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Before we jump into today's episode, I want to quickly tell you about something that I am super excited about. If you have Ms. And you feel like you're doing all the right things, but you're still not seeing the progress that you hoped for in your daily life, you are definitely not alone. And that is exactly why I created Ms. Summer Camp. It's a five day live experience happening July 27th through 31st, where I'll be teaching live every day, answering questions every day, and helping you better understand your walking, balance, strength, fatigue and movement so you can stop guessing and feel more confident moving forward. And if you're thinking it's summer, it's hot. I already struggle with fatigue and heat intolerance. The last thing that I want is another exercise program.
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I completely, completely understand.
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That's actually one of the reasons that summer camp is designed to be primarily educational. The goal isn't to give you more to do, it's to help you get clearer on what matters most for your body, your symptoms and your goals. If you've ever wished you could ask me your questions and get my thoughts on your specific situation and learn alongside other people with ms, I'd love to have you join us. You can learn more and save your spot using the link in the description. I hope to see you inside.
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The big question is, how does someone with Ms. Actually improve their mobility, strength, energy independence? The list goes on. My name is Dr. Gretchen Holley, physical therapist and multiple sclerosis specialist. Women, welcome to the Missing Link podcast. Tune in as I share the top strategies and exercises to help you gain control over your life with Ms. Using research driven insights and advice from top industry experts. Whether you're newly diagnosed or have had Ms. For over 30 years, whether you have relapsing Ms. Or progressive MS, this podcast is for you. You're sure to feel empowered and inspired after each episode.
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Ready?
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Let's dive in.
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Welcome everyone. So everything that I teach is based on research and neuroplasticity and functional exercise. You will likely find that when you have an Ms. Specific approach to exercise, it's very different from an orthopedic approach. And today what we're going to be talking about is our core. Our core is probably the most important area of our body because having a strong core often means that all forms of movement is easier. Walking is easier, scooting forward and backward in a chair is easier. Doing balance and reaching feels easier, tripping happens less. So we're going to dive into what the core is, why it's important, and Actually some core exercises too. So if you're up for it, you can do those exercises right along with me or you can just write them down, do them in the future whenever you think of it. So we're going to first review the core basics and then core and posture exercises. Posture is often something that people think about as a different category from our core. When we think of posture, we more so think of our upper body, our chest, our back, and how much we're rounded. But it, it coincides with the core, very much so. And so it's important that we talk about both together. And oftentimes the better your posture is, the better core strength you can have as well. So we're going to talk about both of those today. And then I do also want to share some helpful products that you might find useful and also some products that might not be useful that you might be already using or thinking about using. And I just like to clear the air with that because I don't want anyone using something that you think is helpful, but it's actually not, not going to be helping you. Okay, so first and foremost, why is having a strong core important? And I think so often we just know a strong core is important. But why? And so, as I already mentioned, easier mobility, walking, even if you're not walking, just transferring from one surface to another, scooting forward and backwards, adjusting yourself in bed or in a chair or on a bench somewhere, anywhere can be easier when you have a stronger core, better balance. So whether that means just standing and reaching for something, maybe reaching in a cupboard or down low in a dishwasher, or to pick up the dog's food bowl, reaching in your closet, any type of standing and reaching or sitting and reaching as well. And also just simply sitting balance. So right now I'm sitting away from the back of my chair. This requires balance and core strength. So being able to sit or stand in a static way without moving is easier when you have a stronger core. Reduced low back pain nine times out of ten. When I was mostly working in a physical therapy clinic and had a patient come to me for low back pain, we would focus on their core. And nine times out of ten they improved with that alone. We didn't even work on their back. But just having a stronger core improved their low back pain pain. And even if you have mid back pain, this can help you as well. Improved breathing. Breathing is huge, especially with Ms. It can be common to feel more labored breathing. And if you're able to fix your posture and your core, it can almost immediately impact