The Mysterious Psoas

female-hip“It’s in the reach of my arms, the span of my hips, the stride of my step, the curl of my lips. I’m a woman phenomenally. Phenomenal woman, that’s me.”

-Maya Angelou

Most people haven’t heard of the iliopsoas muscle, generally called the psoas (“so’ az”), much less know where it is. The largest and thickest muscle in the body, the psoas connects our trunk to the legs, connecting along the lower back (T12-L5) and involves movement of the back, pelvis, legs, and indirectly, the arms. It is deeply buried under the abdominal muscles and down into the pelvis. Think of the psoas when you enjoy that swing in your hips!

Two Fascinating Facts:
1. It’s the first muscle that forms in the human fetus.
2. When a woman is giving birth the psoas helps to push the baby out.

It’s quite common for postnatal women to report “pain in the buttocks, sacrum and along the crest of the hips in the back”. This is the path of the psoas so it’s often the culpit when it becomes tight and contracted, including the hip flexors.

AREAS WITH SIGNS OF PAIN:
low back, hips, thighs, abdomen during bowel movements, while standing or hanging, even difficulty breathing

CAUSES INCLUDE:

  • “Sucking” in the tummy (yes, allow your belly to breath!)
  • Over training
  • Sitting too long
  • Poor posture
  • Poor muscle alignment
  • Impact of childbirth
  • Scar tissue adhesions after surgery (including c-section birth)

You might call it a “deep feminine” muscle as it can also hold deeply buried emotions and tension, just like the pelvic floor.  Alexander Lowen, MD, creator of BioEnergetic therapy, wrote: ”There is a bottom to our despair. It is the pelvic floor.” Though it’s not technically a pelvic floor muscle, it is a vital part of the same web of connective tissues (known as “fascia”) and also helps create stability in our core and trunk so one invariably affects the other. As children, many of us learn to tighten our pelvic floor as a way of shutting down or repressing fearful emotions and trauma. This is a common response of “flight or fight” by the nervous system as a coping mechanism.

Other spiritual and emotional solutions may be:

  • grounding with the Earth,
  • monitoring stress levels
  • assessing whether you’re feeling supported or not

Connecting with the psoas can open up painful emotions and memories but on the other side is the healing, reclaiming our freedom of movement, vitality, dreams, creativity, and sexuality.

Standard psoas massage tends to be a harsh, painful, and even shocking experience. Therapists may dig down deep into the area without allowing the tissue layers to warm and melt so the body can open up beforehand.

Though not necessarily comfortable, I practice the approach called “Muscle Swimming”, developed by Peggy Lamb, which is a more thorough and gentle method of systematically locating and releasing the psoas, abdominal, and secondary hip flexor muscles which all impact the health and alignment of the psoas itself.

Bellydance movement is also extremely healing for the psoas and pelvis, back, abdominals, and core in general.

It’s important to develop a strong core through proper breath work and exercise but rigorous exercise can be dangerous before the psoas is back in basic alignment. Think SAFE and EFFECTIVE exercise. As with all movement, listen to your body and avoid anything that doesn’t feel right (sharp pain, cramping, etc.) Meet your body where it’s at in the moment.

Here are some basic psoas stretches. Remember to breathe…

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psoas-stretch-smallpsoas-low_lunge-small

Self-Test: Do you have diastasis recti aka “mommy tummy”?

diastasis recti, a split in the belly muscles, referred to as "mommy tummy" may be disregarded or surgery given as the only option in many cases. But it can be treated through specialized fitness training and massage.

Diastasis recti, a split in the belly muscles, referred to as “mommy tummy” may be disregarded or surgery given as the only option in many cases. But it can be treated through specialized fitness training and massage.

The major reason diastasis occurs is because of a distended belly, almost always due to poor core function. It happens when the abdominal muscle connective tissues stretch and weaken at the midline or linea alba. The left and right sides of the abs look and feel separated.  Poor alignment and doing the wrong abdominal exercises only make it worse. Some hints that you may have a diastasis include low back pain, “mommy tummy” that you can’t seem to heal, and loss of control of your pelvic floor.

diastasis-recti-m2m-march-2016

66% of women who have diastasis recti also have problems with their pelvic floor function.

