Feel Rotated And You’re Embarrassed To Run

You Need To Check For Separation

If after having children you struggle to control your bladder when you run, worry about sneezing and refuse to skip because it’s just embarrassing then you need to have your separation assessed.

Even if your kids are nearly 10 years old!

This is what I found with one of my recent patients in Bondi. But it’s not why she came in…

She wanted help figuring out why her back pain just wouldn’t go away. There was nothing severe about it, just a constant tightness.

She brought the recent xrays her normal chiro made her get…the spine was in great condition. Way better than mine. There was

           no scoliosis

                  no obvious degeneration

                           no glaring bone deformity

It was fairly straight and uncomplicated. So why the constant back pain?

At 43 years old, she was just sick of waking up in the morning her feeling like an old woman.

Before coming to Balance she was seeing her every month, sometimes more. They believed the pain was a result of her ‘twisted pelvis’. Getting it adjusted helped but it always seems to come back.

To me…the twist seemed more like a compensation pattern than the root of the problem.

As we were discussing how her body moves and feels in general I discovered she still pees a little when running or sneezing unexpectedly. To me this is a massive hint she has a core issue. Immediately my focus went to assessing it.

She had what we call a diastasis rectus abdominus. Abdominal separation. It was around about 2cm and has probably been there since giving birth 9 years ago.

In her case the separation was actually 3/4 more on the right side compared to the left. This same side also tested weaker through the internal oblique (one of your inner core stabilisers). No surprise she also feels the back pain more on the right!

Her body has been forced to work around this issue for 9 years. Walking, running, in the gym and  with everyday activities her body has found a way to compensate for this core issue.

You know how she compensates – rotating the pelvis!

Until she addresses the core imbalance treating the hip will only ever be a temporary solution. You may be thinking…

Why did the Obstetrician and the midwife nurses not say anything about the separation in the abdomen?

She was definitely surprised they didn’t!

Whilst I could argue they should have mentioned it, honestly it is not life threatening and not that bad.

However… If these things aren’t addressed soon after giving birth, then they carry on. They become a problem years later. At the end of the first appointment we had our diagnosis, she understood what the actual problem was. Not a twisted pelvis but asymmetrical abdominal separation.

We also had a specific plan of attack…

1. Treat the back pain and hip rotation for some temporary relief

2. Specific corrective exercises to

   • address the separation and

   • strengthen the weak internal oblique

We followed this approach for two weeks. Each time reassessing and making sure we were following the right path. It was improving steadily which is always a good sign.

A month later she booked in for a review. She was so excited to tell me it hadn’t felt this good in such a long time. I reassessed everything, the back and pelvis, the separation, the core. The difference was significant.

The best news… There was no reason I needed to see her again.

This is just one of the cases I’ve seen recently where problems have developed in women who haven’t addressed common post natal issues. Whether it’s pelvic floor dysfunction, abdominal separation or asymmetries in the core…you really need to get it checked.

A few simple but targeted exercises with a little specific treatment can prevent niggles like ongoing back pain from ever becoming a problem.

If you have kids and know you don’t have full control your bladder let one of our physios assess your separation and core control. The longer you wait the harder it can be to reverse the compensation. Just call the clinic on 9899 5512 and ask for one of the physio’s who specialise in post natal care.

Exercises Are Only Problematic If They Are Poorly Prescribed… Why Most People Misinterpret The Jefferson Curl

Coaches, chiros and physios all seem to miss the fact this movement is not a strength exercise! It’s not designed to load spinal flexion.

It’s time to set the record straight…the for and against of using this exercise

3 Reason You Should Learn The Jefferson Curl Before You Blow a Disc In Your Spine

Is Your Spine Intolerant To Flexion?

Every day I see patients who have a ‘flat spot’ in their lower back as they bend forward. To me, this is an indicator of either…

• a previous either a history of back pain or,

• an increased risk of injuring their disc.

You need to be able to flex your spine. If you struggle to do this it’s not a matter of avoiding it. You can’t live without spinal flexion. 

Instead of continually hurting your discs, would it not make sense to learn to flex each vertebra one at a time… This focus on motor control teaches the brain to understand a movement that should automatically occur, be reflexive.

A Jefferson curl starting at the neck then slowly curling your entire spine one vertebra at a time is brilliant in helping the brain understand how the spine should move into flexion.

Do You Need To Learn How To…

Simultaneously Maintain Spinal Movement And Center Of Gravity?

This control is critical every time you want to pick something off the ground. 

When you flex your spin, your hamstrings need to engage to maintain centre of gravity. Basically they are the anchors stopping you from falling forward every time you lean forward. 

The goal is not to build strength in the hamstring but teach them how to eccentrically load in conjunction with the spine.

Note again it’s about the movement and coordination of muscles. Not strength!

Can You Eccentrically Control Your Spinal Erectors?

For your spine to stay stable, you must be able to lengthen the spinal erectors under tension. 

This will only occur if you allow your core structures to take over. As you breathe out to flex the spine your…

• Lower abdominals

• Lower obliques

• Pelvic floor

• TVA

…all have to engage to create enough spinal flexion! 

At the same time…your lumbar and thoracic erectors have to eccentrically load firstly and then secondly so do your multifidus. Multifidi are usually the ones that fail. 

It happens near when you bend and rotate to pick something off the floor because you haven’t taught them how to eccentrically load. This is where people end up hurting their L4, L5, S1 discs. 

