The pelvic floor is the layer of muscle at the base of the pelvis. One in every four women has pelvic floor issues. A common cause of pelvic issues is carrying a heavy load during pregnancy, hours of laboring and pushing. Aging alone can contribute to pelvic floor problems. Most women I see with pelvic floor issues are over age 40 but more and more, younger women are talking about it. It’s not unusual for women to have the problem for a long time.
Incontinence is one of the most common complaints and can be related to giving birth. Even women who have never been pregnant or given birth can become incontinent. This may be related to the amount of sitting we are doing. Urinary incontinence can be termed ‘stress incontinence’ when coughing, sneezing, or exercise cause urine to leak out. ‘Urgency incontinence’ is when you need to go to the bathroom right away because the bladder contracts inappropriately and needs relaxation. Obesity is a risk factor for incontinence. Another problem is prolapse, which is when organs in the pelvis – such as the uterus or bladder droop or bulge out of place into the vagina.
Some women seek the help of a gynecologist, urologist, gastroenterologist, physical therapist or a colorectal specialist but few think of a chiropractor for a pelvic floor condition.
Current non-invasive treatments:
Strengthening the muscles in the pelvic floor can help.
Some doctors will recommend implanting a sling to support the urethra, the channel through which urine flows out.
Urgency incontinence may be helped by behavioral therapy, medications and/or natural phytonutrients. Some women have opted for botox injections to help relax an overactive bladder. This may last six to nine months and then recur.
I remember one of my first female patients when I was a student in the clinic had a ‘pessary’. These are still used today.
Soft tissue therapy and manipulation help the nerves that control bowel and bladder function.
If you have continued pain in the pelvis ask your chiropractor to help you figure out where it is coming from i.e. bladder, bowel, spinal misalignments, pelvic floor muscles or nerves.
You may consider Chiropractic to help muscle and bone problems, soft tissue therapy can help soften scar tissue, and a skilled practitioner will know how to help you strengthen pelvis floor muscles. Losing weight (in my office we use the ketogenic diet) is an important self care piece of the puzzle, along with exercises that strengthen the core and pelvis muscles, (Pilates type exercises are helpful) and, Peripheral Electro Magnetic Frequency (PEMF). PEMF helps stimulate pelvic floor muscles and can help decrease inflammation around nerves that may be irritated in the pelvic floor area.
Patients with chronic and debilitating elbow pain find relief from my poly-modiality treatment strategy. This includes hands-on myofascial release, Laser, Rapid Release Therapy, Deep Muscle Stimulation, instrument assisted soft tissue techniques (IASTM), PhysioTouch lymph drainage and eccentric exercises.
The key exercise is simple and involves grasping a FlexBar in the injured side hand, with maximum wrist extension. The other hand grips the top of the bar and twists, all the while keeping the involved wrist in extension. Both arms are brought in front of the body, elbows fully extended. The twist in the bar is maintained by holding the non-involved wrist in full flexion and the involved wrist in full extension. The bar untwists by allowing the involved wrist to move into flexion. This movement is repeated 10-15 times, up to three times a day.
To schedule an appointment call 310-444-9393.
In January 2015 Thera-Band will launch the CLX.
Dr. Jeffrey Tucker requested that Thera-band make a continuous loop band like the Stretch Strap and in 2014 they gave Dr. Tucker a prototype. He has been beta testing the CLX for a year before the ‘launch’ in his private practice in Los Angeles, CA. He put together routines based on traditional band and bodyweight training.
Dr. Tucker says “I combined my knowledge of anatomy and movement into progressive CLX training” for my patients”. Dr. Tucker has 30 years of experience teaching patients flexibility and strength training. CLX represents an evolved fusion of the Thera-band Stretch Strap and Dr. Tucker’s fascial knowledge and bodyweight strength methods.
Many techniques are combined using the CLX – fascial stretch, PNF, muscle release techniques, static stretch techniques along with proper form and progressions.
“Those doctors, patients and athletes familiar with CLX will be ahead of the pack. Come in and visit me to learn bleeding-edge exercises, new approaches, next-gen thinking in band training and therapy.”
I like using the following ‘exercise template’ when educating patients on what a long-term exercise program includes:
1) Perform self-myofascial release using foam rolls, sticks, and “knot-outs” as the beginning of an exercise session. These are tools to break up hypertonicity and tension in muscles.