Dysfunctions include at least one of the following:

  • Pelvic floor pain
  • Weak pelvic floor
  • Urinary incontinence
  • Fecal incontinence
  • Pelvic organ prolapse

The gap will become most noticeable when you lie down and relax. The loose skin above or below the bellybutton may seem to sink into the center gap. There may be a jelly like texture to the skin instead of a solid abdominal wall. When you lift your head and shoulders slightly from the floor and engage the abdominal muscles more deeply, you’ll see that the midline or linea alba gap will reveal itself to be deeper and wider.  If your fingers are not pressing into the gap, it may seem to protrude outward, as if the inner contents are pushing out of the midline.

diastasis-test

Checking for Diastasis Recti:

  1. Lie on your back with feet on the floor and knees bent. Arms should be by the sides.
  2. Place your two fingers horizontally into the stomach just above and below the navel.
  3. Inhale.
  4. Then exhale as you raise your head just off the floor.
  5. If there is a gap, the fingers will sink into the abdominal cavity.
  6. One to two fingers’ width soon after the birth is normal and will tighten over time with some modifications to exercise.
  7. Three or more fingers’ width means steps must be taken to close the gap.

Formula for Healing Diastasis Recti (according to The Center for Women’s Fitness)

  1. First Realign
  2. Then Exercise

A pelvic floor assessment with a qualified physical therapist is a very effective starting point. Ask your midwife or OB/GYN, or your doctor if it’s been many years, for a referral. Many of the postnatal health issues in the US can be prevented and treated with this foundational care. It is standard procedure for postnatal mothers in the UK, France, the Netherlands, and Australia. You can find out specifically how to support recovery including whether your pelvic floor is too tense/tight or weak/lacking tone and (whether and which) kegel exercises will help you come back to balance.

Proper breathwork techniques are the first and foundational exercise. They can help to gently rebuild and realign the core and pelvic floor muscles. Breathing should be fluid and not too extreme (neither too expanded during inhales or constricted during exhales).

Some basic breathing exercises:

  • Extended inhales
  • Extended exhales

Avoid exercises that put pressure on your already separated, therefore weakened, abdominal muscles. This includes excessively heavy lifting as well as planks, push-ups, and sit-ups. A postnatal corrective exercise personal trainer is an excellent and effective way to ensure that you will get the customized tools you need to rehabilitate your core and come back stronger and healthier than ever!

Fit for Birth (http://getfitforbirth.com/) is a leading organization in the prenatal/postnatal fitness world and is a great resource for finding a qualified professional in your area. I offer these services in Portland, Maine and Miami, Florida as well as online in live sessions in the US and internationally.

Your body has worked hard to create, nurture, and give birth to your baby. The process of rebuilding the core and healing diastasis recti can be slow, especially if you have had it for many years, so please be patient with yourself.

Sacred Breath: Giving Ourselves Permission

breathing-meditation

“The wisest one-word sentence? Breathe.”
~Terri Guillemets

Breathing is the channel through which the human body is designed to discharge 70% of its toxins. The smaller percentage of toxins are discharged through sweat, defecation and urination. We don’t rid our bodies of toxins properly when we aren’t breathing properly; this means really filling our belly and lungs and fully exhaling, slowly and deeply enough to receive the oxygen that we truly need to function at full capacity.

We tend to forget and “outgrow” the full belly breathing that was so natural for us as babies. We can reclaim a major foundation of our health simply by relearning how to breathe by first becoming aware of our breathing patterns to see how often we actually hold our breath and checking in with our bodies throughout the day.

breathe

In daily modern life, anxiety, stress, and trauma overstimulate the sympathetic nervous system (a system meant to be stimulated for only minutes at a time) on a consistent, on-going basis. We have become shallow chest breathers, just getting by with enough oxygen to survive while holding our bodies rigid.

Breathing affects our respiratory, cardiovascular, neurological, gastrointestinal, muscular, and psychic systems. It affects our sleep, memory, concentration, and energy levels.

Dropping our breath down to deep diaphragmatic (belly) breathing makes a huge difference and helps to re-program our nervous systems away from chronic stress.

The diaphragm muscle is located just below the lungs and, like any muscle, becomes weak when it is underused. Instead, we overuse the secondary breathing muscles located in the neck and the back causing imbalances and leading to neck and back issues and tension headaches. Eventually they can build up and surprise us with a pulled muscle that we didn’t see coming.

