When exercise hurts

This post was inspired by an exchange I had on my facebook page.

I shared a post about foot problems being connected to hip issues and how something like an orthotic is not a good long term solution.

A reader responded regarding her feet, sharing that she wasn’t so sure about all that because she’s had a lifetime struggle with plantar fasciitis. We exchanged comments and her final comment really struck me.

She said, “some of my worst bouts with pf were in my most fit and lean days. Times when I was the most active….running marathons or doing triathalons, times when my muscles were the best conditioned…” She also shared that her best bet now is wearing birkenstocks because they provide support to her feet.

What this dear reader shared is something I suspect is true for SO many of us (me included).

Exercise can make you hurt.

When I was my “fittest”, I had the following issues (not all at once!): shin splints, tibia stress fracture, hip pointer, femoral patella syndrome, low back pain, neck pain, sacro-iliac pain, hot spots on the inside edges of my shoulder blades and a few other aches and pains.

I could run a 7 minute mile, finish a 10K, had a ‘strong core’ and do a handstand easy peasy in yoga.

But I hurt. Often. Constantly, in fact.

What I know now is my lifetime of growing in the shape of a chair, wearing shoes with a heel (yes, even those $150 running shoes that were fitted to me by a running specialist at the specialty running store), running as my preferred form of exercise – on pavement or a treadmill, and yoga that was done faster and less mindfully than it should have been were all contributing to those hurts.

By its nature, most exercise puts us in a repetitive joint movement pattern. In running, the leg comes forward (hip flexion) and the leg moves back (hip extension). We miss ad and ab-duction as well as rotation. When we are wearing shoes with any kind of a heel, we’ve got many misalignments, one of the biggest being the pelvis being ‘worn’ out in front of the ankles. This puts pressure on the mid-foot causing the fascia to separate front to back.  We repeat movements like this in swimming, on the elliptical or while biking.

None of this means running, biking, swimming etc are bad per se, but when you pay attention to variety in your movement patterns, they are probably pretty limited if you are simply exercising. When there’s a high frequency of repetitive joint patterning, that’s just a recipe for problems.

Add in coming to your exercise time having spent 8 hours sitting at a desk or in a classroom, you’re asking your joints aren’t to make major changes in shape that they aren’t so ready (and able) to make.

So, dear reader who had her worst bouts of plantar fasciitis when she was her most active and fit, I HEAR YOU, but I’m also not at all surprised.

The solution to our physical woes often isn’t to simply “get fitter”.

Though we do love a quick fix in our society and I’m all for spontaneous healing, most of us need to make shifts over a long period of time.

Identifying the problem may be simple (I’ve got plantar fasciitis), but the long term solution that restores your body to optimum function without the use of supportive aids, is rarely simple and quick (I need to assess: my habitual alignment pattern and how my leg bones move in my hip socket, how active are my medial glute muscles vs my hip flexors, then get the right parts moving well and THEN strengthen).

Those nagging aches and pains tell us what we are doing isn’t working. We need to find a new path. One that resolves the underlying mobility issues before addressing strength otherwise we are layering strength on top a mobility issue and that won’t make you feel better.

We all need to make a mental shift away from exercise and into that of movement. We need to begin to move more parts of our body and move them better – the tiny muscles in our feet and those bigger muscles in our pelvic region, change the shoes we wear and replace the idea of fit with the idea of function.

Can you still exercise? Absolutely. But, if it’s making you hurt, it’s time to stop and reassess, not stop and stick your body in a supportive chair, shoe or back brace and call it a day (or a lifetime).

The importance of core training for singers

This blog initially appeared on The Opera Stage site. Their blog is no longer active so I have published it here to continue to allow access.

 

Many singers will avoid doing any core exercises in the interest of having total flexibility of their abdominal area. Other singers will do core exercises in an attempt to strengthen musculature that they know is connected to vocal production. And, still a third group considers what they do as classically-trained singers to be adequate work for the abs and leave it at that.

For many of us, the voice works well even though our core isn’t as well coordinated as it could be. However, when the voice and/or breath aren’t working well or you go through a physical change that results in a negative shift in the functioning of your voice or body, core training is a key element of making a change for the better. A well functioning core is crucial not just for pain-free movement, but also for the voice to perform optimally.