2) Perform stretching (static and dynamic) on the overactive muscles. I teach my clients techniques using the ‘Stretch straps’, yoga straps, and bands.
3) Perform movements or isometric exercises that re-awaken and/or strengthen the core and underactive muscles. These are usually bodyweight or thera-band exercises targeted at isolated weak stabilizers muscles.
4) Perform whole body integrated exercises that will add lean muscle and decrease fat.
5) Next, if the client has more time and wants to perform cardio work, this is where I place it.
After talking with patients and hearing what they do or don’t do physically, my suggestions begin first with ‘remove the negatives’. I discuss proper posture, breathing, hydration, diet, supplements, attitude, and sleep. I want to make sure patients are doing the right thing and not the wrong (negative) thing in each of these categories. In addition some patients need to “add in” cardio, strength, or flexibility training depending on there goals. The ‘fatty-bomba-lattes’ who do absolutely no physical activity need to start a walking program; the long distance runner, swimmer or cyclist might need a flexibility program; the Country Western dancer’s and the ‘dance-with-the stars’ people might need some strength training; the yoga dominant person might need some free weight training; the weight lifter might need some cardio and flexibility added on. Depending on the patient’s goals (fat loss, finish a marathon, flexibility, etc), I often find the program they designed isn’t “enough” on its own.
To read the whole article click on link….
Here’s a link to an article on golfing I wrote in Dynamic Chiropractic magazine:
Jeff.. I’ve always been taught to have pt do a pelvic tilt and then squeeze the butt while in this position..before bridging… Is this incorrect?
From the hook lying position, maintain the abdominal brace in order to keep your spine stable.
Have your arms at your side and turn them out so that the back of your thumbs are pressed against the floor. Spread your fingers out as wide as possible.
Keep the spine in a neutral position and slowly raise your pelvis off the floor into the bridge position (at this point you can have the client pre-contract the glutes). I like to observe what strategy they use without coaching on the first several reps. Do they use more hamstrings vs glutes?
Be sure to maintain the abdominal brace throughout the entire movement.
It is also important not to let your low back arch or flatten out at any time during the movement.
Slowly lower back to the starting position.
If getting the spine in a neutral position requires slight pelvic tilt, by all means explore APT or PPT and help them find it. You’ll be amazed at how many low back clients have lost the ability to perform ATP and PPT. Also make sure the knees stay in neutral as well (they don’t drift inward or outward).
Additional bridge progression
Cook Bridge (Hold one knee to chest)
Bridge with strap around the knees
Bridge with heels raised
Bridge with steps
Bridge with one leg extended
Hope this helps.
To Your Health December, 2011 (Vol. 05, Issue 12) Share | By Jeffrey Tucker, DC, DACRB
The most common injury sites for golfers are the low back, shoulder, knee, elbow and wrist. Golfers who have low back pain demonstrate a decrease in range of motion for hip internal rotation on the lead leg (left leg for a right-handed golfer) and lumbar extension, and decreased activation and/or timing of the abdominal obliques, erector spinae and knee extensors. A good golf swing uses the left side of the body as much as the right. The hips initiate movement into the ball. The feet pushing against the ground cause a ground reaction force that sequentially travels up through the hips, the trunk and finally out the arms. The most noticeable difference between pros and amateurs is trunk rotation. Trunk rotation and flexibility are enormously important in golf. Older and less skilled players tend to use less than half the trunk rotation of younger or more skilled players.
Golfers who are looking to maximize their performance and avoid and/or rehabilitate following common golf-related injuries should try these exercises in consultation with their doctor of chiropractic:
Active Warm-Up Exercises Bend forward at the hips to touch the fingers to the floor.
Step into a stride position, extending the right leg (lunge).
Lift the right arm, rotate the spine and the head – hold this pose for 10 seconds.
Return to the stride position.
With hands on the left thigh, drop the back knee toward the floor and reach both arms overhead.
Twist the torso toward flexed front knee and hold.
Return to the hip flexor stretch position then put both hands on the floor.
Go to push-up position.
Sweep the left foot across in front – sit into the stretch and hold for 10 seconds.
Return to the push-up position.
Step forward into a forward bend and hold.
Sit into a deep squat with open knees.
Lift hands overhead, stand up and bring arms back to your side.
