 back to physical therapy for a better life. I'm your host, Christine Linder's physical therapist and board certified orthopedic clinical specialist. Today I'm filming from San Diego on vacation, a place that I spent many, many years and we're gonna talk about the core and I'm gonna tell you everything you need to know about activating your deep core properly and rescuing your back and the rest of your body. But first I wanted to talk a little bit about the title. What does physical therapy for a better life mean? Physical therapy for a better life means performing certain daily movements, exercises, stretches, adjusting how you stand, adjusting how you sit so that you can eliminate your pain and enjoy your life to the fullest. And also at the end of each show I quote myself which is life is better when you listen to your physical therapist and I wanna talk a little bit about what that means and what that means is if you work consistently on the few or several exercise that you need to have your best functioning and your best feeling body with consistency you are gonna go feel better and have the best life. So let's go to the first video to learn more. Okay, so in order to do your physical therapy exercises at home you don't need a lot of equipment for purchase. You can use a lot of home items so you can get a tennis ball, you can use a golf ball and some of these items are great if you have plantar fasciitis to roll your arch out over to stretch out the end of the day. That's the golf ball. You can do the same thing for a tennis ball. It's a little bit more comfortable if your plantar fasciitis is painful. You can use the tennis ball. If you have pain in your calf or Achilles you can do a little pressure point release. If you have a tight glute from a back injury you can massage it out on that and just lay on it and kind of move your leg. And you don't have to get any equipment but it's important to have a couple items at home so that you can do what you need to do to feel better and enjoy your life. Now definitely your things you're gonna need to purchase are a band. Some band to do either your pastoral exercises or your rotator cuff exercises or your hip exercises, things to help yourself regardless of your injury. A band that's open like this is versatile. You can tie it in a knot and untie it. You can also purchase a loop band but you can do a lot of other things for your shoulder. You can put it around your knees or your ankles to do ankle exercises, hip exercises, knee exercises. And the foam roll is something as well as the bands that's definitely worth a purchase. It's great for everyone, athletes, non-athletes, people sitting in a desk doing posture, cyclists that are hunched over their bike for hours on end and you can just lay on your foam roll. Make sure you cycle your stomach in before you get on it to protect your back. Keep your knees bent to protect your back and then you just stretch out this way. So if you have neck pain doing your chin knots on the foam roll is great. Everything is about posture. If you've got neck pain, shoulder pain, elbow pain, wrist pain, you need to open up your chest to get into better alignment and usually I have people do this. I just have them let their head fall to the side and lean to the side and breathe to stretch out the opposite side three times. Then after that, I have them let the head fall and lean to stretch out. You can do a series of modified snow angels or shoulder rotations. You could work on your deep core. There's many things you could do on the foam roll and if you don't have one or you don't wanna purchase one, you can roll up two big beach towels and lay on those. The key is that you have to have it from your tailbone to your head. So you don't really need much at home and you can also use a water bottle or a soup can or one of those new heavy water bottles, fill it up and do your rotator cuff exercises, laying on your side, do whatever shoulder rehab you need. So you don't have to have any fancy equipment to feel good at home. These are tips that I give my patients, my clients, whether they're in my office or I'm seeing them virtually every day because your home is a plethora of objects that you can use for your own physical therapy at home. I don't wanna make it difficult for you. I wanna make it easy and I want you to be able to accomplish it in minutes so that you can have your best body. So let's talk now this big thing. Everybody knows what the core is now. It's starting to be talked about everywhere. What is the core? I need to work my core. I need to strengthen my core. I need to strengthen my back muscles. So let's go to the next video to learn what really is the core. What do we think about when we think about the core? Most times when I ask people about the core, they talk about their abdominal muscles or this kind of region in the body, meaning your center. But that's not just the core. The core actually consists of everything from your vocal folds and your voice box down to your pelvic floor, muscles below. And so when we talk about the core, we wanna access this central powerhouse, this pressurized canister of system to help stabilize our arms, our legs when we're walking to help us achieve balance and stability while we're moving. So a lot of people are doing crunches and planks and activating things in their core, but I just wanna call it to light the importance of activating some specific deep muscles like your transverse abdominis, which is your deepest abdominal muscle and it runs