Pelvic Floor 101
All October, I talked Pelvic Floor for Power Plate in my Women’s Health Live, 12.30pm every Monday.
First lets bust some myths:
- A “strong” pelvic floor does not mean there are no pelvic symptoms. It is possible to have incontinence and pelvic dysfunction with a strong or tight pelvic floor.
- Pelvic floor dysfunction doesn’t only affect mums, it also affects athletes, overweight people (men and women), the elderly, smokers, and those who repetitively strain their bowels…
… in other words, it’s a big deal.
Secondly, lets define what a “strong” pelvic floor is!
For us, it is one that lifts, and drops, at the right time. This means that you have to develop strength, length, and reactivity to be truly functional in your pelvis. Furthermore, you have to take the pressure off, and allow it to align itself in it’s optimal position to ensure true functionality, this means an aligned posture from the neck down, and mobility through the thoracic… there’s a lot to do to ensure pelvic health!
So lets look at it from one aspect at a time. If you have a “weak” pelvic floor, it could also be long/stretched/unresponsive/overworked and/or scarred. It could show up as back pain, hip injury, incontinence, or prolapse (to name just a few symptoms!).
For this reason, it is important to get it diagnosed. You can look up your nearest women’s health physio (WHP) here: http://whta.com.au/ (click on “physio locator” from the tabs across the top).
Once the physio has diagnosed your pelvic floor as needing to strength train, they will prescribe exercises; do them daily. Once you’re good at them, we can build on your competency by:
- adding visualisations (eg. elevator doors, jellyfish, tissue, straw, peanut)
- adding exhale (this is not the only way to do it, but it is your first priority, because you need a lot of strength to hold your wee or organs in when you’re sneezing, laughing, yelling, or coughing)
- adding activation’s (because no system works alone, synchronising your body to lift under load is more powerful than in isolation). eg. press hands, press feet, tongue, squeeze knees, scapular retraction, etc.
- perform this upright
- add powerplate
Now, if you’ve been strength training your pelvic floor but your symptoms are getting worse, it’s possible that you’re “too tight”, “too strong”, or “locked on”. This is called “hypertonic”. If you’ve seen a WHP they will diagnose this.
A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax.
Symptoms are similar to a “weak/stretched/disconnected” pelvic floor including
- painful sex,
- urgency IC
- pelvic pain.
- may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.
If this is you, then we need to re-learn how to drop/relax/lengthen the PF.
Using the same system as last week, first we are going to isolate the pelvic floor muscles group, focusing on a loooong relaxation phase and a short contraction phase, then
- Add long inhale,
- Add relaxation visualisations,
- Perform sitting, then standing,
- Add powerplate assisted relaxation
We had a question after this groundwork regarding pelvic floor was done, regarding incontinence when running, and because I hadn’t addressed this issue in my plans, I answered it in it’s own segment!
The question was: I have been running for about 12 weeks without any incontinence issues during this period. Today for the first time before a run I did the “pigeon” stretch – or seated 90:90. On a PP. I leaked the whole way though my 1 hour run…. Would that stretch be what made the difference – and why (or why not?)
The full answer is here: https://www.facebook.com/PowerPlateAustralia/videos/1006195233555763
Basically, the physio I consulted with said that a possible explanation was that the stretch released a tight pelvic floor and revealed an underlying weakness. If she’s run for 12 weeks without issue, it’s unlikely to suddenly become a problem on a cumulative basis. However, change in cadence, surface, distance etc may trigger a sudden “weakness”.
So here’s the advice:
- We need more information. If you haven’t already you need to see a women’s health physio https://whta.com.au
- We need to repeat the process to be sure it is or isn’t the pigeon stretch. If you’re a menstruating female, you’ll need to repeat the stretch every run for a whole month and keep a diary of your symptoms. If you’re on the pill or post menopausal, do the stretch for just a week, or at least 3-5 runs. Then the following week/month, repeat your routine without the stretch.
