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May 11, 2018 by Julieta Benavides

Reframing “The Sphincter Laws”: Can They Help Us Let Go?

photo by birth presence

For many people, even the word “sphincter” causes their sphincters to contract.  And yet, sphincters in our bodies are so vital to our health.  Sphincters are circular ring-like muscles surrounding a bodily passage or opening.  They are normally constricted, but they relax in order to allow passage through the opening.  These muscles are all about either “letting go” or “allowing in”.  There are over 50 sphincter muscles in the human body, most of them involuntary.  The majority of them are found in our digestive tracts.  There is one at the upper portion of the stomach, to prevent acidic contents from moving up into the esophagus (“hopefully”), as well as at the lower end of the stomach, in between the small and large intestine, and to control secretions from the liver, pancreas and gallbladder into the duodenum.  We also have them in and around our eyes, to control the amount of light our eyes allow in, to blink and to keep our eyes closed during sleep.   Of course, there are the all-important sphincters in our urethras and ani to control the excretion of our waste materials.  We have two in each area, and one of each of these is (finally!) a voluntary sphincter.  If we have so few voluntary sphincters, meaning ones we can actually control, then why bother talking about them?

I will rewind to the 1970’s and to perhaps the most famous midwife in the United States, Ina May Gaskin, author of Spiritual Midwifery and Ina May’s Guide to Childbirth.  She dedicated her life to fighting for natural childbirth and for the right to birth at home.  She contributed much to the midwifery movement over the past 45 years, but she is not without controversy.  She has been credited with “The Gaskin Maneuver”, a method of resolving shoulder dystocia during childbirth, which she “borrowed” from a Guatemalan midwife, thereby appropriating indigenous ideas without proper attribution.  She has also received criticism for putting forth “The Sphincter Laws”, rules by which she claims the vagina, cervix and anus abide.  Her critics harp on these “Laws” because neither the vagina nor the cervix are technically structural sphincters, although she describes them as such.  She also discusses the sphincters of the mouth and throat, but recent evidence has shown that the round muscle surrounding the mouth which was previously believed to be a sphincter is probably four separate muscles.  Her anatomy piece can appear a little loosey goosey, in the eyes of her critics.  However, I don’t believe it’s necessary to throw the baby out with the bath water.  The fact remains that Gaskin attended over 1200 births as a midwife, and she helped thousands of other women indirectly.  She is a birth expert – and while her style may not resonate with everyone, the patterns she recognized in birth should not be ignored.  Perhaps a slight reframe is in order.  It is my belief that her work surrounding the pelvic sphincters (or functional “sphincters”) can still have a lot of value.  By these I mean the cervix (which is not a sphincter but functions as one during pregnancy and childbirth – explained here) and sphincter ani externus, the external voluntary muscle around the anal opening.  Understanding how they work can help us relax and open up, which many women have found invaluable during childbirth.  The good news is that you don’t have to be pregnant to keep reading, because these properties work for ease in bowel movements, too!  (I hope it’s obvious that while I am drawing a parallel between childbirth and bowel movements in that both involve passage through a functional pelvic sphincter, I am in no way comparing or equating the two.)

From my experience, the following three properties of Gaskin’s Sphincter Laws are the most helpful to keep in mind for ease in “letting go”.

  • Relaxing the mouth miraculously seems to relax the “sphincters” at the other end.  Holding tension in the mouth and jaw makes it harder to allow the vagina to open.  In contrast, releasing tension in the mouth also releases tension in the pelvic floor, cervix and vagina during labor.  Below are some great ways to do this.  The same rules apply to the anal sphincter, so try doing any of these things during your next bowel movement to see if they make you more comfortable:
    • Laughter
    • Slow, deep breathing
    • Opening the mouth and making low, deep “sexy” sounds
    • Making “raspberries” or “horse lips”
  • Pelvic “sphincters” do not respond well to commands.  If you have ever tried to command yourself to poop, you know this doesn’t really work.  By the same token, trying to will the cervix or vagina to open during labor doesn’t work either – they don’t respond to pressuring.  Instead, try using gentle coaxing through visualization.  Imagine the vagina to be big, soft and open.  Make this a mantra and repeat it out loud.  Another trick learned from Penny Simkin, author of my favorite birth companion book (The Birth Partner), is focusing on the 3 R’s: Rhythm, Relaxation and Ritual.  She writes about these in the context of pain coping, but these strategies work wonderfully to open the body’s southern sphincters, too – and not just during childbirth. (Most women I know have a morning ritual, which at least involves relaxation, to encourage them to get on what my boyfriend affectionately calls “the poop train”.)
  • Pelvic “sphincters” perform best in an atmosphere of intimacy and privacy.  A quiet, calm environment with low lighting and the least number of people tends to work best.  Before you say “Duh, Julie”, think about the environment in most hospitals!  Bright lighting and lots of hospital staff coming in and out – this environment is not conducive to relaxing and opening.  It is well documented that cervical dilation can be going along great at home and stop or reverse the minute a laboring mom reaches a hospital.  I am not saying don’t labor in the hospital;  if that is where a mom feels the most safe, that is where she should be.  I am saying:  1.  Relax at home for as long as possible before going to the hospital, and 2.  Make the environment in the hospital as intimate and private as humanly possible.