your breathing in a positive way. I was just working with one of my patients and we reviewed things we're going to be reviewing today. And five days later she sent me a text message saying that her breathing already feels a whole lot better. So it absolutely can help with breathing. And then last but not least is bowel and bladder control. The stronger your core is, the better your breathing is. It can allow your body to have better control over your bowels and bladder. So it's important to know that those two impact one another. And so we'll be improving that through this work too. So what is the core? So often when I ask people what's the core? Everyone says it's your abs, your abdominals, and yes, you're absolutely correct, but it's much more than that. It's also your side muscles, your back muscles and your hip muscles. All of these are your core. Which means that if you have really great strength in one of these areas but not the other, you can still feel unbalanced or you can still have low back pain, your mobility will still be affected. Again, nine times out of 10, when I treated those patients who came to me for low back pain, a lot of them, I shouldn't say nine times out of ten, but a lot of them were very strong. They were athletes and I bet you they probably had six pack abs. But when I looked at the more their deepest abdominal layer, they had no strength there. When we looked at their hip strength, it was minimal. When we looked at their side and back muscle strength, it wasn't great. And so yes, you can have strength in certain areas, but it's really the whole package that makes the biggest difference. So we're going to be focusing on that today as well. So what is posture? Posture is holding your body erect against gravity in standing, sitting or walking. And you can have dynamic posture or static posture status. Static is what I'm doing right now where I'm not really moving a whole lot. I might be, you know, shifting my shoulders here and there to pronunciate words, but I'm pretty much staying in one position. So this is static posture, whereas dynamic posture is keeping good posture up nice and tall as I'm walking, as I'm moving. So dynamic really just means movement. So reaching like this, walking forward, backwards, stepping to the side, that would be all dynamic posture. And it's important to know those differences because you can strengthen your muscles in a static way or dynamic or both. So obviously both is going to be great if you have the capacity to do so and the energy to do so. When we're talking about posture, it's important to understand what is required. And posture often requires, if not always, strength and flexibility in your neck muscles, your shoulder muscles, your abdominals, your hips, and your back. And it all depends on what your posture is like. So we're going to go into a few different examples. But just understanding that it requires both strengthening exercises and flexibility and stretching exercises will put you ahead. That's a number one thing to understand when you're working on better posture. So when we're thinking about better posture, what does that even mean when we're sitting or standing? So either one, sitting or standing. We know that poor posture often is rounded like this. So a lot of people think that better posture might mean this and what you can't see. Actually, let me back up so you can see fully what I'm doing. So we might think of poor posture as this, which is accurate. This is not great. And we think better posture means this. And this is not true. So right now, my back is really arched, and this is often what we do sitting or standing. If I'm standing, this would not be great. So we try to overcompensate and arch, and it feels like we're up tall. It feels like we're being as tall as we can. So this must be great. But that's not actually what good posture is. Good posture should not be over extending your lower back like that. That would just lead to more muscle imbalances, more low back pain. The way that I like to think about good posture, seated or standing, is to think of yourself almost like a puppet. And you have a string on the top of your head, and someone is pulling that string up. So you want to just be as tall as you can be without extending. So there's a happy medium. It's getting yourself up there, but without moving too much into that extension, because that often leads to more pain or imbalances. So when should we use posture and core in these exercises that we're about to do? Always. And that is the second biggest thing that you could take away from this call and this conversation that we're having is to engage your core always. And I don't mean 24 7, but so often we only engage our core or have better posture when we're exercising, when we're thinking about it. And in reality, we. We should be implementing our posture exercises and our core exercises during almost every movement that we do when we're younger. Anywhere from, I would say maybe like 7 to 16 or so. It happens automatically. We don't even have to think about it. But as we get older, even Ms. Aside, we tend to just forget what muscles to use. And we don't. If we don't turn them on by actively thinking about contracting them, then they're not going to work. So examples of this would be, before you get in or out of your car, tighten your core muscles. One thing that I've been struggling with a lot lately, my daughter is now almost nine months old. She is getting heavier and heavier, and putting her in and out of the car in her car