Pelvic Floor & Exercise for EVERYONE....

Ahh, the Pelvic floor! I am a humble Pilates Instructor and I won't be so bold as to say that I have all the answers on the vast & varied debate of strengthening (or not) and the hows & whys, but I feel I have travelled a little way on the path of understanding the Pelvic floor in my 8 or so years of Pilates Instructing, and I'd like to share a little of what I have experienced personally & professionally, and provide you with some great links & fascinating ideas.

 A FEW FACTS

• Urinary incontinence affects up to 13 percent of Australian men and up to 37 percent of Australian women.
• Faecal incontinence affects up to 20 percent of Australian men and up to 12.9 percent of Australian women. (1)
• It is not just childbirth that causes urinary incontinence in women, pregnancy itself can contribute (many women suffer incontinence post Cesarean), as can long periods of sitting (desk work), obesity, age & lack of fitness.

Men often feel Pelvic Floor is 'women's business', however having a healthy PF is vital for men for prostate health, and if that isn't enough, Pelvic Floor health will also prevent and restore erectile dysfunction & impotence.

There are many differing professional opinions on this subject, and also, many differing issues that women & men have with the pelvic floor. It is not always 'weakness' that causes problems.  An overly contracted or tight Pelvic Floor loses it's elasticity & usefullness, and can be the cause of many problems. A tight Pelvic Floor doesn't equal a strong one!

Pelvic floor dysfunction is often accompanied by stress, depression, anxiety, hip pain, back pain, pelvic pain and leg pain.

"The pelvic floor is involved in our life experience in multiple ways. Of course it holds things in and lets things out, but it also processes emotion, movement habits, illness, and our sexual/sensual experiences and beliefs. We cultivate life force energy in our pelvis. It is part of our breathing system, working with the breathing diaphragm. It gets stuck fascially, emotionally, breath-wise. Bones can become twisted, pulling the muscles out of place causing tensions to spread through the rest of the body. It is complex! It is far beyond a simple kegel to find balance and enlivenment in the pelvic floor, greater pelvis and body." (2)

WILL PILATES 'FIX ME'?

Many women (and men) come to Pilates due to Pelvic Floor (PF) 'weakness' and a hope of finding a solution. Usually this presents as some form of incontinence, which can be quite mild. Not a subject we are often comfortable talking about. Being open & communicative about any concerns is to step onto the path of solution!

This is a complex subject, and the PF is indeed a very complex (fascinating) muscle. You cannot expect to go to a mat class, no matter how qualified or fantastic the teacher is and expect your PF to improve, it may of course, but  you may need some more specific training by a PF specialist, experienced Pilates Instructor in a one to one capacity or have some specialised physical therapy. 

Over working, using weights that are too heavy or misunderstanding  the correct way to engage your PF can lead to a 'bracing' of the Abdominals which can actually cause a 'bearing down' of the PF (this is a pushing feeling as though you were constipated, which you should NOT feel when exercising). The bottom line is that you need to make sure you see the right practitioners with the right experience & up to date information and if it's not working, find a new practitioner or approach. Also, talk openly & honestly with your Pilates instructor or health practitioner, we can't help if we don't know what's happening!

Our modern lives are counter productive for a healthy PF, spending much too much time sitting (on chairs, but also toilets!), and often in a slumped position (posterior Pelvic Tilt), puts undue pressure on these muscles, but also encourages our supportive core to switch off. Movement with correct posture will allow the PF to work as it is designed to. Increasing your fitness & learning to improve your posture (seated & standing), together with specialised Pelvic Floor work, are the beginning steps towards a healthy PF.

LESS IS MORE

There is a lot of hype about the 'core' muscles and strengthening your 'core' (which should include your PF), and there is a lot of misconception about the PF and how to 'strengthen' it. Most people believe that a strong core feels like a bulging six pack, and that a strong Pelvic Floor feels like a tight squeeze 'down there'.

When your 'core' is working well, IT DOESN'T FEEL LIKE A SIX PACK, it's subtle, deep & supportive, you need to work from the inside out to achieve this.  WHEN YOUR PELVIC FLOOR IS WORKING WELL YOU HARDLY FEEL IT!

We do of course, need to address & correct a dysfunctional Pelvic Floor. Your abdominal 'core' muscles are the deep abdominals, not the superfical ones, and they are there to support you as you move through life. Similarly your Pelvic Floor is working all the time to support you in movement, it needs to be able to switch on and off and it is as important for it to be able to relax as to contract.