There is an important distinction that needs to be made between ‘core exercise’ and ‘core training.’ Core exercise involves doing a set of repetitive exercises without contemplating whether they are contributing to the functionality of the entire body. Core training, on the other hand, addresses functionality in the whole body: your breathing and your muscles, your existing patterns of engagement, resting tension and how you put all of that together (particularly as it relates to your voice) to establish a synergistic relationship throughout the body.

What are the signs of a core-voice connection that could be improved?
” Tension in the shoulders, neck and throat/jaw region.
” Bracing of the abdomen at the onset of sound.
” A held abdominal area that lacks freedom of movement.
” Low back pain.
” A sound that isn’t well supported.
” Weight loss and loss of support of the sound.
” Reports of the voice being effortful to produce.
” Reports of breathing issues that are elusive to resolve.
” Negative vocal and physical changes post-childbirth.
” Hernias of any kind.

What is the Functional Reflexive Core?
The foundation of healthy movement and singing comes from the deep layer of the Functional Reflexive Core (FRC). The part of our body that makes up the FRC is our entire trunk located between where the head attaches to the neck and where the arms and legs attach to the torso.

It has two layers. The deep layer of the FRC is made up of the throat, the diaphragm, the transverse abdominus, the psoai, the multifidi and the pelvic floor musculature. The outer layer is made up of all the other muscles that fall within that central part of the body. We want stability of the muscles in the outer layers of the core, and imbalances here can create problems when it comes to voice production, but when we talk about the core-voice connection, we are most interested in the functionality of the deep layer of the FRC. And, the relationship of the muscles here is heavily influenced by how we are breathing, how we are moving (or not) through our lives and our tension levels in the upper and lower body.

Why do we have these issues to begin with?
Modern life has left us with bodies that are ‘casted’ by sitting, wearing shoes, and moving through a limited range of motion. The good news is, our bodies are relatively plastic and have an amazing capacity to change. We just need to know how to make the change effectively and be consistent in our efforts.

Patterns in the body and breath that indicate an imbalance in the FRC are:
Abdominal Holding – As a result of sitting in chairs our whole lives, our backsides get weak, the abdominal musculature gets recruited to do work it shouldn’t be doing and we carry resting tension in the abs. Second, there is the cultural message that we are somehow more valuable if our abs are flat. That can result in people sucking the stomach in chronically or over-exercising the abs, creating a flatter but definitely not more functional mid-section.

Abdominal Bracing – When the deep layer of the core isn’t functional, we can over-recruit and use the outer layer muscles to make up for the lack. Bracing can be observed in both movement and singing when there is a very visible hook up in the belly at the onset of moving or singing and then it often appears as a static hold – as though you are bracing to prepare for someone to punch you in the stomach.

Bulging – This can occur on inhalation and/or on phonation and movement. If we bulge on inhale, seen through a distended belly, we overload the musculature of the deep FRC. Once overloaded, the muscles lack the relationship they need to the breath and don’t fire effectively. This type of increase in intra-abdominal pressure can lead to things like hernias and pelvic floor problems. Bulging during movement means the belly pushes out when we are doing something like lying on our back and bringing both legs up into reverse table (see below). Bulging during phonation will also show up as a belly that is pressing out in a rigid, fixed way when singing.

Bearing Down – This is just as it sounds. When we move or phonate there is a sense of bearing down – almost like you are trying really hard to go to the bathroom. This is, in fact, the reverse of the motion we want to experience when we are singing or moving. We also don’t particularly want to be bearing down hard to go to the bathroom, but that’s another post for another time!

Here are a few assessments you can do to test the functionality of your FRC

Do you carry resting abdominal tension?
Lie down on your back with your knees bent, feet flat on the floor. Place your hands on your belly, near your belly button. Cough. Cough 5 or 6 times. What direction is your belly moving when you cough? Does it push up into your hand? If it does, as it will for almost everyone, it indicates you carry a level of resting tension in the abdominals that is greater than necessary. That means when you are expelling air to either move or sing, the coordination between muscles and breath could be improved.