I think of the pelvic floor sphincter muscles as the muscles of “letting go”.   Understanding these three properties can help us let go with greater ease, regardless of whether we are discussing something as magical and otherworldly as childbirth or as mundane as the morning elimination.

 

Filed Under: Anatomy

May 9, 2018 by Julieta Benavides

Let Go or Be Dragged

I saw this saying on a refrigerator magnet two months ago, and I loved it.  In hindsight, this was clearly a message from the universe that I had a little work to do surrounding the idea of attachment.  There was a time in my life when I was working a little harder on trying to conquer my tendency to cling to the present as if it could last forever.  I was reading a lot about Shambhala and Tibetan Buddhism back then – admittedly cliche, but I found it genuinely helpful.  One of the main concepts is attachment and the pain it causes when we refuse to just let go and stay in the present moment without judgement. By attachment, I am not talking about emotional attachment to a person or being (although I suffer from that and it’s often related).  I am referring to the spiritual attachment to an idea, like that of permanence.  I experienced a lot of growth at that time and moved on to other life lessons. However, the older I get the more I notice that life’s progress is not linear, and there are certain lessons that I need to learn and relearn in new contexts continually.  This is one.  I think of it as tacking toward my goal.  This month I have had multiple opportunities to relearn this lesson of “letting go”, and I thought I would share in case anyone finds the reminder helpful in their own lives.

Those of you who have been to my space know that I have a serious fondness for plants, and I have a ton of hanging baskets on my patio.  Sometime in March, I noticed that two sparrows had built a nest in my favorite one, a luxuriously full angel wing begonia.  Although I have always been a little afraid of birds, my anxiety surrounding this nest and the fate of my beloved plant was accompanied by curiosity and a sense of necessary surrender.  The nest was expertly constructed, and even though it had been dug down into the soil, I realized that I could still carefully water the plant from the sides without causing an epic deluge inside the nest.  (Can you see the little beak in the bottom left corner of the nest?!)

After a few weeks, I spotted a few eggs.  I grew accustomed to my little friends singing in the morning as I watered the plants outside.  Just a few days ago I began to hear different little chirps – the babies had hatched!  The adult birds went back and forth endlessly, flying away and quickly bringing back insects for their waiting babies.  One afternoon, I heard lots of commotion on the patio.  I approached the screen door and stumbled upon the most delightful chaos:  the babies were learning to fly for the first time, hopping from plant to plant, tumbling from the railing and catching themselves in a fluff of feathers as the parents flitted about supervising.  I tried to get some videos but they simply didn’t do the scene justice. It was magical.  The very next morning I awoke to an eery quiet, and I realized the birds were gone.  I wasn’t ready!  The patio felt so empty.  I will admit that I sulked for a good portion of the morning (although I was excited to be able to water my plant fully for the first time in over a month).  Eventually, however, I realized that I was stubbornly clinging to the illusion of permanence and indulging in my old trigger of abandonment.  I had gotten very comfortable with these birds, but the truth is the cycle of their lives was not about me!  They had given me a huge gift by allowing me the privilege of bearing witness to this moment in nature.  Plant, animal and human lived in harmony for a moment until that moment was over.  It didn’t need to be happy or sad.  I saw that the only truth here was gratitude.