A productive PF  works at about 30%, it's not a tight squeeze.  Often when we look for a tight or strong feeling (or try to connect too low down), the PF is actually depressed and dropped, thus weakening it. Lifting weights that are too heavy, incorrect pelvic or spinal alignment, coming back to exercise too quickly and too aggressively after childbirth or surgery, and repeated PF squeezing, can all lead to a process of PF weakening. I love Melissa Macourek's cue's for Pelvic Floor  http://www.youtube.com/watch?v=ZsZ8VB9XW70. She talks about connecting to PF from the top of the cervix and lifting from there, rather than a tightening lower down,  of the vagina or anus. I have found this very helpful in creating a subtle PF connection and helping clients move away from clenching or bearing down with PF.

Mama Sweat writes a great blog, and has tackled the Pelvic Floor topic in an open way, here's an  article... 'Pelvic Floor Party: Kegels are not invited', an interview with Katy Bowman, Biological scientist, who has a few really interesting ideas about how the pelvic floor should be strengthened. Many of the ideas are contrary to what most people are told or believe they have to do to 'strengthen' their pelvic floor.

http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html 

Katy Bowman emphasises the need to strengthen the glutes with the pelvic floor, and the importance of the pelvic floor retaining it's elasticity, as well as the importance of a Neutral Pelvis postition. As a Pilates instructor, I have observed that  the Pelvic Floor is designed to support us through movement and it needs to be able to switch on and off (or phase in and out) and move with you to support the pelvis & internal organs in a very responsive way. Some movements will require the PF to lift & contract, and others will require it to lengthen.

Katy Bowman illustrates this beautifully in another Mama Sweat article by saying... 

"The muscle tissue in your Pelvic Floor is the same as the muscle tissue in your biceps. When you’re done realllly working your biceps, you’d like your arm to go back to its original length, right? What if, when you were done doing your curls, your elbows stayed as bent as they were when your muscles were the TIGHTEST? If you equate strong with tight, then you’d have “strong,” contracted arms with bent elbows all the time. Tight muscles. Unusable arms.

That’s not what TONE is. Tone is having the MOST strength and the MOST length.

Doing Kegels all the time will get you a TIGHT, unusable pelvic floor. This is why people’s ORGANS ARE FALLING OUT OF THEIR BODY."

The mamasweat article had a follow up article, in which the 'Kegel Queen' says that Kegels do have a place, it's just important that you are doing them correctly.  She has a good video here with her arguement and a nice introduction to your Pelvic Floor with a model PF. http://mamasweat.blogspot.com/2011/06/second-annual-pelvic-floor-party-kegels.html

Melissa Macourek is a great resource, have a look at her youtube videos and website. Melissa is a Pilates Instructor who found a new way of approaching Pelvic Floor work after suffering extensive damage to her PF due to childbirth. She illustrates the fact that even someone who teaches PF on a daily basis may have a lot to learn, and it wasn't until her own body led her to look more deeply at her healing that she deepened her knowledge. I am especially excited by Melissa's Jade Egg work, and rushed out to get myself an egg! This is covered in my previous blog,  'Jade Egg'. 

THOUGHT OF THE DAY

'To achieve a permanent improvement of strength, posture and flexibility we have to change our very patterns of movment, because only when a conscious change takes place on the level of the nervous system will something really change.'

Eric Frankin 'Pelvic Power

EXERCISE OF THE DAY

Stand with feet hip width apart. Slowly bend and straighten the knees, maintaining a long, upright spine. Observe the pelvic bones and notice how they subtly open and close as you bend and straighten. You hip bones at the front (ASIS) gently close as you bend your knees, whist either side of sacrum (PSIS) widens. The opposite happens as you straighten your knees. Notice how this subtle movement affects your pelvic floor muscles and see if you can sense a widening and shortening of the base of the pelvis (the space between your sit bones, tail bone and pubic bone). 

Whenever you perform a squat (even sitting into and out of a chair!), make use of this exercise, and allow your pelvic floor muscles to ASSIST the movement.

RESOURCES

Beate Carriere & Cynthia Markel Feldt ‘The Pelvic Floor’  

This is an amazing book, however most relevent to practitioners and very medical and dense.

Beate Carriere  'Fitness for the Pelvic Floor'

fantastic book for movement practitioners & lay people which prescribes exercises.

