My Father-in-law’s favorite joke is to lift his arm only to shoulder level and say “Hey doc! I can only lift my arm this high.” Then as he raises his arm to straight overhead, he says “But I used to be able to lift it this high.”

After ruling out the need for a psyche consult, a doctor would likely send a patient with a shoulder issue to see a physical therapist. Shoulder problems come in many forms. Regardless of the cause, in order to fully rehabilitate a shoulder, the pelvic floor needs to be a part of the rehab plan.

Pardon me? Psyche consults all around!

You can’t address a shoulder problem without addressing joint alignment, and shoulder joint alignment relies on postural alignment. Postural alignment needs a strong Core, and you can’t have a strong Core without a strong pelvic floor. Cancel that consult!

In 2007, a research team lead by Paul Hodges (1) compared how the pelvic floor and shoulder muscles interacted when a study participant lifted their arm in different directions. One of the things they observed was that the pelvic floor engaged before the arm lifting deltoid muscle every time, no matter which direction the arm went. In a nutshell, the pelvic floor, along with the other inner Core components (Diaphragm, Transverse Abdominis, and Multifidus), secure our physical center to create a sturdy anchor for the muscles that support and create shoulder motion before we start moving our arm, every time we move our arm, no matter which way we move our arm.

A paraphrased “Dem bones, dem bones, dem dry bones” ditty highlights this relationship with an anatomy lesson that works from the outside-in. The shoulder bone’s connected to the shoulder blade  The shoulder blade’s connected to the ribcage. The ribcage’s connected to the spine, and the spine’s connected to the pelvis. Muscles help make all of those connections. However, Hodges research demonstrated that the timing of the muscular connections should follow the pattern of the pelvic floor first, securing the pelvis before all other muscle work begins. So we have to reverse the “dry bones” anatomy lesson and move from the inside-out. Secure the pelvis first with our pelvic floor then rehabilitate and train the muscular and structural chain back out to the shoulder. Who’s crazy now??

The pelvic floor’s claim to fame is its role in keeping us from leaking, and it gets a lot of press for providing better sex. However, It is also a powerful ally in the health of our musculoskeletal system. I have highlighted the particular relationship it has with shoulder motion here-if the pelvic floor isn’t working well then the shoulder won’t work well either. The pelvic floor also works in the same way with other body parts- hips, knees, necks, etc. to optimize the function.

So what is a woman who has had a few kids and has a few leaks when she coughs or laughs  to do about her achey shoulder? Start by understanding how the two issues, leaking and achy shoulders, are connected. Also, know that when you go to the doctor to talk to him/her about what are historically perceived as two separate issues- you too may be considered a nut job!  Hand them a copy of this blog with the research reference below. Then ask for an Rx for a physical therapist in your area who can help you from the inside-out!

1. Hodges PW, Sapsford R, and Pengel LH. 2007. “Postural and respiratory functions of the pelvic floor muscles.” Neurourology And Urodynamics 26, no. 3: 362-371

Pelvic organ prolapse and associated pelvic floor disorders used to be associated with the aging woman. Unfortunately, these diagnoses are now becoming more common with young women who exercise regularly. Jogging is a common culprit, creating a repetitive impact on a weakened pelvic floor which contributes to descent of the poorly supported pelvic organs.

Common culprit

So what is an endorphin junkie who can’t quit the “kick’ they get from a good run to do about their heavy, painful sagging insides?

Refuse conventional wisdom. There is a sense of inevitability about pelvic floor issues for many women, a willingness to run their pelvic floor into the ground and just fix it all later with surgery. However, most surgical fixes ultimately require more surgery in approximately 10 years. This is because the pelvic floor never re-learned how to function properly prior to the initial surgery, so it will gradually descend again. In addition, a common side effect of some bladder lift surgeries is incontinence. No thanks.

Prolapse is an injury. If you sprained your ankle, you would hold off on jogging and focus on a walking program until it healed. This mindset of giving an injury a break must be applied to the pelvic floor. Rehabilitation, restoring normal function, of the pelvic floor is critical and possible! Once this is achieved you can gradually rebuild your exercise routine.