around you like a wide bell. And when you activate that muscle, it shrinks your waistline. It brings in your abdomen and all of your abdominal content. It helps support your inner, like that. And so does your pelvic floor muscles below. They are the bottom of this cocanister as Mary Mass had in her research. And so you need your pelvic floor muscles below to help support all of your organs and everything below on the bottom part. So when our core in the abdominal region is not working, your belly hangs out and you have a lot of pressure on your lower pelvic floor muscles. When you activate your transverse abdominis and you support your internal organs and also activate your pelvic floor muscles, you're activating that on the front to help support yourself from the bottom up. But what's more important is the back muscles. Your deepest back muscles called the multipotus muscles attach from three vertebrae up and they run like little Christmas trees either up your spine or down your spine, however you wanna look at it. And when those muscles contract together, they stabilize each vertebrae. So you don't get extra movement when you're bending, hopefully not bending this way, but there's no way to pick a baby up out of a crib without flexing your spine. The great thing about the transverse abdominis is when you suck your stomach in like this, I say suck it in, when you pull your belly button in towards your spine, you activate those deepest back muscles, those multipotus and in a second, you get a pelvic girdle of support that supports your abdomen and your lower spine. You get the anatomical girdle is what we call. And so I wanted to call it to light how vast the core is. And we're talking about the core, it's not just about working your abdominals, it's working your abdominals in the front, but also using your deepest core muscle, your transverse abdominis to activate your deepest back muscles to achieve spinal stability so you can have balance and prevent injuries in your extremities, but also to get rid of your low back pain. And let's not forget about the hips as well. That video says a lot and it talks about the core when Mary Massary did her PhD and tons of research on the corbing from the vocal folds in your voice back down to your pelvic floor below. And it is this pressurized canister that helps support the essential part of our body. And the key point there is that when you pull your belly button in, when you suck it in, when you make your belly look smaller and you pull that belly button back towards your spine, as soon as you activate the transverse abdominis muscle, your deepest back muscles, the largest stabilizers for each vertebrae in your low back, they can co-contract with the abdominal muscle and they give you an anatomical girdle of support. And that is what is gonna free you of low back pain is retraining your transverse abdominis to help form the anatomical girdle with your low back. Now that's not the only thing you need to strengthen and stabilize when you're trying to get rid of your low back pain, when you're trying to achieve better balance, when you're trying to strengthen your core. That's not just it. You need to strengthen those deep back muscles as well. But if you don't get that co-contraction of your transverse abdominis with your motivitis first, then you're starting off behind. We don't just wanna use our superficial rectus abdominis, more superficial rectus abdominis, more superficial oblique muscles to mask a weak deep core. And I hope everybody's hearing that. You need a strong deep core, which is your transverse abdominis, that wide belt abdominal muscle, your motivitis muscles in the back, your pelvic floor to really help to stabilize your low back and give you that powerhouse that you have inside of you. So I also mentioned at the end, don't forget about the glutes. The glutes are a very important part of your core. And let's go to the next video where we learn why the hips are important. Hips are a very important part of your core. So let me explain. They do a huge job to keep your spine stable and prevent injury in your spine. So when I stand on one leg like this, if I'm gonna show you my waist, my pelvis level stays level. And that is my hip muscles doing that. If I pick up my right leg here and my hip drops, there's a bending in my spine. And I'll show you, I'm gonna do it again. I'm gonna pick up my right leg. Did you see this drop? You'll see this pull. What that is, is that is my spine bending to the side. And that is one of the very common ways of people herniating discs or having terrible back pain, whether you're walking, running, going up and downstairs. It doesn't matter if you are walking and that is happening because your hip muscles are weak and they're not achieving stability while you're on one leg, you're going to get back pain and injury. And so I wanna make sure that we focus on when we talk about the core, hip muscle strengthening as well. That's fantastic. So I hope you all saw that, saw that bending in my spine when the hip drops. Now you're probably wondering what can cause hip weakness that would lead to something like a drop like that that can be harming your spine and you're not even knowing it until all of a sudden you herniated disc or you have sciatica or pain running down your leg or numbness and tingling down in your leg because you have nerve compression from that bending, creating spinal instability because you don't know how to suck it in. You're not in touch with your deep core yet. Well, it