Pelvic Floor 101!

In Pilates classes we give a lot of emphasis to using the pelvic floor muscles throughout all the exercises but I wanted to use this post to look a bit more specifically at some of the precursors to pelvic floor problems & signs you may be at risk or already have issues. 

There are specific signs to look out for which can indicate that you may have a pelvic floor problem – these are all suboptimal issues that you do not have to live with, a trip to the women’s health physio (or men’s) will help get you on the road to recovery just like any other muscle injury. I’ll stress again, these are not just conditions of age or things that ‘just happen’ – you can do something about it, just because something is common does not mean it’s normal.

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  • Peeing when you exercise, laugh, cough or sneeze
  • Needing to get to the toilet in a hurry or not making it there in time
  • Loss of control over your bladder or bowel
  • Accidentally passing wind
  • A prolapse – in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping. In men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
    • Pain in your pelvic area, or painful sex
  • Being pregnant & childbirth

The pelvic floor is just like any other muscle so if it’s too tight or too weak or a combination problems can occur but there are certain events in life & lifestyle factors that can contribute to creating imbalances or dysfunction. Some people have pelvic floor muscles that are too tight (hypertonic) & cannot relax. This can be made worse by doing squeezing exercises & overworking the muscles without learning how to relax – this is why I always try to give time in the class to focus on actually relaxing & releasing the abdominals & pelvic floor.

The main precursors for pelvic floor problems will involve any type of unmanaged pressure within the abdominal canister or where there is poor load transfer .

  • History of back pain
  • Ongoing constipation & straining on the loo
  • Being overweight with a BMI over 25
  • Incorrect heavy lifting e.g using the Valsava maneover
  • Chronic cough or sneeze
  • Previous pelvic injury
  • Poor alignment
  • Wearing high heels

With the right technique & exercise selection, Pilates is a great choice to help strengthen the pelvic floor – at any age, whether you’ve just had a baby or your babies are having babies!

Upper Back Mobiliser

Modern living tends to cast our bodies into a forward flexion bias stiffening & restricting movement of the upper back, neck & shoulders. It seems to be one of the main complaints & one of the things most class participants would like to relieve. 

The thoracic spine (upper, mid back) provides much of the rotation & extension of the spine but thanks to lifestyle factors such as looking (down & forward) at phones or computers, driving, leaning down over children or  poor posture it tends to get very restricted. Anyone that plays sport is likely to find their performance limited by stiffness in this part of the spine  & it’s common to get compensation injuries in other parts of the body as a result.

Typically a stiff thoracic can cause pain between the shoulder blades but also transfer excess loads onto the lumbar spine, neck & shoulders, which in turn can lead to pain in these areas as well as headaches. A stiff thoracic spine will also result in the Old Hunchback of Notre Dame look (!) & lead to a Dowager’s (or Bison’s) Hump – a thickening of the soft tissues at the base of the neck. So, some good reasons there to keep up with some basic maintenance to keep it supple!

In the classes we work through a few different exercises both in side lying & on all 4’s to help mobilise the thoracic spine & then follow up with some strengthening work to help keep the spine aligned. Here’s one of those exercises that’s really effective as the ground ‘fixes’ the hips which will give you a better chance at rotating correctly through your thoracic instead of cheating with another joint deformation.

Thread the needle pilates_16

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Make sure you have your knees hip width apart & hands, shoulder width apart. Don’t collapse your supporting shoulder / shoulder blade as you bring the other arm under & as you reach up try to really extend through the arm (….mine is bent, probably from too much baby holding!). Try 10 on each side, exhaling as you extend the arm up.

The Mummy Movement Workout

One for the mummies! If it feels like you never get time to have a ‘proper’ workout & your best attempts to ‘get back in shape’ are always foiled by the unrelenting demands of being a mum, try optimising your daily ‘mummy movement’ by focusing on your alignment. We need to get it out of our heads that in order to exercise we must be head to toe in lycra & down the gym!