Get your butt up. Positions that elevate your bum above your torso will encourage the pelvic floor to return to a higher resting position, and bring relief. For example, prop your bum up on pillows while lying on your back or front; modify All-4‘s (hands and knees) by resting on your forearms and leaving your bum up; or lay over top of small exercise ball while reading or playing with kids. Begin reconnecting with pelvic floor function in this position-feel it descend with inhale, and rise with exhale.

Get your butt out. A tucked under bum position, flattening the low back, is a major culprit in poor pelvic floor function. Gently untucking the bum, to restore a mild low back curve, will maximize the activity of the pelvic floor naturally without having to think about contracting it. Incorporating this position into sitting, standing, walking and exercise form will re-engage the pelvic floor in day-to-day and fitness activities.

Take a break from the pounding! A jogging hiatus will give your pelvic floor a chance to catch up and get strong enough to take the impact you’re dishing out. As a substitute exercise challenge with less impact, try hiking up an incline or a brisk walk on a treadmill on a grade. Both activities force a longer stride to the rear, which naturally gets your butt out (4th Step) and keeps the pelvic floor active.

Prepare the pelvic floor for return to fitness. A classic Kegel does not prepare the pelvic floor for the motion, impact or speed of jogging. The pelvic floor must be trained for power, speed, and shock absorption just like the rest of the leg and upper body muscles. Train the pelvic floor like you would any other muscle for a return to sport-break down the activity. After reconnecting with the pelvic floor (3rd Step) begin exercises in half kneeling (one knee up and one knee down), move to single leg activities, and activities that link the pelvic floor to related muscle groups, then gradually progress to higher impact activities if tolerated.

Take a breath! In addition to jogging, breath holding during resistance exercise can also contribute to prolapse. The pressure created within the abdominal cavity by a breath hold can put significant pressure on the pelvic organs. Performing an exhale before each repetition begins will relieve abdominal pressure and also causes a lift of the pelvic floor. Use the thought “Blow before you go!” as your new exercise mantra.

Issues like pelvic organ prolapse can absolutely be managed conservatively with surgery as a last resort. Addressing the problem in its early stages, rather than ignoring it or assuming there are no alternative solutions, will give women the best possible outcome from conservative measures. Bottom line: Treat it like you would any injury by identifying contributing factors, address those issues, and then gradually build your exercise program as tolerated.

Hello. My name is Julie, and I’ve got a problem. I’m addicted to the Core.

But not the watered down Core as defined by so many health magazines, TV informercials and fitness blogs. You know, the Core that has anywhere between 12 and 29 muscles that you’re supposed to “engage” simultaneously with exercise or a Core Blaster for only 3 payments of $29.99. And I am not addicted to the Core that is focused only on abdominals. Has that flattened your tummy, yet?

No, I am addicted to a functional, dynamic Core that is driven by the interrelationship between the pelvic floor and diaphragm – a revolutionary way of approaching fitness.

The pelvic floor isn’t just for Kegels anymore- it has a powerful dynamic role to play in your Core strength. The pelvic floor does more than protect our continence. It helps to stabilize the hips, pelvic joints, and low back. If the pelvic floor is not working, then your Core’s not working either. If your Core’s not working, then the rest of the muscular system won’t work to its full potential. This can lead to injury, leaks, and poor results from fitness programs.

Let’s back up a step to understand what the Core does.

There are only four inner Core muscles:

the Diaphragm

the Transverse Abdominis (or TA – your deepest abdominal)

the Pelvic Floor

the Multifidus (a deep spine stabilizer)

Their job is to create stability at our physical center, the pelvis. The four Core muscles create stability at the pelvis so that all of our other muscles have a foundational anchor to pull against as they move us about our day and help us participate in fitness programs.

Never was I more aware of my need for a stable pelvic anchor then after I delivered my first child in 2003. After delivery, I had trouble putting my own physical pieces back together again. Yet there I was as a clinician, putting everyone else’s body back in order. Not cool.

So I set out to understand how pregnancy impacts a woman’s body. What I discovered was that three out of the four Core muscles tend to become habitually underused in pregnancy, and the body overuses other muscles to compensate to try to keep the pelvis stable. I was still in the clutches of this habit and it was keeping my hip achey as I overused my gluts instead of my Core to keep a sturdy center. I could do all the hip exercises and stretches I wanted. However, without getting those four Core muscles working together again to restore a stable pelvic anchor, I would never have a pain free hip and likely wear out that joint over time.