Do you have a diastasis recti (DR)?
Both men and women can experience DR. It is a separation of an unnatural distance between the two rectus abdominus muscles and the connective tissue, called the linea alba, is stretched and thinned. DR is caused primarily by excessive intra-abdominal pressure. To check your body for a DR, lie on your back with your knees bent, feet flat on the floor. Exhale normally and pick your head up off the floor. With the head up, use your fingers to palpate down the midline of your rectus abdominus muscles from sternum to pubic bone. See if you can feel both sides of the muscles and see if there is a gap between the two. The gap is measured by finger widths. It is also measured by depth. It may be normal for you to have some separation between your muscles, but a width of 2 fingers or greater or a depth of a knuckle or more, may indicate you have some issues with too much intra-abdominal pressure.

Do you have a hernia?
Most men are probably familiar with the turn your head and cough test to see if you have an inguinal hernia. Inguinal hernias can also present as swelling or a bulge in the scrotum. A hiatal hernia, which is often associated with GERD will require an x-ray study to diagnose. Umbilical hernias are usually diagnosed through physical exam and present with swelling or a bulge around the belly button. All 3 hernias are associated with excess pressure and weakness in muscle.

What do we do about our imbalances?
Our answers to these issues lie in an approach that addresses the whole body, including alignment, breathing and movement mechanics. When we tune in to how we are moving and where our body is compensating for our limitations we can make gains quickly. Here are some simple movements to begin to explore your current patterns and function. To bring balance, strength and stability to the whole body a more complete practice is needed, but these will give you a sense of where you are in this moment and perhaps inspire you to explore more!

Abdominal Release

  1. Come onto your hands and knees and let your belly sag toward the floor without allowing the back to sway excessively. The pelvis is untucked.
  2. Breathe normally and notice if your belly releases each time you inhale. Focus on letting everything release – diaphragm to pelvic floor on the breath in.
  3. Stay here for about 5 minutes and really tune in to the space from the bottom of the ribcage to the pubic bone.

Notice if you find tension returning and continue to release it each time you notice it. Try singing a few phrases in this position and notice what your body does as you breathe in and as you phonate.

 

 

Waking up the Deep Layer of the FRC

  1. Lie on your back with your knees bent, feet flat on the floor. Bolster your head on a pillow so the lower ribs are on the ground. The pelvis is untucked, with space behind the low back.
  2. Place your hands on your low belly. Take a breath in and notice what moves more on the inhalation –the belly or the ribcage – ideally the ribs will move more.
  3. Begin a long slow exhale through pursed lips or on a hiss.
  4. Midway through the exhale see if you notice the deep part of your core activating in a corseting action this is NOT navel to spine.
  5. On your next breath in, release all engagement and exhale again through pursed lips or on a hiss. Do this 5-7 times. If you do not feel things engaging, don’t worry, keep practicing and the deep FRC will wake up.

Notice if you flatten your back to the floor when exhaling. Notice if you tense in your shoulders or throat when you are exhaling. Notice if your lower ribs pull away from the floor when you breathe in. Be aware that it is easy to engage the obliques more than the transverse abdominus (TVA) muscle in this exercise. Don’t force the engagement of the TVA, allow it to happen organically.

Reverse Table

  1. Repeat steps 1-3 above.
  2. Midway through the exhale, when you have felt the FRC engage, slowly bring the right leg into reverse table.
  3. Breathe in again. And exhale, returning the leg to the floor.
  4. Repeat the above but this time bring the left leg up.

Notice first if one side feels easier than the other. For each side, notice if your belly bulges while moving the leg into the air, or if you are bearing down as you bring the leg up.  Notice if your hips wobble or shift or if your back flattens to the ground as you bring the legs up. Those are all signs you have some work to do to improve function.

For an advanced version of this pose, bring one leg up and then on the next exhale, bring the other leg to meet it. If you have any of the above issues, back up to the phase before.

 

Waking up the deep layer of the functional reflexive core can feel like slow, small work, but the payoff is huge. Having a body that supports you as you move through your life on stage and off, providing you with a solid foundation for the voice to be produced, is an invaluable tool for a singer.

 

If you have questions or would like some help waking up your FRC, don’t hesitate to reach out by email or connect with me on Facebook.

 

The cult of breathing correctly

Today I worked with a client exclusively on breathing and I realized she was asking me the same questions I get from almost everyone about breathing so I thought I’d address them here.

What’s the BEST way to breathe?

I’ve seen it in almost every book I’ve read, whether it is about the voice or the body…there is one way of breathing, as described in the book and that is the BEST WAY. Really? That to me creates a cult-like religion of breathing and I just am not down with that.

