Cross Cultural Pregnancy w/ Esther Gokhale
I'm about to welcome esther go clay the new york times calls her the posture guru of silicon valley this is a continuum of getting to know our pelvis our spine our inner baby carriage esther has worked with people worldwide helping them to heal from back pain and she's here to prevent yours or stop years in his track especially as it relates to carrying that baby either within or without. So without further ado s to go clay welcome two healthy baby healthy pregnancy thank you for being here and I am going to give you the stage all right? So pregnant women are first and foremost women and part of our species and so all the same rules almost all the same rules apply and only more so because I almost see it like a canary in a coal mine kind of situation you know, whatever distortions postural distortions we have is a culture count that much more strongly in pregnant women because of the extra weight because of relaxing that is coursing through your veins and making all the ligaments more ...
vulnerable to stresses and strains and stretching. So we are going to talk today about some common postural distortions on dh how they can be addressed and my favorite way always is to address these distortions in everyday activities because those are the things that we're doing all day every day if you can influence even a small amount the way is set the way you've been the way you walk the way you carry then you're working on your body twenty four seven and I love exercise and exercises but those are things you do only for a short amount of time so I'm always looking for ways that have to do with modifications and everyday activity so we'll try and introduce some of those techniques here the first distortion I want to talk about is swaying the back arching the back and you've heard about that already it is quite common in the population at large you know women tend to especially women tend to thrust out their chest because it's part of what's considered a sexy posture it's also like a the end of a gymnastics routine you might go teta and you have thrown out your chest and just put a whole bunch of pressure on the low back this becomes especially important in its right there it becomes especially important when you're pregnant because you got all that weight and if you don't have the habit and the sensibilities to keep the same shape that was a good shape before you were pregnant then you are even more vulnerable to compression in the lumbar spine as you can see here and then what's happening in the tissues underneath is that with ribcage jetted out you have tightness in the erector spin a muscles you have compression in all the lumbar discs you have possible impingement in the spinal nerves that exit at that level and so this causes problems and it needn't be I have here a picture off a pregnant anatomy anatomical illustration off a pregnant women from the nineteenth twenties and what you can see here is that the spine remains in this optimal shape that I described as j spine as opposed to s spine which is what we've curt more recently come to regard as normal so this whole j spine versus s spine comparison is worth going into some detail and I have a depiction here this comes from a modern anatomy book published in the nineteen nineties it shows as what we in modern times have come to believe is a natural shape in the spine and it's called an s spine and we're encouraged to have lumbar curvature every ergonomic chair is built to support this curve created if you don't have it and so on um this picture comes from and anatomy book published in nineteen eleven and it's really different it has what I call this j spine and I will argue that this makes a whole lot more sense in multiple ways and this comes from a timer we didn't have so much back pain we didn't have so much degenerative disc disease and and stenosis and what have you and that alone should make us curious what were those people thinking and doing that's different in this time of lesser back pain and problems it also makes more sense from an anatomic point to view like if you look at the disks, these discs in the lumbar spine are like little hockey pucks so they it makes sense for them cylindrical is they are to have a cylindrical space to fit into no, it really doesn't make any sense at all to be arching the back and then forcing those cylindrical def into a wedge shaped housing it could say and so I think that you know part of why we have such a huge problem even before were pregnant you know, just the population at large has one hundred billion dollars a year problem and that's just talking about back pain and I think it's because we have a mistaken notion of what is normal and you know as long as we're doing this store spines it's not that surprising that we have degenerative disc disease also that we have arthritic changes in the spine you see how these vertebrae are edgewise stressed their edgewise compressed and here with the j spine you see that the edges are perfectly healthy and normal and in fact you have face to face compression, which is healthy that's how you prevent osteoporosis, he wants dress in your spine but not edgewise when you have edgewise compression, you get osteoarthritis and you're not you're losing out that prevention of osteoporosis effect so not edgewise face to face a jace fine provides it for you this disc, by the way