These issues were not unique to me. I began to recognize that my patients (ranging from moms to grandmas) were demonstrating the same muscular imbalance that I was as a brand new mom. That meant that these women had been moving, walking, exercising, working, and caring for their families on faulty pelvic foundations for years and in some cases decades. The fallout for each patient was different, because their bodies had compensated in different ways. For some they had a shoulder problem, others a low back issue, still others knee pain or sciatica. In many cases they were no longer dealing with a small ache or pain, instead after years of wear and tear, some of these women had major physical issues.

My mission was clear: Change the way health care and fitness is delivered to women after having a baby. I recognized that if I could help women re-establish a functioning Core and stable pelvis early on, they would be spared a lifetime of pain, frustrating and often painful fitness programs, leaking, and bodies that never looked the way they wanted. Educating women (from moms to grandmas) and creating exercise programs that create stability from the inside-out became my new passion.

This led to the creation of the Interior Fitness program, a unique approach to restoring a dynamic Core with a powerhouse pelvic floor that is linked in with the other muscles of the trunk, arms and legs. Through one-on-one care, community education and professional development programs, my goal is to spread the word that the future is bright for women after having a baby.

Are you addicted yet?

1. The Core has four muscles. Not one, not 12, not 15, not 29 (how can you expect someone to exercise 29 muscles simultaneously when you ask them to “engage the Core”….?). The true Core, sometimes referred to as the inner Core unit, is comprised of the diaphragm, transversus abdominis, pelvic floor, and multifidus. These four muscles work together like gears in a machine to stabilize our physical center (the spine and pelvis) during exercise and as we go about our day. Creating this strong anchor gives the rest of the muscles of the body something sturdy to pull against. Only these four muscles are capable of performing this critical task, because they are the only muscles in the body that are designed to automatically activate to stabilize the center before any other muscle group turns on to create a movement. (1)

2. Core exercises should not be confused with trunk exercises. Because all things Core have become so watered down, any exercise that involves the trunk muscles (abdomen, back and buttocks) is now considered a Core exercise. The trunk muscles do have a strong relationship with the Core, their proper activation relies on them being rooted in a strong Core foundation. In order for an exercise that involves the other muscles of the trunk (29 muscles apparently…) to be a true Core exercise, the exercise progression would move from the inside-out. Core first, then engagement of the other trunk muscles. (1)

3. Just because your do the exercise on a stability ball or a Bosu does not make it a Core exercise. Seriously, people can cheat on any piece of exercise equipment, and stability balls and Bosus are no exception. If you are busy compensating (or cheating) with a bunch of trunk muscles because of poor form and no sense of how to really connect with those deep Core muscles, you will not receive any added benefit from being on top of a ball. (2)

4. All together now, say it with me…the pelvic floor is part of the Core. The oogy, “oh we can’t talk about that” factor surrounding the pelvic floor needs to move along with the piano tie, shoulder pads, and jazzercise. Our antiquated misgivings about discussing this group of muscles, b/c that is what they are…just muscles that happened to be geographically related to our vagina’s and penis’ (yes I went there)….needs to go. The pelvic floor is the powerhouse behind a really amazing Core. It is the secret ingredient to a flat belly, keeping backs and hips strong and pain free, and helping you have great sex. Seriously, who doesn’t want that! The pelvic floor must be incorporated into Core work, it is one of the gears in our Core machine. A machine with a missing gear, will not work well (or work for that matter). That Core machine will fail to provide the central stability you are seeking. (3, 4)

5. What does “Engage your Core” mean anyway? The common instruction given along with these “Core” exercises is to “engage your Core”. Considering the definition of which muscles make up the Core varies, how an exerciser interprets this command is prone to some subjectivity. Sometimes the “engage your Core” command is further defined with a follow-up instruction that is something like “pull belly button to spine,” “hollow your belly,” or “pull navel away from waistband.” In my experience, these cues meant to help folks activate the Core often cause folks to tuck their bums under and flatten their lower spines. Try it. Look in the mirror and watch what happens to your bum when you “hollow your belly” or “pull your navel to your spine”. In a bum tucked under/flattened low back position the Transverse Abdominis (your TA, and deepest abdominal) and pelvic floor are poorly activated. So when these exercise prompts are given, they actually reduce your Core muscle work, and force you to compensate with other trunk muscles. This will not only reduce your results, but also leave you vulnerable to injury. (5)

