How Restorative Exercise™got rid of my lower back pain and ill-fitting trousers

Some of the effects of restorative exercise on my life have been quite unexpected. I had hoped that the Katy’s Whole Body Alignment course would help with my lower back pain, that dates back to my teenage years and I wasn’t disappointed, but I hadn’t bargained with a renewed Haute Couture wardrobe.

I stumbled across Restorative Exercise™ on Facebook. Having just recently qualified as an Ante-natal exercise instructor, I was on the look-out for new exercises to introduce to my class. The Best 50 min on the Exercise ball class looked like what I needed. I swiped quite a few exercises from this class but what most impressed me was, that my lower back pain had disappeared after one single hour with Katy. I was hooked. How did this work? What was so different to an exercise ball class at the gym? I signed up for the Whole body alignment course and found lots of answers and a million more questions (at least I am getting to a point where I can ask myself meaningful questions about my body and habits). 

All my life, I have been told that my back pain is due to scoliosis of the spine, with a leg slightly shorter and a pelvis that isn’t level and twisted etc. So why does Katy’s alignment programme work, where orthopedic insoles, an orthopedic spinal corset and physiotherapy had not delivered over the previous 20 years? 

For me it comes down to awareness, knowledge and taking control. I was ready to hear what Katy had to say (even if I am very slow at assimilating it all). At the beginning of the Wholebody alignment course, I went to see a Chiropracter about my scoliosis. The lady told me that I had a couple of twists in my spine (as if one wasn’t enough) but mainly my wonkiness comes from a very tight right hand-side of the torso, pulling the upper body to the right and the shoulder towards the floor. I asked her why this was. She just looked at me and said, “ I don’t know, why are you leaning to the right? “ I went away not impressed, since I had always believed, something made me do whatever I did with my spine and I wanted her to tell me. By this time, I had listened to some Katy and had started to take control over my body. It hit me. Why AM I leaning to the right? It’s my body, so I should be able to make those muscles relax and lengthen and level the shoulders.

This course has taught me to look at myself carefully (I had realised that I almost never do), ask myself why I hold myself in space the way I do and what causes my ailments. Katy has given my invaluable tools to look after myself. I looked at my legs and hips with the aid of a water level and tried to find out if they were uneven length. If they are, it’s only minimally. Then I got two scales, that read the same, to find out how much I lean to the right. I carry about 6 kg more on the right foot, when I think I stand evenly on both feet. I repeated the readings a few times to get a feel for the difference. In the picture, I can see the tension in the right forefoot, from carrying all the extra weight. And this is were my foot hurts after long walks or walks in barefoot shoes - SPOOKY - NOT!

Using the scales, I then tried to work out what it feels like to put my weight through both feet equally. My left side is pretty lazy and quite a bit weaker, so when I stand level, it is complaining of having to work harder.

Curbing rib thrusting, keeping the pelvis in neutral, the lots of walking and Restorative exercise™ while trying to keep my weight equally distributed, meant that my lower back pain has been pleasantly absent. Changing the way I move instead of adding exercise classes to my week to keep fit has been a revelation.

Now the other thing I noticed is, that my back pain is worse after wearing tight trousers or trousers with a belt. With my new Katy alignment investigative power, I thought about the mechanics and causes for this. 

The belt is pulling the abdominal area backwards and down, causing tucking. 

A tight waistline or belt, stops me from keeping the pelvis in neutral when sitting and probably when walking to a degree. It makes me tuck my pelvis and that is a big NONO - if you don’t know why read here and here. Not enough length at the backside of trousers between waist and crotch does the same. I concluded my basic biomechanical investigation, that I need clothes that are made for my body - HAUTE COUTURE - unique to me.

Dusting off my sewing machine and rusty sewing skills, I bought an easy pattern for a light pair of trousers. They are probably not fashionable anymore, as Restorative Exercise™ unfortunately has not improved my fashion sense, but they are fitted, light and give my behind the space it needs, without having to result in elastics.

Thank you Katy for a new me - inside and out.

Are you weight bearing?

No matter which exercise philosophy or alignment theory you follow, there will be a point where you’ll come across weight bearing movement. This term is widely used but not really very well defined.

