Are You Ready For Functional Flexibility?

How Functional Flexibility Will Enhance Effective ways to allow for more resilience throughout the Pelvic Core Neuromuscular System (PCNS)

Mobility in three planes of motion is an effective way to allow for more resilience throughout the Pelvic Core Neuromuscular System (PCNS) and to wake up the neurological system propriopceptively. Traditionally, stretching has taken place in one plane of motion. By integrating triplanar stretching, you effectively stretch muscles from different angles.

For example, take any traditional stretch and add gentle motion in the sagittal, frontal and transverse planes. To stimulate the PCNS from a traditional runner’s calf stretch against the wall, turn the back foot inward approximately 45 degrees and drive the hips front to back (sagittal plane), side to side (frontal plane) and then clockwise and counterclockwise (transverse plane). Perform each motion for 30–60 seconds. This will allow for mobility throughout the lower girdle, including the PCNS.

Figure 1: The Pelvic-Floor Muscles

Breath and Core Support

When training a client with PCNS challenges, one important task is to teach her how to breathe using the respiratory diaphragm for core support against low resistance. Sounds arbitrary considering that we must breathe to live, but as we know, clients do not always know how to inhale and exhale appropriately upon exertion.

Your client may feel that holding her breath provides stability by locking down the core. Actually, it does not provide functional mostability (mobility and stability); what’s more, it doesn’t feel very good. Breathing through pursed lips provides greater stability, while slowly letting the system adjust through rhythmic, three-dimensional decompression and unloading. The following simple exercise shows how to integrate core stability into breathing.

1. Have your client stand with feet shoulder width apart with hands at shoulder height, elbows flexed to sides (you mirror her).
2. Instruct the client that she will take a deep breath in, and on the count of three you will give her hands a gentle push as she holds her breath.
3. Compare stability.
4. Do the same sequence—only this time instruct your client to exhale forcefully as you gently push her hands (compare with task 2).
5. Repeat the sequence, but now instruct your client to exhale through pursed lips (like blowing through a pinhole) as you provide gentle, increasing resistance to your push.
6. Compare stability.

Know Your Healthcare Professionals

Urogynecologist: specializes in the care of women with pelvic-floor dysfunction. This professional has completed medical school and a 4-year residency in obstetrics and gynecology. A urogynecologist has additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs and the muscles and connective tissue that support the organs.

Gynecologist: a physician who has completed specialized education and training in the health of the female reproductive system, including diagnosis and treatment of disorders and diseases.

Obstetrician: a physician who has completed education and training in the management of pregnancy, labor and puerperium (the time period directly following childbirth).

Obstetrician/Gynecologist: a physician who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth and disorders of the reproductive system. This field includes preventive care, prenatal care, detection of sexually transmitted diseases, Pap test screening and family planning.

Physical Therapist: licensed professionals who work with people who have impairments, disabilities or limitations in their overall physical function. Physical therapists examine, evaluate and develop treatment plans on an individual basis. They use manual therapy, functional exercise and other modalities to restore function, improve mobility and decrease pain with the goal of re-establishing a patient’s prior level of function.

Women’s Health Physical Therapist: a physical therapist who has specialized skills and education in the care of the female patient. Areas of focus include pregnancy and pelvic-floor dysfunction.

Fellow of Applied Functional Science: a physical therapist, personal trainer, medical doctor or fitness professional who has specialized training in applied functional science through the understanding of functional principles, strategies and techniques appropriate for use with patients and clients of all types and for all purposes, including prevention, rehabilitation and performance enhancement. This professional will also be certified in functional manual reaction.

Pelvic-Hip Complex Pivot Shift Matrix

The following test (remember, tests become exercises and exercises are tests) assesses and exercises the functional flexibility, mobility and stability of the entire pelvic-hip complex. This is a “Pivot Shift Matrix,” in which we load from the bottom up.

1. Have your client demonstrate her ability to perform single-limb balance (SLB) on both lower extremities.
2. Start with the more successful side (in this case we will describe standing on the right leg, moving the left leg through space).
3. Sagittal Plane: In right SLB, instruct the client to swing the left leg, intentionally and with control, pivoting forward and back at the hips. Let her use the upper trunk to counterbalance. If this is difficult, allow her to toe-touch down in front, then in back.
4. Frontal Plane: In right SLB, instruct the client to toe-touch as far to the left as possible and then return to midline. After a brief pause, instruct her to reach the left leg to the right, across the body. Again, let her tilt the torso to counterbalance the full loading and unloading of the hip.
5. Transverse Plane: In right SLB, have the client rotate at the right hip, turning the body as a whole to the right and then turning across the body to the left. Again, if balance is deficient, instruct the client to toe-touch at the threshold of each rotation.

This exercise assesses glutes, hamstrings and calf muscles in the sagittal plane; hip abductors and adductors in the frontal plane; and hip internal and external rotators in the transverse plane. It also submaximally and subconsciously stimulates the pelvic core from the ground up. Synergistically you have allowed the abdominals to contribute by decelerating, loading and unloading the upper torso to counterbalance the excursion of the hips.

SIDEBAR: Recognizing Pelvic-Floor Dysfunction

While it is clearly not within the scope of practice for fitness professionals to diagnose pelvic-floor dysfunction, there are questions you can ask that will help in the allied health professional referral process. The answers will also help with program design.

• How often do you urinate during the day? (Every 2–4 hours, or 6–8 times per day is considered normal.)
• Do you get up at night to go to the bathroom? If yes, how many times? (Zero times to once per night is considered normal.)
• Do you ever have accidental leakage of urine during activities such as coughing, sneezing, laughing, running, exercising or lifting?
• Do you ever have accidental leakage of urine associated with a sudden strong urge to urinate, or do you have trouble reaching the toilet in time?
• Do you do a lot of “just in case” toileting?
• Do you have trouble controlling gas?
• Have you ever lost bowel control?
• If you are sexually active, do you have pain during or after intercourse?
• Do you have pain before, during or after urination or bowel movements?

Source and References: Idea Fit
Forwarded By, Natalie Pyles

P.S. Natalie Pyles the owner of Fitness Elements is Now offering a New service and added value to all clients, and New customers the Integrated Flexibility Specialist - NASM. Call for your Muscular imbalance assessment today 480-212-1947 or fax assessment request to 623-399-4199 or e-mail fitnesselementsexpress to set up an assessment at your preferred time.