There is a lot of material on the Internet on women’s health and much of it solid. But in an era when anyone can post advice be sure to check the credentials and reputation of these “experts” (feel free to check mine). Just because they put up a buff picture on their website doesn’t mean they’re qualified to help you. And in some cases, they’re lack of qualifications can leave you in worse shape then when you started.

References:

1. Hodges PW, and Richardson CA. 1997. “Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement.” Experimental Brain Research. Experimentelle Hirnforschung. Expérimentation Cérébrale 114, no. 2: 362-370.
2. Mori, Rl, Bergsman AE, Holmes MJ, Yates BJ. 2001. “Role of the medial medullary reticular formation in relaying vestibular signals to the diaphragm and abdominal muscles.” Brain Research. May 25: 902 (1): 82-91.
3. Hodges PW, Sapsford R, and Pengel LH. 2007. “Postural and respiratory functions of the pelvic floor muscles.” Neurourology And Urodynamics 26, no. 3: 362-371.
4. Sapsford, R.R., and P.W. Hodges. 2001. “Contraction of the pelvic floor muscles during abdominal maneuvers.” Archives of Physical Medicine & Rehabilitation 82, no. 8: 1081-1088.
5. Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, and Jull GA. 2001. “Co-activation of the abdominal and pelvic floor muscles during voluntary exercises.” Neurourology And Urodynamics 20, no. 1: 31-42.

Turns out most women prefer my hubs approach. A recent study (1) indicated that few women change their health behavior to prepare for pregnancy. Only 2.9% of the women studied who became pregnant followed the folic acid recommendations (shown to prevent Spina Bifida). Only 57% of those studied who became pregnant had performed any strenuous exercise in the 3 months prior to pregnancy. This last statistic should be a concern because it is well known that a fit pregnancy has benefits for both mother and child. However, the standard for making safe fitness choices in pregnancy is based on the type and level of physical activity one participated in prior to pregnancy. 43% of women aren’t even at the track let alone the starting gate when it comes to preparing for a fit pregnancy.

So if you want to cash in on the benefits of a fit pregnancy, including less aches and pains, controlled weight gain, easier delivery, a calmer and more alert baby and easier recovery for you, the time to start is months prior. You don’t have to be a nut-job like me to reap the rewards, but some simple strategies can help you prepare.

1. Begin an exercise program at least three months before you begin trying to get pregnant

Why three? In the first two-months you will begin to see and experience the benefits of an exercise program-improved endurance, muscle tone and strength. An additional month will solidify an exercise habit. Critical to any fitness regimen is making it a regular commitment in your weekly schedule. Be aware that 2x/week is the minimum recommendation for physical exercise. This is both, good news for the guilt ridden, those who have difficulty getting motivated and a great early goal.

2. Find an aerobic exercise that you like and you can continue until the finish line

As you consider your choices, keep in mind your potential girth, reduced balance, need to protect the fetus from impact and reduced tolerance for impact as the pregnancy progresses. Think low-impact, low potential for falls, and think long-term. Some cardio activities that fit the bill include walking, swimming, low-impact or water aerobics classes, elliptical, stationary bike (less potential for falls), and hiking.

3. Get comfortable with strength training

The benefits of targeted muscular work are numerous. Building the strength and endurance of your muscles will help your body adapt to pregnancy changes, maintain your posture and promote stability. This can be achieved through weight training or through activities that use body weight as resistance, such as Yoga or mat Pilates. Focus your strength training on postural muscles-upper back, gluts, low back, and abdominals (see #5).