During the same week, two of my long-time regular clients told me that they were moving to different states.  While I was happy for each of them, of course I felt the old hook of resistance.  I had gotten very comfortable with the regularity of the schedule with both of them, and I had also grown to enjoy the very genuine energetic connection I had with them during our sessions.  I felt a few tears surfacing after my final massage with both women.  For those of you who are horrified at my lack of boundaries, believe me:  I am aware of what the textbooks say about them.  However, when a woman comes into my massage space, she is also in my home.  When I do an outcall, I am in her home – so on some level there is already something more personal at play.  I tend to attract the clients who want this type of situation.  In addition to the physical and biomechanical work we do together, there is an inevitable exchange of energy which is often unspoken but exists.  The trick is to allow it in during the massage time without expecting anything else beyond, but even so there is always a connection that develops after multiple sessions together.  My point is: I felt sad!  And …here I had yet another “growth opportunity”.  The reframe was:  gratitude at having been given these wonderful women in my life for such a long time.  I learned a lot from each of them.  I also felt confidence in that I had given them the tools, through body awareness and endless little tips, to befriend and care for their bodies on their own, with or without me.  Finally, I saw the newly empty massage slots on my calendar as an open door for other women to come find me who might need my services!

Thank you for indulging me.  I am aware that my personal challenges and philosophy about life are outside the scope of “massage therapy”, but I thought if just one person reading this is struggling with “letting go”, then it is worth the post!  Plus, the spiritual illness that comes from “holding on” affects our bodies, on multiple levels.  For those of you looking for “muscles and stuff”, I have you covered – this week I also posted a blog about the muscles of “letting go”, the sphincters.

 

 

Filed Under: Mindfulness

April 6, 2018 by Julieta Benavides

Your “Other” Glute Muscle

When most of us think about our rear ends, we automatically think of our gluteus maximus muscle.  This mighty muscle is large and extremely powerful, plus it is the most superficial and thus most visible muscle in that region of the posterior chain.  However, just because it steals the spotlight doesn’t mean this muscle acts alone.  The “glutes” consist of three muscles, each with a different yet important role to play in the activities of daily living.  In addition to gluteus maximus, this muscle group also contains gluteus medius and gluteus minimus.  In this post, I will highlight gluteus medius, because it is problematic for many of my clients (and for me, too!).

Anatomy:

Gluteus medius comprises the middle layer of the glute muscles.  It originates on the lateral posterior surface of the ilium, or hip bone, and attaches to the greater trochanter of the femur, or the bony protrusion at the outer top of the leg bone. (If you prefer a video, here is a video.)

 

Function:

Gluteus medius is a powerful abductor of the leg, meaning it is the muscle we use when raising our leg out to the side.  Since it has both anterior and posterior fibers, it is also responsible for both internal and external rotation at the hip.  However, this muscle’s most important role in the body is that of pelvic stabilizer.  It provides stability to the pelvis while standing on one leg, for example.  Considering that we stand on alternating legs every time we take a step to walk, it becomes clear how important this little muscle is!  During the gait cycle, each leg takes a turn holding up our entire body weight as the other leg leaves the ground and swings forward.

Pathology:

If gluteus medius is weak, when we lift and swing the opposite leg forward, we can not hold the pelvis up.  In that case, that opposite hip dips down rather than being maintained upright.

Normally in order to compensate for this weakness, we use our back muscles to shift the torso over the affected hip in order to create more stability through an altered center of gravity, which in time can lead to the dreaded low back pain.  (A recent study found that pregnant women with weak gluteus medius muscles were 6-8 times more likely to have back pain than their “non-weak” counterparts.)  This weight shift can also result in torsion forces in the knee, which can contribute to knee pain.  Other muscles, such as the tensor fasciae latae, which attaches to the iliotibial band, may compensate for the lack of hip stability, which can lead to painful inflammation of the IT band.

My mentor, Ed Buresh, underscores the importance of the gluteus medius by highlighting its relationship to the psoas, a muscle which has definitely reached celebrity status.  Just as the psoas provides stability to the spine, the gluteus medius provides stability to the hips.  The two must work together.  The psoas is often identified as a source of low back pain.  However, one of the things I learned from Ed early on is that if we ignore the role of the gluteus medius in that scenario, we are missing half of the equation.  In my experience, the psoas tends to be tight and the gluteus medius tends to be weak.

The best way to gently build up weak gluteus medius muscles is to start incorporating non-weight bearing exercises, like the clam shell (figure to the right),

and gradually move toward more advanced movements like pelvic lists.

