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Benefits of working with the breath


In his famous book Light on Yoga, B K S Iyengar describes pranayama as “extension of breath and its control”1.  Pranayama includes all aspects of breathwork: inhalation, exhalation, and breath retention.  As clinicians treating pelvic floor dysfunction, we emphasize the importance of breathing as a critical component of rehabilitation.  Physical therapists Paul Hodges (et al) and Julie Wiebe describe a piston-like relationship between the diaphragm and pelvic floor2,3.  Pranayama, or conscious breathing, can enhance this relationship, especially if there are holding patterns in the pelvis. On inhalation, the pelvic floor muscles and diaphragm move caudally. On exhalation, the pelvic floor muscles and diaphragm move cranially4.  As physical therapists, we instruct patients to use the breath in coordination with the pelvic floor muscles to obtain optimal stability and continence.  Pelvic organ prolapse and urinary/fecal incontinence are often caused by a lack of tonic support and muscular strength of the pelvic floor, core and surrounding pelvic girdle musculature5.  Optimal pelvic floor support from adequate strength, core stability, and neuromuscular control allows for continence and organ support. For optimal core stability, there must be coordination and strength of all components of the deep core musculature – pelvic floor muscles, transverse abdominals, multifidi, and diaphragm6. The “Soda Pop Can Model of Postural Control”, conceptualized by Mary Massery, illustrates how the pressure system of an aluminum soda can maintains the stability of the structure7. Loss of support can happen at the top (i.e. tracheotomy), front (i.e. diastasis recti abdominus), back (i.e. disc herniation), or bottom (i.e. pelvic organ prolapse or incontinence). A “leak” in the structural integrity could affect postural control, core stability, and continence.  This concept underlines the importance of breath retraining as one aspect of our treatment plan. Pranayama gives your patient a strategy to decrease sympathetic nervous system overactivity and encourages the parasympathetic response. According to Diane Lee, common areas of rigidity of movement/holding patterns include lateral and posterior-lateral expansion of the ribcage during inhalation8.  Mindful pranayama encourages the student to explore diaphragmatic breathing without gripping in the chest and ribcage.   Examples of pranayama DirghaDirgha is the Three-Part Breath. Inhale, allowing the belly to fill.  If your patient finds this challenging, try a book on the belly when supine or try breathing in quadruped. The second part of dirgha is expanding the ribcage, followed by the collarbones to floating up. After trying this for 10 breath cycles, stop and recognize any new sensations or softening in the body. I recommend my patients set an alarm to go off every hour to remind them to move and breathe. 

Ujjayi

Ujjayi is known as the Ocean breath. It sounds like you have one ear to a giant seashell. Raise one hand in front of the mouth and pretend to fog a mirror with an inhalation and exhalation.  Recreate the same action at the back of the throat, but now with the mouth closed. This breath should sound similar to the signature sound of the Star Wars villain Darth Vader.  Perform this breath with any warm-up or asana while layer this breath onto Dirgha.

 

Letting Go Breath

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Why is yoga a helpful modality for healing chronic pelvic pain?


Today we hear from Herman & Wallace instructor Dustienne Miller CYT, PT, MS, WCS. Dustienne instructs the Yoga for Pelvic Pain course. Join her next month at Yoga for Pelvic Pain, Cleveland, OH on July 18 and 19!

We all know yoga can help chronic headaches, insomnia, anxiety, low back pain, and a myriad of other conditions. How can we apply the principles and benefits of yoga to the treatment of chronic pelvic pain?

Breathing As rehab professionals who treat chronic pelvic pain, we know how critical it is for our clients to learn how to downtrain the nervous system. Breath awareness and training are a useful tool in reducing sympathetic nervous system override. Some clients may not have the awareness that they are holding their breath because of pain, or even anticipation of pain. Because of the direct mechanical relationship between the diaphragm and the pelvic floor, breath holding can lead to pelvic floor muscle holding. By building awareness, which is a learned skill, the client begins to notice and eventually control non-optimal breathing patterns.

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Grounding in Mountain Pose


Today on the Pelvic Rehab Report, we hear from Dustienne Miller. Dustienne wrote and teaches the Yoga for Pelvic Pain course, which is available in Cleveland, OH on July 18-19, and in Boston, MA on September 12-13.