Pauline Chiarelli ‘Womens Waterworks’ 

 FOOTNOTES

(1) Continence Foundation of Australia
(2) Melissa Macourek: melissamacourek.com/PelvicFloor.html

JADE EGG for female PELVIC FLOOR health.....

WHAT IS IT?

Jade egg practices originated from ancient Taoist practices. Today they are useful tools for Pelvic Floor health.  It is a small egg shaped stone made from pure Jade which you insert into the vagina. It has a hole running the length of it, to which you attach a string (unflavoured dental floss!), so that it's easy to take out. They do come in various sizes, but the standard size is about 5.5cm (2 1/8") long and 3 cm ( 1 1/8") wide. 

 BENEFITS

•  Increased, functional Pelvic Floor endurance
• Offload leg & hip muscles as you strengthen deeper within the pelvis
• Proprioception of Pelvic Floor, a great tool to use in conjunction with Pilates
• Decrease pelvic, leg & hip pain
• Increase pelvic stability & 'core' awareness.
• Healing properties of Jade tonify the kidneys, and assist fertility & childbirth.

The Jade Egg encourages the Pelvic Floor (PF) to contract, & strengthen, in a gentle, functional way. Melissa Macourek took her egg  into the pilates studio with incredible results and inspired me to explore it. You don't have to practise the Taoist exercises, unless you feel to. I have found that practising very gentle Pilates exercises & Pilates breathing is very helpful while 'wearing' the egg, as is simply walking around with it in.  Many yoga practitioners practise with a similar stone. For healing any PF damage, I would recommend having it in for short periods, 5-10 minutes at a time, everyday if possible. Practising for too long can fatigue the muscles, short, regular practise sessions will be most beneficial. Please consult a qualified Pilates Instructor or Pelvic Floor specialist for any serious damage or ongoing issues.

The best thing about the Jade Egg, is that you are strengthening the PF and allowing it to work as it should, which is subtly. You do not need to focus on 'squeezing' around the egg, or  trying to 'feel' anything. A healthy PF, after all, should work without you noticing it. You can however practise your Pilates Pelvic Floor lifts, and use it as a proprioceptive tool for working with PF in movement. I'm writing a PF blog at the moment, but it started becoming so long that I thought I'd write about the Jade Egg here separately.


Jade is a healing gemstone which has properties that are beneficial to the female reproductive organs. One of my favourite gem sites 'charms of light', writes of Jade:

"Jade aids the body’s filtration and elimination organs.  It is excellent for treating kidney problems and adrenal glands.  Jade removes toxins, rebinds skeletal and cellular systems, and heals stitches.  It assists fertility and childbirth.  Jade balances body fluids."

MY JADE EGG EXPERIENCE

I have been lucky enough to suffer very little PF stress incontinence during pregnancy, however, in 2007-8 I had a large uterine fibroid, which made it hard to connect to my PF and deep abdominals. Therefore, during this time, my adductors and hamstrings began overcompensating and I ended up with a lot of pain & tightness high on my hamstring insertion points and through the groin. After surgery and lots of pilates, this improved, but was still not 'right', and during pregnancy it became quite painful again.


Post pregnancy, after only a few sessions using the Jade Egg I had some incredible results. Simply wearing it around a few times,  and spending some sessions going through very basic pilates breathing, pelvic tilts, bridging, knee drops and knee floats, I had some profound results. Before then it had been an ongoing battle to take my leg into any loaded adduction (inner thigh squeezes) or straight leg hip extension or hamstring work, without feeling a lot of groin pressure and pain. With the egg in I felt my legs and groin letting go, and I could feel my PF (especially on the side that I experienced the leg pain) gently hugging the egg. I could feel that my Pelvic Floor on that side was weaker. My PF was clearly waking up and allowing me to off load the other muscles. I could control & articulate my spine much more easily with the egg in and it also enabled me to let go of my outer abdominals and connect to my deeper abdominals (transversus abdominus). Since then I have been able to increase the load on my hamstrings & adductors, & range of movement in the planes I was finding challenging and I haven't experienced any more pain! I also have an old hip injury from dancing which periodically flares up, and find that if I pop the egg in that it calms everything down.  Essentially, the Jade Egg brings you back into your center. I've found it so helpful for connecting to my 'core' in back extension (wunda chair, mat & reformer) & hip extension (mat, reformer scooter & knee stretch), for increased awareness & pelvic stability in reformer leg strapwork and short spine, for spinal and pelvic alignment & symmetry in bridging, lateral flexion and side lying work, and it has helped me to re-connect to my core in stronger work such as downstretch.