seat is challenging. And oftentimes it hurts my back unless I activate my core. It has to be an active thought of tighten my core, brace these muscles, and then put the car seat in or then take the car seat out. And when I do that, my back is totally fine, I feel more stable, but it has to be an active thought. Getting in and out of bed. Same idea. You would tighten your core muscles when you get in or out of bed, maneuvering in your chair. So if you're reclined right now, before you even sit up tall, engage your belly muscles, try to tighten those core muscles, Sit up and then scoot forward or backwards, repositioning yourself when you're strengthening your core, especially putting socks, shoes and pants on, walking, getting in and out of the shower, getting dressed, pushing a door open or pulling it closed. These are all moments where right before you do that activity, you can think to yourself, engage my core. And I'll tell you what that means. We'll do an exercise for that in a bit here, but engage my core and then do that thing. And engaging your core, honestly, can take anywhere from 0.5 seconds to 3 seconds, tops. Okay, so we're going to get into some exercises. Before we do our core exercises, I want to touch on posture. So earlier I had said that in order to have great posture, not even great, just better posture, it requires strengthening and stretching. And so there's two most common posture imbalances that I see with my patients who have Ms. So I'm going to demonstrate what those are and then share with you what muscles you would want to stretch and. And what muscles you would want to strengthen based on that posture. So the first one I'm going to show you seated, and I'll also show standing as well. But the first one I just call rounded posture. So what that means is rounded. So you might be sitting like this right now, or maybe you know that this is your normal. So if you're sitting, it might look like this. If you're standing with or without a mobility aid, it would look like this. So it's more of just rounded. So important muscles that you would want to work on in order to go from here to here would be a combination of stretching the front side of your body, your pec muscles mostly. So if I'm rounded and my shoulders are forward, these muscles right here get tighter and tighter and tighter, and they essentially will pull you forward into this position. So if we stretch these muscles out, that can automatically help improve your posture. My favorite way to do this is to get in a doorway, seated or standing. So if you picture me in a doorway right now and the door frame is around me, you can put one arm on the door frame and lean forward. So from this side it would look like this door frame lean. And you should feel that stretch in the front area. You could also do both arms on the door frame and lean. You could also move your arms a little bit higher up on the door frame and lean or lower down and lean. But you have your arms on a surface that will not move. And then you lean forward. So you're getting that stretch in here. You can also get that stretch in a similar way using your chair. So you'd want to scoot to one side of your chair, reach back for any. Anywhere that you can reach. It could even be an armrest and turn the other direction. And you should feel some type of stretch up. And then you would do the same thing on the other side. Grab and reach or down here. Doesn't. Doesn't matter where. But you want that turn. So that would be stretching the front side. If you have really tight muscles here, one simple stretch could be lying down on your bed, on a couch, anything. Just lie down and put your arms out to the side. And if they stay up, that's a huge indicator that these muscles are so tight that you can't even relax your arms down on the floor. I'll show you what I mean because I think this is a great visual. So again, I'm going to demonstrate this on the floor. You do not need to do this on the floor. You could do this in bed, but you would lie on your back and just put your arms down. If you really tight muscles, you'll notice that your arms are not going to touch. Or maybe your hands do, but your elbows don't, or your elbows do, but your hands don't. So that's another way you could just check to see how your flexibility is in the front of your body. So the Second thing you'd want to do, get you to see me again. So that's the stretching component for this rounded posture. You'd stretch here with those stretches, and you would strengthen your upper back right between your shoulder blades. One simple exercise that we all can do seated or standing, is to sit, ideally with your best posture, even if that is rounded. But sit with your best posture. Hands are facing up, elbows are in at 90 degrees, and you're going to squeeze your shoulder blades together and down, almost like if you were wearing jeans. You want to get your shoulder blades to slide down into your jean pockets in your back. So this is what it looks like from the back. Squeeze and release, squeeze. You're holding for about two or three seconds, release, squeeze, and you're just squeezing those shoulder blades together. So that is a great exercise to help strengthen so that once you have the flexibility here, you also have the strength to get into a better posture and stay up here. So those are two of my favorites. There are, of course, plenty others, but just those two is what I worked on with my patient about a month ago, and she texted me five days later saying, whoa, my breathing already