Biomechanist Katy Bowman in her new book ‘Move Your DNA’ likens how we should view exercise as being a vitamin supplement – we need to think of exercise just like that – a supplement to our total daily movement. Just like a vitamin you wouldn’t rely on that to keep you healthy, you’d also try to maintain a nutrient rich diet as well. An isolated ‘workout’ is not the be all & end all – in fact a workout means nothing if you’re a couch potato the rest of the time. Research shows that it’s much better to move (or load) our bodies multiple times per day than do it all in one go.

ENG 2016 Kew Gardens-1This is great news for mums – whilst others are frenetically trying to replicate the daily movement they should be getting but can’t, due to sedentary jobs, mums get the opportunity at an action packed day…well….everyday!! No 5 x 30 mins per week for us, as government guidelines recommend!

So how can you optimise your daily activity? Focus on your alignment when you are standing, sitting, bending & moving etc. Maintain good posture, exhale on exertion (e.g when you are moving away from gravity – like when you lift the baby up) & work your pelvic floor muscles in conjunction with movements like lifting the baby or standing up from a squat. Another useful tip is to wear clothes that you can actually move in for example by wearing stretchy jeans & flat shoes you’ll be more inclined to deepen your range of movement, untuck your tail bone & not mind working up a bit of a sweat.

5 ways to max out your daily activity:

  1. Squat the laundry! If you hang your washing out on a rack, squat down to get each piece of clothing – make sure you have good technique and exhale on exertion.
  2. Lift the baby – a few extra cuddles instead of buggy time can create some great opportunity to work your body – remember to keep a neutral spine, costal breathing & recruit those pelvic floor muscles!
  3. Walk during nap time – I  know, I know “sleep when the baby sleeps” & all that but sometimes a good walk can be just as replenishing particularly if your baby is at a stage where they are sleeping longer at night.
  4. Squat to play with your child – squatting to play with your baby not only reinforces some good habits for them but also creates the perfect opportunity to stretch your calves. If you can’t get your heels to the floor place a rolled up towel or similar under your heels. Try to straighten your feet & untuck your tail bone.
  5. Work your back whilst bathing/cot – These 2 are classic ways to a sore back if you don’t focus on your alignment but if you do then it’s a great opportunity to strengthen your back & stretch out your hamstrings. If you have tight hamstrings & can’t untuck your pelvis then bend your knees until you can. Try to keep your back straight & shoulders away from your ears. Change position to rest when you need to.

References: Katy Bowman ‘Move Your DNA’

Post Natal Exercise – Where do I start??

After a bit of an end of pregnancy slow down (!) on the blog front I thought it would be an opportune time to write some post natal exercise posts to both remind myself & give some direction to anyone beginning the journey of reconnecting with their non-pregnant selves!

With any exercise programme, post natal or otherwise the ability to breathe correctly during exercise is essential to having a fully functioning core. Reconnecting with your breath will provide the foundation to both your core’s recovery rate & help you to progress with bigger more integrated core movement patterns (A.K.A sorting out the mummy tummy!).
Breathe_titled-300x300Whatever birthing experience you had or however fit you were/are post partum reconnecting with your breath is where you need to begin. The nature of pregnancy – with the baby in the tummy thing (!) – can create a disconnect with the way we breathe due to the expanding uterus squashing the diaphragm resulting in there being less room for your lungs to expand – so it is vital to relearn this essential function.

Try this – find a quiet space to practice lying down with a neutral spine & pelvis.

Inhale (the expansion): Breathe wide into your ribs, try to do this 3 dimensionally so use the floor against your back as a reference, don’t just flare the ribs outward. Your abdominal wall will expand. Try to relax your shoulders, neck & jaw.

Exhale (the compression): As you breathe out feel your ribcage contract & lower, your abdominal wall & lumbar/thoracic muscles (see the pic) will tension. Think about connecting with your pelvic floor by drawing it up (think picking up a tissue with your vagina) from your vagina to your anus.

Once you feel you have the full core connection try this sitting & then standing making sure to integrate the pelvic floor contraction on each exhale & fully relax/release it on each inhale.

