​Swimming or water exercises are often recommended for
people with back pain.

You may have already experienced this, but it kind of hurts
​to swim when your back is bothering you!



Classic freestyle requires a certain amount of extension and rotation of the spine.

One way to work around that and use swimming to help you when your back hurts is to keep your core slightly engaged, don't kick with your legs and let them drag lower in the water.

So it will be an upper body freestyle stroke, and I would focus more on the reaching component of the stroke versus the upward motion of the arm.

You're creating a nice elongation action through the torso..ahh

You can alternate laps with a kickboard - try putting the kickboard under your head and be on your back as you kick.
It's very easy on the neck and shoulders and is a great workout for the legs!
It's harder than you think

Water exercises in general are a little bit more user-friendly.
If your back hurts more while you are walking in the water or doing knee lifts etc. you are probably going through too big of a range of motion and not stabilizing your spine.

Focus again on slight core activation to help stabilize your spine and keep the steps and leg movements at a range that doesn't aggravate your back.
Of course the same goes for any arm movements that you may want to include.

You can do some nice stretches for the trunk and low back using the edge of the pool, the possibilities are endless!

Reach out anytime if you would like some specific ideas for your current situation, we can schedule a session or even do a half hour video session to go over great ideas for you.

My Child Was Just Diagnosed With Scoliosis
​
For some parents this comes as a complete surprise - other times the parents suspected it and initiated the evaluation.
Either way - it is a stressful time with lots of questions and often hard to get answers.
 I am discussing AIS - Adolescent Idiopathic Scoliosis. 


First of all - what is it? 
It's a 3 dimensional change in the shape of the spine and torso in an otherwise healthy child. We don't know why it happens and we do know there is a familial tendency.


The key things your doctor should be looking at are Risser or Saunders score and the degree of the Cobb angle.


Risser score is a measurement of how far along in the growth stage they are by looking at xrays of the pelvis.
Saunders also looks at growth stage but looks at x rays of the hand. It is considered more accurate.


Cobb angle is a measurement of the curve or curves taken on the xray - it's important as a baseline but also to determine if and when a child would benefit from bracing. I should mention that Risser or Saunders score weighs into that decision heavily as well.


If a brace is recommended for your child, it is worth seeking out an orthotist who specializes in three dimensional bracing, since scoliosis is a three dimensional problem! 
A Rigo Cheneau style brace is a good place to start. 
There are others. Feel free to reach out to me if you find yourself in the situation. 


Unfortunately the bracing terminology is not standardized so it's hard to sort through. 
At minimum, speak to a few orthotist before you let them fabricate the brace and make sure they have experience with scoliosis and  address the three dimensional components. 
Even within the same company, ask for the closest thing they have to a scoliosis specialist!


I think one of the hardest things for families is the unknown. 
The truth is, we have no idea which children will progress more rapidly, not at all, 
or sometimes smaller curves even regress. 
So no one can offer a guarantee. 


The main goal with adolescents is to limit the progression of the curve until they are done with bone growth. The risk of progression goes way down as they are closer to bone maturity.


Research has shown that bracing, if indicated, and PSSE can be helpful. 
PSSE stands for Physiotherapy Scoliosis Specific Exercise. 
The Schroth method and the SEAS  method are the two most evidence based of those schools.


Some physicians will refer you for specific physical therapy after your diagnosis, but often times the referral will only happen if the family requests it. 
The other challenge is whether or not you have a trained physical therapist in your area. 
Feel free to ask me how to find a trained PT in your area.


It's important for your child to understand the mechanics of scoliosis and the shape of their particular curve or curves. That's a big part of scoliosis specific exercises and these become tools that they use for the rest of their lives to care for their spine health.
 Of course, what and how I would teach a 12 year old is very different than how I would teach a 17 or 20 year old. 
But we are still laying the foundation!


Long-term consequences to scoliosis will vary from person to person as well as on the degree of the scoliosis and whether or not surgical intervention is required. 
There is no reason they can't live a full and healthy life, carry and bear children, participate in sports etc.
How that manifests will be different depending on the individual.
The more they understand their curves and how to stabilize them as they grow into adulthood, the less likely they are to have secondary joint and pain problems. 
And if they do, they will know better how to manage them.


So… :) … in the short term, it is important that your child sees a pediatric scoliosis spine specialist to properly assess their curves, x-rays, bone growth etc. and guide the plan of care.
​From there it may be more up to you to seek out a well trained physical therapist to educate and work you and your child.


I should also mention mental health - there are  great groups and books offering support for the stress and anxiety that can occur.  Search in the group and you will find a few!




Join my Scoliosis Facebook Group to keep in touch and learn more: 
https://www.facebook.com/groups/863924137312889

Your Back Your Core


Having a back that doesn’t keep you from doing things you love, is a goal most who have had back problems place at the top of their list.

Of course if you are in the midst of a flare up your more urgent goal may be pain relief,
which is of course understandable!