A quick look on-line came up with this:

weight-bearing

The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. (www.biology-online.org/dictionary/Weight-bearing)

Katy Bowman defines weight bearing in her Foot pain relief book as: 

weight bearing: when a structure is carrying the full burden of its own mass, in the human case, when the bones are holding the vertical mass of the body.

Weight bearing exercises are usually all exercises in which you support your full body weight as a unit, as in running or walking as opposed to exercises were you don’t. 

Not fully weight bearing:

Swimming: the water supports a lot of your body weight

Cycling: where part of your body weight is pushing against a cycle seat, taking the load off the hip joint - part of the body is supported on the cycle seat, and another part on the pedals - two separate units. In this case the hip joint is not weight bearing.

In Katy’s alignment theory weight bearing is often referring to the hip (joint). If you are aligned, i.e. hip is aligned over knee and heels you are more weight bearing than if your hips are out front aligned over the mid-foot, where you are less weight bearing.  Aligned in this instance means aligned to the graviational pull i.e. straight up and down or vertical.

Described as less weight bearing as hip aligned over front of foot.  (www.restorative exercise.com)

On the other hand, you have descriptions of situations where mis-alignment causes more weight being “borne” e.g. the weight on the spine increasing with mis-alignment, see Figure 1 (as recently pointed out in one of the RES questions). Here the head is described as "getting heavier and the spine has to carry more weight with mis-alignment". The further the head is forward the harder your upper body has to work to keep it in place.

The hip or the head being out of alignment is the same situation. In both, the weight is forward of their supporting bones. So why are we talking about bearing less weight in one scenario and more in the other?

As we all know, the actual mass is not changing and neither is the weight. The weight being the mass pulled towards the ground by a constant gravitational force. So why are we talking about more or less weight being borne?

The answer to this, is in the way the weight is borne and what effects the weight has on the part of the body that is carrying it. The weight can be borne by being balanced on a bone and squashing the bone vertically towards the ground or it can be borne by muscles, which pull the weight towards a bone that can support the weight. Here is a graphic of a simplified leg bone and a foot.

You may not be able to see this clearly as the scale of the image is small, but the overall forces on the bone (blue arrow) are the same in both situation, aligned and non-aligned. The only difference is the angle of the force. Gravitational squash is a little less in the second non-aligned situation where muscular pull occurs to make up the difference. The length of the arrows shows how large these forces are. This gives an overall simplified picture of the forces created by gravitational pull on the leg. 

The same appies to the situation of the head being out-front of the spine. Here it is a little bit more complicated since the spine consists of several vertebra stacked on top of each other. By the way they are shaped and connected they are able to carry weight just like a solid leg bone. The further forward the head is in front of the spine, the more weight is pushing down on thin air, causing rotational forces. These rotational forces are then counteracted by muscles in the neck and upper back. Instead of the head being balanced on top of the spinal column and creating just bone squash in the spine, the muscles have to pull the head back connecting it with the spine, which can carry the weight. 

In Conclusion:

When people are talking about less weight bearing they usually talk about bones not being squashed by all the weight above them as some of the weight is carried by the muscles pulling the bone back to vertical.

When they talk about parts of the body becoming heavier then they talk about the muscles that have to pull on these part of the body and try and stop them form falling on the ground. The further forward you carry a body part to their supporting bones e.g. head forward of the spine, the “heavier” it gets as most of the weight is pushing down on thin air creating larger rotational forces that the muscles have to counteract. 

Weight bearing also depends on which part of the body you are looking at and how you are positioned in space. When sitting down, you hip joint is not weight bearing but your neck is still carrying all the weight is usually does. If you do a head stand the neck will be carrying a lot more weight than usual. In the second example the body is positioned in space in an unusual way and what you define as “fully” weight bearing may need to be defined differently.

Does it matter, how your body weight is carried? 
I have found no evidence in literature that the alignment of bones to the vertical axis is crucial for bone regeneration, it seems to depend more on the impulses that are send through the bones and not the angle they are at and both muscle contraction and gravitational squash can cause bone regeneration (more about this in a later blog). 