For some women, it will come as a relief knowing that all is required on the exercise front is a bit of breathing to get started but for others wanting to just get the running shoes back on & pick up where they left off, it may pose more of a frustration or perceived limitation to getting their bodies back. Understanding why we need to start with the breath is key to accepting your journey to hot mumness (technical term!) – safe in the knowledge that you’re going to reclaim (& maybe even improve on) the body you want both aesthetically & functionally without having to pee your way through a kettlebell workout because you haven’t addressed proper pelvic floor & core restoration!

So – at a glance list of ‘Why’s’:

  • Costal breath patterns (as directed above) will help take pressure away from healing abdominal & pelvic floor tissue.
  • Develops your MUCH NEEDED pelvic floor reconnection.
  • Increases your oxygenated blood to help healing abdominal & pelvic tissues.
  • Strengthens & supports your post partum abdominals, back & pelvis.
  • Helps aid valuable relaxation which in turn will help balance the hormone levels that control weight.

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Test Your Balance, Part 2

As a continuation of the post I did on testing your balance part 1 I wanted to add a simple continuum of exercises from easy to hard that you can practice & use to challenge your stability.

 

So as aforementioned in part 1 the goal of these balances is to test your proprioceptive balance system – that does’t mean using strategies such as bending your knees or holding your arms out high wire style…or fixing your eyes on something, it’s about testing your own internal balance system with your body in the correct (or as close to correct) standing alignment.

pilates_16cYour body uses your proprioception system to create an image of what is internal or inside the skin – in much the same way as a dolphin uses sonar or an animal uses it’s whiskers. Proprioception literally means ‘ones own perception’ & that information about change of skeletal position travels by our neurones to the brain to act on. The more muscle fibres you have firing & the more supple (not tight) the tissue, the better the proprioception.

When you practice these consider your alignment: stand with your feet hip width apart & the outside edges of your feet straight. Back your pelvis up over your heels keeping your ribs aligned over your pelvis. Then draw your head back over your spinal column. When you come on to single leg balance make sure you push down into the floor with the standing leg as opposed to hiking the low back/hip up on the non-weight bearing leg.

1. 2 foot balance eyes open
2. 2 foot balance eyes closed
3. 1 foot balance eyes open
4. 1 foot balance eyes closed
5. 1 foot balance eyes open with head turns
6. 1 foot balance eyes closed with head turns

Test Your ‘True’ Balance, Part 1

From time to time in class we focus on standing balance – it’s a good way to test all the principles we practice throughout the classes & as an indication of general muscle balance health. So I wanted to use this post to look at what goes on when we try to balance, how to test it & how to improve your ‘true’ balance.
So our body’s stabilise by using the relationship between the proprioceptive system (that’s information coming from the muscles, joints & tendons) & the processing of that sensory input (i.e. what the brain tells the body to do with that information). Tight or shortened muscles send ‘fixed’ information from your proprioceptors and this data/sensory input gives incorrect information to the decision centre (the brain) which in turn acts on this mis-information. The outcome is an overcorrection, a wobble or lurching movement in an attempt to stabilise you. Any restrictions or sub optimal muscle length tension will alter the correct information given to the brain.

Testing your ‘true’ balance – See how well you’re balancing with these simple tests.

pilates_16dStand with your feet pelvis width apart & check your feet are straight (as in the outside edges, see pic) – how does this feel? Any wobbles? Now close your eyes & see if there’s any difference with them open or closed. Maybe you felt you moved about more with your eyes closed – this is the ‘true’ part of the balance test – your eyes are not part of the sensory input we speak about when we mean whole-body balance, they are not part of the proprioceptive system they are part of the vestibular system (eyes & inner ears) but the poorer your proprioceptive system is the more you rely on your eyes to make corrections. So in order to stop the eyes doing all the work (& incurring eye muscle fatigue, dizziness & age-related changes in vision) you need to fix your body’s internal sensory input or proprioceptive system.

The progression to the 2 foot balance with eyes shut is to come onto a single leg with eyes shut. Whilst we may have some muscle tension issues within the body it’s also our inability to process information through our feet & inform our bodies of correct posture, due to footwear that down trains our proprioceptive system. Think any type of heel, thick inflexible soles & too narrow toe boxes.

