The Pelvic Floor and the Kinetic Chain
The body functions in a rhythm, each piece perfectly coordinating with the other, and the pelvic floor is no exception. It’s certainly not a standalone muscle that needs only kegels to become stronger. That outdated concept needs to be left in the dust.
The pelvic floor certainly did not peak my attention while in Physical Therapy school, for then I wanted to be an ortho PT. I especially loved seeing patients with chronic pain because it was puzzle that I needed to solve! Nagging hip pain for years? You’re my favorite!
No, the pelvic floor came front and center on my radar as a game changer when I had some pelvic floor issues. I had a rough pregnancy that included premature labor. The doc put me on modified bed rest, so I spent a lot of time sitting around because moving brought on contractions. (A short stent of inactively can cause the pelvic floor to shut down. No demand = No output)
The delivery process was pretty easy, no trauma, small baby and fairly quick. When I went in for post-partum check up 6 weeks out I thought I was golden. (You know, not going to be one of those women with pelvic floor issues.) The midwife stuck her hand in and said squeeze (if you’ve had a baby, you know the drill), I passed with flying colors. She even exclaimed wow, your pelvic floor muscles are strong. – No they weren’t.
About 6 months later, we were going rock climbing every weekend. (Yes, my child grew up on the side of a mountain.) I noticed that I wanted to go pee every 5 seconds, especially before climbing. That’s not something I really noticed before baby.
I wasn’t actually leaking, but I was afraid I was going to. Does that happen to you? Do you swing into the restroom prior to exercise or in my case a tree? Do you worry about leaking if you cough or laugh suddenly? You might have some pelvic floor issues.
Now, I could do a perfect kegel and hold it 10 seconds + no problem. So, my volitional contraction of the pelvic floor was fine. According to the midwife, exceptional! So, what gives? How could I have a pelvic floor issue without having any pelvic floor weakness? That’s what started the investigation (complete obsession) into the pelvic floor and my deeper understanding that pelvic floor strength needed to be incorporated into not only ortho PT but Pilates as well. The pelvic floor patients like me are not seeking health care but rather your studio for exercise.
The pelvic floor must work in conjunction with the diaphragm, core and hips to produce not only a strong contraction but also one that fires with the timing needed to control incontinence. It also plays a role in stabilizing your SI joint as well as your hips. Believe it or not, the piriformis is part of the pelvic floor!
The diaphragm moves up and down as you breathe. This timing should sync with the timing of the pelvic floor, which is an issue for a lot of patients. They either have a shallow breathing pattern so they never utilize their diaphragm, or their timing is off with their pelvic floor. Either way their pelvic floor strength is diminished. Teaching correct deep breathing is critical to getting the pelvic floor to full strength.
Next in the chain is the core. I like to think of your core as your canister. The diaphragm is the top and your pelvic floor is the bottom. The alignment of the top and bottom by the core is crucial to allow them to both function properly. That leads us to posture, posture, posture! I cannot stress enough how important correct posture is for the pelvic floor. If you hunch or let your belly hang out, your diaphragm, low back and pelvic floor will pay the price. Getting your rib cage inline with your pelvis helps everyone work like they should.
One of the biggest factors I see is tight paraspinals (back muscles) working too hard. This can come from trying to have great posture but coming upright like you are in the military instead of from your TAs and Internal Oblique’s (Abdominals).
I love the cue in Gyrotonics to come up taller through your core, not by arching your back more. That’s great! (I had my first Gyrotonics lesson with Martha at Upward Spiral Pilates Studio in Cambridge last week. It’s fun stuff.)
The next factor I see is forward head posture. It’s so hard to fight forward head posture when the majority of us look at computers and phones for most of the day. I love chin tucks and head lifts for building strength in the front of the neck and getting your head back in line with your body. Forward head posture slouches your entire body forward, fully relaxing your abdominals (or worse making you grip the top of your abdominals).
As you might imagine, hip strength plays a role in pelvic floor strength. When you move dynamically, you stress your hip muscles (glutes, adductors, etc.). This stress is transferred to the pelvic floor and asks the pelvic floor to fire. If you never move dynamically, then your pelvic floor does not get the stress it needs to get stronger. I see this particularly with the loss of internal rotation. Your hip should be able to rotate in and out with control. When you lose internal rotation, the internal rotators of the hip as well as the external rotators get weak and unresponsive, this weakness transfers to the pelvic floor.
One of the biggest ways I see this weakness come out (other than lack of rotation) is in gripping. If something is weak, we tend to hold on for dear life. Si
mply making sure you do not clinch your glutes is the easiest way to get some function back. Not sure if you grip them? Try squeezing your glutes then letting them go. Pay close attention when you are standing and completing a task, like washing your hands. As you lean over the sink, your glutes should progressively relax allowing for eccentric loading (lengthening). If you are squeezing your glutes when you lean over, they will not lengthen and your lower back will take the brunt of the movement. (Check out the pictures to your left.) If your back takes the movement, your canister gets squished. We now know what happens when our canister gets squished! We weaken our pelvic floor!
To recap: Focus on correct posture, a strong diaphragm, inline core and dynamic hip strength to create a strong responsive pelvic floor that will never cause you a minute of worry again!
Sarah is an orthopedic physical therapist with over 15 years of experience in the wellness field. She teaches CEU classes for trainers, Pilates and yoga instructors. She has a 3 hour class on the pelvic floor certified through PMA ready for 2016. If you are interested in taking a class or hosting, please contact her at Sarah@CoreExerciseSolutions.com. She loves teaching and her classes are as entertaining and fun as they are instructive. If you want more information on pelvic floor strengthening, check out her article Top 5 Exercises for Strengthening the Pelvic Floor.
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