Property of Julie Wiebe, PT All rights reserved. transfer and/or transmission of all course videos and materials is prohibited.

Transcription

1 DIAPHRAGM/PELVIC FLOOR PISTON FOR ADULT POPULATIONS ONLINE Julie W. Wiebe, PT, MPT, BSc Module One Concepts Evidence Core Function/Dysfunction Module Two Alignment Module Three Diaphragm Breathing Mechanics Module Four Pelvic Floor Transversus Abdominis Module Five Synergists: POS Module Six Synergists: LS/AOS Module Seven Synergists: RS Gait Plyometrics MODULE THREE: DIAPHRAGM/BREATHING MECHANICS Julie W. Wiebe, PT, MPT, BSc materials is prohibited. 1

2 Module Three Preparation Full length mirror One or two each: Hand towel, bath towel Pillows (2 of different thickness, and size) Selfies: Your standing alignment (uncorrected or perfected, please) both a front and side view. Have a fried or colleague video you while taking a deep breath (from the front, and side). Core Components Diaphragm CORE Diaphragm Diaphragm CORE Postural Function of the Diaphragm in Persons with and without Chronic Low Back Pain Kolar et al (2012) During postural challenge: patient group significantly smaller excursion on inhalation, recruited other muscles to make up for less Diaphragm Altered position and recruitment resulted in a reduction in IAP More cranial position of the diaphragm in patient group Reduced movement in anterior and middle portions during inspiration materials is prohibited. 2

3 Diaphragm Anatomy 101 Origin: Vertebral-bodies L1-2 (L), L1-3 (R) Costal-inner aspect lower 6 ribs Sternal- posterior xiphoid Insertion: Central tendon inserts at L3 Diaphragm Anatomy 101: Action Diaphragm is cross section of multiple systems: respiration, aides circulation, lymphatics, GI motility, continence, postural stabilization, movement control, limbic system, ANS down regulation Mobilizes rib, thoracic, and lumbar segments (Wike) Contributes to the elasticity of the pelvic floor Diaphragm: Function Function: Utilize A-P, Lateral, and Vertical components IAP on inhale stabilizes trunk as abdomen and pelvic floor undergo eccentric lengthening Exhale will engage Core trunk stabilizers (Piston) Diaphragm is gateway to the rest of Core; access to mulitple populations ( Blow Before You Go ) materials is prohibited. 3

4 Diaphragm: Dysfunction Chest Breathers: Causes thoracic extension Sustained inspiratory position Decrease inferior excursion of diaphragm (decrease IAP gradient potential) High, flared ribcage Diaphragm: Dysfunction Belly Breathers: Rigid, compressed ribcage Sustained expiratory position Reduced abdominal tone (decrease IAP gradient potential) Decreased intercostal contribution to a balanced breath Diaphragm: Dysfunction Breath Holding: Valsalva: large loads Substitution for the Core in postural control, movement strategies, transitions and prepping for small exertions Repeated high intra-thoracic (ITP) and IAP can contribute to incontinence and constipation materials is prohibited. 4

5 Diaphragm: Dysfunction Chest and Belly Breathers: Lateral component dysfunction (lower 6 ribs) Keeps ribs high and flared or fixed Core disconnected/iap potential is reduced Both use breath holding as a stability strategy Diaphragm: Intervention Umbrella Inhale Close the Umbrella Around the Handle Dog Breath materials is prohibited. 5

6 Umbrella Breathing Barriers to a Balanced Breath q Abdominal gripping q Pelvic floor over-recruitment q Diaphragm fixing, rib cage held open q Forced exhalation q Alignment (bells rung up/down q Goal: Ease of breath (best cue to tie it to alignment) Independent Diaphragm Standing Lab Re-assess breath pattern in mirror and in pre-taped video (standing) Use preferred alignment cue (ski jump, bum string, tailbone lift) and re-assess breath (see and feel for change) Try a 360 umbrella inhale (ribcage opens to side, front and back) Try umbrella breath in new alignment, and old alignment which is easier? Shift back to middle and see if you maintain the breath Relax abdomen and observe for change in pattern Relax pelvic floor and observe for change in pattern materials is prohibited. 6

7 MODULE THREE: REFINE THE BREATH Julie W. Wiebe, PT, MPT, BSc Chest Breathers Intervention Belly Breathers Intervention materials is prohibited. 7

8 Alignment is the key! Barriers to a Balanced Breath q Abdominal gripping q Pelvic floor over-recruitment q Diaphragm fixing, rib cage held open q Forced exhalation q Alignment (bells rung up/down) q Goal: Ease of breath (best cue to tie it to alignment) Independent Diaphragm Supine Lab Chest Breather: Pillow under head, shoulders and top of rib cage Play with pillow height, number (less ribcage protrusion) Observe changes in breath pattern with pillow transitions Use hand on chest to remind, hand on ribcage to encourage direction of inhale Align pelvis with hand triangle, or middle of extremes (feel how this changes breath) 360 umbrella inhale, allow gentle belly rise with abdomen open Gentle exhale through a straw (blowing petals off a flower) Use an extended exhale to help close the ribs, so that you experience a fuller lateral excursion on inhale Note abdomen follows breath (rise on inhale, fall on exhale), do not force the exhale materials is prohibited. 8

9 Independent Diaphragm Supine Lab q Belly Breather: Pillow under head to maintain airway, align spine Play with pillow height Observe changes in breath pattern with pillow transitions Use hand on belly to remind, hand on ribcage or sternum to encourage direction of inhale Align pelvis with hand triangle, or middle of extremes (feel how this changes breath) 360 Umbrella inhale, draw air in to open the ribcage to the front, back and sides n Start with small breaths that don t create a large belly rise Gentle exhale through a straw (blowing petals off a flower) Note abdomen follows breath (rise on inhale, fall on exhale), do not force exhale Concept Synthesis Name That Alignment materials is prohibited. 9

10 Rear: Scoliosis Scoliosis Week Laci-Intake materials is prohibited. 10

11 Box Jumps-Pre Box Jumps-Post Module Summary materials is prohibited. 11

12 Module Summary Link between alignment and breathing Balance breath Provide changes in lots of inputs to brain Harness the pressure system Strength not only in exhale. Inhale, IAP increase with the tummy and PF in lengthened position-this is a balanced, solid and trustworthy system too. But in most cases you need to build to this. What s Next.Module Four Pelvic Floor integration External tools: How? When and When not to? Functional assessments Link with alignment and breathing: Pistons Interventions strategies Piston Science materials is prohibited. 12