How To Run And Walk Without Pain & How To Tackle Stress Incontinence When Nothing Else Works with Helen Hall #481
Dr. Rangan Chatterjee welcomes movement therapist Helen Hall to discuss the superpower of walking, the impact of head position and foot health on overall movement, and a deep dive into tackling stress incontinence for women by addressing whole-body mechanics.
Deep Dive Analysis
13 Topic Outline
The Undervalued Superpower of Walking
Walking's Impact on Venous and Lymphatic Systems
Common Movement Patterns Observed in Society
The Crucial Role of Head Position in Movement
Addressing Stuck Head Posture Through Awareness
Importance of Extremities: Head and Feet
Why Some People Run Better Than They Walk
Self-Assessment for Walking Efficiency and Foot Health
Understanding and Addressing Stress Incontinence
The 'Tin Can' Analogy for Core and Pelvic Floor
Connecting Breathing Mechanics to Pelvic Floor Function
Impact of Tracking Width on Pelvic Floor and Movement
Day One: Starting a Body Movement Journey
5 Key Concepts
Contralateral Movement
This refers to the complex, diagonal movement pattern in humans where the arm and leg on opposite sides of the body move together during walking. It involves a twist through the system, engaging the top, bottom, front, back, left, and right of the body, making walking neurologically complex.
Speed Hides Need
This concept suggests that running (speed) can mask underlying movement limitations or restrictions present in the walking system. When running, leaving the ground and landing on one foot can provide a sense of freedom, temporarily alleviating pain or discomfort that originates from less efficient walking patterns.
Tin Can Analogy (Inner Unit)
This model describes the core as a cylinder, with the pelvic floor forming the base, the abdominal muscles forming the sides (all the way to the spine), and the breathing diaphragm forming the lid. For optimal function and pressure regulation, these components should move in harmony, expanding and contracting together.
Tracking Width
This refers to the space between a person's feet as they walk or run. An ideal tracking width allows for efficient weight shift and full engagement of the foot, contributing to innate pelvic floor strength and reducing strain on the lower limb, unlike a narrow 'tightrope' action.
Jellyfish Breathing
This mental model encourages thinking of the ribs and diaphragm expanding and contracting in all directions (like a jellyfish) rather than just front-to-back or up-and-down. This ensures a full, circumferential expansion and contraction of the 'tin can' for optimal internal organ massage and pressure regulation.
8 Questions Answered
Yes, humans are innately designed to walk, as evidenced by our movement development from infancy to upright posture. Walking is a whole-body movement that engages every part of the body, including internal organs, and is crucial for venous return, lymphatic circulation, and overall efficiency.
Walking is often undervalued because people associate 'exercise' with high intensity and calorie burning, overlooking walking's efficiency and profound benefits for tendons, ligaments, brain function, and internal organ massage (like for gut health).
Poor head position, such as a forward head posture, significantly increases the effective load on the spine and can lead to pain anywhere in the body, not just the neck. Correcting head position can improve overall movement efficiency, reduce strain on internal organs, and alleviate various pains by optimizing the body's entire kinetic chain.
The lymphatic system is a vast network responsible for collecting metabolic waste fluid, broken cells, and dead cells for elimination. Walking, particularly the action of dropping the heel into the step, is the strongest known mechanism for promoting venous return and, consequently, optimizing lymphatic circulation.
Running can 'hide' underlying inefficiencies or restrictions in walking because it involves leaving the ground, which bypasses some of the complex contralateral movements and stability demands of walking. While running might feel better temporarily, the root cause of issues often lies in the walking pattern.
To become more aware, one can start by observing their head position, checking for maximum head rotation in different positions. For feet, videoing oneself walking (a 'foot selfie') can reveal how much the foot moves and if there's asymmetry, which can then be addressed with practices like foot wiping and rope play.
There's a strong connection; Helen Hall has never seen a woman with stress incontinence who didn't also have poor breathing mechanics. The 'tin can' model of the core (pelvic floor, abdominal muscles, diaphragm) highlights that if the breathing diaphragm moves down during inhalation but the pelvic floor doesn't also descend, it creates excessive intra-abdominal pressure, contributing to leakage or prolapse.
Constantly holding your tummy in restricts the natural movement of the diaphragm and abdominal muscles, compressing the 'tin can' of the core. This interferes with optimal breathing mechanics, increases intra-abdominal pressure, and can prevent the pelvic floor from moving in harmony with the diaphragm, potentially exacerbating issues like stress incontinence.
41 Actionable Insights
1. Improve Breathing for Incontinence
Prioritize improving your breathing mechanics if you experience stress incontinence, as poor breathing is consistently observed in all affected individuals.
2. Holistic Core Approach for Incontinence
If conventional methods for stress incontinence have failed, adopt a holistic ’tin can’ approach by coordinating the function of the pelvic floor, abdominal muscles, and breathing diaphragm as a single unit.
3. Practice Diaphragmatic-Pelvic Breathing
Practice breathing in by allowing your diaphragm to descend and your pelvic floor to relax downwards (breathing into your perineum) without forcing it, ensuring the ’tin can’ expands harmoniously.
