As musculoskeletal specialists, we are adept at identifying postural dysfunction. I often explain to patients how their ribcage might shift posteriorly relative to the plumb line and how gravity can amplify forces on specific structures. To help patients understand the difference between their habitual non-optimal posture and a more optimally aligned posture, many occupational and physical therapists use the IPA’s Vertical Compression Test (VCT). This test effectively demonstrates how improved alignment facilitates better weight transfer through the base of support. Sometimes this test reproduces back or pelvic pain which allows the patient to understand how their posture might be a contributing factor to them not feeling their best. In addition to the VCT, I incorporate Mountain Pose as an additional kinesthetic tool for postural retraining.

Many moons ago, I was working with a lovely client on embodied postural awareness using Mountain Pose. I suggested she could close her eyes if she felt comfortable (some people will feel safer lowering their gaze instead of closing their eyes). Working from the ground up, she realized her weight was predominantly in her heels. When I guided her to shift her weight forward by hinging from the talocrural joint, she experienced an “aha moment,” saying, “It feels like my pelvic floor just sighed.” She hadn’t been aware that her habitual posture involved standing with her weight behind the plumb line, which contributed to overactivity of the posterior pelvic floor. Once she adjusted her base of support from the ground up, she felt a significant release in her habitual tension.

At our follow-up visit, the client noted an increase in her postural awareness. She was surprised by how frequently she noticed her pelvic floor gripping in a state of overactivity. She also reported enhanced awareness during her standing yoga postures in class. Grounding down through the feet, cued as imagining the soles of the feet getting magnetically drawn into the floor, can be a useful verbal cue to assist with letting go of unnecessary gripping. The experience of achieving embodied optimal alignment has given her greater self-efficacy, and she’s successfully translated this improved postural awareness into her daily life. Self-awareness and empowerment are central goals in my physical therapy practice, and integrating yoga into this process makes my clinical work even more fulfilling.

To learn more, join Dustienne in her remote course Yoga for Pelvic Pain this September 14-15! This course discusses a variety of pelvic conditions including interstitial cystitis/painful bladder syndrome, vulvar pain, coccydynia, hip pain, and pudendal neuralgia. Dustienne also describes the role of yoga within the medical model, contraindicated postures, and how to incorporate yoga home programs as therapeutic exercise and neuromuscular re-education both between visits and after discharge in this course.

Author Bio:
Dustienne Miller PT, MS, WCS, CYT

Dustienne Miller is the creator of the two-day course Yoga for Pelvic Pain and an instructor for Pelvic Function Level 1. Born out of an interest in creating yoga home programs for her patients, she developed a pelvic health yoga video series called Your Pace Yoga in 2012. She is a contributing author in two books about the integration of pelvic health and yoga, Yoga Mama: The Practitioner’s Guide to Prenatal Yoga (Shambhala Publications, 2016) and Healing in Urology (World Scientific). Prior conference and workshop engagements include APTA's CSM, International Pelvic Pain Society, Woman on Fire, Wound Ostomy and Continence Society, and the American Academy of Physical Medicine and Rehabilitation Annual Assembly.

Her clinical practice, Flourish Physical Therapy, is located in Boston's Back Bay. She is a board-certified women's health clinical specialist recognized by the American Board of Physical Therapy Specialties. Dustienne weaves yoga, mindfulness, and breathwork into her clinical practice, having received her yoga teacher certification through the Kripalu Center for Yoga and Health in 2005.

Dustienne's love of movement carried over into her physical therapy and yoga practice, stemming from her previous career as a professional dancer. She danced professionally in New York City for several years, most notably with the national tour of Fosse. She bridged her dance and physical therapy backgrounds working for Physioarts, who contracted her to work backstage at various Broadway shows and for Radio City Christmas Spectacular. She is an assistant professor of musical theater and jazz dance at the Boston Conservatory at Berklee.

Dustienne passionately believes in the integration of physical therapy and yoga within a holistic model of care. Her course aims to provide therapists and patients with an additional resource centered on supporting the nervous system and enhancing patient self-efficacy.