Archive for October, 2009

21 October

The Diaphragm – The Core: Part Five

diaphram

In an Eric Franklin class I once took about breathing, he started off by asking us to close our eyes and go to our favorite room in our house and visualize ten objects.  After about thirty seconds people could name their ten objects.  Then he asked us to do to the room in our body called the diaphragm and also name ten objects.  Well…that took longer.  Most of the class laughed at the request.  The point being is that we know more about our house than our own bodies.

The diaphragm is the last piece of the puzzle to discuss in our core section.  Remember, we have the trasversus abdominis creating the main portion of the cylinder in the front and around to the back via the lumbar fascia, the multifidi in the back, the pelvic floor at the bottom of the cylinder, and the diaphragm is the top of the cylinder.  The diaphragm is the main muscle of inhalation, and separates the thoracic cavity from the abdominal cavity.  Depending on how deep of a breath you take, the diaphragm will move 1/2 to 2  inches downward.

The diaphragm originates on three low back spinal segments via the left and right crus, lower six ribs and the bottom tip of the breastbone, called the xiphoid process.  I think xiphoid is a good name to remember for scrabble.  Xiphoid means tip in latin.  The diaphragm connects to itself via it’s own central tendon in the middle of the muscle. The central tendon is a little more dense than the rest of the diaphragm.  Like the center of a parachute is thicker than the ends.

Now take a deep inhale and tell me does the diaphragm ascend or descend when you inhale?  I have had knock down drag out fights in my class over this question.  Which do you think it is?  You may have a sensation of upward lift because the ribs are expanding to allow the lungs to fill with air, but the answer is that as you inhale the diaphragm concentrically contracts, pulling the fibers together and thus lowering the dome of the diaphragm to pull in the air.  Read the last sentence again if you need to.  It is a vacuum system, like a bellows that stokes a fire, or a bicycle pump.  Get a bicycle pump and place the tip upward and the handle down to the floor.  The handle represents you diaphragm. Pull the handle down toward the floor and air will be pulled in to the pump.  Same with the diaphragm, as it contracts and moves downward, air is pulled into the lungs.  There is a pressure change too that happens in breathing, but I won’t go into that now.  If you would like more write me and I will be happy to oblige.

What happens on an exhalation?  As you exhale, the fibers of the diaphragm stretch apart which is called an eccentric contraction.  The diaphragm is a muscle.  Therefore it is important that it is exercised in both a concentric and eccentric way.  The inhalation is the concentric contraction, and the exhalation is the eccentric contraction.  You know someone has not trained their diaphragm in an eccentric way if they have a weak, quivery voice.  As the diaphragm eccentrically contracts it pushes the air over the vocal cords to create sound.  If the person cannot generate enough force to push the air over the vocal chords, then they will have a soft, shaky voice.  Singers that can sing one note over a long period of time are demonstrating amazing control of their diaphragm in an eccentric contraction.

Exercises

  1. Seated or standing, visualize the diaphragm descending on the inhale and ascending on the exhale.  You can play with this concept further by taking deeper breaths and visualizing the diaphragm descending further, up to two inches.  Then taking shorter breaths with the diaphragm moving less than that.  Basically, however deep the breath will generate that similar effort of movement in the diaphragm.
  2. Check that you have an equal inhale and exhale.  Count as you inhale.  Count as you exhale.  Is it the same number?  If not work making them equal, and then see if you can increase your inhale and exhale by two counts.  This is a fun exercise while walking.
  3. Take singing lessons.  Some of the best diaphragmatic exercises can be found in a singing class.  If you are too shy to take a class then get a book, or sing in the shower or car.
11 October

The Pelvic Floor

The Core: Part Four – Week Five of Pilates

pelvic-floorView of the female pelvic floor from above

My first experience with pelvic floor exercises came when I was working with Alan Herdman in London.  Alan and I were in the middle of a side over exercise when a beautiful woman walked by and thanked Alan for teaching her about her pelvic floor because her client base had increased dramatically over the last month.  I, of course, had two questions, what did she do for a living and what did he teach her?  Alan’s answer to the first question: she was a high priced escort.  I was too embarrassed to ask the second question so I looked it up.