4. Consciously Coordinate Diaphragm-Pelvic Floor
Once you’ve established full diaphragmatic breathing (e.g., lying prone), consciously connect it with your pelvic floor, aiming for the pelvic floor to descend on inhalation and ascend on exhalation, rewiring this coordination with consistent practice.
5. Retrain Pelvic Floor Release
If you’re accustomed to Kegel exercises, practice pulling up your pelvic floor on the exhale, then consciously and completely letting go on the inhale to retrain the natural downward movement.
6. Prone Breathing for Rib Expansion
Lie on your tummy and observe your breath, allowing it to fill your lateral and posterior ribs, as this position encourages fuller diaphragmatic breathing by restricting anterior belly swelling.
7. Stop Holding Your Tummy In
Avoid habitually holding your belly in, as it restricts breathing and can hinder free, efficient movement, making you faster for less effort.
8. Optimize Head Position
Consciously position your head correctly, as a forward head posture significantly increases the effective weight your neck supports, reducing movement efficiency and potentially causing pain throughout the body.
9. Improve Organ Circulation via Posture
Correcting a forward head posture is crucial not only for pain but also because it prevents the squishing of internal organs, thereby improving circulation and their overall health.
10. Find Optimal Head Rotation
To improve head position, intentionally jut your head forward, then slowly bring it back until you find the ‘wibbly wobbliest’ spot where you have maximum rotational movement when looking over each shoulder.
11. Improve Neck-Rib Cage Connection
Lie on your back, locate where a necklace would sit at the base of your neck, and gently imagine sending that point down to the bed, allowing your chin to drop and the base of your breastbone to rise, always within a pain-free range.
12. Address Movement Disconnects
If your head or rib cage doesn’t move fluidly during the neck-to-bed exercise, gently assist the movement (e.g., with a small head nod) to help rewire the connection, then re-test for smoother motion.
13. Maintain Head Freedom
Actively find your head’s freest position and develop awareness of when and why you deviate from it, helping you maintain optimal alignment throughout the day.
14. Enhance Foot Freedom
Assess your foot freedom by videoing yourself walking, then enhance it through daily foot wiping and rope play to ensure active, symmetrical movement and prevent stiffness.
15. Self-Assess Foot Movement
Record yourself walking barefoot towards a camera to observe how much your feet are moving and identify any asymmetries, as your feet should actively engage their 33 joints during walking.
16. Engage in Rope Foot Play
After foot wiping, spend five minutes playing by walking up and down on a 30-40mm diameter rope, draping your feet in various ways to dynamically improve foot mobility and address tightness.
17. Know Your Feet Better
Develop a deeper awareness and understanding of your feet, recognizing their complex role in movement rather than just as passive structures, as they are crucial extremities often overlooked.
18. Improve Foot Mobility for Shin Splints
If you experience shin splints or other lower leg pains, focus on improving your foot mobility, as restricted foot movement can be the root cause of issues further up the leg.
19. Optimize Walking/Running Tracking Width
Consciously optimize the space between your feet (tracking width) when walking and running, as an ideal width supports pelvic stabilization, efficient weight transfer, and the innate strength of the pelvic floor, preventing lower limb strain.
20. Widen Tracking Width for Chafing/Incontinence
If you experience chafing when running or stress incontinence, try increasing the space between your feet (tracking width), as this can improve pelvic floor function and reduce related issues.
21. Use Tracking Width for Pelvic Insight
Adjust your tracking width (space between feet) when moving to gain insight into your pelvic floor function, as its critical role involves stable pelvic stabilization and weight transfer between legs.
22. Make Daily Walking a Habit
Integrate daily walking into your routine, recognizing its fundamental importance for running performance, general health, and the optimal function of your lymphatic and cardiovascular systems.
23. Prioritize Regular Walking
Engage in regular walking as it’s a whole-body movement practice that internally massages organs and provides beneficial load and impact for joints, bones, and muscles.
24. Walk for Venous Return
Make walking a daily practice, as the action of dropping the heel into the step is the strongest known method for promoting venous return and aiding circulation.
25. Walk for Lymphatic Health
Walk regularly to optimize your lymphatic circulation, which is a vast network responsible for collecting and eliminating metabolic waste and dead cells.
26. Increase Daily Walking Opportunities
Choose to park further away at places like supermarkets to increase your daily walking, adding significant movement value to your day through whole-body engagement.
27. Cultivate Movement Awareness
Become more aware of your body’s movements and your surroundings, shifting from a ‘heads down, eyes down’ focus to engaging peripheral vision and noticing how you move.
28. Enhance Body Self-Awareness
Start to feel and think more about your body and movements, as increased self-awareness is the most important step towards understanding and improving your physical well-being.
29. Expand Movement Perspective
Avoid viewing your movement ability solely through the lens of pain; instead, consider its impact on overall efficiency, internal organ health, and general well-being.
30. Master Four Pillars of Health
Focus on optimizing your diet (whole foods), movement (e.g., 30 mins walking daily), sleep (circadian biology, 6-8 hours), and stress management, as these fundamental pillars can resolve many health issues.