in our species is wedge shaped so it makes sense that you would give it a wedge shaped house to live in no, it doesn't really make sense to have a great deal of tucking the pelvis and that's the second postural distortion we're going to talk about going to talk about swing the back and we're going to talk about talking the pelvis is being actually quite problematic and when you tuck the pelvis you can imagine what is going to happen to this wedge shaped disk in our species this l five s one disc is wedge shaped and when you do that which part of it do you suppose gets compressed the front and then the contents get pushed backwards and that is about the most dangerous direction in which to have compression in any disk you don't want the filling being compressed so that it's pushing backwards because that's where all your nerve roots are you don't want to be pushing against interviews I can tell you from personal experience came at this the hard way and I would contol about my experience later um so this j spine which this pregnant lady is very happily respecting good angle here relatively straight up higher even with baby pulling on the lumbar spine if if she wasn't using the appropriate muscles to counter all right we're going to look at a very beautiful illustration again from earlier in the twentieth century and it's just so beautiful it's got you know her behind is behind his beautiful tone in her glued ius media's we'll talk about how glutinous media's is an important factor and actually holding your pelvis in a good position and and then the rest is beautifully aligned and we are going to now go into how you might use an everyday activity to come to this kind of structure and I would love for one of you to come up the volunteer be a student who would like to come up yes it's wonderful and you have lots that grilling on you then I am going tio just have you turned sideways if you don't sign and I'm going to ran my hands up and down your back and you know how many months are you along? Well it's nine e just you know I always I always said to my students that nature designed as really well for the first eight months and then the last month you have to kind of close your eyes and hold your nose and out through your eyes a little little bit of that fact so you know I see that the spine is a little bit are you aware that there's a little bit of extra lumbar curvature here it's like pulling forward a little bit heading in this you know s spine so let's see what we can do with just plain sitting and I'm going to have you sit on this chair and then sit on this chair so you can experience what that might feel like to have every day sitting actually work towards improving your spinal curves because we have this assumption that sitting is just bad for you has become more and more the fashion to dis sitting you know, sitting has become the new smoking and fact is we do have to set some in our lives and I my experiences that sitting can be put to good use if you sit well yeah so we've gotten here it's kind of built in this is a chair I designed after years of people telling me like oh design some thing because it's like what you should be used I'm not sure this chair modify of this way and that way and said come on do something so I came up with the chair which has built in nubs so in the back there these kind of sticky nubs that will help glue help you hold help hold you up ok? So let's experience that you're coming a little bit away from the back rest and now you're going to do what I call re banker move so it's your rotating the rib cage is what we want to do so you are curving forward like this very nice and you can feel with your fingertips that that slight arch if you if you reach back and you feel how it kind of flattens out, yeah, and then you want a mint attain this position as you then use your hands and maybe you can grab here with both hands. You want to further elongate your spine, so you going to leave your buttocks in the chair, maintain this forward can't know of your rib cage and then further elongated by lifting the top of you away from the bottom and what you want to watch out common mistake jetting out the ribcage because we're so used to doing that, we think of that our parents have been have told a sit up straight stand up straight so that's what we think offers good posture and now we're going the opposite way, which feels a little weird, but you want to stake her forward so it's truly the back your lengthening now you lift up the top away from the bottom, keep curving forward, beautiful and then imagine you're a pig chair hanging from the wall, you attach yourself to the nubs and that those numbers could also be like, ah folded towel or something with friction is what you want and then you're hooked up there and now I know that you've succeeded because I see a pinch of skin above the point of can can you feel that your back is a little bit stretch and certainly and then once you hooked yourself there, you don't have to remember anything you don't have to sit up straight, you don't have to be right you can just sit there and enjoy sitting and your back is getting a little traction um all the all the hours that you're sitting so this could be in your car seat it could be when you're watching tv talking to your friends or at your computer those hours could be put to good use in going from what is somewhat of an s curve to more