WHERE DO I GET ONE?

I purchased my egg at The Desilets Method, this is linked from Samsara Pilates. There are quite a few sites online that sell them, and if anyone knows where you can get them in Australia I'd love to hear! I chose a medium size which is the only size at The Desilets Method, some sites sell smaller or larger ones. Also, I would love to hear from anyone who gets an egg and uses it and has any feedback, especially if you suffer any urinary incontinence, hip pain or pelvic pain. Melissa Macourek has some great information and Jade Egg exercises for those of you that wish to explore specific egg work! 


  

THOUGHT OF THE DAY

'Mental hunger and spiritual nutritional process often accompany physical hunger. We may sometimes feel our whole being starving for greater love and for banquets of healing truth.'

Nancy Mellon 'Body Eloquence'

MOVEMENT OF THE DAY

Imagine you are wearing a Jade Egg, and imagine that you can touch it from both sides. Is one side harder to feel? Can you touch it from front & back, is there any difference here? Try gently lifting it up, and then letting it slide down. Make sure you are breathing normally and that these movements are very gentle! Your belly should stay soft. My favourite part (from Samsara Pilates), can you 'put a lid on it'?

Exercise after birth....

Pregnancy, birth & the early stages of motherhood are truly momentous in a woman's life, each woman's experience as diverse as the women themselves. One commonality is the huge bodily changes she will go through during & after the pregnancy: hormonally, emotionally, physically & posturally. The rigours of motherhood are also hugely taxing: sleep deprevation, hours flexed forward to feed, carrying baby around the clock, and recovering from the birth. This is a time that requires a new mother to be patient, gentle, nurturing, kind and accepting of themselves.

Every woman will experience birth, pregnancy & the recovery differently. My advice to any new mother or practitioner working with a new mother, is to work slowly and gently. Take the pressure off! Allow a good 12-18 months to get back your fitness. You have the rest of your life to be as physically active as you like. This early baby time is short & precious and your body needs to be honoured & nurtured, not pushed.

NEW MUMMA EXERCISE TIPS

• There ARE parcels of time that you can  make valuable use of! A few times a week, or once a day, set aside one of baby's naps to GIVE YOUR BODY SOME LOVING.
•  I cannot emphasize enough how important it is to BE GENTLE WITH YOURSELF, especially in the first 3-6 months.
•  KEEP IT SIMPLE. You will be amazed the benefits you will reap from just 30 mins of breathing, one or two simple exercises or a few stretches and you will notice over time that you can do more & more.
• LISTEN TO YOUR BODY. It will tell you when you have overdone it. Trust your instincts, some days you will feel like doing more than others.
• WALK!! Spending time in nature, breathing fresh air and getting out of the house is invaluable. Walking is also one of the best forms of exercise you can undertake in the early months, and you can start almost immediately after the birth. Wear baby in a carrier or take the pram and walk for an hour each day.
• CONGRATULATE YOURSELF when you find time to re-connect with your body. 
• Abdominal work in the first 6 months should be very gentle, many people are ill informed as to the correct abdominal exercises that are safe. KEEP YOUR HEAD ON THE FLOOR (no crunches or sit ups!). Single knee floats are great, as are, knee drops and Pelvic Tilts or Bridging. You can progress to double knee floats when your deep abdominals are strong enough that you can keep your belly flat to lift the second leg!!  (this will feel light & easy, not a strain through the front of your body)
• FOCUS ON WHAT YOU CAN DO! There is so much you can do to strengthen your legs, arms, glutes & calves in first post natal months without putting pressure on your abdominals. Enjoy feeling these muscles strengthening!

EXERCISE GUIDELINES

• You are able to resume GENTLE EXERCISE at 6 weeks post vaginal birth, & 12 weeks.post Cesarean.
• Find a reputable PILATES Instructor with post natal experience & you will need a letter of clearance from your GP. 
• Have someone CHECK FOR A DIASTASIS (separation in the rectus abdominis). This is very common & just means you will have to be more gentle & patient with yourself. IT WILL HEAL and close and you WILL be able to do all your favourite exercises, just not yet!
• AVOID: Any exercise that puts strain on your rectus abdominis, such as the plank (push up position), crunches or sit ups, roll ups etc. (especially with a diastasis) I would avoid these for 6 months minimum, as long as you are breast feeding your ligaments & connective tissue are subject to the hormone relaxin, so be mindful.
• AVOID: Any big back extensions till you are sure your deep abdominals can support these movements. Large back extensions stretch the front of your body and can push your rectus abdominis apart. (especially with a diastasis). Avoid for at least 3 months.
• DO gentle Transversus Abdominis strengthening. Pilates is great for this, but make sure you aren't overloading your abdominals, LESS is MORE to begin with. 