feels so much better. Because when you're in this better posture, you can take a deeper breath versus when you're down here. If you try to take a deep breath in, you'll notice you hit an end point. You can't take a full breath in, but if you're up here, you can often take a bigger breath in. The second posture technique that I notice mostly in standing, but even in seating, seated, is a hinging posture. So it's not necessarily rounding. Instead of rounding, it's hinged. So you're just forward. Your hips are more bent, if you will. If you're standing with or without a mobility aid, it often looks like this. So this is a completely separate type of posture that would not necessarily benefit from those exercises that we just did because that focused more on our upper body. When you're like this, it's more of a hip tightness and weakness. So when you're like this, what we want to do is stretch the front. So we want to stretch our hip flexors. When these muscles are tight, it pulls you forward, so we want to stretch those muscles out. One simple way that we can do this is by lying on your stomach again in bed or on a couch, just lying on your stomach gets your hips into a fully extended position. So that's one exercise you can do. Another one that I really like, you can hold on to something if you need Step back and tuck your hips under, and you should feel a stretch in the front of the hip of the leg that's behind you. And then you do the same thing on the other side. One leg, back, tuck under, and that's when you'll feel that stretch here. So those are two really good examples of stretches. So that could stretch the front muscle. Tightness always wins over strength. So even if you full strength, if these muscles are tight, you'll still be in this posture. So stretching those muscles out. Now, the strengthening component. We'd want to strengthen the back side, so we stretch the front, we strengthen the back. A standing exercise that you could do to strengthen the back could be as simple as squeeze your butt and relax and squeeze and relax. You can hold on to something for balance if you need, but you're squeezing and trying to push your hips forward, relax, squeeze, hold for a few seconds, relax. Another standing exercise could be, and this is challenging, but it could be to move your leg diagonally back. And you should feel that here from the front, it looks like this. So any of those are good options. Sitting. The way that you could do this would be to keep your feet and your knees in, Open your knees and squeeze your glutes, squeeze those butt muscles as hard as you can, then relax and close. So open, squeeze your butt muscles, relax and close. So this is a seated glute strengthening exercise that would help with posture because the stronger your backside is, the more it can pull you up. Seated exercises for our core, the number one always is bracing. If you get any exercises from today, the one that you should remember is bracing. It has other names. The muscle that we're strengthening when we're doing this bracing exercise is the transverse abdominis or the ta. So you might see other names for this exercise like TA activation or transverse abdominis strengthening. It's all the same thing. And what that means is we're strengthening the deepest abdominal layer. So if we think of our court, if we were to take all of our belly muscles away, everything, take it away. The deepest layer is this ta, the transverse abdominis muscle that runs from our belly and it comes all the way and attaches to our back as well. So I'm going to share with you how to strengthen that muscle. Before I do that, I just want to share the other exercises that we're going to get into. If you remember, for core, we talked about it not just being our belly muscles, but also being our side, our back and our hips. The exercises that we just did with the standing and Our knees opening, standing and squeezing our butt muscles, standing and leg going out to the side. Those are all for our glutes, for our hip muscles. But I'm also going to show you exercises for our back and our sides. And then the bracing is going to be the one for the front of our body. Okay. So for the bracing exercise, it's going to be easiest to do this if you get into a tall position, your your best posture, and then sit supported by the back of your chair so you can be a little bit reclined. And what you're going to do is use your belly muscles to flatten the arch of your back or wherever your arch would normally be, flatten your arch into the chair and then relax. So it's a little hard to see with this in the way. I don't know if that helps at all. But if you imagine if I really try to exaggerate my back, this is where the arch of my back is. I'm trying to flatten it using my core muscles. Using my belly muscles, I'm flattening and hold, hold, hold, and then relax and flat in. You're trying to make sure that there's no space that someone would not be able to put their hand or fingers through your low back into the chair and relax. I'm only having my arms up here so you can see what's going on. But if you're doing it, your arms can just be relaxed wherever you want. It's a challenging exercise to teach because it's such a small movement and you might not see any movement happening. But when you're the one doing it, what you should feel is engagement of muscles somewhere below your belly button and horizontally. So anywhere in this region would work. So again, you're just flattening your back and then relax. Another way that you can think