What it does affect however is pressure in joints and tension pattern in muscles throughout the body. If you use muscles further down the body to keep you upright, you often end up using muscles further up the body to do the same. This causes tension in muscles that have not evolved to carry body weight. Bones are stronger and have evolved to do this.

In joints, when they are pushed together by bones at an angle that is not optimal, they often wear out quicker. The pressure on joints in these situations tends to concentrate on one part of the joint e.g. the inner knee only. When pressure is distributed over the whole area of the joint, the pressure decreases and causes less wear and tear.

Barefoot Bliss 2

As you may remember, I have been trying out minimal footwear and proudly presented my home made barefoot shoes in April. They were very comfortable and a lot more sturdy than I thought but as you may have guessed from the use of the past tense they are not completely intact anymore. The leather soles are fine but the back heel stitches went on my right shoe. I need to re-enforce them with a double layer of materials and they will be fine again.

The other problem I encountered, was that my feet weren't ready for that much barefoot walking. After a few weeks, I had some persistent pains in the arch of the right foot and I went back to wearing more supportive negative heeled shoes. I need to stretch and roll/mobilise my right foot on a tennis ball a lot more before I put that much pressure on it again for that amount of time. Katy Bowman's "Fix your Feet" DVD is one of the programmes I follow to regain foot mobility. Have a look at a trailor.

I found some Bama shoes - Schuhe wie Barfuss - in my mum's wardrobe which didn't fit her well and adopted them. They are cute and very thin soled. Unfortunately there is a little heel at the back.

I also tried out the Swiss kevlar socks last time I was in Austria and they are fine but very fiddly to put on. I didn't wear them lots but went completely barefoot instead.

If you into sewing I very much recommend making your own barefoot shoes out of sturdy material. Send me a photo if you do.

Oh and a little aside, I have figured out what to do with one of my last pairs of high heeled shoes - mules that I wore throughout my pregnancies. They are now my very own garden clogs - ideal for getting into a full squat with neutral spine while weeding and planting.

Get the most out of your time in the pool

I know a lot of pregnant mums and new mums like to spend time in a pool, swimming or baby swimming to prepare for birth in a gentle way or to get baby used to a watery environment. I teach aqua-natal classes and love the lightness I feel submerged in a pool at least once a week. It's great for me but even nicer for my highly pregnant mums. Post-natally, movement in water helps relax those overworked joints and back and give you a break from carrying baby.

The movement that work the best for me in the pool are tension releasing stretches as the water is a naturally relaxing environment. If you enjoy the suberged feel, try the following restorative stretches next time you are in the pool. A couple of minutes before or after a class, or lane swimming will add a new dimension to your pool work out.

The calf stretch is great to relieve tension at the back of your legs. If you don't have a woggle you can do a double calf stretch instead. Stand an arms length away from the pool side with hands on the side. With fully extended legs push your bottom behind your heels and bring your head between your upper arms. Let your head hang. This one is great for the back of your legs and the upper back.

The number 4 stretch is one of my favourite and the water is an ideal medium to practice it. When crossing your legs and sitting back as if onto a chair, try and keep your knees over your heels and you get an even deeper stretch.

Keeping up your activities through pregnancy and preparing for birth

Pregnancy is a time of major change to the body and expectant mothers often aren’t sure how to adapt activities and exercise accordingly. This leaflet outlines how to adapt your fitness regime and provides activities to prepare for birth.


You can buy a version of this information as a PDF leaflet, that is an A4 printable and foldable leaflet. The leaflet is a great reference point for mums-to-be or hand-out for birthing professionals. Cost: 50 p.

BEFORE STARTING ANY NEW ACTIVITIES CHECK WITH YOUR DOCTOR OR MIDWIFE TO ENSURE YOURS IS A LOW RISK PREGNANCY.