DIASTASIS checking  yourself: Here's a great link, although if you have any concerns please seek professional advice! 

Pelvic Floor is a very hot topic & I am currently putting together an article with some great links, so I won't go into it too much here. Pregnancy puts a lot of strain on the Pelvic Floor, just carrying the baby to term is a big task! Birth itself can of course dammage the pelvic floor too. Many women have pelvic floor issues before the pregnancy also. If you know you have or have developed a problem in this area it's important to get rehabilitation of some sort. I do not advicate surgery and would try all other avenues first. Pilates is a great start (but make sure it's studio classes, rather than matwork, as there isn't the time or personal attention here to make sure you are working correctly), if you still don't notice an improvement, you may need more specialist help through a pelvic floor specialist or pelvic physiotherapist (physical therapist).

THOUGHT OF THE DAY 

"Essence and energy, body and breath, are indivisable: when the body does not move, essence cannot flow, energy becomes stagnant." Sun Ssu Mo

MOVEMENT OF THE DAY

CAT STRETCH 

This is a great stretch pre & post natally. Draw your belly into your spine and feel your tailbone hang down to your knees as you flex your spine. Keep your glutes (butt muscles) soft and your shoulders relaxed.  As you lengthen your spine and lift your chest forward, be sure to keep your lower back soft and your belly gently drawn towards your spine. You can hold each position for several breaths, or move from one to the other each time you exhale. 

NEW BEGINNINGS

My beatiful daughter Sascha Leilani was born June 18 2010, almost 8 months ago now, she's starting to settle into routines and is becoming less of a baby and more of a little girl every day....  

 

I'm finding myself better slept and excited about my life which feels full of new beginnings! I have recently begun working from home, teaching Pilates from my boutique style studio 'Anuenue Pilates Massage' in central Victoria.  (After working as an instructor in various pilates studios & for physiotherapists for the past 8 yrs in Australia, London & Hawaii).  anuenue.webs.com


Being a new mother is such a precious time, and with it, for me, has come a greater appreciation of time, breathing, relaxation and exercise, and finding space for this in my now rather full life!

I am finding I have more time at home, snatches of time in which I seem to be able to get an enormous amount done, quiet time (while Sascha naps) which is perfect for reading & online research/ socialising, and having my home studio I now have more of a chance to play & explore Pilates and also begin healing my post baby body! I have found my Pilates practice at this time has been a daily place of healing for body, mind & spirit, a chance for me to 'center', relax, nurture & repair, and helps to make me a more balanced mother & partner also! Although I'm blessed with an equipment studio at home, you can do so much with a mat & a couple of simple props. 

I am beginning this blog to share my journey, knowledge and body mind experiences. I will post exercises you can do at home, as well as books to recommend, thoughts, ideas & mantras that inspire me, guide me and that I feel to share!

I am currently reading Eric Franklin's books 'Relax the neck, Liberate the shoulders', and also 'Pelvic Power for men & women'... two bibles to come back to again and again and very accessible for anyone! My thought of the day comes from the Pelvic Power book...

THOUGHT OF THE DAY

'To achieve permanent improvement of strength, posture and flexibility we have to change our very patterns of movement, because only when a conscious change takes place on the level of the nervous system will something really change'.  Eric Franklin

MOVEMENT OF THE DAY

Again from Eric Franklin, but a technique I used daily as a Qi Gong practitioner....

Place your palms an inch or two apart and breath into your hands, notice the sensations, warmth, tingling, a magnetism, perhaps even heaviness. Gently move your hands away from each other and then towards (without touching), continue, and notice the thickness of the air between them. This is energy, qi or prana which is present in all living things and indeed in the earth itself. You can use this energy to heal yourself and others, you can gather it from the earth, sky, ocean, rivers and you can strengthen and build it with awareness & practise. 

After several minutes of feeling the energy between your hands, place them anywhere on the body that feels stiff or sore (if you're lucky enough not to feel tight anywhere you can place them on your kidneys) and feel the warmth and healing energy you have created as it moves into your body... enjoy!