We can talk about a biomechanically optimal breath, and I do teach people what that is, because I believe it is valuable to know, but (you knew there was going to be a but, right?), that’s not my end goal in working on someone’s breath.

If your breathing is disordered, I’d like to help you find a breathing pattern that supports your body’s health. Sometimes that looks like addressing ribcage mobility. Sometimes that looks like changing the breath ratio. Sometimes that’s moving from mouth breathing to nose breathing. And, sometimes it’s all of the above plus a few other things.

If your pelvic floor is suffering, I want to teach you the ways in which your breath can impact the pelvic floor and help you find ways of breathing that support your movements so you no longer wet your pants when you sneeze.

If your goal is to sing your best or speak your best, my goal is to help you find a freedom to the breath so it responds to the emotion you are trying to communicate and contributes to the colors of the voice that reflect that emotion.

If your body is in pain, my goal is to help you optimize your breathing because that will both help lower your pain response, but a good exhale always facilitates better movement too.

 

Why is my breathing a mess?

Breathing is governed by the autonomic nervous system. That means as long as you are alive, your body is going to breathe. That also means when your nervous system is out of whack – due to stress – your breath is going to change. Sustained stress, means sustained breathing changes. However breath isn’t completely at the mercy of stress. The breath is actually our most efficient mechanism for shifting the nervous system.

Breathing is also reflexive, meaning we breathe in response to the way we move. If you aren’t moving much, your breathing isn’t being varied and it’s easy to get stuck in a pattern of limited breathing.

 

How do I fix my breathing?

There is no one right way to ‘fix’ disordered breathing because there is no one right way to breathe. I want you to have the ability to breathe appropriately given the situations you encounter.  I usually start with a series of assessments of just breathing and breathing and movement to see where you might be running into breath blockers (bulging, bracing and bearing down) and from there, use a series of breathing practices that progress from simple to more complicated and work with breathing and movement to see how the two fit together. If we’re putting it together with the voice, we listen to sound and emotion and see how they’re working.

It takes time, awareness and practice, but there’s no need to subscribe to a cult of breathing where you think there’s just one way to breathe and that way will magically provide the answers to all your issues!

Consistency is Key

We all know that right? Consistency is what will ultimately bring about change. Want to shift your voice? Your body? You have to put the time in.

But…there’s always a but, right?

What if being consistent is the thing that stops you in your tracks?

I’ll be the first to admit I usually start something great guns, but after a while I will peter out. When I began to investigate why that is I made a startling realization.

I’m someone who really needs external accountability to keep me on track. In my life that can look like paying for a gym membership, buying the right shoes for the movement I want to do, signing up for voice lessons. Hell, I rescued a dog so I would be forced to get out the door and move every morning because I knew if it were up to me I’d just stay where it’s warm and cozy.

Gretchen Rubin has done some really cool work in this area and come up with Four Tendencies – categories that most people fit into – Obliger, Rebel, Upholder and Questioner. You can take a quiz here to see which category you are.

I’m a classic obliger. If I tell someone I’ll do something for them, I do it. If I tell myself I’ll do something for me, it’s more than a little questionable as to whether I’ll follow through, unless I find a way to make myself accountable for it.

It is my understanding that there are an awful lot of obligers out there.

So, here’s my question….are you wanting to make a change to your body or voice, but simply making that commitment to yourself isn’t getting you where you want? If you need some external accountability, reach out and let’s talk. Maybe it’s a class. Maybe it’s a series of 1 on 1 sessions tailored to your needs. Maybe it’s a workshop.

But, rest assured, you don’t have to do it alone. I’m here to help keep you accountable!

The connection between your upper and lower body tension

What is going on in your lower leg is also happening in your neck and shoulders.

Are you working away at reducing tension in your neck and shoulders, but not seeing a difference? Or, are you calf stretching every day, wearing shoes with no heels, but STILL have tight calves? Perhaps it is time to look at the whole body and get a better understanding of how the tension at one end of the body impacts the other.

Here’s one reason why your lower leg is impacting your neck…

Shoes

Yes, even those cushy, comfy, ‘supportive’ shoes.

Why are they involved?
1. They have a heel which puts the ankle into constant plantarflexion (toes pointed).
2. Toe bed is elevated, keeping the toes slightly lifted off the ground
3. Stiff soles prevent all the small joints in the foot from moving well
4. Narrow toe box forces the toes together (bunions anyone?).