off a jaker this is making sense so let's do that again you come away, you cur forward a little bit with the rib cage grabbed you can also push on the seat pan you know as a way of lifting the top of you away from the bottom that said keep curving forward though that's it and now think of yourself as a picture hanging from the walls himself. Now let go and now you've got all of that lift feeling and more this time you were more successful and then also another measure that's very helpful to keep you from peeling away from that that hook is to do a shoulder roll and I wanted a time because each shoulder has a little bit different trajectory forward up and lots back and then we'll go and visit the other one and we'll go a little forward a little up a lot back it totally relax and what's nice about this way of repositioning his shoulders is that once you're there you don't have to remember to hold back you don't have to tighten any muscle and that makes it both practical and healthy because if you have to remember to hold back good luck how long does that last like maybe ten seconds yeah so this way it's almost like you're ratcheting the soft tissue back a notch yeah so one at a time little forward little up plots back totally relax and you'll notice that your arms you know feel a bit like little to ran a saurus rex arms you know not their own reach out quite as far but that is something that is actually natural normal and you will get used to it how's that it's fine I can see that this area is moving a little bit like when you breathe and you want that you actually want this area to be slightly stressed that's another healthy stress you know somehow in modern times we've come to believe that belly breathing is good for you and chest breathing is bad for you and that I don't think really makes sense your lungs are here why wouldn't they expand in this direction and in my experience people who do breathe here come to develop a more full chest and people who only breathe here tend to kind of start stressing against the bottom lower border of the rib cage and almost come up with the kind of skirt like shape here you know where the ribcage ejecting out so now you want to change those stresses you want these muscles thie internal obliques re banker I call family of muscles to kind of pull back on the bottom of your rib cage and have your lungs breathing start creating a healthy stress so that this area becomes more convex becomes fuller and that can only help baby and you and you've got a lot of work coming up and so you want healthy stress you want as row best rip cage and lung capacity as you can muster thank you so much you can I would like to show this one more time on a way you can use some other kind of chair because it doesn't have to be the pain free chair that I designed but it could be a chair I have a cushion that you can use in like a, um car seat or some other chair that you don't that you like then you can modify it by adding this and what you can also do is it's it's fabric if it'll hold you can add a towel this way or this way coming I invite you to come and try so let's see if we can do the same maneuver and let's see if your back would also be helped from so what? So there's a little bit of a curve in this in the lumbar area, right? I mean that I have a huge curve when I had trouble and my trouble came in the ninth month of pregnancy and I grew up being doing gymnastics and being a yoga model in bombay where he grew up and I would get lots of collapse because it was extremely flexible I would, um you know, do a back bend and I could grab my ankles and I could lie on the floor and put my legs on the ground and everyone would clap and join up for the swamis um close that I was doing it from a rod not the right location it was going to high up but around l too in my spine like right around you know this area this way and so when I was nine months pregnant I had such a deep trust here um that my reached a certain threshold and my cyanotic actually five s one um discriminated I had a very large herniation and the m r I showed on a scale from zero to ten it was like a nine like I had such a huge herniation um they recommended surgery and in any case all the usual things alternative and conservative had not worked so petey and exercises and chiropractic connected puncheon resurgent me checking my head what's why is this happening to me in my mid twenties you know I'm so athletic and I did yoga growing up and so on the night you know couldn't make sense of it and but the fact was it was really bad after the baby was born it continued to become worse and worse and and then I was at a point where I have said it was like an ice pick in my butt and I would wake up in the middle of the night with severe spasm and I had to walk around the block for two hours in the middle of the night every two hours to get out of spasm I didn't want to take pain pills because I didn't I was nursing my baby I didn't want pain pills in the system and so I was just suffering really badly and so every two hour is walking around trying to relieve get out of spasm and go back to sleep in the night wake up again so this is no way to live I don't wish it on anyone and so finally I had surgery I have my little battle scar here you can see right there till five us one on that gave me some relief but then a year later I had the same problem all over again and now they