Pelvic Floor Dysfunction: Move Over Kegals, There’s a New Exercise in Town
According to physical therapist Dr. Pauline Chiarelli, pelvic floor problems can affect one in three women. If you come to see us for advice on rehabilitation and help with an injury, you’ll quickly notice that we ask questions that are not only related to your current concern, but also questions about your general health. We do this for various reasons; We’re doing this primarily so we can put your current concern into context, but it also allows us to see if you’re having other issues that you might have thought were “just normal.” When we ask these questions, our clients frequently mention some form of pelvic floor dysfunction that they have just learned to live with.
Is pelvic floor dysfunction more of a female problem than a male one? The scientists, Ireland and Ott, say that the male pelvis is denser and that the bony part of the pelvis is generally smaller in diameter, allowing for quicker coordination between all the muscles. This density combined with the smaller area means that the male pelvic floor is less likely to become dysfunctional. In contrast, the female pelvis is less dense and wider, as the bony structure is designed to house and deliver a baby. This means that the female pelvic floor is more susceptible to decreased strength and coordination between the pelvic floor muscles.
How is your pelvis supposed to work and why do people have problems, for example incontinence? In normal posture, the pelvis should be tilted forward, allowing the pelvic bones to support internal organs, muscles, ligaments, etc. In women, the bladder is supported by the pubic bone in the forehead, which, in turn, creates support for the uterus. A large proportion of troubled women stand with a posterior pelvic tilt and diminished lumbar spinal curvature. This puts more pressure on the pelvic floor by removing bony support from the bladder and uterus and creates pelvic floor problems. The good news is that this can be avoided by learning how to move your pelvis correctly… I will discuss a little later how to correct pelvic floor problems with exercises that are much more complete than Kegal.
When looking at the muscular support of the pelvic floor it is helpful to look at other muscles involved in its proper function: the abdominals, the muscles of the spine, the hips and the respiratory diaphragm. These muscles function as a functional group. For example, as the respiratory diaphragm contracts, it lowers, drawing air into the lungs, as it lowers, it causes the organs below to move downward. This increased pressure in the abdominal cavity gently presses on the pelvic floor causing a harmonious movement between the diaphragm and the pelvic floor. The pelvic floor assists in lumbopelvic stability (Markwell 2001) along with the muscles of the lower back, hips, and abdominals. Anatomically there are also connections; one of the hip muscles, the obturator internus, and part of the pelvic floor, the levator ani, are connected by a common tendon, the arcuate tendon. This means that if there is restricted movement in one or both hips, perhaps from arthritis, tight muscles, or even ankle injuries, part of the pelvic floor will also be affected.
So is it more than just the pelvic floor muscles? Due to the interconnected nature of the pelvic floor and the muscles of the lower back, hips, and abdominals, we always look at the “pelvic nucleus neuromuscular system” or PCNS for short. This term was originally coined by my friends and colleagues, Christina Christie and Rich Colossi, physical therapists specializing in pelvic floor dysfunction. By taking this approach, we can determine if current pelvic floor issues are actually being maintained by other things, such as poor posture, faulty breathing patterns, or even something as far away as an old ankle injury. Physical therapist Gary Gray argues that for the pelvic floor to function optimally, all the structures of the PCNS must be subconsciously integrated. For example, you don’t have to think about strengthening your leg muscles to keep from falling, it just happens, and that should be the case for your pelvic floor as well. You shouldn’t have to consciously tighten your pelvic floor to prevent leaks, it just should happen.
What is pelvic floor dysfunction?
It can take many forms, including but not limited to pelvic pain, pelvic organ prolapse, anal incontinence, and urinary incontinence. Urinary incontinence can be subdivided into three categories:
- stress incontinence– involuntary loss of urine with increased intra-abdominal pressure, for example, a sneeze or a jump causes a small loss of urine.
- urge incontinence– the urge to empty the bladder with only a small amount of urine.
- Frequency incontinence –urinating more than eight times in twenty-four hours.
So what is normal? Generally, you should urinate every two to four hours during the day and zero to once at night (although pregnancy temporarily increases the incidence of urinary incontinence).