4. Learn how to use your pelvic floor

This is when women start to tune out, but stay with me. Knowing where this group of muscles is, before a baby sits on top of them for nine months and your lady parts stretch to deliver said baby, is critical. Any muscle that is well-trained before an injury will recover much more quickly. A recovered and strong pelvic floor will help prevent incontinence, support your hips and low back, enhance your Core activation and get your sex life back on track.  But trust me on this, if you don’t know how to make them work or even how to find your pelvic floor muscles before pregnancy and delivery, trying to locate them after can feel like searching for a needle in a haystack. ( See Kegel 2.0 for some helpful hints).

5. Stop doing crunches

Find some new abdominal activities that you can do throughout the pregnancy and beyond, such as planks, side planks, push-ups, and activities on all-fours. Crunches can put excessive pressure on the pelvic floor, are very hard on low backs and can set you up for a diastasis during your pregnancy. A diastasis is a very common, non-painful separation of the abdominals that allows the abdomen to accommodate the growth of the baby. Doing crunches of any kind while pregnant will worsen this separation and set you up for abdominal dysfunction after delivery. An unresolved diastasis will set you up for that jelly belly that is most feared by women.

My husband never did give up anything in preparation for trying to get pregnant. The joke’s kind of on him as he gained an additional 15 lbs. of sympathy weight during the pregnancy. Always been glad I carried the kids, and they ended up with only one head, each.

In the end, exercising before and during pregnancy isn’t about pulling a Heidi Klum and shedding all your baby weight six weeks after birth. No, this is more important. This is about girding yourself against the changes of pregnancy and birth, and setting yourself up for a better recovery. This is about making sure you’re not just fit enough to make it through the next nine months, it’s about making sure you’re fit enough to make it through the next 90 years.

References:

1. Inskip et al. Women’s compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ, 2009; 338 (feb12 2): b481 DOI: 10.1136/bmj.b481

1. Does your belly pooch out while you are doing crunches?

If a bulge resembling a small pup tent seems to form on your abdomen with each rep, then not only is your Core not strengthening but its off practicing Kumbaya. The TA (a.k.a. Transversus Abdominis) is your deepest abdominal muscle and one of your four Core muscles. The job of the TA is to stabilize the spine and pelvis, cinch the waist, and flatten the abdomen. If the TA is active in a crunch, the abdomen would flatten or descend slightly before the crunch begins. As you complete the crunch with the TA engaged, the abdomen will remain taut with some skin folds, but no more campsite on your belly. (* However, Crunches are not recommended. See “Why Crunches Don’t Work” )

2. Do you leak while exercising?

You wish it was just sweat, but deep in your heart you’re bummed because you know what it really is. Everyone leaks after a kid or two, right?? Wrong! The pelvic floor (your Kegel-ing muscle) is another of your four Core muscles. The pelvic floor stabilizes the pelvis, controls leaks, and helps the rest of the Core work at its best. A weak pelvic floor is a sign of a sleepy Core. Closing and lifting your pelvic floor on exhale before a rep will make your sweat-only wishes come true.

3. Are you holding your breath to complete even light resistance activities (pulling on your spandex shorts, bending over to tie your runners, lifting your gym bag into your locker, etc.)?

Breath-holding is a built in mechanism that allows us to lift big things, like refrigerators and VW bugs. If you find yourself holding your breath to get out of the car in the gym parking lot or to open the gym door, your diaphragm (another of the four Core muscles) has forgotten that it has another job beyond the exchange of oxygen and carbon dioxide. The diaphragm plays a huge role in stabilizing the spine and activating both the TA and the pelvic floor. Exhaling with exertions, even small ones, is a good start. Adding a two-count exhale before you begin a rep will link the work of the diaphragm with the TA and Pelvic floor.

4. Does your back feel fragile, like it might snap?

If a back spasm is always lurking, waiting for a misstep, a slipped grip, or a funny twist, your Core is out to lunch. Research has shown that at the onset of low back pain, the TA stops working properly. In addition, the fourth Core muscle called the Multifidus tends to go MIA in the presence of spine pain or injury. The job of the Multifidus is to stabilize each segment of the spine. Finding and strengthening this powerful muscle will help put those lurking spine demons to rest.