So hopefully this will give you a clearer idea of what you are aiming for when you consider/assess your balance – test yours & practice some ‘eyes shut’ standing to monitor your progress.

3 Restorative Shoulder Stretches

If you have tight shoulders & are looking for relaxing ways to ‘unstick’ them here’s a few ideas that we use in the classes that also work really well particularly as transitions from one exercise to another. If you imagine where your arms are hanging most of the day & the range with which you mostly use them in you can see that these 3 variations on a shell stretch really take them into much more of an unused plane thereby freeing up all the stuck tissue around pectoralis & latissimus dorsi.

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The picture above shows how you should anchor the stretch. Arms are pushing away into the mat & sit bones are pulling down, so you’re flexing the lumbar/lower spine by engaging the abdominals & pulling the ribs up (in the direction of the second smaller arrow). By drawing the ribcage up you will tension the stretch better through the shoulders instead of over extending into the thoracic spine – have a go with the ribs up & then down on your thighs & you’ll feel the difference.

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If you want to optimise the stretches try to work with the breath by directing it into the ribs & underlying diagram in a 3 dimensional way (think like an accordian). You’ll be able to feel the skin stretch around the rib cage & so try to emphasise that expansion as you inhale & breathe out the tension from the stretch as you exhale.

  • In the first variation the arms are straight out in front, trying to keep the hands in line with the wrists, elbows & shoulder. Head is relaxed, toes are tucked under for an extra, bonus plantar fascia stretch! There are many variations on the specifics of this pose for example Yoga’s Child Pose comes with a different emphasis but here as we are trying to specifically release the fascia around the shoulders I’ve selected these teaching points.
  • In the second picture the arms are externally rotated with the palms up & correspondingly the forearms are also rotating outward – you will feel how this tensions the stretch differently & you’ll probably find it more of a challenge. See how far round (or not!) you can get your thumbs/backs of the hands flat to the floor! Head relaxed & breathing wiiiiide! Keep thinking about the same anchor points, this is not a flop-on-your-thighs-&-go-to-sleep kind of stretch, you want to be actively working on the position both with the breath & with the anchor points. As the intensity of the stretch dissipates you can try to reach a little further.
  • Lastly we’re working more laterally into the sides of the back by bringing one arm all the way across & anchoring onto the the other side. This time we breathe into that side – feel the skin stretch & try to expand it with each inhalation.

For more information or to attend one of my sessions get in touch & fill out my contact form!

……And Breeeeeeathe!!

Different Pilates teachers put different amounts of focus on the breath  & whilst it can add to the seemingly endless checklist of things you are trying to get right in an exercise. For me, it is key to the success of any core restoration & here’s why.

Once you understand the body’s breathing apparatus & functionality it becomes quite clear that we get an intrinsic core contraction (tensioning) with each exhale & an intrinsic expansion (or opening) with each inhale so only by harnessing this inherent bodily function will we truly get the core working optimally. Working against this pattern will help facilitate back pain, exacerbate a diastasis recti & generally leave you vulnerable to injury.

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But as well as providing an intrinsic support system for the body, breathing correctly also helps reduce stress – controlled breathing can cause beneficial physiological changes that include:

  • lowered blood pressure & heart rate
  • reduced levels of stress hormones in the blood
  • reduced lactic acid build-up in muscle tissue
  • balanced levels of oxygen & carbon dioxide in the blood
  • improved immune system functioning
  • increased physical energy
  • increased feelings of calm & wellbeing.

Conversely when a person is under stress, their breathing pattern changes. Typically, an anxious person takes small, shallow breaths, using their shoulders rather than their diaphragm to move air in & out of their lungs. This style of breathing disrupts the balance of gases in the body. Shallow over-breathing, or hyperventilation, can prolong feelings of anxiety by making the physical symptoms of stress worse as well as facilitate adaptively shortened muscles along the neck & shoulders.