The degree to which 1-4 happen varies depending on the type of shoe, but it isn’t limited to high heels. It happens in those $150 running kicks you got from a shoes expert at your local running store.

Think about the shoes you wear most often…running shoes, dansko clogs, 2″ heels from DSW, etc.

When you are wearing stiff soles, heeled footwear with a narrow toe box you create adaptation in the joints of your feet and ankles. Adaptation isn’t a positive shift. It means less mobility.

 

Tension in the Calves

The connection between tension between the lower neck and the shoulder neck, continuing…muscles in the calf.

Not only are our feet impacted by shoes, but our calves are as well. Heels (of any kind, remember, not just high heels) create a shortening in the calf muscles.

Sitting also creates a shortening in the muscles.

We ALL have chronic shortening in the muscles of the lower leg.

This shortening impacts our gait (how we walk). For many of us, our short calves mean we have what is called a ‘negative stride length’, meaning the heel of the foot of the leg that stays behind when you step forward can’t stay on the ground long enough to allow you to push off posteriorly (using your glutes and hams). Instead, you are doing a process of falling forward and catching yourself when you walk.

Why a wave can help explain things

This picture shows a wave in the distance where the water is moving at the same (or close to it) speed. Then it shows waves at the shore that are breaking – the top is moving over the bottom as they crash forward.

The waves break at the shore because the lower part of the water is encountering the rising shore line which slows it down. That slow down creates a whip-like effect at the top of the wave propelling it forward until the top part of the wave falls forward and crashes into the shore.

Our bodies are like these waves. The tension, stickiness (highly technical term!) and lack of mobility in the joints of our feet and ankle make our lower body move more slowly as we walk. Our upper body should be propelled forward by that slow down BUT we know falling forward is a bad idea SO we create extra tension in the upper body to keep ourselves upright. You won’t be aware that you are doing this it is happening on a pretty subtle level.

Is this the only reason you have upper body and lower body tension? No, definitely not, but if you are working on it consistently and not seeing any changes, this is an important factor to investigate!

When you DO have to sit…suggestions for small changes that bring big rewards

Ok, so sitting is a reality in our lives…can we make it work better for our body?

The most obvious solution is to sit as little as possible in your daily life – walk to do errands, walk your kids to school, take regular movement breaks at work.

But, when you have to sit, here are some things to explore:

Sit on the floor – there are a myriad of ways you can configure your body on the floor (I think I’ve sat in no fewer than 11 different positions as I’ve written blog posts this morning). The hardness of the ground lends itself well to making your body shift, which means lots of different joint configurations. It can take time to transition to floor sitting, so maybe start with only a few minutes on the floor a day and slowly add more so your body doesn’t hate you!

Sit on the floor when:

  • watching tv
  • talking on the phone
  • eating dinner (indoor picnic anyone?)
  • your kids are at the playground
  • playing with your kids
  • working
  • waiting at a child’s sports event or in a waiting room

I’m sure you can think of other places you can get your behind out of a chair and onto the ground. Please share in the comments!

Sit better: when you have to sit on a chair or some other raised surface try these suggestions to get you out of a tucked pelvic position

  • If the seat is bucketed (like in your car), fold a towel to fill in the bucket, bringing the seat level
  • Sit forward in a chair so you can sit on your sitz bones
  • Use something like sitonthewedge.com
  • If your legs are long, sit forward and drop one knee toward the floor
  • If your legs are short, put a block or a small step stool under them

You can view a video on how to sit better here.

Create an active standing workstation:

  • You can turn a box upside down on a desk that brings your computer to the right height.
  • Don’t just stand there! Put things at your feet – tennis balls to roll and step on, half foam roller for calf stretching, a cobblestone mat to step on (something like this one, or make your own in a boot tray filled with river rocks).
  • Take breaks from standing and move.

Create a low workstation:

  • Place your computer on a coffee table or other low desk
  • Lie on your belly (create a small bolster with a hand towel that runs across the front of your pelvis to keep your low back from getting crunched – it’s all unhappy from all that sitting, remember?) to write.

Are you still sitting there?

There were some pretty sensational headlines a few years ago claiming ‘sitting is the new smoking‘. These articles talk about research that links sitting with an increased risk for cancer, heart disease and type 2 diabetes.

