Like every good Therapist and Pilates Instructor, I will always be making sure classes, treatments and Therapy sessions are evolving with the most update research and effective ways of getting people results.
With this in mind, this brings me onto a subject which has been part of Pilates classes, for as long as I can remember, which hasn't changed much over the years... Pelvic Floor.
For many, Pilates classes are seen as a great way of strengthening Pelvic floor muscles, which are we have believed to be weak. For years (and I also included my classes) everyone (women & men) were taught how to 'draw up' their pelvic floor muscles and to pull 'tail bone to pubic bone' & 'sit bonez together' to get Pelvic floor muscles working. There isn't anything wrong this method but it only covers the basics, so now its time to progress things on (and I've been doing this for a while in my Pilates classes).
If you have been a member of my class this year, you would have noticed I have spent a bit less time with this method and you could be forgiven for thinking I no longer focus on Pelvic floor in classes, however by the end of this article hopefully you will see we are actually working pelvic floor more effectively... and you may not even have noticed it.
So lets get started.
Why do people try to strengthen Pelvic Floor?
The main reason is usually down to functionality of pelvis floor (incontinence (often found in post-natal clients and athletes who compete in trampoling, gymnastics and/or dancer), Pelvic Girdle Pain, Lower back/Sacroiliac pain and pathology involved with the viscera, affecting both male and female population.
What was wrong with the old method of squeezing and drawing everything up?
Well, nothing really... it was just only doing half the job. Pelvic floor is a difficult area to have awareness of, so I'm going to use a different type of analogy.
Firstly, think back to the pelvic floor muscles and the exercises of 'drawing up'. This puts the muscles into a contracted state, that helps with strengthening. Now just park that thought and we are going to use an example that will make easy to understand. Let's focus on the elbow and the bicep muscle. If you tense (contract) your bicep muscle then that will do the job of bending your elbow, which is great because that's the biceps job and this will strengthen your bicep muscle. Now pelvic floor, if we 'draw up/squeeze' pelvic floor muscles, it will strengthen pelvic floor muscles. Now here's the thing (going back to the elbow and bicep) I would imagine at some point we are going to want 'release' that elbow and straighten it out again aren't we? We wouldn't want to have permently bent elbow for two reasons: 1. We won't be able to function in our elbow properly because its permanently bent (so function will be lost, we need to straighten it again to be able to bend it again) and 2. if it stay permently bent it will get tired, fatigue and when that happens, we again lose the function and also fatigue can cause discomfort, so we need to be able to have the strength (this is known as eccentric strength) to return from a contracted position (bent elbow to straight elbow).
Making sense so far?
Now we can apply that same principle to pelvic floor. It's great to know how to contract these muscles, but what happens if they stay contracted.. well the same as above, they fatigue and lose their function... which can lead to (as you can probably guess) incontinence, Pelvic pain or SIJ discomfort. Why, because we need to know how to 'eccentrically' strengthening pelvic floor, to relax it, so that we can strengthen it again, when it needs to be strong. Ever been taught how to do that (relax or stretch pelvic floor)? Me neither, so that's why I have slowly been integrating some methods onto classes of doing this.
So how do we release (eccentrically strengthen) pelvic floor?
There's two ways. First is Diaphragm breathing. You will notice we do this every class without fail. How does this work in relation to Pelvic floor release? When you breathe into diaphragm it pushes downward and cause you abdominals to lift up. What also happens when do this it causes the pelvic floor muscles to eccentrically lengthen (stretch) due to the load. Now the real key bit in relation to strengthening pelvic floor. When you take a full outbreath out (remember in class I always try to get you to breathe out as much as possible) it creates 'suction affect' which causes the pelvic floor muscles to naturally draw up (remember that method we have been taught previously), thereby covering the concentric and eccentric strengthening in one single breath. Now just think if you can get really good at doing this (diaphragm breathing) and make it a natural process of your everyday life, then pelvic floor muscles will get conditioned a lot quicker compared to just doing them once a week in a Pilates class.
The second way, is hip movement. Take knee floats like we do in class. Now as you will all remember I am always reminding people to move in their hip (moving the leg keeping the pelvis still). If we think of pelvic floor muscles and where they attach to (floor of the pelvis) if that pelvis is constantly moving during hip movement then they are going to have less of chance to get strong, because they are constantly moving (this is why always recommend people to never tuck their tailbone under or push their lower back to the floor). If we are managing to keep the pelvis still, not only are we giving the pelvic floor muscles a chance to work (enhanced further if the breathing is going well) but we are also getting our hips so much needed quality movement.
Does that mean the 'old-way' is no good?
Definitlely not... it's a good starting point and I think even if you do that alone you will get benefit. I also think if you can incorporate it into what I have discussed above we will get much more benefit in a lot quicker time.
Remember, like all these things it takes time, patience and persistence for it all to take effect. Remember it doesn't have to be 'perfect' to be effective, so even if you feel you are not quite getting it right, you are still getting the benefit.
Thanks for reading and if you have any further questions, please feel free to ask.
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About the author
I am a Manual Therapist covering a range of different disciplines including massage & Biomechanics. I also run small specialist Pilates classes around Corfe Mullen, Broadstone, Wareham, Wimborne & Poole. Instead of just purely rubbing the pain, I always look to see if I can find a potential cause (or causes of the pain) and then work on treating this.
Pilates Instructor & Therapist, helping you understand why we do what we do!