"It feels like my pelvic floor just sighed."Grounding in Mountain Pose

As musculoskeletal professionals, we have a sharp eye for postural dysfunction. We explain to our patients that the ribcage is sheared posteriorly to the plumb line and how gravity magnifies forces at specific structures. Some physical therapists perform the Vertical Compression Test (VCT) to allow the patient to feel the difference between their typical habitual posture and a more optimally aligned posture. This works well to “sell” your patients on why their newly aligned posture allows for more efficient weight transfer through the base of support. In addition to the VCT, I utilize Tadasana, or Mountain Pose as an additional kinesthetic approach to postural retraining.

Last week in the clinic, I was teaching my client postural awareness using Tadasana. I asked her to close her eyes, or lower her gaze if she was not comfortable closing her eyes. Working from the ground up, we started bringing awareness to her base of support. She noted that she was standing with her weight mostly in her heels. When I encouraged her to bring her weight forward, hinging from the talocrural joint, she had an “aha moment.” She said, “It feels like my pelvic floor just sighed.” She was unaware that her habitual posture was to stand with her weight mostly posterior to plumb line, thus encouraging her posterior pelvic floor to remain in an overactive state. Once she balanced her body from the ground up, she felt a major release in her holding patterns.

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Overcoming Trauma and PTSD through Yoga

dustienne

H&W instructor Dustienne Miller, CYT, PT, MS, WCS wrote this post.

 

As specialists in pelvic health, we have the honor of being trusted with very private information. Our patients trust us with their secrets, their emotions, and their bodies. Sometimes patients reveal traumatic personal stories, both past and present. Even if our patients have not suffered emotional, physical, or sexual abuse, we can assume that the diagnosis of pelvic floor dysfunction is traumatic itself. Bouncing from clinician to clinician and inability to share their pain and experience with coworkers and friends is enough to increase baseline anxiety and depression levels. Yoga has proven to be an effective method in helping to heal Post Traumatic Stress Disorder and other mental comorbidities associated with pelvic floor dysfunction. But where do you start? How do you make your patient feel safe?

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Upcoming Continuing Education Courses

Feb 25, 2018 - Feb 27, 2018
Location: Touro College: Bayshore

Mar 2, 2018 - Mar 4, 2018
Location: Texas Children’s Hospital

Mar 2, 2018 - Mar 3, 2018
Location: Texas Children’s Hospital

Mar 2, 2018 - Mar 4, 2018
Location: Marathon Physical Therapy

Mar 3, 2018 - Mar 4, 2018
Location: Florida Hospital - Wesley Chapel

Mar 3, 2018 - Mar 4, 2018
Location: Loyola University Stritch School of Medicine

Mar 9, 2018 - Mar 11, 2018
Location: Mount Saint Mary’s University

Mar 9, 2018 - Mar 11, 2018
Location: Northern Arizona Healthcare

Mar 9, 2018 - Mar 11, 2018
Location: Core 3 Physical Therapy

Mar 9, 2018 - Mar 11, 2018
Location: Bella Physical Therapy

Mar 16, 2018 - Mar 18, 2018
Location: Middlesex Hospital

Mar 17, 2018 - Mar 18, 2018
Location: DeKalb Medical Atlanta Hospital and Medical Center

Mar 17, 2018 - Mar 19, 2018
Location: The Sage Colleges

Mar 23, 2018 - Mar 25, 2018
Location: University of Central Arkansas

Mar 23, 2018 - Mar 25, 2018
Location: Henry Ford Macomb Hospital

Mar 23, 2018 - Mar 25, 2018
Location: Robert Wood Johnson Medical Associates

Mar 24, 2018 - Mar 25, 2018
Location: St. Francis Physical Therapy

Apr 6, 2018 - Apr 8, 2018
Location: WakeMed Health & Hospitals

Apr 6, 2018 - Apr 8, 2018
Location: Aurora Medical Center

Apr 7, 2018 - Apr 8, 2018
Location: Florida Hospital - Wesley Chapel

Apr 7, 2018 - Apr 8, 2018
Location: Saint Luke\'s Health System

Apr 13, 2018 - Apr 15, 2018
Location: St. Joseph Hospital Rehabilitative Services

Apr 13, 2018 - Apr 15, 2018
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Apr 13, 2018 - Apr 15, 2018
Location: Highline Medical Center

Apr 14, 2018 - Apr 15, 2018
Location: University Hospitals

Apr 15, 2018 - Apr 17, 2018
Location: Touro College: Bayshore

Apr 20, 2018 - Apr 22, 2018
Location: The George Washington University

Apr 20, 2018 - Apr 22, 2018
Location: Marathon Physical Therapy

Apr 21, 2018 - Apr 22, 2018
Location: Core 3 Physical Therapy

Apr 21, 2018 - Apr 22, 2018
Location: The Everett Clinic