Understanding the Brace in Physical Therapy

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses the ins and outs of bracing and how to engage in conversations with fitness professionals to make sure we are all speaking the same language.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today.

RACHEL MOORE Good morning, PT on ICE Daily Show. What is up? It is Monday morning. My name is Dr. Rachel Moore. I am here representing our pelvic division, hanging out today to chat with you guys about bracing. So really breaking down the brace, understanding this concept a little bit more, understanding maybe where some pitfalls are in our communication with our fitness professionals that we are working with. So diving into that, let's just get started. IS ALL BRACING INSTRUCTION THE SAME?The brace as a term is kind of like poorly defined. There's really an understanding maybe in the PT world of what the brace is and then maybe in the strength world of what the brace is. And oftentimes what we're seeing or what we're getting feedback from is maybe there's a disconnect between what we're teaching as PTs or being taught as PTs and what the fitness professionals in our communities are being taught. And we wanted to kind of break down where this comes from. So for one, a lot of times fitness professionals aren't necessarily ever truly like taught how to do a brace. The most common cue we hear in like the fitness professional space is brace like somebody is going to punch you in the belly or like somebody is going to hit you in the stomach. And a lot of times that kind of brings about, or people think that this means this push out and this push out. on the PT side of things is actually what we're trying to avoid. And so we get some feedback from students in our courses and that's actually kind of what inspired the topic today is we got an email from one of the students who had taken our courses who said that she was kind of hearing from fitness professionals in her community that the way she was teaching the brace wasn't correct. So what do we do with that conversation? How do we navigate that conversation with those fitness professionals? And how do we kind of get across that we're probably saying the same thing, but it's not coming across the same way. WHAT DOES IT MEAN TO BRACE? So first thing I want to do is really define what the brace is. And in order to define what the brace is, we have to define the component pieces of the core canister, which is what's involved in the brace. So when we're talking about our core canister, we're talking about a 360 degree canister that has a top and a bottom. The top of that is going to be our diaphragm. The bottom of that is going to be our pelvic floor. The front insides are our anterior abdominal wall. A lot of times people just say, oh, that's the transverse abdominal muscles. But in reality, we have to understand that that is more than just the transverse abs. That's actually all of the layers of the abdominal wall. and then the back is the spine and the muscles of the spine. When we talk about this brace, we want the canister to have equal pressure distributed around it and dissipate forces in an equalized manner, rather than maybe one side of the canister getting too much force, which then causes a leakage of pressure into a different direction. So when we're explaining the brace, or we're teaching the brace, We oftentimes teach it as tense your abs, or think about pulling your pelvic bones together. A cue that we use a ton over in the pelvic division with our pregnant athletes is if you have a baby, hug your baby, or if you can remember what it felt like to recently be pregnant, hug baby, that pull together of the abs. We are never queuing a push out because if we think about this canister, a push outwards is going to cause a mismatch of pressure within the inside of that canister. That's then going to come downwards through the pelvic floor. And oftentimes in the pelvic space can elicit pelvic floor symptoms like leakage, heaviness, or farting in the bottom of a squat or when we're lifting. so we expect that the pelvic floor is going to match the degree of abdominal brace we don't necessarily cue an intentional pelvic floor contraction when we're saying brace we might in our populations that are having issues with symptoms cue almost like an over correction because especially if there's somebody that's actually bearing down or pushing when they're bracing and not understanding that they're lengthening their pelvic floor rather than either staying at the same level or allowing their pelvic floor to match the demand of everything that's on top of it. So when we're cuing our brace, it is tense your abs, pelvic floor either stays the same or we slightly lift pelvic floor to match that pressure. That's how we teach that brace. THE CONFUSING NATURE OF THE WEIGHTLIFTING BELT The confusion I think comes in especially when we start talking about layering in a belt. So oftentimes in the strength training world, we see athletes busting out a belt and maybe they're using it all the time for every However, whatever the weight is on the bar, it's not necessarily just that they're heavier lifts or maybe they're reserving it for their heavier lifts. The key thing with the belt is that when we layer in the belt, the brace doesn't change. And that's something that I think we need to make sure our athletes and our coaches are understanding is that the belt is there to give us this extra support and really proprioceptive input to allow that increase in spinal stiffness to happen, but it is not a mechanism to push into. and I have my husband's belt. I left mine at the gym, so this isn't gonna fit me exactly right, but I wanna walk through the fit of the belt and where I think this confusion maybe comes