Try practising the breathing exercise described above whilst lying on your back in a quiet area – then begin to introduce some gentle core exercises as you do so & see how well incorporating the breath helps engage the whole core system.

How To Lift Properly

I’ve adapted this from a list included in Isa Herrera’s book ‘Ending Pain in Pregnancy’ (a must read if you’re expecting!) even if you’re not pregnant you can be sure that following advice given to a demographic with arguably the most compromised core system out there has to result in the gold standard in lifting advice!!

  • Bring the load/Object Close: Bring your body as close to the load/object you are about to lift as possible. This will prevent you reaching too far forward to grab the object, placing increased stress on the low back. You want the object almost directly underneath your body before you lift it.
  • Wide base of support: You want a wide base of support when you lift objects to improve your balance & allow you to reach the object without straining the back or legs. Widen your stance & try to keep your toes out, as if you are about to straddle the object.
  • Squat down & bend your knees: To reach the object, you will need to squat down by bending your knees. The most important aspect of squatting down is maintaining a flat back with a slight lumbar curve or arch. This is what helps the jelly in the vertebra stay centred, placing less stress on the intervertebral discs.
  • Keep the load close: When you grasp the object, bring the load as close into your body & stand up with your back remaining straight up & down.
  • Take steps, do not rotate: Do not rotate, or twist your trunk to place the object on a different surface. Instead, take small steps with your legs to reposition your body. Set the object down using the same principles.

Remember, proper body mechanics take time but by mastering these steps you’ll prevent aggravating existing problems & reduce risk of future injury.

5 Core Exercises To Practice

Regular conditioning of your core with proper muscle activation is key to maintaining good alignment & preventing back, neck & shoulder pain. This post will be a reminder for some of the exercises I teach in the classes as well as add a bit of variety for home practice.

post2First make sure you create space & time to focus on your technique – you will need to use your brain to find the right muscles (!) – predominately the co-contraction between transversus abdominis (TVA), pelvic floor & multifidus AS YOU EXHALE!

Try this technique to engage with your TVA:

Lie on your back with your spine in a neutral posture (slight curve in lower back). Take a breath in & as you exhale think about lifting your lower tummy up (not sucking in) & *gently* drawing your tummy button toward your spine – you should not feel any movement of your hips, pelvis or spine & you can feel the TVA activate by placing your fingers on the inside of your hip bones. It should feel like a deep tension not so much that it pushes your fingers away.

Try holding this contraction for 3-5 seconds & then release – breathe throughout this exercise! Repeat & hold for 3 sets of 10 repetitions 3-4 x a day.

Once you’ve mastered this you can apply it to all movements/exercises that involve any level of effort. Just remember to go with the breath pattern always exhaling on exertion to benefit from the intrinsic TVA contraction, tensioning your abdominals & lower back muscles.

So here are 5 exercises to practice whilst integrating TVA & pelvic floor activation through different planes of movement:

1. Single leg extensions: Lying with your spine in neutral (slight curve in lower back) ‘bolt’ your tailbone down as you lift knees up to 90 degree. Moving with the breath exhale as you drop one toe to the floor. Repeat, alternating legs for 10-20 x as along as you have good control with no bulging/doming abs.

2. Ball roll outs: From kneeling with shoulder ‘set’ roll forward until you feel the hips open at the front. Make sure you engage your core (as above) to keep the spine in neutral. Repeat 10-20 reps as along as you have good control with no bulging/doming abs.

3. Squats: Inhale as you go down & exhale to go up, move with the breath. Try to keep your spine neutral by untucking your pelvis an& make sure your knees don’t extend over your toes. Repeat…all day long!!

4. Knee lifts: From all 4’s with shoulder set exhale as you engage core & hover the knees. Repeat 10-20 x

5. Side Lift: Assume the position in last pic, inhale & prep core then exhale to lift the top hip up. Try to keep the supporting elbow under your shoulder (mine’s sliiiiiiiightly forward!) Repeat 10-20 x both sides.

Remember you don’t need to do specific ‘ab’ exercises – rather learn to & actually use your core muscles throughout your daily activities. Crunches will merely retard the body’s correct muscle balance.