The pelvis is the foundation of our functional dynamic body in motion. It connects the lower body to the upper body and needs stability from our core to effectively and responsibly accomplish this. Consider your abdominal canister as a house. The roof is your respiratory diaphragm, the floor of the house are your pelvic floor muscles (at the base of the pelvis), and the walls are your abdominal and back stabilizing muscles. This is the main focus of our true “core system”. We will discuss how these major muscle groups work together, how posture and breath affect this system, and how we can use these principles to 1) improve performance, and 2) reduce and/or prevent dysfunction such as injury, urinary incontinence, urgency, frequency, and pelvic organ prolapse. These strategies will benefit the high impact athlete (male and female) from high school/college levels to adult weekend warrior, the mindful yoga and pilates practitioners, and anyone who moves throughout their day wishing to fortify their core for a strong healthy lifestyle.
The four main motor components in our true “core system”:
- Pelvic Floor Muscles (PFM’s)
- Diaphragm
- Transverse Abdominal Muscles (abdominal stabilizing muscles)
- Multifidus (back stabilizing muscles)
Sports and activities to consider but not limited to:
- Cycling
- Sports
- Running
- HIIT
- Pilates
- Yoga
- Crossfit
- Weight lifting
- Dance
- Gymnastics
Daily tasks to consider but not limited to:
- Loading the dishwasher or washer/dryer
- Lifting loaded laundry basket
- Lifting baby or toddler
- Lowering baby into crib
- Baby carrier, car seat
- Changing table
- Washing dishes
- Vacuuming
- Gardening
- Getting out of the car
- Getting out of bed
The Breath:
When we inhale, our respiratory diaphragm contracts down. To accommodate for the downward pressure the diaphragm is now placing on the abdominal contents, the pelvic floor muscles lengthen down, and the abdominal wall expands out. So picture the inhale phase of the breath as filling a balloon and our abdominal canister is expanded and lengthened. When we exhale, the pelvic floor muscles and the diaphragm raise back up into place and the abdominal wall returns. This phase of the breath we have recoiled and are able to engage and stabilize more optimally. This up and down movement with the diaphragm and PFM’s acts as a “piston” relationship as Julie Weibe, PT explains in many educational YouTube videos:
Keeping this in mind will allow you to use your exhale to generate more power behind your activity when you need it, or to lengthen your pelvic floor if you tend to be on the tight side. Take a peak at this video to give you a better visualization of this movement with the breath:
The primary concept for protection is to avoid breath holding. Consider your abdominal canister as a “pressure cooker”. The “release valve” for your pressure cooker is your exhale. If you hold your breath, you are cutting off your “release valve”. Now, the pressure is still there and it will move towards the path of least resistance (the weakest link). That may be to your pelvic organs leading to urinary leakage or down shifting of the pelvic organs referred to as prolapse, or it could be forward at a weak abdominal wall, or towards the back putting us at risk for hernia’s or strain.
Now, I understand there are some bracing techniques used for heavy weight lifting referred to as valsalva where a big
inhale is performed followed by breath holding to lift an extreme weight. With this technique, we are seeing bladder dysfunction and pelvic organ prolapse due to repetitive bearing down and extreme forces on the organs and connective tissue. Instead, I invite you to play around with “spreading the workload” as Antony Lo, Physio Detective, explains: http://physiodetective.com/antony-lo/, and exhaling partially prior to the breath holding technique in order to find a “sweet spot” that can accomplish your task with a lifted secure pelvic floor.
Breath holding can be sneaky too! You may think you are exhaling during the hard part of an exercise or a functional task such as standing up. However, often folks will hold their breath for the beginning part only to exhale at the very end of the task. In this scenario, you have held your breath during the hard part and put yourself at risk without even realizing it. Try starting the exhale before you begin the task, and continue to exhale the whole way through. Compare both ways and assess what feels more stable and secure (or symptom free).
Posture:
We established the relationship of the pelvic floor muscles and the respiratory diaphragm with our breathing as an up
and down “piston” relationship. Here is where we start to look at posture to allow for the “piston” relationship to take place and set us up for more optimal core engagement. The intention is to start moving towards lining up the ribcage over the pelvis in a neutral position in order to line these structures up. Now, we need to be able to move in all different positions, but if we work towards a more optimal posture for our more challenging tasks, we will be at an advantage to increase our performance and prevent unwanted pressures on our more vulnerable structures. We will review how to find this posture for you and what feels right in your body.
Impact:
Leakage often occurs with impact during jumping, running, jump rope, double unders, jumping jacks, box jumps, dance jumps/leaps, kicking, and quick direction changes. Things to consider are landing strategies, forefoot vs heel strike, shorter quicker strides vs longer bounding strides, leaning into the movement (ribs over pelvis), upper body rotation to avoid abdominal gripping/pressure, stride/jump height, pelvic/rib posture on landing, breathing strategies, and hydration/bladder irritants (caffeine, energy drinks, artificial sweeteners), and stress/anxiety.
Core strengthening program:
When working with a client, I look at the exercises or tasks they are either currently doing, or want to get back to. I look to find their “borders” and identify at what intensity can they perform these tasks with good posture, and breathing strategies. We develop an individualized plan with specific cues that work to optimize motor planning strategies. The Transverse Abdominis (TvA) is the deepest abdominal muscle that presents like a corset around the trunk. Strengthening and tuning into this muscle ca keep you in the “game” longer and harder!
Dynamic stretching is a key component to build flexibility for power and resilience. Lengthen to strengthen! I look to find ways to do this without “sitting on the joint” like many prolonged static stretches have the potential for doing. Foam rolling and self release techniques with balls are great ways to prevent shortening and tissue restrictions as well.
PFM Assessment and Treatment:
Many athletes feel that if they have a strong pelvic floor, they will be a super athlete and never have to worry about leakage, or prolapse. However, more often than not, these symptoms are occurring due to PFM overactivity from over training in the shortened phase and not enough lengthening of the muscles. A tight muscle is a weak muscle! This is important to identify before you start doing kegels to “fix” your problem. The kegels may be exacerbating your situation. Learning how to lengthen your muscles very well may be the key to generate an effective contraction with good strength. The focus with lengthening the pelvic floor muscles will be on the inhale.
I get it, that’s a lot of information! We will dissect all of these concepts and review any questions or specific tasks you
are struggling with on Tuesday 5/19/20 during the free virtual pelvic health support call “The Pelvic Floor of Your Core” at 11:00am EST. please visit the “Free Support” section of this website for the Zoom link and calendar reminder. Please subscribe to my email list if you would like updates for upcoming events and blogs!
Finding your borders and safely moving above and beyond!
Laura Rowan, OT/L
Pelvic Rehab Specialist
www.essentialpelvichealth.com