There are many advantages to keeping active during pregnancy, including:

• Keeping up energy levels and improved sleeping pattern
• Can relieve pregnancy discomforts, swelling, sickness, constipation, varicose veins, leg cramps
• Stronger muscles and greater endurance can ease deliver and labour time and improve recovery time for mum and baby
• More efficient placenta during pregnancy and birth which ensures oxygen and food supply to baby     
• Relaxed, strong muscles and the ability to keep correct alignment alleviates back and joint pains, strengthens the pelvic floor.
• Ensures healthy weight gain and reduces risk of gestational diabetes.

Adapting exercise for pregnancy

GUIDELINES:

• Always keep well hydrated. Drink a glass of water or squash every 20 min during exercise.
• Have a light snack within the hour before exercise to make sure your blood sugar level does not fall too low.
• Keep your exercise moderate. If you over-exert yourself, your muscles compete with babies food supply. On a scale from 1 - 10 (1 = no exercise and 10 = as hard as you can work) stay within 5 - 6. You should be able to hold a conversation when exercising.
• Train to maintain fitness levels not dramatically improve them.
• Stick to what your body knows. Donʼt start new types of exercise. If you havenʼt been exercising, keep fit by walking or  attending ante-natal or aqua-natal classes, which are based on  functional, everyday moves.
• Due to increased production of the hormone relaxin, which  loosens ligaments in preparation for birth, be careful with high impact sports or over-stretching as joins become more unstable
• Avoid forceful twists straining your already stretched tummy muscles, e.g. as in tennis or golf strokes
• Don’t exercise when you are feeling unwell and stop exercising if you start feeling unwell, light headed or very tired.
• Avoid exercise in hot and humid conditions to avoid overheating.
• Wear a sports bra or several bras on top of each other
• If you feel dizzy when lying on your back, roll onto your side as baby may be lying on a major vein, constricting your blood’s  circulation back to your heart.

AMOUNT OF EXERCISE RECOMMENDED 

Regular activity 3 - 5 times a week for 20 - 60 min at moderate level is recommended throughout a low risk pregnancy.

Research: Women who continue to perform weight-bearing exercise throughout pregnancy have been shown to have a shorter, often unaided labour and delivery and faster recovery after the birth. Positive effects of exercise on fitness during labour are particularly pronounced if you can exercise right up to full term (Clapp, J.F., 2002). Weight bearing activities are any movement where you support your whole body weight. Walking is the most accessible weight bearing activity.

Activities in preparation for birth

AEROBIC ENDURANCE

Walking in alignment is the kindest and most efficient whole body movement, ideal for training the heart and lungs. It’s free and keeps pressure on your joints low. Speed up for a minute or two until you feel slightly out of breath and slow down again - simulating contraction. Aqua-natal is another low impact way to keep up endurance right up to the birth. Endurance is an important factor for birthing success and recovery.  

ALIGNMENT

Keeping your whole body especially the pelvis aligned is one of the most effective way to prepare for birth. Keeping the pelvis neutral (see picture below) when sitting and walking will increase the birthing space, improve pelvic floor strength and help keep your abdominal muscles strong. Keeping the weight of your body in your heels and feet facing straight ahead will prevent, knee, hip and foot pain and helps keep your pelvis aligned. It is NOT possible to keep beneficial alignment in HIGH HEELS. 

          

PELVIC FLOOR

A strong pelvic floor, will help channel the baby into the pelvis during labour and help it turn before emerging. Traditionally, pelvic floor exercises consist of squeezing the pelvic floor muscles as if to stop urinating and pulling them up and in, Slowly first and then with fast twitching moves. It is beneficial to know how to squeeze and particularly release the pelvic floor. However, too many pelvic floor exercises and sitting on your sacrum with your pelvis tucked under result in a tight and weak pelvic floor.This leads to a decreased birthing space as a tight pelvic floor pulls the sacrum into pelvis. To lengthen and strengthen the pelvic floor and open the birthing space, sit on your sitting bones and exercise the buttock muscles to pull the sacrum backwards with e.g. the squat.

THE SQUAT

With your feet a little wider than hips-width and the outside of the feet parallel and straight ahead, bring weight into your heels and lower. Try and keep your shins as vertical as you can by leaning forward with the upper body and only lower until you start tucking your pelvis. Come back to an untucked position and hold or push back up through your heels.

