ARE YOU ENGAGED?

As one of the Gravity Training System (GTS) instructors at Duffy and Bracken Physical Therapy, one of the first questions I ask a client is whether there is a specific body part they would like to work on. One of the top answers is, "I want a flat tummy! Give me some abs". In response, I remind people abdominals already exist. They just need to be defined.

So how does one do that? First off, doing crunches all day will not work alone. Bulky abs under a layer of fat will be the end result. However, with a combination of aerobic exercises and resistance training, definition will become more evident. In addition, there stands one more element in regards to exercise that is a key component in getting maximum results during a workout; abdominal engagement.

Doubling as a physical therapy aide at the clinic, I find that patients have to learn how to properly engage their core. When the lower abdominals are incorrectly engaged during exercises that require flexion at the hip, it is common to compensate using another set of muscle called the hip flexor. The hip flexor is used to bring the thigh closer to the trunk and is primarily used during exercises such as running and leg lifts to stair climbing. So how do you distinguish between which ones you're using? It's not that you want to isolate the two completely, but you do want to focus on working the abdominals more with certain movements. The only way to do this is practice!

One way to practice is an exercise called transverse abdominis contraction (TAC) with marching. To do this, lie on your back and bend both knees. Keep feet about six inches apart with feet flat on the ground. Naturally, your lower back will have a slight curve away from the floor.

(Transverse Abdominis Contraction shown in the figure where dotted line is shown. Navel is drawn in towards spine and back is flattened)

The first step (TAC) is to engage your lower abs by tensing the muscle. Try drawing your lower abs towards your spine. You should be focusing on the muscles you feel engage when you cough or laugh. Do not hold your breath! This should make your lower back press towards the floor, providing a protective mechanism for your back. The next step is "marching". Slowly, lift one leg at a time bringing the knee towards your trunk, maintaining the 90-degree angle in the knee. Return leg to starting position and switch legs.

If performed correctly your back will stay pressed down and your lower abdominal should be overpowering your hip flexors. If the back begins to arch away from the floor, chances are your hip flexors are overpowering your abs. This can cause stress in the back.

Practicing transverse abdominis contrations can be done anytime. Sitting, standing, and walking are excellent opportunities to practice, as it will improve posture. To learn more about how to better engage your core during everyday activities or exercises, feel free to consult your physical therapist. Remember, the core is like the foundation of a building. The weaker or stronger the foundation, determines how well the building will stand.

Toupelle Goodman, PT Aide & GTS Trainer

Photo References:

Nicholas Institute of Sports Medicine and Athletic Trauma; http://www.nismat.org/ptcor/lbp

Jackie Brand Personal Trainer; http://www.jackiebrand.com/page46.php

Massage Junkies

Before being a physical therapist (PT), I was a licensed massage therapist for 13 years. In that time, I discovered what an amazing tool massage is in relieving pain, lowering stress levels, facilitating length in muscles and, in general, giving back to a person a deep sense of health and human connection....Temporarily.

That is the key-word -- TEMPORARILY. 

Massage can be a powerful ally in PT, but because it is a passive therapy, the person receiving the massage is reliant on someone else's hands and elbows to give them relief. The analogy would be, the massage therapist is the guy with the bucket in a boat trying to unload the boat from taking on water, whereas in physical therapy, the PT, through therapeutic exercise and patient education gives the patient the rudder of the boat and shows the patient how to steer her/himself out of troubled waters.

In other words, the PT empowers patients by giving them knowledge to help themselves so that when they are on their own, they can continue to take care of themselves. That is altruism at its best, which is one of the reasons why as a massage therapist, I wanted to graduate to become a physical therapist. The beauty of this is that the PT and the patient become 'A TEAM' that works together in achieving the patients' goals.

This brings me to you --- our dear patients at Duffy & Bracken and the topic of massage. Duffy and Bracken is a manual clinic, which means that we specialize in hands on techniques. It would be easy to falsely assume that because we are manual PT's, that we perform a lot of massage when we treat you. Manual therapy actually means that the PT, through their hands and eyes, assess and diagnose a patient.

From that assessment, we choose what would most help you, which may or may not include massage. So what this means to you as the patient and team member in your re-hab, is to resist thinking that the massage is the centerpiece of your session. We realize how difficult it is when massage can feel so good, but think long-term. Would you rather have the quick temporary fix, or would you rather invest long-term and actually address the real reason why you came to physical therapy in the first place? (Please answer, "yes" to the latter!)

Also trust your therapist if he or she one day decides not to do massage. Your PT may have decided that massage would actually make your symptoms worse. In general, we do indeed encourage you to seek out a good massage therapist to act as an ally in your rehab. We can always refer you to one if you are unsure of where to look. In fact, we offer massages on Tuesdays and Fridays here at Duffy and Bracken. In the meantime, we ask you to not become a Massage Junkie and sell your PT short of their skills by thinking that all you should be doing at PT is lying down on the table to get the "rub".

John Howard (Johann), DPT, LMT

john@duffyandbracken.com