of this is to use your belly muscles, your abdomen muscles, to pull your belly button in towards your spine. For some people, that makes more sense. And then you relax. Another way you can think about it that helps other people is think about pulling your belly button in towards your spine and then up towards your nose, almost like you're zipping up your abdomen. So if you're wearing jeans, you're zipping up, you're pulling up and in, and then relax. All of these are just different ways to think of the same movement. So regardless of which way helps you understand what it is, ideally what you'd be feeling is somewhere down here. With that said, 50% of the time, if not more like 75% of the time, even if you understand what to do, you might not be feeling it. And that's okay. That is completely normal if you haven't used this muscle in a long time. So for the majority of my patients who understand what I'm telling them and they're trying to do it, but they're just not feeling, can take anywhere from about four to six weeks of practicing this exercise daily before they finally have that thought of, okay, I think I know what she's talking about. I think this is what I was supposed to be feeling back when she told me to do this. So we can take a while, but that bracing exercise would then be progressed by, instead of sitting back here and doing it, we'd sit at the edge of our chair and we'd brace. We'd pull our belly in. And so you'd practice it there and then brace and relax. Then you would progress it, and this would be weeks later, if not months later, standing and try to brace. When you're standing, you're pulling those muscles in and relax. Embrace and relax. And the final way to progress this exercise is to do it in action. So if you want to practice picking something up off the floor, you brace and then bend down, up, and then let the brace go. Brace, pull that belly in, bend down, up, and then let it go. So you would brace while you're doing activities. Okay, so that's the best exercise I could ever give you for having a stronger core, better balance from a stronger core, reduced low back pain. But as I talked about, there are other areas of our core as well. One way, another exercise you can do from a seated position to activate the front of your core would be to relax back. Try your best not to use your arms from your armrests as you pull to a tall sitting position. And then slowly relax and fully sit back down, and then pull to a tall seated position. If this feels too easy, first and foremost, go slower. The slower, the harder. If it's still too easy, you can scoot more towards the edge of your chair so there's a bigger distance that you have to sit down so you're relaxed. Pull yourself up. Slowly relax. So this is also for the front side of our core. The next one we're going to do is for this side of our core. My favorite for this, I call it the Penguin, because I feel like a penguin every time I do it. But you're going to sit up tall. Feet and knees are touching. The more they're touching, the harder this will be. So if you need it to Be easier. You can open your. Your feet and your knees, but legs are touching and you're going to tip towards one side. So you're not leaning, you're not shifting your body weight off of this leg. Your body weight stays even through both hips. You're just tipping. It's just an upper body exercise. And then come back up and then the other side. And what you're doing is you're stretching this side of your body and then you're strengthening that side of your body. And ideally, you're just tipping directly side to side. So if I show you this way, it looks like this and then this and up. So you're not necessarily reaching forward. Sometimes people will reach forward because you can reach further. So you might feel more successful because you're getting closer to the ground. That's not the goal with this exercise. The goal is to strengthen the proper side muscles. So just one side and then the other side. So that would be that side exercise. So we've done the front, our side, our glutes. So then the next is the back. So how do we strengthen these back muscles? One of my favorite ways is to do it by reaching. And so we ideally would brace first. So we activate our front muscles as we reach forward with a flat back. So we're not rounding your. Your best posture, keep your back flat, hold for a few seconds, and then come back to a tall position and then reach forward again. Hold, hold, hold, flat back, not rounding, and come back up. So you could do lots of repetitions of that, or you can do, I like to call this around the world. So your hands are touching, they're together, and you're keeping a flat back as you reach to the side, come all the way forward and then back to the center, slow and steady. And you're. I'll show you from this side, you're keeping a flat back the whole time. The key is to have the flat back. So even if you're only hinging this much, that's fine, that's still a good strengthening exercise. But that flat back is what's going to get you to strengthen those erector muscles on the back of your spine, those extensor muscles. The last one that I want to show you is a twisting motion. Because having a strong core means also having a mobile core. And our bodies move in more directions than just forward, backward and side to side. We also turn. And so my favorite exercise to strengthen our core that also helps with posture, to rotate is to simply practice rotating. So I like to hold onto my hands and it just helps me