5. Are you frustrated by your lack of results at the gym?

If, despite your best efforts and hard work, you have lost all your baby weight but your belly still hangs over the top of your jeans,  your cute bum has disappeared, and your bra size (not cup size, unfortunately) has gone up since kids, then a sleepy Core may be the culprit. The job of all the Core muscles is to activate together before any movements begin in order to stabilize our center (the spine and pelvis). This creates a central anchor, so exercising muscles have something sturdy to pull against. A sturdy center promotes correct form so that exercising muscles maximally strengthen and tone. Your muscles will perform at their best, and you will look your best.

If you answered “yes” to any of these questions,  than a Core makeover may be in order.

A decade of new research has helped us gain new understanding of the critical role that the Core plays in the issues that plague mommies and their pursuit of a return to fitness. Interior fitness is dedicated to helping moms regain their sturdy center again through very specific Core restoration programs, contact julie@interiorfitness.com for more info.

These three issues are intertwined. Exercises that are too difficult for you at your current fitness level will lead to bad form. The result, injury, and way too much time spent with physical therapists. To keep you exercising, making steady progress, and injury free, a few words to the wise to help you make well-informed decisions about how you exercise.

1. Know the physiology.

Building strength and making changes to your physical appearance takes time. 6-8 weeks to be exact. In the first 2 weeks of a fitness regimen you will experience strength improvements. This is related to better communication between the brain and your muscles, so they fire better. With consistency, over the next 4-6 weeks the muscles will actually begin to tone. They are actually adding muscle cells and you will be able perceive some changes in your muscles appearance. That is approximately 2 months to create a solid foundation, but it is still just the beginning of fitness, more time will be needed to reach your goals. Take Out: Plan ahead. If you know you want to lose pounds or inches before your June wedding or you want to run the Memorial Day 10K, don’t start training on May Day. Too lofty a goal, with too little time to prep, will likely force you into aggressive exercise and injury.

2.Watch your form.

Most folks read about a great exercise routine in a magazine or on the web for perfect abs, or strong shoulders and just dive in. The appeal of the end result overcomes them and they do the exercises without thinking through the precision needed for the movements. Or while attending a class or following a DVD, attendees sacrifice form just to keep pace with the instructor. Bad form not only increases vulnerability to injury but reduces results. Take Out: Slow down. Start by performing the exercises slowly and carefully in front of a mirror to be sure of your form. In a fast moving class, sacrifice repeated reps that use momentum for fewer reps, with perfect form, that get good results from the muscles you are trying to work.

3. Know when to say when.

Your body will give you clues that the exercise you are doing has moved beyond a challenge for your current fitness level, and into injury land. Breathholding is common when the you are not strong enough to pull off the activity you have chosen. Take Out: Just breathe. If you cannot perform an exercise without holding your breath, it is too difficult for you.

Pain is another clue that the activity is beyond your current capacity. Muscle work should bring about fatigue perceived at the middle of a muscle, this could sometimes be described as an ache that is relieved when the activity ends. But pain at the insertion of a muscle or in the joint is your bodies way of letting you know that you are doing damage. Post-exercise muscle soreness should be easing significantly in no more than 24-36 hours after your workout, any pain that lingers lets you know that you went too far. Take Out: Listen up. Your body is talking. It will signal you with pain, don’t ignore it. No pain, no gain is a long outdated fitness philosophy.

4. Build a comprehensive program.

Often exercisers focus on what are known as “mirror muscles”. These are the muscles on the front of the body that you can see in the mirror, ignoring those that cannot be visualized. This will lead to muscular imbalances that create faulty postures, injuries and poor results. Take Out: Think 360º. Every muscle has an opposing muscle group, this is the yin and yang of a workout. The bicep is balanced by the triceps, the quads are balanced by the hamstrings, and the abs are balanced by the gluts and lats. In order to maximize results, achieve healthy posture, and muscle balance think about a 360º program that works opposing muscle groups. If you yin, you gotta yang.

5. Be realistic.

If you trained and pulled off a 10K last Fall but the cold weather put a kibosh on your running program over the winter, don’t expect to run a 10K the first day of Spring. Muscles begin to lose the training effect of a workout after 4-5 days. A 4-5 month hiatus will set you up for an injury if you try to dive back in where you left off. Also, don’t think that Yoga Fusion DVD you did instead of weekly mileage kept you in running shape either. Muscle training is very specific. Yoga preps you for more yoga, not running, basketball or Zumba. Take Out: Smarten up. Evaluate your current fitness and activity levels (be honest!), the length of time since your last workout, and lingering injuries. Set gradual intensity, frequency and duration goals.