Now repeat this on the opposite side: Bend forward at the hips to touch the fingers to the floor. Step into a stride position, extending the left leg (lunge). Lift the right arm – rotate the spine and the head – hold this pose for 10 seconds. Return to the stride position. Hands on right thigh, drop the back knee toward the floor and reach both arms overhead. Twist the torso toward flexed front knee and hold. Return to the hip flexor stretch position then put both hands on the floor. Go to push-up position. Sweep the right foot across in front – sit into the stretch and hold for 10 seconds. Return to the push-up position. Step forward into a forward bend and hold. Sit into a deep squat with open knees. Lift hands overhead, stand up and bring arms back to your side.
The shoulder is the key anatomical structure involved in every phase of the golf swing. If you’ve suffered a shoulder injury related to golf or are just looking to improve shoulder rotation and performance, ask your doctor of chiropractic about these exercises:
Wing stretch: Place the back of your right hand on the outside upper gluteal (buttock) region so the elbow sticks out to the side. The back of the hand touches above your “pants pocket” area. Grab the right elbow with the left hand and pull it the elbow forward, simultaneously resisting the pull by stabilizing your shoulder girdle backward on the stretching shoulder. Hold this stretch for one minute.
Open book: Lie on your left side with your knees bent and your arms straight out in front of you, palms together. Keeping your knees on the ground, take your top arm and rotate your upper body all the way in the opposite direction. Perform 15 reps. Repeat on the other side.
Thoracic rotation: Get down on all fours, place your right hand behind your head, and point your right elbow out to the side. Brace your core and rotate your right shoulder (think about moving through the shoulder blade) toward your left arm. Follow your elbow with your eyes as you reverse the movement until your right elbow points toward the ceiling. That’s one repetition. Do 20 reps right and left.
Band diagonal raise: Attach a band or handle to the low pulley of a cable station. Standing with your left side toward the pulley, grab the handle with your right hand in front of your left hip and bend your elbow slightly. Pull the handle up and across your body until your hand is over your head and your thumb is pointing up (a Statue of Liberty pose). Return to the starting position. Complete 10-15 reps and repeat with your left arm.
Scaption: Perform this exercise standing in front of a mirror to monitor their form. Hang the arms down by the thighs and rotate both hands to a thumbs-up position. Retract and depress the scapulae as you lift the arms up to shoulder-height at a 45-degree angle from the trunk. The arms should make a Y in front of them. Make sure that the upper trapezius isn’t pulling the shoulders into the ears. If it is, work on pulling the shoulders down in order to push the arms up. Perform two sets of 15 reps per set.
Lie face down on a bench with your upper shoulders off the bench to perform these exercises, which involve raising the arms / shoulders to mimic the shape of a Y, T, W and L (e.g., arms up over the head forms a Y; arms straight out to the sides forms a T; etc.). Standing Y-T-W-L exercises can also be performed using a stretch strap, which allows you to maintain a consistent arm position.
One More Great Exercise:
If you’re suffering from increased thoracic kyphosis (rounded upper back / shoulders), protracted shoulder blades and/or forward chin position, ask your doctor of chiropractic about this corrective exercise: Stand, feet together, looking straight ahead. The feet should remain in this position for the duration of the exercise. Put one hand beneath your collarbone and one hand on your belly button. Keeping your hands in that position, lift the chest with the hand under the collarbone while simultaneously pulling down with the belly button hand. This will help to lengthen the spine and reduce the slouched position. Holding the achieved position, level the pelvis by raising the middle of the pelvis with the lower abdominals. Lengthen the neck by slightly tucking the chin and imagining the crown of the head is being pulled toward the sky. Bend your knees very slightly, just enough to remove any tension from the posterior knee. Holding the achieved position, lean forward slightly to shift the center of gravity to the midfoot instead of the heel. Practice this frequently to improve posture. This opens the chest and allows for more natural breathing as well. While non-golfers may not realize it, the physical challenge of golf can be more daunting than the mental part of the game, particularly if you don’t use proper mechanics during every part of the swing. Injuries are common, which will either affect your game dramatically or stop you from playing altogether.
Talk to your chiropractor about these and other exercise strategies to improve your golf game and avoid injury. ——————————————————————————– Jeffrey Tucker, DC, is a rehabilitation specialist who integrates chiropractic, exercise and nutrition into his practice in West Los Angeles. He is also a speaker for Performance Health/Thera-Band, NASM and FMS.com .