The Jefferson curls is a great because it…

• teaches the multifidus and spinal erectors how to eccentrically load

• helps you understand how to breathe for movement control

• help the hamstrings understand their role as anchors

• facilitates engagement of TVA

If you don’t know how to control this common movement, how are you going to pick anything up off the floor?

In saying that…

You Just Can’t Give This Exercise To Everyone

If you don’t know how to use your hips properly…

• You’re never going to be able to engage your hamstrings correctly

• You will always incorporate too much of a knee bend

Before You Even Contemplate a Jefferson Curl You Must Be Able To Hip Hinge

If you don’t you’re always going to rely on their quads. The problem with this, it’s not going to allow your posterior chain to eccentrically load. This puts pressure on the front of your hips first then straight through your discs.

Lifting weights without knowing how to hip hinge means it’s only a matter of time before you’ll start seeing lower back and disc problems.  

The ability to hip hinge takes priority over using a Jefferson curl to learn motor control of flexion.

Even Then It’s Not Your Go To Exercise

I will never prescribe this exercise until I know you can perform a regressed non weight bearing variation. I use band assisted roll up (sit up). It’s orientation to gravity is different so the challenge isn’t exactly the same, but it does follow the same movement pattern.

If you can’t perform this exercise I’m not going to add more variables and increase the challenge by having you stand up and do a Jefferson.

The Biggest Reason To Avoid A Jefferson Curl…

 PAIN!

If it’s aggravating your symptoms this exercise is way to advanced for you. Do not push through because you need to learn the movement pattern. Stop immediately, regress and then build up to a Jefferson.

Remember You’re Not Doing This To Build Strength

Focus On Movement Control And Save Your Spine

Pregnancy, Gymnastics and Weightlifting....Why Pilates?

The simple answer…

‘Pilates helps you make the most of what your body can offer’

I am definitely biased, but teaching Pilates has changed the way I assess and treat as a Chiropractor!

Just yesterday in the studio I was helping a lady in her 2nd trimester with pelvic pain, a junior elite rhythmic gymnast work on her turns and competitive weight lifter strengthen his core.

Interesting combination right…

So,

What Exactly is Pilates and Who’s It For?

Developed in the early 20th Century by Joseph Pilates, or Uncle Joe I like to call him, Pilates is a movement system where the focus is to strengthen, stretch and stabilise key muscles.

Originally it was a means for the rehabilitation of soldiers. Years later, after being refined through work with New York Ballet it is used by people of all walks of life to

• Deal with pain like supporting a growing belly during pregnancy

• Improve movement control like the turns required by a rhythmic gymnast, or

• Strengthen the core to assist in transferring force from your legs move a heavy barbell overhead

For me..

It’s the missing link between treatment, traditional exercise rehab and return to sport (or life)…

Now I am sure most of you have heard the connection between Pilates and your core.

It’s the key!

Your ability to become aware of and control movement from the centre out is critical for:

• improved performance

• injury prevention

• rehabilitation

This ‘core control’ is the central philosophy for all Pilates based exercises. Your ability to move effectively and efficiently transfers directly to recover and performance.

So you might be asking yourself,

What Exactly Constitutes Your Core?

I think it is essential that we all understand what the core actually involves.

I won’t go into too much detail but let’s start with the basics.

The core is like a barrel:

• The top is the diaphragm (or breathing muscle) and is located under you lower ribs.

• The bottom is your pelvic floor and is like a hammock or trampoline at the bottom of your pelvis. Most people think the pelvic floor is only important in women who want to or have had kids. Noooope! It is super important for everyone (including you, boys!)

• The front is a muscle called your transverse abdominals or TVA for short.

• The back consists of muscles called your multifidus

• Side consists of internal abdominal obliques or IAO

Your core muscles work together to create a strong powerhouse in the centre of your body.

If our core works well, it helps to control the rest of our body.

There are so many stories I could tell you about patients who have directly benefited from Pilates…

• The Mum who told me she has no pain in her back for the first time in 5 years

• The CrossFit athlete who hit a PR after learning how to utilise their core

• The runner who runs without lower back pain

Awareness of and ability to control your core ‘barrel’ play a critical role in your ability to recover and perform.

Pilates just happens to be a form of exercise perfect for teaching these skills.

Whilst it can be frustrating at times learning new ways to move – no growth or improvement comes without some type of struggle.

If you remember the case of my patient in her 2nd trimester…

She had been seeing me throughout her pregnancy for lower back and pelvic pain. This was her first pregnancy and by this point she was struggling to bend over and sleep due to the pain in her back.

A lot of her pain was due to the fact her pelvis was stretching to allow the growth of her baby. A completely normal part of pregnancy!

But for her…

It was causing constant discomfort.
She was struggling to sit and stand, drive and sleep.

Along with manual treatment to manage her pain, we implemented a gentle Pilates program to help her strengthen her core to help support her constantly changing body. Despite getting frustrated at times, these simple exercises worked perfectly to stabilise her expanding pelvis.

The combination of treatment and Pilates worked perfectly to reduce her pain levels as well as move more freely (without fear of injuring her lower back).

Clinical Pilates at Balance

Using specially designed equipment in the reformer, trap table and wunda chair we keep classes to a max of 3 so the program is always individualised and specific to your goals.

If you know there are issues with your core strength and movement control Pilates is the missing link.

There’s a reason I see most of our practitioners at Balance and there families for Pilates!

See the difference it will make for yourself.

For all Pilates appointments please call the clinic. If you have a friend you know would also benefit, get them to come along with you…