personally. I'm sitting up tall in the middle of my chair and I'm just going to rotate. I'm trying to turn my body as far as I can without pulling with my hands. My hands can't help. How far can I get a body to go? And then slowly release and go the other way. Turn, turn, turn. And the key here is to truly put 100% effort in. As if your goal is to turn complet completely to the back wall, obviously that's not going to happen. But the more effort you put in, that's when you'll feel the obliques and the rotation muscles kicking in. If you're just loosely attempting, you're not really going to feel your muscles kick in. And it's not a strengthening exercise. So if you want to strengthen, really put that effort in every time you rotate. So those are some exercises. I know that's a lot at once, but those are some exercises for, for posture and core that cover everything from the front and back of our chest and back all the way down to the front, side, back and glutes of our hip and core. So the last thing I want to do is just review some products that may or may not be helpful. Okay. So the first product that a lot of people get to help with posture and core is this back brace. I'll call it. It's more like a shoulder brace where you strap it around your shoulders. It's almost like you're putting on a backpack, but then you tighten different areas of it. And the idea is that it takes you from here to here. And for some people, they work. If you've tried this product and it does work for you, amazing. Keep using it. For the majority of people that I work with who have tried this, what ends up happening is it causes discomfort and maybe even pain in the front area where those straps are sitting. And the reason for that is because while it might be helping you change posture from here to here, it's doing that by putting pressure into your body in certain areas, not by strengthening your muscles. So oftentimes it just hurts here, and then as soon as you take it off, you come back down here. As a physical therapist, my problem with this device is that it's not actually stretching or strengthening any muscles, which is why usually it hurts when you're wearing it. A better approach would be to stretch and strengthen, and then you could use a product like this after you've stretched and strengthened, and only use it as a reminder of which muscles you should be using. So when you start to feel that discomfort, if you're using one, when you start to feel that, use it as a reminder to do that shoulder blade exercise that we did and try to sit up tall instead of just leaning into that discomfort. If you're just using this product and not doing exercises long term, it's not going to help your posture. It's not going to reduce any pain that you might be having. It's simply just something that you're wearing that isn't affecting what your muscles are actually doing. Again, for some people, they've tried it and they love it. And if that's you, it's great, go for it. But for most people, what I have found is that it's not as effective as you think it might be. And then the last product I want to mention, because this is something, this is a question I get every time I talk about posture and core, and especially if you have that posture and core positioning where you're hinging forward or rounding forward. So the question that I get is, can't I just get an upright walker or Rollator, or can't I just move my handles on my Rollator up higher? And again, for some people, that does work for them. But for the majority of people that I work with, if you are using a Rollator and you're hinging like this, or you're rounded, the assumption might be if you raise the Rollator or get it upright one, wouldn't that be helpful? In my experience, no. And the reason for that is because you're not changing your muscles at all. You're still hinging or rounding. All that does is it changes your arm position up to here. And what most often happens is it might help you correct your posture for about 30 seconds or less. But then eventually, you don't have the strength to stay up here or you don't have the flexibility to stay up here. So after 30 seconds, your arms are still high, but your back is still rounded, or your arms are still high, but you're still hinging. And so again, it really, really does boil down to strengthening the appropriate muscles, stretching the appropriate muscles. You can use tools like the one that feels like a backpack, that you're putting it on, that upper back brace, an upright walker, you can use those in addition to the strengthening and stretching exercises. But strengthening and stretching needs to be number one. With that said, it does take time. It might take weeks, if not months, if not six months before you really start to notice those strengthening and stretching exercises helping you. So it is okay to use tools and products that help you, but, but they should not be a replacement for those exercises. And most of the time that I'm working with people who are using them, they're using it as a replacement. So that's why I like to mention that. Okay, so I just want to end this conversation by reminding you that activating your core muscles during exercise and when you're moving is the key to long term success. Success when it comes to having great posture or even decent posture and a stronger core. If you're activating those core muscles and doing these exercises that we did today as your exercise routine, that's phenomenal. But that's just one part of it. The other piece is implementing it and