HINT: Try and squat carefully onto a chair/toilet when sitting down and off it again when standing up without using your arms

ABDOMINALS

Keeping your deep abdominal muscles strong throughout pregnancy will support your lower back and prepares them to support contractions during labour. 

On all fours, with hands below shoulders and knees below hips, relax your tummy and keep a neutral back with a gentle hollow in your lower back. After an out-breath, lift your tummy towards to your spine, lifting your baby towards your body. Keep this position for a couple of breaths and release tummy towards the floor. Let your tummy relax but try and prevent your ribs from poking out. Repeat. 

HINT: You can repeat this when walking, standing, sitting anywhere.

(c) Restorative Exercise, Inc.

STRETCHING

Increase length and strength of muscles affecting hip mobility

One of the tightest area are the back of our legs, which restricts mobility of our hip joint and can cause the pelvis to tuck under. 

The double calf stretch increases the length of the calves and hamstrings and encourages a neutral pelvis and spine. 

Step with the front of the feet onto a rolled up towel/mat. Heels stay on the floor. Feet are hips-width apart facing straight ahead. Lean forwards from the hip and hold onto a chair, sofa or ball Only lean as far forward as you can without tucking the tail bone under. The weight of the body rests in the heels and legs are fully extended. See if you can push the buttocks behind your heels. You can do this exercise to start without the rolled up towel.

(c) Restorative Exercise, Inc.

RELAXATION

Regain energy and control between contractions and make contractions more efficient by breathing naturally and releasing muscle tension. 

Practicing efficient and calming breathing

Bring both hands to either side of your ribcage. Breathe slowly in through the nose and feel how the ribcage expands to all sides. Slowly breathe out through the mouth and gently push the ribcage back together. Keep breathing as slowly and calmly as possible. As labour progresses, you will breath faster through your mouth. The expanding rib cage is still a great point of focus. 

Practicing letting go of tension

Birthing hypnosis and birthing pools/baths or birthing massages are a great way to release tension and speed up labour. Practice releasing tension with each breath:

1. Breathe in as described above and with the out-breath relax your face, head and neck. Add a cue word in your mind e.g. Relax, Release 
2. With the next out-breath relax your face, head and neck and add shoulders and arms. Repeat your cue word.
3. Breath out and start relaxing with the head and neck then shoulders and arms and add your tummy area
4. Repeat adding the pelvis with the next breath and finally the legs and feet. Always starting with the head until you relax the whole body with each breath, adding a cue word in your mind.
5. To check for tension held in parts of your body it helps to tense the muscles when breathing in and letting go on the out breath.

You can buy a version of this information as a PDF leaflet, that is an A4 printable and foldable leaflet. The leaflet is a great reference point for mums-to-be or hand-out for birthing professionals. Cost: 50 p.

 

Further Reading:

Cherry Baker (2006) Pregnancy and Fitness. A&C Black. London

Katy Bowman (2011) Every Woman’s Guide to Foot Pain Relief. BenBella Books Inc. Dallas.

James F Clapp III MD (2002) Exercising Through Your Pregnancy. Addicus Books.

Judy DiFiore (2003), The Complete Guide to Postnatal Fitness 2nd ed. A&C Black. London.

Useful organisations:

The National Childbirth Trust:

http://www.nct.org.uk/

The Active Birth Centre

www.activebirthcentre.com

Rewlea Swimming

http://www.rewleaswimming.co.uk/

The Register of Exercise Professionals

www.exerciseregister.org 

Natal-hypnotherapy/Hypnobirthing

www.natalhypnotherapy.co.uk

www.hypnobirthing.co.uk 

Relevant blogs:

MumsKeepFit:

http://mumskeepfit.blogspot.co.uk

The path you take:

http://pathyoutake.blogspot.ca/

Katy says:

http://www.alignedandwell.com/

For more information contact:

Pre- and Post-natal fitness instructor:

Christine Shuttleworth  

Email: mumskeepfit@hotmail.co.uk

Website: www.mumskeepfit.com

Blog: mumskeepfit.blogspot.co.uk/

Birth space

Congratulations to all our expecting Mums! You have passed the first hurdle of creating life. Your baby is growing happily, slowly expanding its living quarters.