 

 

Here is Katy Bowman explaining the pelvic list:

For some in between exercises, here is an excellent resource I found online:

gluteus medius strengthening

The gluteus medius is often overlooked, although it is commonly one of the weakest muscles in the hip and thus directly involved in various soft tissue dysfunctions.  Becoming aware of the health of this muscle is key to maintaining proper gait biomechanics.  In my clinical experience, most of us could benefit from incorporating some strengthening of the lateral hip into our weekly movement program.

RESOURCES:

Yoganatomy  (for my yoga people)

Physiotherapy Exercises (other good ideas from same resource in article)

Filed Under: Anatomy

March 8, 2018 by Julieta Benavides

Shoulder Mobility in Baby Steps

In a perfect world, the shoulder would be one of the most mobile regions in our bodies.  It is comprised of the shoulder (or glenohumeral) joint, the space where the arm connects to the body, and the shoulder (or pectoral) girdle, which includes the collarbone, the shoulder blade and their surrounding muscles.  In both of these areas, there is great opportunity for movements in all planes of motion.  However, despite the possibilities available in the anatomical “best case scenario”, the majority of us suffer from a general lack of flexibility in this region.  Of course, each person has individual reasons for this and they are often multifactorial.  However, one of the most common factors contributing to this decreased range of motion is too much time spent in static postures or a narrow range of repetitive movements.  Being hunched over isn’t necessarily “the problem” – it’s being constantly hunched over for hours and hours without switching it up.  Studies have shown that what is generally considered “good posture” has very little correlation with a lack of pain in the shoulder region (or anywhere, actually).  Just as standing 100% of the time is not the fix for the discomfort caused by continual sitting, throwing your shoulders back and sticking your chest out 100% of the time is not the solution for hunching.  Variety, as they say, is the spice of life.  My clients who work at computers will inevitably spend a large part of their day with their arms in front of them, rotated inwardly, just as I will inevitably spend much of my day with my arm rotated so that I can put my forearm on a client’s body in front of me.  We need to accept that SOME of these postures are unavoidable consequences of our biomechanical environment, but we have agency over how much movement we can sneak in even within limitations.  If we are mindful of performing a variety of opposing movements, we can avoid some of the discomforts and range of motion issues experienced by our modern lifestyles.  One simple way to focus on this is to periodically lengthen the muscles that become continually contracted through daily living.  Stretching a muscle will not necessarily produce any permanent changes in muscle length, but introducing motion in a different direction can ultimately increase the range of motion.  From my clinical experience, two of the main muscles that could benefit from this temporary lengthening on almost everyone are pectoralis minor and subscapularis, both in the shoulder region.

 

Pectoralis minor:

Pec minor is a small but very important muscle in the chest region.  It originates on the surfaces of the third, fourth and fifth ribs and attaches to the coracoid process of the scapula, which is the little hook-like structure of the shoulder blade which sticks out on the front of the body.  It pulls the shoulder blade medially, forward and down.  In other words, when it contracts we end up in the “hunch” position. Click here for a 30-second video of pectoralis minor in action.  Since many of us end up in this position chronically, it’s helpful to alternate our computer work / driving / massaging with short bouts of lengthening.  The doorway stretch is excellent for accomplishing this and can be done any time we pass through doorway, or, for example, every time we get up to get water or on our way back from the restroom.  Here is Brent Brookbush demonstrating proper form for this stretch:

Subscapularis:

Subscapularis is another muscle which can easily become chronically contracted.  It is the internal muscle of the rotator cuff, originating on the interior surface of the shoulder blade (the part against the ribcage that we can’t normally touch) and attaching to the humerus of the arm.  Other than the stabilizing function of the rotator cuff muscles as a group, subscapularis is responsible mainly for rotating the arm medially, or inward.  Video here.  Hunch posture starting to sound familiar?  Performing a broomstick stretch once in a while to lengthen this muscle is an easy way to counteract that habit.  I like Dr. Mandell’s version:

We may not be able to incorporate constant gentle movement into every moment of our days.  If we have desk jobs, we are going to sit a lot and perhaps hunch a lot.  The important thing is to try to switch it up when we can.  These are but two easy ways to do that.  Of course, you could also get your massage therapist to help you release these muscles too 🙂

Filed Under: Anatomy, Best Practices

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