The solution, offered at that time, was to get a standing desk. Even better than that, get a treadmill desk. Just standing isn’t a whole lot different than just sitting.

So, what is the deal with sitting and standing?

It isn’t an issue that you sit or stand. The issue is HOW MUCH and HOW OFTEN you are sitting and standing. When we assume positions over and over again, as we do when we sit, our muscles adjust to being a particular length. That length will limit your joint’s range of motion. Those limits create small changes that show up as aches and pains. Those aches and pains lay the foundation of much bigger issues down the line – osteoarthritis, pelvic floor problems, foot neuropathy and on and on and on.

When we sit, there are pressures put on parts of the body (the pelvis in particular when sitting) that create unhappy circumstances of rolling back onto your sacrum (think about slumping into your super comfy couch, or sitting in the bucket seats in your car, or just being so super bored in your latest department meeting) – we aren’t building bone in the hip joint, we are causing changes in the tissues of our glutes (hello, wide, flat butts), creating pelvic floor problems, and without glute strength, we’re over recruiting our abdominals to stabilize the spine.

When we stand we aren’t really using the body, we’re just staying in a relatively fixed position – I well remember my parents starting up their school year of teaching and the pain they remarked on in their body in the first few weeks as they went back to standing for extended periods of the day. Treadmill desks probably deserve their own post. There are benefits that will come from using a treadmill desk, but the mechanics of walking on a treadmill aren’t optimal for the body, so if we are really looking to make a difference in the body, walking on a treadmill won’t do it.

The hard reality is we aren’t meant to be still anywhere near as much as we are in our modern lives. We are built to move. There is no right way to sit, or stand, but there are better ways to sit and stand. Way that have us sitting and standing in as many different configurations as we can.

I do recognize that sitting is a part of modern life so in my next post we’ll talk about how to make shifts in your sitting habits that will bring positive changes to your body.

Welcome to the Human Spine

The spine is made up of 32 bones, and 23 discs stacked and grouped into 4 segments. In the neck are 7  vertebrae referred to as C1-C7. Next are the 12 thoracic vertebrae, T1-T12. It is on the thoracic vertebrae where the ribs attach in the back of the body. Continuing down the spine,there are 5 lumbar, L1-L5, then we have the sacrum which is actually 5 vertebrae fused together to form a triangular shaped structure and finally the Coccyx, 3 bones, referred to as the tailbone. The spinal discs, located between the vertebrae, are tough and membranous on the outside and more gel-like on the inside. They act as shock absorbers, if you will, between the vertebrae.

When it comes to the shape of the spine, we have multiple curves that are indicators of spinal health. These curves are normal and we want them to exist in the spine to a reasonable degree. The cervical and lumbar spine areas have curves that are called lordotic, or inward curves. The thoracic and sacral area have curves that are called kyphotic, or outward curves. It is possible in any body to have a lack of curvature, or a straightening of the spine or excess curve called hyper-lordotic or hyper-kyphotic.

The spine serves as protection for the spinal cord and provides structural support and place of attachment for muscles and ligaments and serves as a connector of the upper and lower body. It can also move in 6 directions – Flexion (forward bending), Extension (back bending), Right Lateral (side bending), Left Lateral (side bending), Right Rotating (twisting) and Left Rotating (twisting). I find the ability to move the spine well in these 6 directions is compromised in almost everyone.

The state of your spine is a direct reflection of how you have and haven’t moved over the course of your lifetime.

When we encounter a body and offer a postural suggestion to try and improve the way the body appears, we need to be careful. For example: If you observe that there is an excessive lordotic (inward curve, swayback, thrust) position in the mid-back, near the juncture of the thoracic and lumbar spine, it is easy to suggest fixing it by tucking the pelvis. That may give the outward appearance of resolving the lordosis, but it has possibly removed the healthy, lordotic curve of the lumbar spine, leaving you with a straightened lumbar spine. Which translates to creating more problems than you think you have solved. A lumbar spine without a healthy curve (in either direction) is implicated in disc degeneration, problems with the knee joint and pelvic floor issues to name a few issues.

We do so love a quick fix in our world. Unfortunately, unraveling the issues of our spines and their excessive or lacking curvature isn’t as simple and just moving one part in another way. Because everything in our body is connected.