could be something as simple as having plantar fasciitis or having had a foot or ankle surgery, a bunion surgery, hurting your knee and walking with your foot turned out or leaning to the left. Everybody's done it. That's hurt themselves. You walk with your leg kind of out to the side and when you do that because you have an injury, it decreases pain in the joint that is injured. However, once the injury has healed, you have now adapted a pattern of walking with your foot out and when you land with your foot out abnormally like you taught yourself when you had that injury, I know I've done it myself with all my injuries. Now you don't set up the chain reaction that is needed to fire that gluteus medius to stabilize your leg like this on your pelvis without having that drop and you don't even know it until all of a sudden you have low back pain or nerve pain down your leg and you come into the clinic and I ask you to stand on one leg and balance. I do it on both sides. I ask you to walk and I ask you to stand and do a single leg squat in front of me so I can see what is causing your low back pain? Is it because your foot though? Is it because you're overpronating? Is it because your hip is dropping? Is it because you hurt your back? So I just want to call to your mind how important the glutes are to the core. So let's go back and let's find out how do you fire your transverse abdominis? How do you fire up your deep core in the best position so that you can free yourself from pain and be able to do all the exercises and life activities that you'd like? Let's go to the next video where we learn how to fire your transverse abdominis in neutral spine. So there's many ways that you can access your core and exercise your core but what I'm going to show you right now is how to access your deep core. And by deep core what I'm referring to is your transverse abdominis, your multivitus in the back and your pelvic floor. So it's important to learn how to find your neutral spine and it's not an exact science but basically your neutral spine is the position when you lay on your back like this with your legs bent up that your spine is in. So there's a little bit of a space I can shove my hand underneath there but I can't get it all the way under there. Now some people may have a real sway back and some may be tilted like say they've been hunched over a desk for years. Those are the exceptions but in general you should be able to slide a space between your lower back and the table and feel the pressure right on your tailbone and your shoulder blades. You shouldn't feel your low back pressing down into the table or the floor. So once you're in your neutral spine you're not pinned flat and you're not super arched you're just somewhere in the middle which many people find that is their neutral spine just as soon as they lay there like this. You are gonna pull your belly button into your spine so I tell people just suck it in it's not air and you're not gonna do it as you breathe you're just gonna pull your belly button in like this. So you see it bringing down I'm not bringing it in and tilting like this you're not seeing this part move you wanna make sure you have that tailbone contact firm on the floor and pull your belly button in. And when you do it you'll feel tensing but you'll also maybe feel a little strain on your breathing or if you really pull it in you feel strain if you're trying to talk like I am because your transverse abdominis attaches on the sides to your diaphragm. You don't wanna pull in your belly button and here as well because now you're just compressing your diaphragm with your large rectus abdominis we want your deep core not your superficial core. So you're gonna if you want you can put your hand here so you can see that only this moves down and not this too to get your diaphragm. So you're just getting transverse abdominis pull your belly button in belly button in belly button in. So to progress that so you can now pull your belly button in and breathe like I am and talk like I am and it's still in I'm not out I'm in. Now you wanna try to move your legs to make it more automatic and teach your transverse abdominis your multifidus to stabilize your spine while you move your legs so you're gonna pull your belly button in and you're gonna lift your left foot one inch and you're gonna put it down you're gonna re-tighten by pulling your belly button in more and lift your right leg one inch. Now I call this the TA march the transverse abdominis march. And so you the point is to pull your belly button and maintain that contraction while you move your legs and a lot of times people don't have the control so they'll see their pelvis tilting like this. So that's what you normally see and that means you're not getting the co-contraction between your transverse abdominis and your multifidus. So it's important to really pull your belly button and just lift it one inch and then really pull your belly button again lift another inch and really get this exercise going well before you progress. So once you've done that you can progress, you can progress other things like pulling your belly button in and bringing your legs up to the chair position. Now if you notice, I did not flatten my back and then bring my legs up. I kept that contact point on my tailbone. I sucked my stomach in I brought my legs up and this stayed the same I stayed in neutral. I will have people do that and they'll keep pulling this in don't let this bulge out keep pulling your transverse abdominis