from when we start talking about fitness professionals queuing a push-out. So with the belt, when we're talking about using a weightlifting belt, we want to think about, if you have YouTube or Instagram live up, I've got the belt here, and I'm just gonna kinda walk through the fit of the belt and what we're looking for. So when we are putting a weightlifting belt on, we're looking to fill that space in between our pelvis and our ribcage. If there's a little bit of overlap, that's totally fine, but we're kind of going like the top of the pelvis and that's my marker for where this belt is going to go. When I put my belt on, I'm going to put my belt on and as I tighten it, I want to fully exhale. I'm not like sucking in and shrinking and shriveling up as tiny as I can. I'm just doing a comfortable exhale. And then from there, I'm tightening. And in this tightening, I can breathe. I can talk. I can put a finger in between me and my belt, and I'm not uncomfortable. It's not squeezing me. If we have the fit of the belt correct, then that approximation that comes from inhaling i think is maybe what the confusion is coming from so if i have my belt on right i tightened it on my exhale as i do an inhale and i think about inhaling into my belly and into my spine that good solid 360 breath i feel my tissues push into that belt that is different than me intentionally pushing into the belt, that push your belly out sensation. If you're watching this live or listening to this later, put your hands on your belly and feel what happens when you push your stomach out. What do you feel at your pelvic floor? More than likely, it's a dropdown. If we think about tensing our core, Usually we don't feel much there. Maybe we feel a slight lift. And if we do feel a drop down, then we over correct and think about going up towards the basement to mitigate that. But the key here is the fit of the belt and understanding how to do that brace. So where does the confusion come in? When we're talking about our fitness professionals or maybe people who have never been trained in how to use a belt, the thought is to push out into the belt to create that contact with the belt. But if we have the belt fitting correctly, we don't need to do that push up. That's the biggest thing that I want you guys to understand and take away is it all comes back to the fit and making sure that we're using that belt correctly. Even without the belt, our brace stays the same, right? We're thinking inhale into belly, tense abs. It's never push out as if we're pushing our abdominal wall away. WORKING ALONGSIDE FITNESS PROFESSIONALS So when we're having these conversations with Fitness professionals or other coaches in our community who are maybe pushing back and saying like that's not how we teach our brace Really breaking this down and explaining to them where we're coming from and why. I think a lot of the time like we assume that everybody is just saying the opposite just for the sake of saying the opposite or maybe like they're just digging their heels in and there's no sense in educating them. But in reality like we have a lot of opportunity here to create bridges with these fitness professionals and create positive relationships. And we're not gonna do that by saying, well, you're wrong, or telling the athletes, well, your coach is wrong, just do it how I teach you. So using this as an opportunity to get in front of those coaches and those fitness professionals, and as a way to kind of bridge this relationship of, hey, you guys are coaching, I'm teaching your athletes, I would love to get on the same page, this is how I teach a brace, this is why. The goal here is to create equalized pressure across this core canister, If we push out in one direction or another, we put ourselves at risk of potentially having pressure leakage, quote unquote, out through that wall. It's also just not as strong. And at the end of the day, all of us are here to help people get stronger and move better. So if we think about this and conceptualize all of these walls of this castle being strong rather than one being broken or pushed out, then we can kind of understand that that applies into better, more efficient bracing mechanic, which then leads into better lifting and higher strength with our sets that we're working on, increasing our strength and capacity there. If this is confusing to you, I've got another podcast episode, episode 1577 of PT on Ice Daily Show that's all about the Valsalva, kind of breaks down a little bit more of the specifics of the Valsalva, which is that breath hold with the brace. The Valsalva can also have the belt, so we can have this spectrum of breathing. SUMMARY We really break down the spectrum of breathing in our live courses. Our live course is coming up in March. There are so many opportunities to catch the live course out on the road in March, y'all. March 2nd and 3rd in California, 9th and 10th in North Dakota, 23rd and 24th in South Carolina. So holy cow, so many opportunities to come hang out with us. Be on the lookout. Christina Prevett and I also did a clinical commentary that will be coming out in the spring 2024 edition. of the Journal of Pelvic Obstetric and Gynecologic Physiotherapy, so that should be coming out here pretty soon. We'll be blasting that all over the place when it does come out, but be on the lookout. Sign up for our pelvic newsletter, because that's gonna be one of the first places that drops, as well as on our hump day hustling. Thanks for joining me this morning, guys. I hope that cleared up some confusion. If you have any questions about bracing, or you're not sure how to explain it, or anything along those lines, please reach out, shoot me a message. I'm happy to chat with you more.

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