This will give you a clear idea of whether your fluctuating hormones, that particular stretch, or something else is playing a role in your incontinence.
- If you keep leaking, running is not for you (right now anyway), try hill or stair sprints (run up, walk down) because they’re just as hard but don’t have the load on your PF, or invest in an assault bike.
- Finally, what other factors were there? Were you stressed? Have you been sick? What time of the month is it? Did you run faster? A different course? Could it be the accumulative effect of 12 weeks of running? What other factors are there in your everyday life? Have you recently transitioned through menopause? Sometimes these things develop over time, not happen because of one single event. Again, see the physio.
- Posture impacts pelvic floor function, both through your shoulders and pelvis, and your landing pattern will add or absorb impact too.
After you see a physio, put yourself through this course and follow the program to return to running injury and pelvic-floor-dysfunction free: https://clarehozack.au/product/from-deep-core-dysfunction-to-running-long-distances/
Adding Movement to PF Training
So at the beginning of this blog we discussed the Kegal, or pelvic floor lift, and syncing it with your exhale. Now, we are going to build on that journey and integrate that skill with movement. Now, we want to make it clear that this is not the only way to move, or train – this is concentrated core. Like the abs track when you do an aerobics class, this is just a component of your overall exercise program – targeting the deep core.
Begin with the Power Plate off, although we still use it because of the unstable platform, which will trigger unconscious contraction.
Practise exhale on Exertion during your regular gym movements, remembering that the exertion phase is the one where you’re lifting weight against gravity. You can see the exercises we used here, as an example: https://www.facebook.com/PowerPlateAustralia/videos/2113015408846103
- Lunge and step to balance
- Push ups
- Campbell crunch
Once you’ve mastered that skill you can perform these movements with the Power Plate on, but understand you won’t get a full drop through the PF because the vibration stimulates a lift. If you need to remember why, head back to the beginning of this blog where we discuss our definition of a “strong” pelvic floor! For this reason, if you have a tight PF, locked-on PF, or a pelvic floor that needs length and relaxation, you may not use the power plate the way I show you in the video above. Instead, you would use it for massage and down training.
Examples of down training including seated, and lying relaxation postures with the Power Plate on 50htz.
Once you have been consciously training the deep core, it is time to co-ordinate it. Unconscious pelvic floor training is brilliant for increasing tension across the abdomen (important if you have diastasis, or abdominal separation), and to coordinate the 5 layers of 14 distinct muscles that make up the pelvic floor. Any movement that requires the muscles of the pelvis and trunk to move and coordinate is an unconscious core exercise!
So our four movement examples all work across the deep core, but we are not consciously lifting and dropping the pelvic floor anymore. These should only be attempted once you’ve mastered the above skills. While you’re watching the examples, keep an eye on how my shirt moves when I move my arms or legs… THIS is how your skin, subcutaneous tissues, fascia, etc all move within you!
- Step over a fence off the plate
- 3-way windmill
- Woodchop with step back
- Single leg deadlift with reach
See them here: https://www.facebook.com/PowerPlateAustralia/videos
In summary, pelvic floor training is about so much more than squeezing the muscles of your vagina. You need strength, yes, but strength is specific to a task – how do you need your deep core to work? You also need length, and reactivity or coordination for a truly functional deep core and pelvic floor.
Find your closest women’s health physio: https://whta.com.au
Power Plate AUS: https://powerplate.com.au/ref/4/?campaign=PowerPlateHomePage
Personal PP Aus: https://powerplate.com.au/product/personal-power-plate/ref/4/?campaign=PPP
Trainers: great course on returning to exercise after pelvic floor dysfunctions: https://clarehozack.au/product-category/courses/core-dysfunction-series/
Free course on PP basics: https://eatfitness.nz/courses/power-plate-discover/
#powerplate #powerplateaustralia #powerplatenz #wholebodyvibration #womenshealth #vibrationtraining @NovoFitAus