in. You want your deep core to work too not just a superficial pull your belly button in and then you straighten one leg a little bit bring it back straighten the other leg out and bring it back keep pulling this in because it wants to pop up that means you're not using your deep core anymore you want to use your deep core. You could also just do like a kind of back and forth like you're kind of riding a bicycle almost or doing a stair climber that's a little bit easier than the chair. Those are just a few ways that you can learn how to strengthen your deep core. So a couple of huge points about that video. Number one, if you want to learn more information about the transverse abdominis and how critical it is to the deep core and stabilizing your spine you can type in my name, Christine Linders into the Google search and the critical role of the development of the transverse abdominis in the prevention and treatment of back pain. I had the opportunity to publish an article in the orthopedic journal at the hospital for special surgery. You can look it up on PubMed and NCBI and find out everything that you need to know that was in 2018. If you want more information it does illustrate more of those exercises. And the second point is that I was in Monterey visiting two of my best friends and they are the epitome of physical therapy for a better life. They're both extremely active. They're in their 40s. They cycle at a very elite level and I went riding with them two days in Monterey. It was amazing. I could say with them because I started with them but I was long gone in the first few minutes but they get off their bike and before they even rack up their gear they are doing their stretches. They are elongating their things and they're exercising and undoing the sport like I like to say. And I was so impressed and the reason why they do that is because they want to be able to not be in pain as they age they want to be able to cycle just as hard the next day. So I'm just very inspired and impressed by them because that's kind of what it takes. So if you are at a desk all day and you are slouching forward then go and stretch in the corner. I have done numerous amounts of videos in my previous show movement matters that will show you everything that you need to do to get out of or undo your desk posture and I go through it for pretty much many sports and lots of positions. So use that information. It's very good information. That's why I do this is so that you have access for these exercises. So now let's go to the last video, the gluteal exercises where we show you how to strengthen your buns to get rid of your back pain. Need your gluteus medius, your powerful hip muscles to stabilize your leg and your spine when you're walking. And here's just a couple of great ways to work your gluteus medius and your deep core and your multifidus. You put a band around your feet or around your ankles. You're gonna lie in your back. You're gonna pull your toes up. You're gonna squeeze your buns tight. As soon as you squeeze your buns tight, like you're gonna lift them up off the table or you're not, you will get your multifidus to fire. As soon as you push down, you're gonna push your legs down, slide them apart. You're not lifting, you're sliding them apart. So toes up, buns tight, press down and slide. That gets your powerful gluteus medius. I need you to do about 15 to 20 here and then I will hold one leg straight as if I'm standing on one leg. Push down and slide. You're not gonna lift. A lot of people like to lift. You're gonna push down. As if we're gonna lift those glutes. Slide one leg out to the side 15 to 20 times. Switch, re-stabilize. Slide the other one out to the side. Now another great exercise that combines deep core and hip rotators, deep core, translodomis, multifidus, pelvic floor, is getting in that neutral position, sucking your stomach in a neutral, lifting your buns all the way up, which gets your glutes and your deep back muscles and then opening your knees coming down an inch. There should be no pain when you do this. This is a little bit of a more advanced exercise, but it gets your glute muscles as well as your deep core. And then to make it more functional, functional as if we're gonna apply to our daily life, you could just put the banner in your ankles and walk sideways in a little crouched position, sucking your stomach in. If you don't have space, you can go out, out, in and just always make sure you keep tension on the band. So you could do 10 to 20 leading with your right leg. After that, 10 to 20 leading with your left. And this is what it looks like on the side. You're in the neutral position, you're sucking your stomach in, your posture is upright, and you're working your deep core and your hips. Okay, fantastic. So there you have everything you need to know to activate and get in touch with your deep core and stabilize your body from the inside out. So you as well can have your better life. I'm gonna wrap it up and I'm gonna give a big thank you to Scott and Katie for hosting me in Monterey and inspiring me to do this show and for filming it in some of the most beautiful locations that I've been. And also to think at Hawaii and all your staff and donors for allowing us to bring this to you today. I hope everyone has a great day filled with much aloha. And as always, life is better when you listen to your physical therapist. Aloha everyone. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. 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