These guidelines, while universally applicable to men and women, are particularly important if you have had a baby. Too many moms, desperate to lose the baby weight and flatten their bellies, work themselves out too hard, too fast and end up with injuries, lousy posture and get poor results from their programs. The bottom line: use your noggin. And NO dunking.

Feeling the front half of the pelvic floor is just the first step. Now we need to take it to the next level, this time reconnecting the pelvic floor with the Core. The pelvic floor is one of four muscles that make up the Core. The diaphragm, transversus abdominis (TA) and multifidus are the other three. The Core muscles are designed to work together as a team to function at their best, in order to enhance the performance of each element of the Core it has to work with the other three components.

One of the reasons that classic Kegels, which teach women to isolate the muscles that stop and start your urine flow, don’t work is due to the fact that this activity attempts to train the pelvic floor separate from its relationship with the rest of the Core team. In addition, women make a big mistake by holding their breath while practicing their Kegels. This eliminates the activity of the diaphragm, another component of the Core. Rather than enhance the activity of the pelvic floor through diaphragm teamwork, the pressure from above created by a breath hold actually fights the pelvic floor lift.

Reconnecting the movement of the diaphragm with the pelvic floor is one of the keys to a Kegel 2.0. When you inhale, the diaphragm lowers and the pelvic descends. When you exhale, the diaphragm lifts up and the pelvic floor rises back up to its resting position, usually lifting 2-3 cm. Understanding that the pelvic floor moves down and up with the rhythm of the diaphragm and tapping into this ebb and flow is critical to a healthy pelvic floor. Let’s apply this with a few easy steps:

Step 1: Get to know your diaphragm

Stand again in front of the mirror and take a deep breath. Watch your rib cage carefully as you inhale. Does your rib cage lift up and back into your upper chest? If yes, you are a chest breather. Or does your rib cage stay pretty still but your belly fills way up? If yes, you are a belly breather. Neither of these breathing processes are efficient or complete uses of the diaphragm. The rest of the Core (particularly the pelvic floor) relies on optimum use of the diaphragm to do their jobs well.

Both belly and chest breathers use the diaphragm in a way that only creates front to back movement of the rib cage or abdomen. But a diaphragm moving properly will cause the rib cage to open sideways as well. Let’s try it.

Step 2: Show your diaphragm who’s boss.

Stand in your ski jump position (a gentle diagonal shift forward from the ankles) and put your hands on your lower rib cage. Inhale and try to open your ribs into your hands, imagine you rib cage opening like an umbrella in your chest. Exhale slowly and gently as if you are blowing out through a straw, while you close your ribcage umbrella around your spine. Practice this a few times. {Note: it may not feel like a full breath. Chest breathers focus on closing your ribcage around your spine; belly breathers focus on opening to your ribcage into your hands.}

Step 3: What goes up, must come down!

Remain in your ski jump position. On your next umbrella inhale, think about allowing your pelvic floor to gently lower toward the floor. Don’t be afraid! The pelvic floor is supposed to do this, and it can’t go up if it doesn’t go down first. Begin your exhale through a straw. While exhaling, lift the pelvic floor up and in. Repeat this. Inhale, pelvic floor lowers, exhale through a straw, pelvic floor lifts. This relationship between the diaphragm and the pelvic floor will bring about a revolution in your ability to lift your pelvic floor higher and with greater strength.

Use this method when you squat down to pick up your baby, grocery bags, briefcase, etc. Before you lift, practice your exhale through a straw with a pelvic floor lift, then rise up with heavy object in arms. Use while waiting in line, changing diapers, doing dishes, and blow drying your hair as great opportunities to practice your Kegel 2.0.

Restoring the teamwork between the diaphragm and pelvic floor will be a huge upgrade in your Kegel.

Contact Julie Wiebe, PT with questions or comments at julie@interiorfitness.com.

Time for a change

In the last decade, research has given us new insight into how the pelvic floor (our Kegel muscles) works. We can finally give women new tools to enhance pelvic floor function. Want to see real change “down there”? Follow these three steps.

