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