This blog is aimed at the time period when you are no longer in a flare,
but possibly dealing with some symptoms, and mostly want to get a
healthier back and core so it doesn't happen again.

I see time and again that most people don’t really get the results they are after
when trying to achieve a stronger core and back. We can all
download exercises from the internet, but what really matters 
is how you do them and which muscles you are actively recruiting.


So what are your core muscles anyways?
They are your deep stabilizer muscles of the spine, abdominals and pelvic floor.
You can’t necessarily touch them since they lie deep to other muscles and structures.
It’s the same in other joints of the body too - the muscles that lie
closest to the joints are our stabilizers,
not the ones closest to the skin - those are typically our prime movers.

Pain often causes our deep stabilizers to be tense,
guarded and not fire when we need them most.
That’s why using techniques to improve recruitment
as well as the ability to contract and relax at the right time is a key function
of developing a healthier back.

So what are your deep stabilizers?
There are three categories to focus on:

1. Deep Abdominals - Transverse Abdominus
2. Deep Spinal Stabilizers - Multifidi
3. Pelvic Floor Muscles

The catch is that they are not always easy to cue and get them to activate properly
- it’s not like telling yourself to make a muscle with your bicep!

Here are some simple tips: 
First start in hook lying - lying on your back with knees bent. 
Instead of jumping right into your abdominal exercises take a few minutes
to see how well you are stabilizing.
Place your hands gently on your lower abdomen and lift one foot a few inches off the ground.

Did your abdomen pop up into your hands? 
If so, you were not stabilizing well with transverse abdominus. 
So imagine what happens when you are doing harder exercises!

Spend some time here learning to control this, and only move on to more
challenging exercises when you can do so at any stage.
To work on this think of gently drawing your navel towards your spine,

then try lifting one foot again.

Next cue is to first draw your pelvic floor up, then navel to the spine, then lift your foot.
You will most likely notice better control of your abdominal wall.
That’s because the deep stabilizers “talk” to each other so using your
ability to cue pelvic floor can help you activate your deep abdominals.

We can more easily cue the pelvic floor muscles since we have the
physiologic function they serve as an easy way to cue them!

The deep spinal muscles are harder to cue but if you are doing the other
two groups that will get you off to a great start!
One cue you can try though is to be in hook lying or side lying and
imagine a guide wire going from either hip bone (ASIS) or your pubic bone
to a point in the lower back
- imagine drawing one of those front points towards your back point.

With all of these techniques, practice activating with control and releasing with control.
It really is a coordination activity that you do as a foundation for any strength work you do!

As far as your yoga practice goes, the same principles apply,
so think about how well you balance front, back and bottom of
your trunk in your poses …. But that’s a whole other blog post…..

I hope you find this helpful! I
If you are in the San Diego area we will be doing all of this live in my
upcoming Back workshop  
There are 2 dates available, February and March.

If you are not local, stay tuned for the online version which will be live in a few months.
Be well and don’t hesitate to message me with your questions!








​

​I hope to share helpful information relating to health and wellness, based on my years of experience as a physical therapist and yoga practitioner/teacher.
We all have to start at the beginning - so here we go!



Step One - in order to help ourselves have a better life we need to be aware of what we are hoping to effect.  Is it general wellness, injury prevention or recovery, improved energy or focus?  The list could obviously go on and on……. it is for each of us to define.

Self awareness on the most basic level. What do you want to accomplish today? Where are you today? - no…not literally:)
 Sounds so simple, doesn't it?  While working with many human beings I see that often we disconnect from what really matters to us as well as from what and how we are actually living.
If I narrow this down to the physical, I see that many of my patients and students have truly disconnected from their bodies.

Therefore….STEP ONE is to help inspire self observation and awareness. 
How can any thing change if we aren’t even aware of it?
​
Most people come to physical therapy or a yoga class with some type of change in mind. I believe helping them see where they are in the present moment helps them actualize and understand the changes they are hoping for.  
Maybe the hope is for less pain, better function, more sleep, less anxiety, more knowledge and wisdom of how to achieve these goals.
Step One = Self Observation and Awareness so you can work towards those goals.

​So many of us use this approach as we try to start or restart fitness programs. We think we should be able to jump in where we left off 6 months ago, and then we give up when doing so leads to pain and defeat.

I’ve been a physical therapist for 30 years and can’t tell you how many times I’ve had this conversation with my patients and my yoga students.
Coaching the behavioral side of things has become a regular part of my practice.

Why is moderation so hard?  It takes patience and humility. We need to acknowledge that our body needs time to catch up to our wishes.

I have been there too. After an injury - I slowly start to get more active and am challenged by how much I have to do.  First there is the excitement and enthusiasm, then the realization of how slow I will need to go. Not fun - but so what? It’s better than the alternative of doing nothing.

We all need to sort through this and come to terms with the ebbs and flows of rehabbing from an injury, getting more fit or picking up a new activity.

Don’t crash and burn!