Men, Pilates and the male pelvic floor
By: Kerrie Murphy | 16/08/2016
Men, Pilates and the Pelvic Floor
This article will focus on the male pelvic floor and pelvic health especially as it relates to the prostate, bowel; pelvic and spinal alignment; the use of breath and healthy movement patterns.
My name is Paul Schembri and I work at Infinity Pilates Studio. Over the past 16 years I have focused on bodywork within the Pilates Method methodology.
Within my own Pilates teaching practice I have recently been experiencing a number of my male clientele; age 50+, who are experiencing issues with their prostate and bowel health and therefore a loss of continence – whether as a result of inflammation, the development of cancer or as a post-surgery complication or symptom.
In my experience it is easy for us men to get caught up in the thinking part of our minds and be removed from the awareness that the mind and body work together.
We respond to life’s demands and external stressors such as work; family commitments; obligations and financial responsibilities. We generally don’t know there is something wrong with our bodies until pain and discomfort causes us to stop from performing our daily tasks. Forced to address an underlying health concern or address a movement dysfunction.
Generally, I believe men are already compromised in their optimum function of pelvic strength due to their sedentary seated lifestyles and working lives. Often, the comfort design of most chairs allows us to slump in our seats and therefore slump in our spines and we end up sitting on our tailbones and on the belly of our gluteal muscles instead of sitting upright onto our sit-bones and allowing our tailbones to float behind us (1).
This positioning of the pelvis in a posterior pelvic tilt is often replicated in standing and general posturing. Such positioning of the pelvis can cause our gluteus max muscles, our hip flexors (psoas, ilio-psoas, rectus femoris) and our piriformis muscles (sometimes considered a part of our pelvic floor diaphragm ) to shorten.
In a posterior pelvic tilt, there can be increased pelvic pain from this increased loading, positioning and instability of the pelvis. This pain and postural slump can create “a change in the nerve pathways that send pain messages to the brain. Once muscles and nerves in the pelvis start to behave abnormally other organs can subsequently develop problems. There may be difficulty passing urine, with bowel function or with sexual function” (3).
The pelvic floor – or diaphragm – is like a bouncy trampoline which connects the bony landmarks of our pubic bones, tailbone and sit-bones. This diaphragm bounces and responds to our breath and also the forces operating in and around the pelvis. Combining this with the notion that muscles i.e. the trampoline of the pelvic diaphragm can be short, tight and weak, or, long, loose and weak; we can begin to appreciate how dynamic this sling musculature can be. The forces of movement pass through it from both above and below. This musculature wraps around our prostrate, urethra and bowel.
This can commonly be appreciated and understood with male populations after they have undergone surgery for either prostate issues or bowel issues. Immediately following such surgical procedures, there is often a loss – or further loss – of pelvic floor continence and sexual control.
In fact, when a catheter has been inserted through the urethra of the penis, any pelvic floor exercises are discouraged due to the obstruction of this foreign object, and from the intrusion of a surgical blade and site inflammation. Combine this with lots of bed or couch rest, this slumped posture becomes the norm.
This may result in a loss of function – or further loss in terms of continence and sexual health – all of which can affect our self-perceptions of masculinity and virility and therefore self-esteem.
Once the catheter has been removed, the usual protocols for self-management and recovery are ‘Kegal’ exercises (contracting the pelvic floor sphincters) and walking short distances. Building endurance of these tasks is encouraged over time.
If the pelvis has already been compromised in alignment however and function prior to surgery, such prescriptive self-management exercises may work in the short term, but long term, there could be ongoing issues.
Faulty pelvic alignment is reflected throughout the body where posture and functional movement meet.
It alters the natural curvature of the spine. It can also affect the internal functions of the torso and pelvis: lungs, internal organs, bladder, bowel and sexual organs. It alters the way we move in space through changed gait. The imbalances affect efficient movement and postural patterns which is then recycled along the chain of dysfunction (4).
Through alignment and effective physical exercise, as taught and beautifully encompassed in the Pilates method, we can promote efficient movement and optimum function that can help men on the pathway to better health and improved lifestyle.
As Pilates Instructors we can utilize the Pilates Method to bring intentional awareness and focus to the areas of the body that are compromised and can facilitate all parts of the body to move energetically as an integrated whole.
At Infinity Pilates Studio, we understand the body in motion.
We teach the Pilates method to evoke awareness of the mind, body and spirit working together as one and see each individual as they present their unique movement patterns. Imbalances are addressed and also where that imbalance may be translated elsewhere in the body.
I believe that the key to a speedy recovery post-surgery is achieved through conditioning the body by addressing spinal alignment and pelvic support. Providing the tools to build confidence and to resume and enjoy the life they want to live.