Most of the bodies I see are fairly jacked up (which is definitely a very highly technical yoga term) from a lifetime of moving and not moving in certain ways and breathing in limited ways (did you know an optimal breath helps the spine experience extension?). When we turn to an alignment based model that relies on using bony markers, thus putting a body on a grid, we can begin to better understand the relationship of the parts to each other and begin to work on solutions that restore the spine to a more optimal state.

What’s the state of your spine and what kind of postural cues have you been given, or do you give, to try and improve the state of the spine?

Beyond The Kegel

In 1948 Dr. Alfred Kegel developed the pelvic floor contraction exercise for women that we now call Kegels. It was a pretty big deal because before that it was surgery or nothing for women who were dealing with incontinence and prolapse. His exercise gave women options and empowered them with something they could do to restore function to their body.

But, kegels have become a bit of a hot button issue in the fitness and women’s health world. Some people say you should absolutely NOT do kegels. Some say you absolutely SHOULD do kegels. Some say you only need to squat and not to kegels.

The whole debate will leave you wondering, will kegels help me? Should I be doing them regularly? How exactly do I do a kegel? Please, FTLOG, someone just stop me from wetting my pants!

Pro Tip: Save yourself the pain of googling “how to do a kegel” because you will get 95,000 answers, each one a bit different.

Here’s what I have gleaned about Kegels and you can make an (hopefully) informed decision about their role in your life and the health of your pelvic floor.

Kegels are a targeted, spot treatment, focusing on the musculature of the pelvic floor. The theory behind them being that the reason incontinence is happening is due weakness in the muscles of the pelvic floor and therefore the muscles have too little tone. Of course, what we need to do when something is weak is strengthen it, right?

I attended a conference where Women’s Health PT (WHPT) after WHPT was interviewed and shared that they see far more hypertonic (too much tone) pelvic floors than hypotonic (too little tone) pelvic floors (especially in those in the fitness world, interestingly enough). Those pelvic floors that are too tight will still register as weak if they are tested because the muscles are already tightened to their max and they can’t engage MORE than they already are. So, kegeling in those cases is no bueno because it will just further add tension to tight muscles.

For some women kegels are enough to solve the problem, though there is some research out there showing the long term viability of kegels is questionable – meaning it might shore you up for several years, but after that things can start to go downhill. Sometimes we forget that it is equally as important to release muscles as it is to engage them. Kegels are also not always great for prolapse either. If you are prolapsed and squeezing the pf muscles, you may just be strangling (for lack of a better word) the organ that is prolapsed and that can make things worse.

Every moment of training I have received in yoga and movement over the last 18 years has emphasized that the places where we experience pain and problem in the body are only a small part of the whole picture.

Solutions to problems in the body come when we consider the WHOLE body, the breath and the brain.

I have seen and experienced the truth in that statement in my own body and in other bodies.

When we apply that to the issue of pelvic floor weakness, we get this: when you have a group of muscles like the pelvic floor that are meant to engage in response to the information (loads) they are receiving from the rest of the body via movement and breathing we will find a long-term solution when we engage in practices that address all of the following: upper body tension, calf tension, rib cage position, core strength and how the breath impacts all of that. After all, over 34 muscles in the body are sending input to the pelvic floor. And, believe it or not, how you think can also impact how the body functions and how you perceive pain. So, your belief in your body’s ability to heal will impact the rate and level to which you get better. Plus, a group of muscles that are meant to fire reflexively will simply not do well when we try to spot treat them by isolated movements.

Might kegels be a part of what you do? Maybe, if a WHPT determines that you have pelvic floor muscles that will benefit from them, but I would hope that he or she has you do them in conjunction with being mindful of the position of the body, the breath and the movements you are doing.

Might kegels be a good thing to do if you are seeking to reconnect to your pelvic floor (like soon after birth or if you have disconnected due to years of pain and discomfort). Yes, they can help your brain re-establish a connection to the pelvic floor.

Might using a kegel-type exercise like the pelvic floor ruler be a useful way to assess how much control and ability to engage you have in those muscles? Yes, it can be very useful to track how well you can engage and release the muscles.

Can you solve your pelvic floor problems without doing a kegel per-se, because you are recoordinating your body through a whole body approach where the pelvic floor might go along for the ride when you are breathing and moving? Absolutely.