wanted to do another surgery and, you know, you don't want to make a habit out of back surgery. Yeah, I was in my twenties mid twenties, so how my sixty is gonna look like I was asking myself, so this was not good, and that was how I had to look wider. I had to cast a wider net and find something, you know, where all the usual conservative and alternative techniques had failed me, really? I didn't understand why it happened to me and how to not make it happen again. And so anyway, so this is one of the banks that I find fantastic, because I remember not being able to sit no it's to go ahead and city, I remember being at a friend's dinner table and having to get up and walk around and kind of make things better, this is not we're better designed them that, you know, way blame sitting, but really sitting should be okay, you know, not all day, every day, not without moving but it's a healthy position, so to make it healthy, if it isn't already, we come away from whatever it is you're going to hook yourself, too, that could be a towel could be this is our stretch, said christian could be nubs in a chair could be something that has friction and then you want to lengthen your back in two ways, so this rib cage anchors good and you don't want to send your head too far forward on your shoulders to four for really wants to be isolated in the rib cage idea, so now you've got that and you can feel your back is kind of flattened. Don't you feel it now you're going to use your hands, both sides or this chair, hand someplace, and you're going to push down so that the top ofyou lengthens away. You wantto your buttocks to kind of stand here, so don't tighten up the legs or anything, just the arms than a lift you tall and then we're basically gonna attach you to the back rest. You have now transformed your back pressed into a kind of traction device, and you sit there and you relax and then you feel it holding you here and then you can do your shoulder roll little forward, little up, back and down. Nice follow along little forward this you can do no matter what position would be a standing, walking whatever and then you totally relax and you let your hands rest some case how's that then night sitting pretty good, so this is a simple, everyday activity that you could transform too. Counter this tendency we have toe arch our backs and so on and I want to teach you an exercise so if you have been learning plenty of exercise anything you do and with combined with this awareness of not jutting out your rib cage but rather making your ribcage flush with your abdomen now so you actually want to put your hands on the blower board do you want to feel bone? You don't want to poke around in your abdomen but if you confined bone and very gently kind of nah gypped backwards you are actually rotating your entire rib cage and lengthening your back and now any exercise at all you do I mean could be dance this is my favorite form of excess in it so you know any of these movements if done carelessly would do what to my low back if I write easy to sway the back and then but if I developed this awareness of keeping my rib cage in its place and against a work against these movements to keep my rib cage in its place now there's no damage to my back at all you see on my back is staying j spine it's not swaying and I'm getting a two for out of this awareness I'm sparing my back and I'm getting the best ab exercise there is I mean this is a cz good as it gets you do this and you every time you and it doesn't have to be dance, it can be all sorts of things like you put luggage and an overhead compartment right? What do we tend to do, archer? Dax there we go. And so instead of doing it that way or putting a dishes in a cupboard or serving tennis or doing one of your yoga poses now instead of doing it in the with our usual are frequent tendency to arch the back you really pay attention to not arch the back. Now all of these actions have suddenly become really helpful so and that's true for everything you do, everything you do in life either helps you or hurts you. So are you still feeling some stretch? I am fabulous. Thank you. Thank you. Yes, please prompt yourself to do that. Would it be useful to contract your abdominal muscles or not? A very good question. So if you had the connection between your brain and the right muscles to contract which are these internal obliques mainly also external oblique spent mainly internal bleeding. If you have that memorized, then you can just do it. See, they suppose I started out with the big sway, so here I am, arching my back right now if I knew to isolate my rib cage movement notice I'm not moving my pelvis at all I know how to do that that's a good thing to do but for many people they don't think the muscle they connect tio in the ab set is rectus that's the one we always focus on me do crunches we do tucking we do all kinds of stuff to strengthen that muscle and if your brand is connected mainly direct us then the way you're going to get rid of that sway is kind of like this you know either tucking the pelvis exclusively or both tucking the pelvis and the rib cage who and you really don't want to tuck the pelvis so if you know to isolate this motion that's the way to go and you can learn it you know that this is what we we have a six lesson course and everybody learns this you know there's it's not rocket science but it's also not trivial