31. Practice Postural Awareness
Develop a constant awareness of your balance and posture throughout the day, drawing inspiration from cultures that carry items on their heads, which fosters innate structural alignment.
32. Aim for Postural Improvement
When working on head position, aim for gradual improvement rather than perfection, as even slight corrections will yield benefits and gains for your entire body system.
33. Practice Short, Focused Movements
Perform movement exercises in short, focused bursts until you feel a slight improvement, then re-test the initial movement as a marker for change, avoiding mental fatigue.
34. Trust Your Body’s Innate Wisdom
Listen to your body’s innate knowingness and gut feeling; if a health practice doesn’t resonate or yield results, it’s a signal to explore alternative approaches rather than blindly following external advice.
35. Address Walking for Running Issues
If you experience pain or problems when running, investigate your walking mechanics, as the root cause may lie in restrictions within your walking pattern, which is neurologically more complex.
36. Run for Your Body’s Efficiency
Instead of adhering to a specific running method, focus on finding the most efficient way for your individual body to move, allowing your body to guide the process.
37. Activate Dormant Side for Unilateral Pain
When experiencing pain on one side of the body, focus on ‘waking up’ and activating the non-painful side, as the symptomatic side may be overloaded from compensating for its less active counterpart.
38. Begin with Extremity MOT
Start your body improvement journey by performing an ‘MOT’ on your extremities (head, feet, hands/arms), as these areas provide foundational information that influences the entire central axis of your body.
39. Check Shoulder Girdle Tilt
Regularly check your shoulder alignment in a mirror to identify any tilt, as asymmetry indicates a lack of freedom in the shoulder girdle that can affect your entire body’s movement.
40. Correct Shoulder Tilt via Head Position
If you observe a shoulder girdle tilt, work on improving your head position, as a forward head posture often contributes to shoulder asymmetry, and correcting it can restore balance.
41. Reframe Exercise as Movement
Consider reframing the concept of ’exercise’ as ‘movement’ to help appreciate the value of simple actions like walking.
7 Key Quotes
If we're not born to walk, I'm not quite sure what else we would be born to do. But walking has more gears than one.
Helen Hall
Walking is a whole body movement practice. Every single bit of you is moving. Even the head is moving, but you just don't realise it because the eye reflexes are ironing out the bobbly nature of the head movement.
Helen Hall
The site of the symptom is not always the site of the problem.
Helen Hall
If I hold my tummy in, how do I breathe? So, so often when people are running with me, as soon as they stop holding their tummy in, they move more freely. They move more. They move better. They are faster for less effort.
Helen Hall
We are resilient until, okay, now we're struggling. So let's unpick why we are now struggling. It won't just be a thing, in my experience.
Helen Hall
We need to let our body run us. And if it's uncomfortable, we then need to explore why that might be.
Helen Hall
Your body knows best and we still don't know everything about the body. So that is by a torturous way, I feel, of saying don't lose sight of your sixth sense.
Helen Hall
3 Protocols
Head Position Awareness and Adjustment
Helen Hall- Jut your head forward and rotate it to look over each shoulder, noting your range of motion without forcing it.
- Find the 'wibbly wobbliest' place for your head by gently sending it back and forth, aiming for maximum rotational movement.
- Lie on your back comfortably, imagine where a necklace would sit at the base of your neck, and gently send that point down to the bed.
- Observe if your chin drops down and the base of your rib cage comes up in response, indicating spinal extension and connection.
- If the head or rib cage doesn't move fluidly, gently combine the neck-to-bed movement with a small head nod or assist the rib cage movement to help establish connection.
- Practice a few times until it feels smoother, then re-test by simply sending the necklace point down to the bed to see if innate movement has improved.
Foot Wiping and Rope Play for Foot Health
Helen Hall- Use a cheap, scratchy mat (like a doormat) or a rough towel.
- Stand on one leg and vigorously scrub the sole of the other foot on the mat, front and back, side to side.
- Incorporate a 'stubbing out a cigarette' motion to engage the skin where the toes meet the foot, promoting internal and external rotation.
- Switch legs and repeat the vigorous scrubbing and stubbing motions.
- Obtain a piece of rope (30mm diameter for children, 40mm for adults) and place it on the floor.
- Walk along the rope, draping your foot in various ways, exploring forward, backward, and sideways movements to massage and mobilize the feet.
Stress Incontinence Breathing Practice (Tin Can Optimization)
Helen Hall- Lie comfortably on your tummy on a bed, turning your head to one side.
- Begin by simply noticing your breath, allowing your belly to fill and expand wherever it can (sides, back of ribs).
- Observe if your easy breath in slightly lifts your back (bum, lower back, base of ribs) and if you sink back down on exhale.
- Once you've established this diaphragmatic movement, start to notice what your pelvic floor is doing during inhalation and exhalation.
- If the pelvic floor is pulling up on inhale (instead of descending), consciously connect the 'pull up' (if familiar from Kegels) with the exhale, then allow for a full release and descent on the inhale.
- Practice consistently, moving from prone to seated positions, to integrate this harmonious breathing and pelvic floor movement into daily life, aiming to rid the habit of holding the tummy in.