The pelvic floor is the group of muscles known as the levator ani, or in Latin, anus lifters.  It is composed of the puborectalis, pubococcygeus, iliococcygeus and the ischiococcygeus.  These muscles line the base of the pelvis from the pubic bone in the front to the inside of the tailbone and across the pelvis from one sit bone to the other.  The pelvic floor is important in maintaining the “fit” of the pelvis and sacrum puzzle pieces, supporting the bladder and reproductive organs and pressurizing the abdominal cavity.  This pressure supports the low back but is only beneficial when all members of the pelvic floor are working together harmoniously.  As mention in the first article on the core, the members of the core are the transversus abdominus, multifidi, pelvic floor and diaphragm.  When these muscles are imbalanced the system is forced to compensate and this has far reaching consequences for the low back.

The pubococcygeus is the most anterior of these muscles.  It is important for sexual function and is sometimes injured during childbirth without knowing it.  Dr. Kegel designed the exercise in which the subject engages the anterior pelvic floor for a given length of time and then releases it.  While a Kegel or “bracing” may be an acceptable way to sensate or find the anterior pelvic floor musculature, it is not recommended for daily use.  This is for two reasons:
1). The Kegel does not address the breath.  Since the diaphragm and pelvic floor work together during a breath, if the breath is held while engaging the pelvic floor the diaphragm will not be able to participate fully.  This disrupts the harmonious functioning between the members of the core.
2).  Integrating the breath underlines the kinesthetic relationship between the top and bottom of the core and incorporating the breath is more likely to bring about using the pelvic floor in everyday activities more quickly and effectively in your life.

The posterior pelvic floor or pubrectalis tends to be ignored in comparison to the anterior pelvic floor.  However, it can sustain significant injuries (it has been known to rip during childbirth) and its function is also important to low back health and function.  Imagine the pelvic floor like the foundation of a building.  If there is not support for the backside of the building, pretty soon what is above will soon start to slide down.

The iliococcygeus and ischiococcygeus travel from the outer bones of the pelvis to the coccyx, the evolutional remnants of a tail at the very end of the spine.  These two muscles tip the base of the spine backward, in direct opposition to the muscles of the back.  The pelvic floor is locked in a dance of stabilization with the muscles of the spine.

The four muscles of the pelvic floor must be constant and dynamically active to support a pain free loading of the pelvis.  When healthy, the pelvis has remarkable mechanical abilities to transfer weight and movement seamlessly up to the trunk and down to the feet.

Exercises for the Pelvic Floor
1. Diamond Sit – Seated on the floor or hard bench/chair.  Visualize the four corners of the pelvis (pubic bone, coccyx, left and right sit bones) creating the shape of a diamond on the floor or chair.  In between those four points lies your pelvic floor.  If you would like, you can place a soft, 4-5 inch diameter ball in between the four points to better feel your pelvic floor.  As you inhale, visualize the diaphragm and pelvic floor moving downward.  As you exhale, visualize the diaphragm and pelvic floor moving upward.  Visualizations you can use are your pelvic floor moving with the quality of a jellyfish, or lava lamp, or any image that conjures something strong and supple without too much tension.
After you have done this exercise for awhile, notice that as you engage your pelvic floor on the exhale, you may also feel your abdominals engage.  The research scientists Sapsford and Hodges, that we have discussed before, did a study that showed the pubococcygeus engages with the transversus abdominis.  Can you feel that connection?
2. Sitting and Standing – This is an exercise I learned from Eric Franklin.  Seated on a chair, notice the two sit bones touching the chair.  As you lean forward the sit bones move apart, and as you move back to a seated position, the sit bones move together.  Inhale forward and exhale back.
After you have done that for awhile, lean forward with sit bones apart, move forward off the chair onto your legs, bring the sit bones together and you will stand.  Reverse the sequence to sit.  Lowering yourself to the chair, the sit bones will spread, touch the chair with your pelvis and go back to sitting the sit bones will move back together.  Bonus if you write me in a comment and can tell me when in this exercise the pelvic floor is eccentrically(stretching) and concentrically(engaging) working, and with what breath pattern.  Let’s see how many of you read this!

References

Franklin, Eric.  Pelvic Power. Princeton Book Company. Hightstown, NJ.
2003

Lee, Diane.  The Pelvic Girdle. Harcourt Publishers Limitied.
Edinburgh, UK. 2000.

Sapsford R.R, Hodges P.W., Richardson C.A., Cooper D.H., Markwell S,
Jull G.A.  Co-activation of the abdominal and pelvic floor muscles
during voluntary exercise.  Neurophysiologey and Urodynamics 2001:20.
Pg. 31-42.