so if what you used to is this you know using rectus to fix your sway then I would recommend use your fingers use your hands and very gently nudge the bones back and educate your body on hat on this different pattern more more healthy pattern yeah so you're using your hands to tuck your rib cage not your pelvis so next let's do an exercise maybe a floor exercise where we're strengthening this rib banker so with someone like to volunteer and come here yes when will you had me going tio give you a kind of kill oh so you're going to lie down on your back and I'm going to give you something under your rib cage because what that does is it and leave your knees bent just in case you have a tight so as um so if we put something under the rib cage what that does is it effectively rotates the rib cage a little bit it's a very healthy way teo get the rib cage to rotate now that's not enough because we also need something out that the head we need some kind of pillow or something because otherwise, you know, for most of us the head would be dangling back and we don't want that so we are going to give you something on the ahead all right? So no, we would also like tio feet a little bit wider knees open nice it's useful to have a little bit of extra length in the back. You know what when you are doing any kind of ab exercise because it's easy to distort and if you're distorting on a compressed spine that's a little dangerous little and if you have ah nicely elongated spine then it will more easily tolerate some distortion. So to get a little bit of extra length I'm gonna have you prop yourself up onto your elbows this yeah roll onto your side is a good way to come up coming up on two and then you lot, you go back onto your elbows so you're you're lying on your on your back, and you're on your elbows like that. Beautiful then you're going to dig in and create some extra length in your back just to make all these exercises a little safer and you can see we have too often push up the pillow a little bit because you succeeded and actually elongating his spine, and this is a really helpful thing to do in many contact context, like getting massage treatment or eat lying down at night. So now, um and totally relax, have your feet a little wider, and so now what we're going to do is try and get that rhib banker set of muscles isolated it's tricky because you know what? Like I said, the one way used to using his rectus so it helps to use your hands and push these must this rib cage back, and I'm going to help you see like that, seeing how palestinian move and say this is good, and so then you can kind of squeeze the back of your rib cage against the mat, and I always say back of the rib cage pressed back, not belly button back, because if you think that lee bucking back, that automatically looks you so it's the rib cage back so now we've got good pressure behind the rib cage and now so this would obviously be good for early pregnancy not you know, there's a point after which you don't lie on your back and that these muscles are available throughout pregnancy very healthy to use um so you keep that in police and now you can create challenges and challenges could be anything you do with your arms and with your legs two that have a tendency to arch your back so let's try cycling in the air you maintaining here can even imagine you have kind of a blood pressure cuff here it's really staying tight and then you're cycling and you want to wiggle his little is possible and what you want to feel you want to squeeze my hand more that's it you're keeping that pressure behind the rib cage constant as you do, you know increase she's pretty strong so let's have her go a little closer to the ground create more challenge but the moments he now it's kind of pumping up so that's too much challenge so we want to respect the shape of the spine above it all you know so that's the priority keeping this very, very steady and now you create jobs and could be challenges with your arms too and if you want and you're a dancer like I knew you as it is you can you know martin put on some music you like and move it no, but this part doesn't move this part states steady and that's a way to exercise that re banker the internal obliques and that whole set of muscles and you can imagine this extrapolates to everyday life you know? And she could be dancing she could be putting stuff it where she could be doing things that's what we do you know, all day long we do things with their arms and legs and if you don't watch it that easily distorts the back and you're developing a habit to not distort the back I felt really good I'm the way you did it I'm not surprised you go ahead and roll onto your side which is always gentler on the neck you know after you all relax you don't want to kind of rip your neck into action and might lag and then it's like everything gets a little threatened so thanks yes man so that is an exercise you know, exercise exercise to strengthen those muscles and you know my preference is always and my my what I look out for always is how you can find some everyday activity to do the job and so for me this sitting stretch sitting I call it is fabulous and and really worth it takes you once you've learned it, it takes you all of two seconds to do, and then you have potentially eight hours. If you have a desk job, you have eight hours of stretch available to you. How good is that?