Are there any other problems I may have due to pelvic floor dysfunction? When we talk about urinary incontinence, it is worth noting that the loss of control and coordination of the pelvic muscles puts pressure on other structures in the body. Many people don’t realize that back pain, sacroiliac dysfunction, sciatica, knee pain, and ankle sprains could stem from dysfunction of their PCNS and vice versa.
What is an effective way to correct these problems?
Due to the highly integrated nature of the PCNS with the rest of the body, it doesn’t make sense to continually isolate it and rely on exercises like Kegals. That would be like treating knee pain caused by limping due to a sprained ankle. The ankle should be treated first, otherwise the knee pain will keep coming back. That said, there are circumstances where specific pelvic floor work like Kegal is helpful, but if you can, it’s more beneficial to strengthen the pelvic floor in an integrated way.
So what do we recommend to strengthen it? To create an environment in which the pelvic floor and its functionally related muscle groups (diaphragm, lower back, hips, and abs) work unconsciously, we need to exercise the body in all three planes of motion using the arms and legs to ” boost”. ‘ or move the body to create a specific load for the entire complex of functionally related muscles.
Step aside from Kegals! Introducing the Pelvicore Exercise Ball… This simple device was developed by physical therapists Christie and Colossi to help their patients get faster and better results from the exercises they were doing. It consists of a small inflatable ball that is placed between the knees and an elastic strap that goes around the thighs keeping the ball in place. Strengthening the hip muscles becomes easy when using the pelvicore ball because if you step to the side, all the lateral hip muscles have to work against the resistance of the elastic strap and when you step back , all medial/adductor muscles work against the pressure of the ball. Depending on your skill level, pelvicore ball exercises can range from simply sitting down and slowly spreading your legs apart and then bringing them back together to exercises involving squats, lunges, and reciprocating hand thrusts. These are full body exercises that engage all aspects of the PNS from the ankle to the neck.
Try this exercise suggested by Christie and Colossi:
The pivot shift matrix of the pelvic-hip complex
- See if you can balance on one leg for about 10 seconds, if you can continue, if you can’t, practice that before trying this.
- Start with the most successful side, in this example we will stand on the right leg and move the left leg through space
- Sagittal plane:Stand on your right leg and swing your left leg back and forth, do so with control, repeat 10 times.
- Front plane:Still with your right leg, bring your left leg as far to the left as you can and then lightly touch your toe to the ground, being careful not to put weight on it. Then return to the middle, pause and bring the left leg to the right across the body in front or behind, gently tap the toes to the end of the range, repeat 10 times.
- Transverse plane:Again, on the right leg, twist your whole body to the right by pivoting on your right hip, once you’ve gone as far as you can, twist to the left by gently touching the ground with your left toe if you lose your balance, repeat 10 times.
- Repeat all of the above on the other side.
Whats Next? If you thought you were resigned to doing Kegal exercises for the rest of your life, now you know there are alternatives that may work better for you. Clients often ask us what they can do at home to help prevent problems from coming back. The pelvicore ball provides a simple and easy to use exercise program that can be done at home to exercise the
PCNS correctly. We are the only provider of the pelvic ball in Western Canada. We are sure that for one in three women who suffer from pelvic floor problems, this offers them the opportunity to become stronger and more flexible. What a relief not to be afraid of the familiar accidental leak that can all too easily happen when the pelvic floor isn’t working properly!
Chiarelli, P. 2002. Waterworks for Women: Curing Incontinence. Wallsend, New South Wales; George Perry.
Christie, C., & Colossi, R,.2010. Paving the way for a healthy pelvic floor: Ignite the Pelvic Core Neuromuscular System with triplanar movement and functional education. Idea Fitness Magazine.
Gary, G., & Tiberio, D. 2010. Seminar. Chain reaction transformation. The Gray Institute.
Ireland, ML and Ott, SM 2004. Special Concerns of the Female Athlete. Clinics in Sports Medicine, 23(2), 281-98.
Markwell, SJ 2001. Physiotherapy treatment of pelvic/perineal and perianal pain syndromes. World Journal of Urology, 19(3), 194-99.