It is also a foundational “core” muscle. It is the beginning point for core strength and core rehabilitation. Both the diaphragm and pelvic floor work in tandem and are both toned during diaphragmatic breath. If we don’t use our diaphragms regularly while breathing, we don’t build foundational core strength. Proper breathing is essential to the natural course of laboring and birthing. It builds deep core muscle strength which aids mothers during pregnancy and postpartum recovery.

Breath plays a major role in the functioning of the immune system; in fact, improper breathing is a common cause of ill health and, in some cases, life-threatening disease. Medical research reports the prime cause of 1.5 million heart attacks each year is hypoxia (a lack of oxygen). Scientists have confirmed that a key precursor of cancer is a lack of oxygen at the cellular level.

It takes time to correct our breathing habits and develop the diaphragm muscle but, with repetition and consistency, you will feel the difference. Try this lying on your back with you knees up and soles of your feet down on any surface, just before you go to sleep. Repeat each 10-20x.

MAKE NOTE: If you get lightheaded, dizzy, or nauseous, this is a sign of detoxification and lets you know that your body really needs this. Just back off and take a drink of water. Return to the breathing when you feel clear again.

  • Place your hands on your belly, inhale, filling it like a balloon.
  • Exhale fully.
  • Place your hands on the sides of your ribs.
  • Inhale deeply, expanding your ribs out sideways avoid your chest rising.
  • Exhale fully.

See what happens when you give yourself permission to take up some space and time and really BREATHE.

Healing After C-Section Birth: Scar Massage

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“To all women who have brought life into the world, to their courage and power. Thank you all.”
-Jane Claire, “C-Section Guide: A Handbook to be Informed, Empowered, Pro-Active”

A C-section is two very important things. First of all, it is birth. C-section birth is also major surgery which requires rehabilitation. Education and support is often lacking in regards to being aware of the potential post-surgery complications. Basic tools for healing and repair beyond “go home and rest” are sorely needed as follow-up to ensure the health and safety of mothers.

C-section surgery cuts through six body layers leaving a scar. The incision cuts the fascia (connective tissue) of the abdominal and pelvic floor muscles, superficial nerves and disrupts the lymphatic flow. As a result, scar tissue forms along the abdomen and uterus.

If you’ve had a C-section, these signs and symptoms may indicate that you’ve developed the bands of internal scar tissue known as adhesions.

  • Generalized pelvic pain or abdominal cramps
  • Sense of pain, tugging or pulling in the abdominal area when you bend forward or sideways, while lifting, leaning, reaching or standing up straight
  • pain, discomfort, or urgency when urinating
  • pain or discomfort with intercourse
  • infertility
  • gas, bloating, diarrhea or constipation (including IBS)
  • low back pain
  • incontinence
  • pelvic organ prolapse

“If not treated, scar tissue can spread in multiple directions. It can also travel up towards the diaphragm and inhibit breathing”.

How Can You Immediately Address Healing After Cesarean?

  • rest and recovery
  • avoid doing too much, too soon
  • keep your incision clean
  • avoid lifting anything heavy
  • eat well to support healing

cesarean-scar-healing

Scar Tissue Massage as Medicine

With physician clearance post-c-section, women can generally begin scar massage at 6-8 weeks postpartum. Or seek a qualified massage therapist or physical therapist. Gentle, consistent massage for as little as 5 minutes per day is effective. It involves massaging the scar tissue so it becomes softer and more pliable using “three dimensional focus, slowly and gently separating the adhered tissues in all directions.”

Some women don’t want to look at or touch their scar because of pain or numbness. Everyone has different responses; there may be little to no pain, a burning sensation, pain, or emotional release which can include feeling sad, angry, or incredible relief, crying, laughing or any combination of emotions.

Benefits of Scar Tissue Massage

  • softens tissues
  • increases circulation
  • lightens color of the c-section scar
  • reduces “pooch” if caused by fluids trapped by the dam of scar tissue
  • creates a flat, smooth scar
  • stimulates the nerve endings
  • reduces/eliminates numbness
  • increases circulation
  • improve body awareness
  • reduce lumps and chords which may contribute to complications from adhesions (see list above)

Initially, hold below your scar to avoid it opening. The actual scar is much deeper down than what you can see and feel.  Focus on gentle, deep breaths into your belly to help relax the muscle and skin tissues and the nervous system. After you massage for a long time, the scar softens and you can penetrate the abdomen more deeply and help dissolve the deeper levels. To prevent keloids, apply silica strips or gel which will help with discoloration and scar texture on the surface.