First step: Figure out where the heck your muscles are

Your pelvic floor is a hammock of muscles that run from your pubic bone in the front to your tailbone in the back. All the muscles of the pelvic floor work together and you can use them in different ways. The parts of the pelvic floor towards your backside will close and lift your anus up and in, which helps to support and control your bowel. The parts of the pelvic floor towards the front will close and lift up and in your urethra and vaginal opening.Thus providing support and control for your bladder and uterus.

Second step: Try to activate your pelvic floor

Stand up and try a Kegel as best you can, using your current strategy for a pelvic floor lift. Where do you feel the contraction? Around your anus? More toward the front of your pelvic floor? Do you hold your breath? Contract your bum? Contract your abdominals? If performed properly, you should feel a balanced contraction between the front and back parts of your pelvic floor and they should lift up and in. It is very common for women who are struggling to stop urine leaks to only feel the contraction around the anus when they try to perform a Kegel. If this is what you experience than this means that the parts of your pelvic floor towards the front that support and control the bladder aren’t responding to the call to lift. A squeeze only around the anus will not stop a urine leak.

If you hold your breath, squeeze your bum, or brace your abdomen, these are substitutions your body has made for a weakened pelvic floor (happens after pregnancy for some, but some women experience weakness and leaks even if they have not had children). These muscular compensations will not help you control a leak. In the case of breath holding or an abdominal contraction, this will actually make leaking worse because of the significant pressure that is created from above pushing against a weakened pelvic floor.

Third Step: Take it to the next level: Kegel 2.0

Let me teach you a trick to get the front of the pelvic floor going again. While you are standing take a mental note of where you feel your body weight goes into the floor, is it through your heels, mid-foot or toes? Look at your profile in a mirror, take note of where your upper body is in relation to your lower. Is your upper body slanting or slouching behind your bum, if yes, then your natural standing position likely puts your weight in your heels.

Now if you are in your heels already, stay there, but if you feel your weight elsewhere, then shift back into heels (nothing extreme, don’t lift your toes, just shift at the ankles). While your weight is in your heels, perform a Kegel and take note of where you feel the contraction.

Now shift your weight forward as if you were going off of a ski jump. Look at your profile again, your upper body and lower body should be aligned in a diagonal angled forward with the shift occurring at the ankle. In this position perform a Kegel and take note of where you feel the contraction.

Shift back and forth, heels to ski jump diagonal. What did you feel? While in your heels you likely felt the pelvic floor work only around your anus. While in the ski jump with weight shifted forward, you likely felt the work of the front of your pelvic floor. The contractions toward the front of your pelvic floor are the elusive muscles you have been searching for, these are the muscles that help stop the leaks. *

This trick is based on current research that has shown that the pelvic floor responds to our postural alignment. The position of our rib cage in relation to our pelvis will determine how well we can connect and utilize the pelvic floor. If in your natural standing posture your rib cage sits behind your pelvis, upper body slanted or slouched behind your bum, then your weight is in your heels throughout the day. So when a sneeze, cough or gut busting joke comes your way then you will squeeze primarily around your anus and not be able to catch a leak. If however, you are in the midst of leaning forward to wash dishes or change a diaper, the same scenario may not cause a leak (Ever wondered why sometimes you leak and sometimes you don’t? Now you know).

This new insight into how to enhance pelvic floor function is also the explanation of why Kegels can be so frustrating and have poor results. If you are practicing them while standing slouched with your weight in your heels or while slouched in sitting, the front part of the pelvic floor will not respond, nor will it be trained.

Now that you feel the right muscles, practice using them in a balanced way (front and back) where ever you are! You will find that your posture will determine how well you can connect to the front of your pelvic floor and help you control leaks.

Stay tuned for learning more tricks to get that pelvic floor really rocking!

Please contact me julie@interiorfitness.com with questions or comments

{*If shifting forward and back brought no change for you, check your profile again and watch your rib cage. As you shift forward into the ski jump, watch to see if your rib cage continues to lag behind your pelvis. If it does then you will continue to experience squeezing around the anus. Try again to create a diagonal alignment with a shift at your ankles as you come forward.}