activating those exercises when you're moving just in day to day life. And what I mean when I say activate those exercises is just tighten those muscles. As I mentioned earlier, just getting my daughter in and out of her car seat in the car, if I'm not activating or tightening those muscles, it hurts, it's not comfortable. What I do in those moments is I'm standing, my car is right here. All I do is I do that standing bracing movement. So I'll brace my muscles, I'll tighten my core and then I put her car seat in, or if I'm taking her car seat out, it's here. Before I even lift anything, I'm in this position, I tighten my belly muscles and then I lift. And it's the same idea if you were to go for a walk to your bathroom, tighten and keep those muscles tight as you're walking. So implementing is part of equally as important as doing the exercises in your strengthening and stretching routine. How do other factors like nutrition or overall fitness impact core strength and definition? Great question. Nutrition affects everything. Our muscles work better when we are fueling them well. And that's not just food, that's water too. And I, I like to point out water because so often with ms, urinary urgency, frequency, retention, incontinence can be a real symptom. And so when that exists, we tend to stay away from water. And that's actually the worst thing that you could do. So making sure you're staying hydrated and fueling your body with nutritious foods plays a huge role in our muscles getting stronger. I will say though. So part of this question is how do other factors like overall fitness. So if you're always doing the same routine over and over again, you're likely strengthening the same muscles over and over again, not the ones that are weaker so it's very easy to strengthen certain muscles and just your body forgets about other muscles because you don't need them. You already got stronger muscles. That plays a huge role on core strength. Most of my patients without Ms. That I worked with in the PT clinic with who would come to me for core strengthening and back pain, as I mentioned earlier, a lot of them were athletes. They were doing yoga classes five, six, seven times a week, or they were doing rock climbing five, six, seven times a week. But it was always just one thing. It was always like just yoga or just rock climbing or just one thing. When you're just doing one thing again, you're not often you're forgetting certain muscles. So the best thing that you can do is add some variety to your routine, making sure that you're not only focusing on one area. What I typically like to recommend, if you're doing stretching and strengthening, which we discussed today, I personally think it's beneficial to do the stretching first, then one or two or however many strengthening exercises, and then if there's time and energy, the stretch one more time again at the end. And the reason for that is because stretching first can loosen up your body so that then the strengthening exercises are more effective. But strengthening exercises tighten your muscles. So if you then do the stretch again at the end, you're loosening yourself back up and you can be more mobile. So that's kind of the sequence that I typically recommend. But in terms of, should I only stretch until I'm more flexible and then add in strengthening exercises? No, no. I would do them at the same time. I would do them together. You don't have to wait until you're flexible enough to start the strengthening, or you don't have to wait till you're strong enough to start the stretching. You can do them at the same time. So with leaning, or anytime that you notice that you have a certain posture or a certain part of your body or side of your body that is weaker, I would always recommend strengthening, doing the exercises on both sides, but you can add some more exercises for the weaker side. If you're always leaning to the right, you can still do the side bend. The penguin exercises, I called it, for both sides, but you could do it a few extra going to the left to try to really stretch and strengthen that opposite side. Same thing if you had a weaker leg. So often when people have a weaker leg, their mindset is, I'm only going to strengthen my weak leg. My strong leg's already strong. And yes, that's true, but we want to keep that leg strong. With ms, it's so important not just to keep the muscles strong, but to keep that neural pathway strong, which is the connection between your brain and the muscle. And the only way to keep that neural pathway strong is to keep doing those movements over and over again. So you'd want to do the exercise equally on both sides, and then if you have extra time or energy and effort, you could do a few more repetitions on the weaker side. Thank you for listening to today's show. I am so grateful to have you as a listener.
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If you'd like extra resources such as a video of one of my seated exercise classes, my favorite core exercises, and the opportunity to ask me your questions, head to missinglink.com insider. That link will be shared in the show notes along with links to my social media handles. If you loved this episode and think a friend or family member with Ms. Would benefit from listening, please go ahead and text or email this podcast to them right now. Sharing this podcast will help me educate and empower as many Ms. Warriors as possible. Thanks again for joining and be sure to tune in next week for another episode of the Missing Link podcast.