“[I] felt as if I had every muscle working for me. First day out of bed – firmly putting two feet on the floor aligned was a feeling I will never forget” David, aged 65, post his bowel surgery
“My level of physical fitness assisted in a much quicker recovery. Both my Surgeon and Cardiologist were amazed at the speed of my recovery and used it as an example of what can be achieved by having a reasonable level of fitness pre surgery. I was out of hospital 2 days earlier than scheduled. Their physical assessment of me pre surgery was equal to a fit 60 year old.” Sonnie, aged 80, post his bowel surgery
According to the Prostate Cancer Foundation of Australia, 1 in 5 Australian men will develop prostate cancer by the age of 85; 3300 men die each year! Over 120000 Australian men are living with Prostate cancer. More men die of prostate cancer than women die of breast cancer! (5)
Pelvic floor dysfunction is evident post-op in those who have undertaken prostate or bowel surgery. If the patient has postural patterns that inhibit functional motion, this will impact on their recovery. In comparison to those who work on posture and alignment pre-op this speeds their recovery.
“There is some evidence to show that physical activity and regular exercise can be protective factors for cancer” (6). Thirty minutes a day minimum is recommended. Men understand the importance of exercise.
Many choose gym training as their exercise routine. Heavy loading and inefficient performance can potentially place undue strain on joints and ligaments. Intra abdominal pressure is overloaded and the pelvic floor is stretched. This type of overloading can exacerbate already compromised function.
If not addressed, we can create sacro-iliac joint dysfunction, abdominal herniation, hip joint degeneration and dysfunction and these things can eventually create further problems up the spine and into the neck, shoulders and down into the hips, knees and feet.
“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.” (7)
This brings us to the problem of the classic Kegal exercises. Such exercises are designed to draw awareness to the pelvic floor and in particular the closing of the passages (anus, urethra and in women, the vagina). While it is a great starting point to draw attention and awareness to the pelvic diaphragm, the alignment of the whole body is involved in support.
If the pelvic floor is already dysfunctional and tight, trying to tighten those muscles more will create further problems and establish gripping patterns.
Kegals are like your hand grabbing a suitcase handle, but that action is not going to help you lift the suitcase above you into the overhead locker. More work, awareness and integration are needed.
Gripping these already dysfunctional muscles can results in further gripping of tight muscles around the hips. This action shifts the head of our femur forwards (think of a golf ball teetering on the edge of the hole on the green as opposed to it dropping into the hole) preventing the joint to function freely. Physical pain contributes to increased guarding, and inefficient movement patterns.
“It is well established that when a novice learns a new skill, they tend to use a co-contraction strategy until they learn to refine their movement. Co-contraction is known to be an ‘energy waster’ in initial motor learning situations” (8).
In the case of an overly tight, hypertonic pelvic diaphragm, sometimes reverse Kegal exercises are prescribed i.e. to let go and release those muscles. If the pelvis has already been compromised in alignment and function prior to surgery, such prescriptive self-management exercises may work in the short term, but create long term issues.
There is always a level of activity sustained throughout the body for spinal and postural support. If the body is unable to lengthen and contract when load is applied this could set up bracing patterns to perform any task. Undue stress and pressure bearing down on the pelvic diaphragm could result in herniation within the abdominal wall and along the inguinal canal.
“Post op, every patient is given a folded towel taped to hold its shape – approx. 30 X 20 cm and about 5 cm thick. It is held against the stomach like a comforter. The pressure gives a sense of security especially as you are being asked to cough which tends to exert pressure in the opposite direction (from the inside.) They also suggest that you sleep with the towel on your stomach for the first 3 days.” Sonnie
“The pelvic floor is more than just a set of muscles in the middle, benignly tightening to prevent incontinence. The pelvic floor is a dynamic sling of muscles that work in conjunction with surrounding hip musculature and abdominal cavity, as well as actively responding to the pressure of the diaphragm [the floor of our lungs]. Since Pilates focuses on the hips, core and proper breathing, these results [that Pilates is as effective as traditional pelvic floor exercises] do not surprise me one bit…The pelvic floor should not be isolated! It is part of an interconnected system of moving parts that must function together to function properly” (9).
It is this interconnectedness that brings us so readily into the world of Pilates and therefore into the integrative nature of the method.
“I am sure my… pelvic floor and core work was of great benefit in handling the operation but and also the continence management period (today is day 13 without catheter) and has been hugely successful with only very minor events on a sporadic basis…
I am certain the abdominal and core work were all helpful in the recovery and would hate to think how people who haven’t prepared would respond in any other way than shock to the system!). Not trying to dwell on the detail but I anticipate it could be helpful to understand the procedure.
Interestingly, I was also advised that even when nerves are not interfered with the actual shock of the region being disturbed can cause them to shut down. For example, without the side effects of constipation from pain killing drugs, the bowel effectively goes on strike for 2 – 3 days because of the disturbance and the nerves involved with erectile function, even when not touched or disturbed mechanically can take many months to recover (can be 18 months or more) and return to their pre-operative state, whatever that might have been.” Rob, aged 61, 2 weeks after his prostate surgery
The work of the Pilates method increases your awareness of postural alignment.
