Pilates and the Pelvic Floor
By: Paul Schembri | 19/09/2013
Throughout a Pilates session, a client will invariably hear the cue to “pull up” or “lift” their pelvic floor muscles; or to “draw their tail bone to their pubic bone,” or to “squeeze your sit-bones together”: These are all cues designed to find a deeper, internal sensation of work and support for the various challenges applied to the torso as a client moves through all their healthy/appropriate ranges of motion.
But what IS the pelvic floor? How do we know if we’re using the correct musculature? How does it support and help – not only one’s Pilates practice – but ALL of our movements and activities in our daily lives? Often, we are not fully aware of our pelvic floor until it lets us down somehow. Or we are asked to find work, connection and awareness in that area and we rise to the challenge and discover the varying degrees of muscular activity and potential…or fall humbly short.
In our western culture, the discussion and exploration of this pelvic area is generally fraught with taboo, censorship, sexual overtones and/or restriction. Societal ‘niceties’ insist that one generally doesn’t discuss such a topic over the office water cooler or family dinner gathering! As a result, many people are confused by what working their pelvic floor actually consists of and there is much misinformation floating around. Add to that all that is associated with the pelvis: urination, defecation, sex and childbirth – all intensely personal, private and individual matters – we can begin to appreciate how misinformation can persist and/or the area be ignored.
So let’s clarify a little what the pelvic floor is not and some other misconceptions.
The term ‘Pelvic floor’ does not mean you are going to push or press your pelvis into the floor. You do not even need to get onto the floor to work these muscles, as they can be worked (or found) in a seated position, standing, on all fours, or whilst lying on your front, side or back. The pelvic floor is also an area that your instructor would never directly touch, opting instead to verbally cue the required work, or to touch surrounding areas to focus your attention and assist muscular activity there. It is also not just a “woman’s thing” – men have a pelvic floor too and it is just as important for them to develop awareness, strength and flexibility there as it is for women, to ensure continence control, minimise hernias, and to achieve stronger erection/ejaculatory control.
So how do we find our pelvic floor? Let’s start with the bones. In a seated position, rock your body from side to side a few times and feel how your sit bones alternately press into your chair. Now (keeping the body still) place one hand on your pubic bone and the other hand on your tailbone. You have now just defined and identified a diamond shape using these bony landmarks. If we divide this diamond horizontally, we get two triangles: the Urogenital triangle (right sit bone – pubic bone – left sit bone – the ‘front triangle’) and the anal triangle (right sit bone – tailbone/coccyx – left sit bone – the ‘back triangle’). Together, they form the pelvic diaphragm and sit within this bone-diamond structure and support the viscera i.e. bladder, intestines, the uterus (in women) and also helps with continence functions with the urinary and anal sphincters.
Now, how do we work the pelvic floor? Often, people are advised to interrupt their water flow when going to the toilet to help identify these muscles (also known as the ‘stop-test’) however it is not recommended as a long term/regular exercise in and of itself. This awareness can be then layered with ongoing visualisations/imagery of stopping the water flow and holding in wind at the same time. The muscles around the front and back passages should lift and feel like they are lifting/squeezing up inside the pelvis. Then, it is important to relax these same muscles, creating a sensation of letting go (not pushing or bearing down). Many people can confuse this internal squeeze action with the external actions of their gluteals and may tuck or curl their bottoms under, shortening the length of their torso and/or holding their breath. If done correctly, there is no ‘obvious’ bodily movement, save for the internal lift/squeeze sensation and perhaps a drawing in/narrowing of the lower abdomen (and a visible lift/sensation of lift of the scrotum in men) and the breath cycle is still normal.
Once the pelvic floor muscles have been identified and a degree of conscious control is experienced, a sense of endurance then needs to be developed. This can be done by holding the squeeze for longer (5 – 10 seconds) followed by a release and/or doing quick contractions/releases: both exercises can be done a number of times throughout the day. Remember, if you’re having trouble with these exercises, try doing them in some of the different positions mentioned earlier (seated, standing, on all fours, lying on your back, side or front).
Once awareness and endurance has been developed, the next step is integration into one’s daily activities, especially within a Pilates session. The pelvic floor muscles are part of the core stability ‘trinity’ (the transversus and the multifidus muscles being the other two). A general rule of thumb when it comes to integration within one’s Pilates session is to work the pelvic floor as much as you can (for the given exercise) yet as little as you need (to discourage overwork/gripping or bracing patterns).
To work well and efficiently, these muscles need the ability to not only contract, lift and tighten but also to relax and soften. Constant ‘bracing’ and not allowing the muscles to relax can create stiffness in these muscles which can create other issues of incontinence, pain or discomfort in the pelvic area, or possibly the prolapse of pelvic organs. Many factors can contribute to pelvic floor problems: pregnancy and childbirth; constipation; over/under-working the pelvic floor; being overweight; heavy lifting, persistent coughing or sneezing and also aging in general. It is also possible, depending on the contributing factors, to develop asymmetries within the pelvic floor (some muscles within the pelvic diaphragm may engage more readily than their mirrored counterpart) and these may need to be addressed by your instructor. In such cases, or if there are further problems with activating pelvic floor, you may need to be referred to a continence professional who can assess your pelvic floor and create an individual pelvic floor training program.
Infinity Pilates is also a registered studio with the Pilates Alliance of Australasia (PAA). The PAA (www.pilatesalliance.net) is an independent and not-for-profit organization established by the Pilates industry as a regulatory body for control of quality instruction, member support and integrity within all legitimate approaches to the Pilates Method. It is a strong non-biased regulatory body that represents a broad range of styles and stipulates a firm educational underpinning for membership and encourages the public to look for well educated and holistic Pilates Practitioners/studios. Highlighting educational standards in Australia for Pilates Professionals is of paramount importance and all of Infinity’s Instructors have as a minimum qualification, a comprehensive ‘Diploma of Professional Pilates Practice’ in conjunction with the studio’s PAA registry.
Websites Consulted www.wikipedia.org www.med.umich.edu/bowelcontrol/patient/teaching/male_kegels.pgf www.thewomens.org.au