Next stop: Bringing your baby into this world as safely, fast and as non-eventful as possible.

There are many ways to prepare for birth but one of the best must be the physical and mechanical preparations of creating the biggest possible birth space. The pelvis and pelvic outlet is pretty inflexible with the exception of the movable sacrum at the back. The sacrum and attached coccyx is the lowest part of our spine. It is also an attachment point for the pelvic floor. The other being the pubic bone at the front. The sacrum is able to move into the birthing space and out see Fig. 1 and Fig. 2. The red arrows show the length of the pelvic floor and birthing space:

Fig. 1: Looking down into the pelvis, the sacrum is pulled back and lumbar spine (lower spine) is curving neutrally into the body.

Fig. 2: Sacrum is pushed into the birthing space and lower spine is pushed backwards, flexing the spine and causing extra pressure on the lower spine joints.

Now, ideally we all want our birthing space to look like Fig. 1, more space for baby to pass through and less trauma to the coccyx and sacrum, when baby's head pushes against them on its way out. So how does the sacrum move?

1. The muscles attaching to the sacrum from within the pelvis are the pelvic floor muscles. They run from the coccyx to the pubic symphysis at the front of the pelvis. The red arrows point to attachment points of the pelvic floor in the above figures. They also run from the sacrum to either side of the pelvic outlet, creating a hammock for internal female organs and the baby. A very tight pelvic floor will pull on the sacrum and over time will cause it to move into the birthing space, Fig. 2. This is why traditional Pelvic Floor exercises in excess are counter-productive. The more you squeeze these muscles:

- the tighter they will become, 

- the more the sacrum moves into the birthing space and 

- the shorter and weaker the muscles become. 

Short muscles have less contractile length and produce less force. To keep the pelvic floor healthy and birthing space open, it is very important to be able to relax pelvic floor muscles completely and lengthen them.

2. One of the muscles attaching to the outside/back of your sacrum are the gluteus maximus muscles (buttocks), two of the largest muscles in the body. They are used for e.g.:

-  extending the leg behind you, if you happen to walk by extending the leg behind and not lift it in front and falling onto it and 

- stabilising the pelvis when pushing up from a seated or say squatting position.

Whenever the gluteus maximus is active it will pull on the sacrum and over time move it out of the birthing space as in Fig. 1.

3. The sacrum is also moved by passive positioning. If you tend to sit slouched e.g. on the sofa with pelvis tucked under, you are sitting with your upper body weight pushing onto the sacrum. Sitting like this, the sacrum is pushed into the birthing space and the pelvic floor shortens as in Fig. 2. You may also feel lower back pain as a result as this sitting position, which forces the lumber or lower spine to flex and put excess pressure on it. 

To achieve optimal birthing space try the following:

* learn how to relax and lengthen your pelvic floor. If you do do pelvic floor exercises, add a relaxation at the end of each pelvic floor contraction by letting go of the pelvic floor contraction completely and gently pushing down on the pelvic floor. This will help identify the right muscles to use during birth. 2 sets of 8 pelvic floor squeezes a day are easily enough to get to know your pelvic floor. Read more detailed info on a TooTightPelvicFloor and there will be a follow up on this article on how to relax and increase length in the pelvic floor.

* incorporate squat movement into your daily routine see You don't know squat and Maui Squat for more info.

* be aware how you walk. Do you lift your leg in front and fall onto it or are you using your fully extended legs to push back and propel you forward (cue: legs behind body - using your gluteus)? See Walking or Bouncing for more info on how to walked aligned.

* DO NOT SIT ON YOUR SACRUM!! Sit on your sitting bones with your backside behind you and not underneath you. Sit on the chair the wrong way round so you lean forward (also a good way to get baby into the optimal birthing position but about this another time). Sit on the floor leaning on an exercise ball, sit cross-legged, on your heels or don't sit at all, stand, walk, squat, lie - change position as often as possible. For some more ideas have a look at Your position in life.

Enjoy your bump and good luck for the big event!

                                                    Quite a while ago now! Missing my bump(s).