Imagine 3 spheres balanced on top of each other, with space in-between each one. Each sphere playing the part of the torso: head, chest and pelvis respectively. If we relate this sphere image to our slumping spine, then the middle sphere will be behind and out of line with the other two.
Imagine a canister in-between the spheres that creates length and space within the spheres. Space along the torso provides room for the joints to move more freely. The spine elongates and minimizes any holding, guarding or gripping patterns. Our lungs and internal organs are no longer compressed and compromised: we can breathe more freely and more deeply into our lungs and oxygenate our bodily tissues more readily.
It is this space and breath that connects us so intimately to our pelvic diaphragm. In respiration, the diaphragm of our lungs moves upwards in our chests to reduce the size of the lungs and causes us to exhale.
If we’re not breathing to our full capacity, chances are, our pelvic floor is not tramlining to its’ full capacity either and this poor breathing pattern will create a loss of mobility along the spine. In the Pilates method breath is the key to develop awareness and postural support and movement.
As the diaphragm moves down our chest, this increases the lung dimensions and therefore we inhale. If we are slumped and misaligned, the lung diaphragm is restricted in its’ movement and therefore we are restricted in our capacity to breathe. Our pelvic floor – at the very least – should mirror our lung diaphragm movement (10).
As Pilates practitioners we observe where the breath is moving and encourage and awareness and attention to areas of their lungs and ribcage they are not accessing to their full potential in respiration. Once this is achieved, we start to develop awareness and integrate the pelvic floor for full body movements.
I’ve mentioned two diaphragms (pelvic and thoracic) and these are also reflective of our cranial diaphragm and cervical diaphragm (tongue, soft palate). The knee joints i.e. our meniscus and bursa and the arches of our feet can also be considered diaphragmatic (11). We can really begin to appreciate the interconnectedness of the body systems.
A slumped posture or imbalanced posture has a direct implication on our Vagus nerve which plays the role in regulating the flight, fight response in the autonomic nervous system.
The vagus nerve begins approximately from our brains below our ears, down the sides of our necks, our chests and into our heart, lungs, thoracic diaphragm and digestive tract.
It runs from the neck as it runs parallel to the common carotid artery and internal jugular vein inside the carotid sheath  which is inside the thick rope-like muscles, you can see extending from your ears to the top of your breastbone).
The ideal head-neck-shoulder-chest alignment becomes even more important to allow this nerve to do its job freely and not be crimped or challenged by a faulty alignment.
It helps to prevent inflammation in the body by alerting the brain to any inflamed areas and instructs the brain to release anti-inflammatory neurotransmitters. It help us breathe and controls the heart.
It is the regulator of our ‘fight/flight/freeze’ response and helps to transmit acetylcholine which calms us down and it helps to create memories as it releases norepinephrine into our brain’s amygdala to consolidate our memories (12).
“Functionally, the vagal brake, by modulating visceral state, enables the individual to rapidly engage and disengage with objects and other individuals and to promote self-soothing behaviors and calm states…the vagal brake provides a neural mechanism to rapidly change visceral state by slowing or speeding heart rate”(13).
It allows our breath to be the vehicle to connect mind and body.
The cone of silence around issues for men who to suffer from pelvic issues needs to be lifted. The loss of or poor continence or sexual control through postural dysfunction and pelvic surgery can add to feelings of embarrassment and emasculation and ultimately be potentially deadly. Promoting a healthy, informative and experiential discourse should be encouraged for a full and active life.
Kegal exercises are the “Once upon a time” introduction to a larger story about pelvic and spinal alignment and the health of our pelvic floor diaphragm.
At Infinity Pilates Studio, we work together with each individual to bring awareness to the function and integrated nature of the male pelvic floor and how misalignment can contribute to dysfunction. The interruption of the flow of energy upwards from the feet impacts on the rest of the body. We create a safe and supportive environment to allow men to address their imbalances within their whole body.
It’s never too late to understand how strengthening and realigning your pelvic floor can optimize the lifestyle you want to embrace!
With an increasing complement of male clientele attending the studio, it’s great to see them sink their teeth into the various issues that are concerning them. To watch them feel empowered as they develop insight into how they use their bodies and experience the changes they are exploring in their bodies. This provides the means for a full and meaningful life and they are able to meet the challenges they experience every day.
Men, Pilates and Pelvic floor Pilates classes
See on our workshop page or register:
- http://www.thelifeisamazing.com/this-is-what-sitting-too-long-does-to-your body/
- Professor Eyal Lederman, The myth of Core Stability, CPDO Online Journal/www.cpdo.net, page 8.(http://www.cpdo.net/Lederman_The_myth_of_core_stability.pdf)
- To be advised…
Other Useful references/links…