Struggling to Breathe

Asthma is on the rise – in 2010 the CDC indicated there are 25.7 million people in the US living with asthma, and they indicated they expect an increase of 15% per decade (1). That’s a lot of people who are struggling to breathe and if your studio is like mine, you’ve seen an increase in singers who are dealing with this issue.

What singers with asthma have shared with me: they struggle to get through phrases, feeling like they are running out of breath. Higher notes feel harder to hit and to sustain. And, when their asthma is active, singing at all can feel like an impossibility.

Asthmatics have differences in breathing patterns, ribcage position and mobility as well as quality of  speaking voice and singing voice.

What is Asthma?

Asthma is defined as a chronic disease in which the airways can be inflamed, constricted and lined with too much mucus during an asthma attack.

The symptoms of asthma can be triggered by a number of stimuli including: pet dander, dust, pollen, tobacco smoke, emotional stress, cold air, exercise, fatigue, infection or food.

Symptoms of an asthma attack include coughing, wheezing, and shallow, fast, labored breathing as well as a rapid heart beat.

Asthmatics also have a greater likelihood of experiencing reflux, rhinosinusitis, sleep apnea, and they are more likely to experience anxiety – much more on this in a bit.

Medical management of asthma includes both bronchodilators and corticosteroids. Bronchodilators are ‘rescue’ inhalers, like Albuterol, used to bring quick relief of the symptoms of an asthma attack. Corticosteroids, like Prednisone, are used to manage the chronic inflammation that many asthmatics experience. As with most medicines, both types of treatment carry risks/side effects. Rescue inhalers can mask an increase in chronic airway inflammation and therefore mask the severity of asthma when they become overused. Corticosteroids can reduce the need for rescue inhalers, but can cause hormone changes, weight gain, glaucoma and bone loss as well as hoarse voice and thrush.

Many singers with asthma know to rinse their mouth out after using an inhaler to help their voice function a bit better.

To be clear, I am not advocating in any way, shape or form, abandoning the medical management of asthma. What I would like to suggest is there are some practices you can engage in that can help you manage your asthma, change your experience of breathing and how you experience your voice.

When I was first researching asthma back in 2008 I was fascinated to see that reflux, sinusitis and anxiety were all factors that were frequently concurrently present. To me, that suggested that a whole body approach was going to be an important one in managing this condition. Diet, stress management, weight, movement and general health all need to be considered in the treatment and management of the disease.

We know the breath is intimately linked to anxiety – when we get anxious the breath becomes higher and shallower. There is no doubt in my mind that feeling like you can’t breathe is an anxiety producing situation! It isn’t clear which came first, anxiety or asthma, and in some ways it doesn’t matter, we know the two go hand in hand. One of my goals in working with singers with asthma is to help them break the cycle of anxiety and breathing.

Working with Asthmatics in the Studio

Here is my action plan for working with an asthmatic in the voice studio. It is built on the following: Awareness, Skill Building, and Implementation. That process is rarely linear but it is a combination of those three areas that helps singers find success.

  1. Do an extensive intake questionnaire so you know from the first meeting what all the factors are in terms of asthma, allergies and acid reflux, anxiety and medications along with how much they are moving throughout the day.
  2.  Complete a breathing assessment in the initial lesson. Asthmatics are classic ‘over-inhalers’, meaning they are taking in more air than they are letting back out (not hard to see how that would impact singing, right?!).
    1. Within the assessment discover the breath ratio and explore mobility of the ribcage. Very often it is ‘stuck’ in the inhale position (called ribcage flare) and part of the work they need to do is to learn how to move the ribcage on the breath in AND the breath out.
  3. Give the singer the task for the week between when they will see you next of observing their breath in different situations – low stress, high stress, hanging out with friends, speaking in public and private situations, while they are singing, in the morning and at night.
  4. In the studio begin the lesson with gauging where the breath is that day. Use the first 5-10 minutes to do some kind of breath work to help balance the breath. ** DO NOT do this if they are symptomatic.
  5. If they are symptomatic begin here. If they are not, do this next, and incorporate it into vocally warming up. Use postures that target the thoracic spine, ribcage and diaphragmatic ability as well as deep relaxation through forward bends, spinal twists and psoas release.

If you have a singer you are working with, or you are a singer with asthma and I would like some support on your journey, don’t hesitate to reach out!

  1. https://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf