Posture Must Be Consistent

Following my blog about Brianne Grogan’s Ebook, FemFusion Fitness for Intimacy, that highlighted healthy muscle relaxation, there have been some outstanding questions about what to focus on throughout daily activities.  If we know we need to strengthen our entire pelvic basket in our workouts, and we know we need to be able to achieve complete relaxation of these muscles when voiding and when lying down at rest, then what should our focus be throughout the remainder of the day?

The Answer is Posture!  And posture is positioning!  Let’s go back and review optimal postural positioning, highlighted in the Hab-It DVD and many of my blogs.

To obtain optimal posture, you should work to hold equal weight on each foot.  You want to have “soft knees,” meaning that your legs are straight but you are able to wiggle your knees a bit (i.e., they are not locked back).  Your hips and low back should be held in neutral spine, which means that you are not standing with your buns tucked under nor are you standing in a gymnast’s posture either.  Rather, you should hold your spine between these two extremes so that you have a slight lift of your tail bone and a soft lumbar curve.  To finish up through your spine, simply open up your hands.  This simple action is subtle but it has huge effects, because it rolls your shoulders back and, where your shoulders go, your head will follow.

If your focus is on optimal postural positioning, you put every muscle in your body at the perfect length/tension to fire as needed.  Re-read that statement.  Appropriate positioning puts just the right amount of tension in your muscles because they will be stretched to just the right length.  This allows them to fire efficiently before every reach, every push, and every pull.

What a focus on posture does not do is require a strong active contraction of our pelvic floor or pelvic basket.  We simply have to set their position.  Two areas of our body that I want to compare in this blog entry on positioning are our external rotators in our shoulders and our pelvic basket of muscles that stabilize our pelvis.

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Can My Rectus Abdominus Be Too Strong?

Below is a question posted in our “Ask Tasha” section of this website.  I wanted this question to lead into a blog entry because I had a lot to say about “quieting your Rectus Abdominus (RA).”

The question:  “I read all these posts from women and they just had babies.  I haven’t had a baby in 11 years.  I think it was me  working out my abdominals in the wrong way, building up my upper abs too much through tons of crunches that I was so hard in that upper region that I created my problem, sound logical? I only do the exercises you suggest now for my abs… It’s only been 8 months since discovery and only 7 months since I started doing the two-step Kegels and Hab-It DVD. I’m more determined than ever to keep working my TA and multifidi muscles… One more question, you mentioned I may be doing too much flexion in my routine not too sure what that means or includes can you please give me an example….”

I love this question because it is based on her own observations of how her body is responding to a change in her workout regimen.  Body awareness is ½ the battle!  She has taken notice of the way she is currently working her abs versus how she used to do it – and with that change, she is noting better control of her pelvic floor and entire core stability!  So awesome!!!

But old habits die hard.  We all love to work on muscles that feel strong and exercises that we are good at.  The problem with this is that those dominant muscles begin to jump in before the smaller muscles that act as stabilizers are able to fire.  This is called  firing pattern” and when we lose the correct firing pattern of stability before movement we have dysfunction, pain, and/or instability.

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Questions from You to Me: Frequency of Exercises and Standing Kegels

I had my first baby 9 months ago and was diagnosed with a Grade 2 Cycstocele and Rectocele.  How many times per week should I be performing each workout? Should I do all in one session or just one per day?  Also, I have a tough time feeling the kegel when I am standing – is this normal? I do see my TA pulling in a bit – is that right?

I like to see everyone work through the workout with the purpose of really slowing down and isolating the individual muscles of the pelvic basket.  The first two workouts do this – take your time, because often it can take a couple sessions to get full activation of the muscles and to quiet the ones that like to take over!  Once you feel good about your TA, mulifidi, pelvic floor, adductor, and hip rotator contraction, then you can move on to workouts 3 and 4.  The minimum workout requirement is 3 workouts per week, but if you choose to do one workout per day, that is of great benefit to you.  Beyond that, if you have time to complete more than one workout per day, my recommendation is to keep your 2-step Kegel reps to just 8-10 per day.  This means that if you are going to work through Workouts 1 and 2 on a given day, you would skip the 2-step Kegels on Workout 2.

On your question about the 2-step Kegel being more difficult in standing – Absolutely.  It is much harder in this position due to gravity, but obviously it is the most functional position.  You should see/feel your TA pulling in with your 2-step Kegel so it sounds like you are on the right track.  Perhaps you should perform your first four Kegels lying on your back and then stand for the last four.  This may ensure that you are working the right muscles.

Cardio Choices and how They Affect Your Pelvic Floor

Let’s talk about cardio.  I know there are a lot of questions about what women can and can’t do for cardio when experiencing prolapse and/or incontinence symptoms.  This happens to be a loaded question because the answer is dependent on your conditioning level, your over-all strength, and your symptoms of pelvic floor dysfunction.  So while I can’t give you any “definite” on what you should or should not do, I can provide some thoughts that may help guide you.

 

To begin, it’s important to have an understanding of all the muscles of your pelvic basket and how to activate those muscles.   Establishing a baseline strength of these deep core muscles through appropriate strengthening exercises is important before beginning any cardio.  When you begin with a solid base strength, you will continue to build on this strength as you introduce cardio, further decreasing your symptoms.  If you skip the base-building step, you will more than likely note increased symptoms with cardio activities.  With this understanding, we can move forward and discuss the positives and negatives of many cardio choices.

 

Let’s first talk about walking for fitness.  Walking is a fantastic activity.  However, I would like to give a few tips to make your walking better for your body and for your pelvic floor.  The first tip is to focus on your push off.  Feel your toes (your big toe especially) work to push you forward.  This simple change of focus will decrease your heel strike and decrease the force of impact of every step.  It also promotes hip extension and naturally lifts your chest.  You will feel like you are walking taller, which is a good thing!!!

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A Good Way to Start 2012 – Another Look at Posture!

Posture should be the subject of one out of every four blog posts I write because good posture is one of the cornerstones of successful pelvic floor rehabilitation.  Your posture affects your prolapse and incontinence every waking hour that you are standing or sitting.  Once you realize this, you can begin to understand the profound importance of mastering optimal standing and sitting posture.

 

There is a position in the physical therapy world called “neutral spine.”  This is a position where you hold a soft, natural “S curve” of your spine.  It is somewhere in between the extreme gymnasts posture that many women find themselves in, where their lower abdominals offer no support around the front side of their pelvis.  Or the other extreme of the flat back, “buns tucked under posture” where their tail bone is so tucked under that their entire pelvis is actually tipped from its natural position to a more vertical position.

 

To find your neutral spine, first place your hands on your hips and begin to rock your pelvis.  First rotate your pelvis so that you tuck your buns under as far as you can.  This is one extreme.  Now rotate your pelvis back, sticking your buns out like a gymnast.   This is the other extreme.  Now, from this gymnast position, draw your transversus abdominus (TA) muscle tight by pulling your belly button “up and in.”  You will note how activating this muscle rocks your pelvis back ever so slightly, softening the sharp lumbar curve, and pulling you back to neutral spine position.

 

I recognize that this is not easy.  We all have a tendency to get lazy and allow our bodies to be supported by locked joints.   This may be easiest, but the human body is dynamic and not meant to be in a locked position.  With this in mind, unlock your knees, unlock your pelvis, and open your hands up by rotating the palms of your hands to face forward.  All of these subtle postural changes engage muscles, open neural pathways, and increase blood and oxygen flow throughout our bodies.  This requires effort and constant awareness of your body.  Initially it will have to be a conscious effort to get in front of a mirror and find your own neutral spine.  Then, with consistent effort, neutral spine positioning will become your norm.

 

Now, let’s go through neutral spine in a sitting position.  To achieve this, you want to be in a position where your knees are slightly lower than your hips if viewed from the side.  This may require you to slide to the front edge of your chair so that your knees drop slightly.  You can also use this measurement in choosing the correct size swiss ball for exercise or for sitting at your work station.   By sitting so that your knees are slightly lower than your hips, you make it easy to roll forward onto your “sitting tripod” made up of your two sit bones and your pubic bone.  Note that your sitting tripod does not include your tail bone!  Your tail bone should be free from all pressure when sitting in neutral spine.  This makes the car and the couch the two toughest places to sit with good posture.  Optimal sitting posture is just that easy…find your tripod!  Once you feel pressure on your pubic bone, you are automatically in neutral spine.  This is simply positioning, not any muscle action at all.

 

So, now let’s talk about what neutral spine posture does specifically for our pelvic floor function.  We talked about neutral spine posture being a dynamic position, so it requires both our multifidi muscles within our low back as well as our transversus abdominus muscles, which wrap around the front of our pelvis, to be engaged in order to hold this position.  Our pelvic floor naturally co-contracts with these two muscles as our bodies’ deepest core stabilizers.  Also, our pelvic floor is now set at a perfect length, with just the right amount of tension to allow for the strongest contraction it can give.  If we stand with our tail bone tucked under, our pelvic floor is hanging way too loose and relaxed to respond with sufficient support when needed.  Also, if we are standing in a gymnast posture, then our pelvic floor is stretched beyond its functional limits and it, again, cannot provide sufficient support when needed.  However, when we are in neutral spine, with our tail bone in slight extension, then our pelvic floor muscles, stretching from our tail bone to our pubic bone, are at the perfect length/tension to give optimal support.

 

I hope this is useful information for all of you.  I can’t stress the importance of posture enough.  For many it may be the last missing piece of the puzzle that will lead you to greater improvement of your pelvic floor symptoms!

Neutral Spine Posture Is Not Easy…It’s Dynamic!

Neutral spine posture is a key piece of the puzzle when working to rehabilitate pelvic floor dysfunction. It is one of the three key components of a successful rehabilitation program and probably the hardest to comply with. Why is it so hard to follow through on neutral spine posture? For those of you who work hard to find and hold optimal posture throughout your day, you are well aware that neutral spine posture is a dynamic position. It is a position of free movement and balance between full extension and flexion of all of our joints. It requires muscular control versus the locking of joints or the tension of ligaments or tendons. This begins at our knees where we don’t want our femoral condyles locked in full extension on our tibial plateau, but rather just out of full extension in a position of free movement. This dynamic position requires coordinated firing of our quadriceps, hamstrings, and calves, to provide stability to our knee joints. This position is not as easy as locking our knees, but it is so much better for the health of our knee joints as well as our posture up the chain.

Next, we can look at our pelvis. It is easiest to either allow our pelvis and lumbar spine to lock back in full extension (anterior pelvic tilt) or to rock forward, resting on the tension of our hip flexors and ligaments (posterior pelvic tilt). Either of these two positions will set us up for injury through excessive compression of our lumbar vertebrae or pelvic/hip dysfunction. Rather than locking joints, positioning of the pelvis just out of the fully extended position allows free movement of the multiple joints of our pelvis, hips, and spine. Finding your neutral spine is key to maximizing blood flow and muscular control, setting the base for your thoracic and cervical spinal building blocks. This position of free movement of your pelvis and lumbar spine is not easy. Just like our knees, it requires a coordinated effort of muscles on the front and back side to hold this dynamic position. It is the co-contraction of our multifidi muscles, our transversus abdominus, and our pelvic floor muscles that help to stabilize our lumbo-pelvic girdle, setting the base upon which the rest of our spine is stacked.

Much like everything in life – if it seems too easy, it’s probably not right. Posture certainly follows this rule. It takes an awareness of your body and consistent reminders to hold neutral spine posture. You can refer to http://www.youtube.com/user/PTPartners#p/u to see and hear the cues that will help you find your own neutral spine. Let your posture be a focus by keeping your muscles “on,” and your body in a position of free movement. It’s not easy but the benefits are worth it!

Questions from You to Me: The TA vs. the RA Muscles

Is there a difference (in terms of which muscles are activated) if you pull your belly up and in as opposed to just pulling it in? In other words does the “up” do something different?

I use “up and in” because these actions help coordinate the pelvic floor elevation along with the transverses abdomius (TA) which is what we are trying to get back, since this is how the muscles should fire normally but have often stopped doing so due to childbirth, poor posture, etc.

As far as our abdominal muscles go, there is a clear difference between the transversus abdominus and the rectus abdominus and their functions.

In a nut shell, contraction of the rectus abdominus does definitely increase our intra abdominal pressure and press down on the pelvic floor. The transversus abdominus, however, tightens around our thoracolumbar region acting more like a vacuum or a compression stocking. If you perform a 2-step Kegel and tighten your sphincter muscles and then elevate your pelvic floor, you will feel your TA draw in with the elevation of your pelvic floor. Put your hand on your belly button and you will feel it draw away from your hand when you do the lift and hold. Once you become proficient at contracting your TA before overhead lifting, reaching, etc, you will feel the same connection to your pelvic floor. It will elevate as you engage your TA muscle.

Bottom line, you never want to see your belly pooch out when you contract the muscles. If you do, it’s the rectus abdominus being engaged. Instead, you always want to see your belly draw in when you contract muscles. When you do, you will know that you have activated your transversus abdominus.

Work Extension as You Walk

Oh how I love to talk about extension! It is so important to maintain the natural extension of our spine that I can’t help but talk about it again.

What does extension do for us? It lifts our ribs allowing us to take in a deeper breath, it allows for better shock absorption throughout the length of our spine, it positions our muscles at the perfect length to contract, and more. It is our job to maintain our extension as we work against the many forces that are pulling us forward into a flexed position throughout our lives. The force of gravity pulls us forward, the endless daily activities that are performed out in front of our bodies pull us forward, and don’t forget how most of us sleep in a curled up flexed position as well.

I have written about how swimming is a great extension activity, I have encouraged you all to lie for 5 minutes on your stomach each and every day, and I have written extensively about postural awareness helping to extend your spine throughout your day in both sitting and standing positions.

Now I would like to talk about how to get more extension when you walk. This is one of those simple adjustments that you can add to your daily walk outside or even as you walk around the house. It is as simple as exaggerating the push off phase of your walk. “Popping off your toes”. More than likely this will be a change from your normal walk where your heel strike is the dominant force that occurs as your leg reaches out in front of your body. Now, I want you to focus on a strong push off from the ball of your foot, especially your big toe, as your leg is extended behind your body. This simple change in emphasis will automatically decrease the impact of your heel strike and increase the muscle activity on the back side of your body. The beneficial muscles that will be activated include your glutes, your back extensors, your hamstrings and of course your calf muscles.

Give it a try today. This is one of those activities I encourage everyone to do. The teenagers with slouched posture will benefit, the new mom who is always cuddling her newborn will benefit, and men and women working to maintain their posture later in life will benefit. Exaggerate your push off and feel the difference!

Developing Pelvic Floor Endurance

I have been asked several times about the process of building up pelvic floor endurance, so I’ve decided to focus on this question in this blog entry.

Perhaps one of the most frustrating things we experience as our bodies work to gain better control of our pelvic basket is the increased symptoms with simple activities such as a walk around the block or a trip to the grocery store. Our first instinct may be to restrict activity. However, the reality is that doing so will only serve to further our deconditioning and exacerbate muscle weakness, thereby leading to increased symptoms with even easier activities. So, probably not surprisingly, my advice it to get out there and move! And, to help you do that, I want to share some of my favorite exercises that I remember doing.

However, before getting into the actual exercises, I want to briefly discuss the importance of giving our pelvic floor time to recover. Just like our bodies have to recover after a hard workout (e.g., with activities such as stretching, icing, rest, compression garments, and/or cross training), we have to be aware of what will help our pelvic floor recover following a long day on our feet or an exercise session that taxes our pelvic basket.

Some of us may have to give our pelvic floor opportunities to recoever several times a day, depending on our symptoms and how early we are in the process of regaining optimal pelvic floor control. For example, after my second and third deliveries, you could find me on the floor performing my multifidi extensions (described below) at least three times per day. I liked this exercise because it put me in a position of extension and, by lying down, it took gravity out of the equation. There was no pressure on the muscle fibers of my pelvic floor in this position and it allowed me to essentially re-set my pelvic floor support.

Some women note the same benefit from any exercise in the hands and knees position. Whatever your preferred position of recovery, it is important to recognize that your pelvic floor may need to re-set throughout your day. Get in a position that gives it some relief from the job of supporting your pelvic organs. This means that coming home from a long day on your feet and simply sitting on the couch with slouched posture is probably not your best option. Follow the instructions for my multifidi extensions as instructed below for a great approach to re-setting your pelvic floor.

Multifidi extensions (3 sets of 10 repetitions) – Position yourself on your stomach with your forehead on a towel roll to avoid having to turn your head to the side. In this position you will perform 10 contractions of your multifidi muscles (the very small muscles in between each segment of the spine that holds the natural curve or neutral spine). Simply rotate your pelvis, lifting our tail bone up toward the ceiling. The movement is very subtle so you shouldn’t see a big rotation of your pelvis. Remember to SLOW DOWN holding each lift for a count before relaxing and repeating.

I also wanted to include one of my favorite exercises that I often work into my daily strengthening routine that I feel has a similar benefit for me now that my pelvic floor is well past the early recovery phase. I call these standing hamstring extensions.

Standing Hamstring Extensions (3 sets of 10 repetitions) – To begin, stand with your feet approximately 6 inches apart with a slight bend in your knees. From this position, hinge at the hips tilting your upper body forward. Take care to keep the arch or “lordosis” in your lower back as you tilt your upper body forward. It may help to think of sticking your buns out. When you reach a point of hamstring tension, stop your forward lean and begin a set of 10 knee extensions, straightening your knees followed by small knee bends. Three sets of 10 repetitions will produce good passive tension in your pelvic floor as well as a good hamstring stretch.

I also want to refer you to Edgar Caycee’s site http://www.choosing-natural-health.com/hemorrhoids-cure.html which presents exercises aimed at controlling symptoms from hemorrhoids. I do like the exercise he demonstrates, reaching for the sky and then grabbing air as he bend from the waist and allows his arms to fall to the ground. It is due to my hamstring tightness that I altered this exercise and came up with my standing hamstring extensions as described above.

Good luck to everyone “re-setting” your pelvic floor!

Give Your Tail Bone a Lift!

Did you know that if you don’t extend your tail bone, your pelvic floor will never fire with optimal strength?  A tucked under tail bone takes our pelvic floor, which attaches at our tail bone and our pubic bone, and makes it slack.  And, over time, this loose muscle responds poorly and becomes weak because we are never able to fully activate all of the fibers because our two attachments sites are sitting too close together. 

If we extend our tail bone, giving it a slight lift, we put our pelvic floor muscles at the perfect length/tension ratio where it can fire all of its muscle fibers efficiently and effectively.

As a visual, picture a trampoline.  If the springs on that trampoline are loose and stretched out, the trampoline itself has too much slack and doesn’t respond with a good spring when you jump on it.  But, if those springs are tight, the trampoline is taught and gives you a good bounce with every jump.

Your pelvic floor needs solid springs to support your pelvic organs and to close down the pathway from your bladder to your urethral opening.  Our springs are our tail bone and our pubic bone, so we have to keep these attachment sites solid. 

There are two particular times in our lives when it is common to see these attachment sites begin to move closer together.  One is immediately after having our babies and through that first year or more when we carry our babies the most.  As we spend time sitting with our little ones, usually in a very relaxed position rolled back on our buns, our tail bone gets tucked under for a good portion of our days.  Then once we stand, we like to thrust our hips forward and our tail bone under to allow our baby to lay on our chest or to provide a hip or belly for them to perch on.

The second time in our lives when tucking our tailbone under is most common is around those menopause years.  Our spine slowly loses mobility as we age unless we work its full range of motion.  The most common postural change with age is to flatten out the curves of our spine, including our lower back and tail bone.  Remember, a healthy spine must have both flexion and extension to maintain good blood flow and prevent degeneration changes.  Throughout our years, every task we perform throughout our work day is in front of us pulling our spine, including our tail bone, into a forward flexed position.  Unless we actively work to maintain the extension of our spine with specific exercise, we are all coming forward, rounding our shoulders, and tucking our tail bone under, giving our spine the same curve as a turtle shell.

Think about this for a minute!  What do you do throughout your day to work the back side of your body?  Check to see if you are comfortable lying on your stomach.  This is a great starting point.  Then begin to work the multifidi extensions, the glute lifts, etc. from the Hab it: Pelvic Floor DVD to strengthen  the extensor muscles of your spine.  Because we all do so much work out in front of our bodies, it is important to do at least two extension exercises every day to maintain the extension in our spine. 

So for those of you who have been so diligent about working your pelvic floor muscles but have not bought into the importance of working the surrounding support muscles, you are selling yourself short!  The posture that we hold throughout the hours that we are either standing or sitting has a dramatic effect on our pelvic floor function.  As I  recommend on our Hab It: Pelvic Floor DVD, just 8 repetitions of endurance and short burst repetitions for your pelvic floor muscles every day is plenty, but I also stress that complete rehabilitation of your pelvic floor has to include strengthening of your multifidi muscles, your tranversus abdominus, your inner thighs, and your deep hip rotators.  Strengthening your entire pelvic basket is the key to resolution of your symptoms.  Good luck!

Mis-Information About Kegels

I recently read through two different sites with the bloggers writing about how Kegels are worthless.  If I could delete these entries just as quick as I read them, I would so that it didn’t cause any more confusion for all of you searching for answers.  Do I agree that pelvic floor strengthening has been over-simplified – YES!  But to say that you don’t have to do another Kegel is simply not correct.  Our pelvic floor is a muscular area with the ability to tighten on the urethra (the pathway from the bladder to our urethral opening in our pelvic floor) and to support/cradle our pelvic organs.  Not to mention the sphincter muscles of our pelvic floor which provide the second line of defense within our pelvic floor to control the passage of solids, liquids, and air from our bodies.

To say that we don’t have to and shouldn’t work this muscle makes no sense.  It has a neuromuscular connection to our transverses abdominus and our multifidi, working as our three deepest core stabilizers.  These muscles play a huge role in our posture and in maintaining stability of our lumbosacral spine, as well as controlling issues such as incontinence and prolapse.  So how do I believe we should work our pelvic floor for optimal benefit?

It starts with the ability to find and contract each of these muscles individually and then progresses to exercises where they all three fire together.  Let’s start with our transverses abdominus, then talk about our multifidi, and finish with our pelvic floor and the coordination of our deepest core stabilizers.

Our transverses abdominus (TA) wraps around us like a corset.  This muscle is able to stretch lengthwise to accommodate a pregnancy belly and still work to support our low back and pelvic floor.  Think of this muscle as the shrink wrap – the deepest abdominal layer that encircles your spine, extending down within your pelvis.  To activate this muscle, work to pull your belly button up and in.  The best exercise to start with to help find and activate your transverses begins on your hands and knees.  In this position, relax your belly, allowing it to hang loose.  When you contract your TA by drawing your belly button up and in, you will see your belly draw up from its relaxed position to a tighter position.  Keep in mind that you want no rocking of your pelvis when you’re in this position on your hands and knees.  If we rock our pelvis in order to hollow out our mid section, we will actually be activating our rectus abdominus which is not our goal.  So take care to keep your pelvis and low back in a locked position as your draw your belly up and in.

To find and activate your multifidi muscles of your low back, stand by a mirror so that you have a side view of yourself.  In this position, rotate your pelvis, giving a small lift to your tail bone.  Your multifidi are small muscles in between each segment of your spine that help to extend each of these joints and can lock you in neutral spine when your pelvic floor needs to pull on a secure anchor that is your tail bone.  You should see a slight lift of your buns in the mirror and a slight increase in the arch of your low back, but no other movement of your upper or lower body.  Work to isolate these muscles with repetitive, small extensions of your lumbosacral spine.

Our next step is to contract and elevate your pelvic floor muscles.  We have talked extensively throughout my blogs on how to activate every fiber of your pelvic floor muscles and we will review it all again now.  Your initial contraction is to squeeze your muscles as if to stop the flow of urine or the passing of gas.  The next step is to draw your pelvic floor up into your pelvic outlet as if there is a string attached from your belly button down to your pelvic floor and you are attempting to draw it up into a flattened, tighter position.  It is during this step that you will feel your belly button draw in, as you co-contract your transverses abdominus with your pelvic floor in order to elevate the muscle fibers.  It is these muscle fibers that tighten to elevate our pelvic floor that work as endurance muscles, cradling our pelvic organs and squeezing on the urethra before it reaches our urethral opening.  Working longer holds is appropriate for these muscle fibers, so tightening and elevating your pelvic floor, and continuing to pull up on that string attached to your pelvic floor for a full 8-10 count is your goal.  Then you can switch your focus to the sphincter muscles of your pelvic floor.  Remember, they squeeze the three openings within the pelvic floor tight so we want these muscles to fire quickly if needed.  To exercise these quick reacting muscle fibers, we can work them through “quick flicks” of our pelvic floor.  Following a long hold with quick flicks that are performed repetitively to a rhythm of “contract, relax, contract, relax, contract, relax, contract, relax”, will work all the fibers of your pelvic floor.  This combination of longer holds and quick flicks performed 8 times each day will keep your pelvic floor firing efficiently and effectively.

Finally, we change our focus to the coordination of firing our deepest core stabilizers (TA, pelvic floor, and multifidi) before every lift, every reach, every cheer, etc. We have just reviewed how to contract each of these muscles individually, but now the final step is to coordinate their actions.  Contracting our multifidi muscles, giving a slight lift to our tail bone and locking it in this position is important as our pelvic floor attaches to our tail bone and will pull against it.  If we don’t activate our multifidi muscles, our tailbone will move when we activate our pelvic floor, leaving us with a weak, ineffective pelvic floor and possible symptoms of incontinence and prolapse.  By finding our neutral spine, which requires us to activate our multifidi muscles, we ensure that our pelvic floor is pulling against a solid tail bone or anchor.  As we squeeze and elevate our pelvic floor by drawing it up into our pelvic outlet, we automatically activate our transverses abdominus.  Our transverses abdominus co-contracts along with our pelvic floor, displacing pressure up under our ribs as it squeezes like a cone within our pelvis.  This co-contraction of our TA and pelvic floor creates a stronger contraction of our pelvic floor muscles as it lifts the pressure off of the working muscle fibers.

So putting all of this together is the challenge that will lead you to optimal pelvic floor control.  Working to find neutral spine and performing a pelvic floor strengthening sequence while lying down, while sitting, and while standing as instructed on our Hab It: Pelvic Floor DVD is functional training of the deepest core stabilizers.  A progression of exercises as included on the DVD will train this firing pattern that will allow you to remain continent and in control throughout all of your daily activities!

A Closer Look at Our Transversus Abdominus

The transversus abdominus muscle (TA) plays a very important role in pelvic floor (PF) rehabilitation and function, yet most explanations for controlling continence don’t mention any exercises other than Kegels. Why is this? Have our media outlets failed us by over-simplifying the method of PF strengthening, leaving those who are following their direction destined for failure? I believe so. Today let’s take a closer look at this postural muscle and the role it plays in core stability and pelvic floor strength.

First let’s get a good visual of our anatomy (you can find a good visual here: http://www.easyvigour.net.nz/fitness/hpilatesintro1_2.htm ). The muscle fibers of the TA, or lower abdominals, encircle our abdomen and pelvic area, reaching around to the thoracolumbar fascia of our lower back. This area that our TA muscle encircles narrows from our waistline down within our pelvic inlet (the area bordered in the back by our sacrum and on the sides by our two pelvic bones.) The transverse fibers of our lower abdominals run around our waist and within our pelvic inlet like a corset or brace that we can cinch up by drawing our belly button in. This corset of transversus muscle fibers narrows like a cone, ending at the level of our pubic bone. As our TA contracts, this cone squeezes like a shrink wrap, displacing air and pressure upwards and providing more stability to the individual segments of our lower spine. I also like to describe this TA squeeze as a vacuum, helping to pull our PF up and our lower abdominals in tight, only to displace the pressure upwards to our expanding lower rib cage and chest. It is easy to recognize someone standing or sitting with the TA muscle engaged because their chest will be lifted making them stand and sit taller.

Now let’s focus on the role the TA plays in PF strength. It has been shown that the lower fibers of our TA muscle that lie within our pelvic inlet work closely with our PF muscles, which span the base of our pelvis. Some preliminary studies have even shown that there may be a direct connection of some of the fibers of the PF and TA. Whether or not this is proven to be true – one thing we do know is that these two muscles work together as the deepest contraction, the first stabilizers, as the root of our core. (You can also include our multifidi muscles in this deep contraction but we will talk about those segmental stabilizers on another day).

You can feel this intimate connection between your pelvic floor and your TA as you perform pelvic floor elevations. When doing the two-step Kegel that I teach on the Hab-It: Pelvic Floor DVD, you will begin to feel how your TA is activated every time you work to draw your pelvic floor up into your pelvic outlet. Conversely, you can also feel your PF contract every time you work to draw your TA in while holding neutral posture. Studies have shown an increase in contractile force of our TA and PF muscles when activated together vs. contracting individually. This paints a clear picture that we need a strong TA firing along with our PF muscles to achieve optimal strength gains and efficient firing of our pelvic floor. Complete resolution of incontinence or better control of our prolapse symptoms can not be expected if we don’t have both these muscles firing together.

Now that we know the importance of our transversus abdominus muscle, how do we strengthen it? The easiest way to identify and begin TA strengthening is in a 4-point kneeling position (i.e., knee and then place your hands on the floor, right underneath your shoulders). Initially as you start, I recommend you be in front of a mirror, positioned so that you have a side view of your belly. To begin, in the 4 point kneeling position, drop your back down to a “flat back position” and relax your belly, allowing it to hang down with the pull of gravity. From this position, draw your belly up to a tighter position without rounding or lifting your back. The side view you have in the mirror will be great visual feedback; you should see your belly draw up as if you are cinching up your midsection, being careful to maintain your flat back position throughout. Lifting your belly and holding for a 5 count, 3 times each day is a great start to finding and “waking up” your TA.

Once you become aware of your TA you can begin to activate and draw this muscle in tight when you sit down at your computer, when you stand in the grocery line, as you drive your car, etc. I recommend you use a mirror to view the cinching up of your midsection in sitting and standing positions as well to ensure that you are working the right muscles.

Some other helpful tips:
• You should be able to continue with a regular breathing pattern while holding your belly in this drawn in position.
• You should see no movement of your back when you activate your TA. If your buns tuck under then you know you have activated your rectus abdominus instead of your TA. Remember, your belly should draw in with no movement of your low back.
• You may feel a tightness in your low back as you contract and hold your TA in. This is because of the attachment of the TA to the fascia of your low back and the co-contraction of the multifidi muscles of your lower back that also work to hold neutral spine.

To close this blog, I want to stress the complex rehabilitation of the pelvic floor. “Do your Kegels” should no longer be the very simply message going out to those suffering from incontinence or prolapse symptoms. The truth of the matter is that strengthening our pelvic floor and changing our symptoms requires knowledge of finding and holding your neutral spine in sitting and standing, strengthening of your TA and other coordinating muscles of our abdomen and pelvis, as well as a thorough, two-part, Kegel contraction. Continence will come with consistency!

“Bad” Abs vs. “Good” Abs

Let’s talk abs for a bit. Did you know that you have different kinds of abs that perform very different actions? There is the rectus abdominus, which are our 6-pack abs, that start just below our sternum and run down to our pubic bone. It is the rectus abdominus (RA) that people are talking about when they say, “check out his/her abs!” The true function of our RA is to curl our spine forward, bringing our ribs closer to our pelvis. Everytime we contract our RA, we compress our abdominal and pelvic cavities, increasing our intra-abdominal pressure. This increased intra-abdominal pressure can wreak havoc on our pelvic floor, on hernias, on hemmorrhoids, and on varicose veins on the lower half of our bodies. So, that rectus abdominus may be better left for looks, because the negatives of overusing this muscle definitely out weigh the positives.

We also have our internal and external oblique muscles, which run in a diagonal pattern on both sides of our midsection. I group the oblique muscles with the rectus abdominus because they also flex our spine forward (and rotate it to one side or the other). Our obliques, along with our rectus abdominus will tend to push our belly out, an obvious sign of increased pressure within our abdominal and pelvic cavities.

Now let’s talk about the good abs – our transversus abdominus (TA) or lower abs. These abs wrap around our lower abdomen like a back brace or a corset. Our transversus abdominus muscle draws our lower belly up and in acting like a compression stocking for our abdomen and pelvis. It puts a firm grip on our lower spine, providing a good anchor of stability for all of our other muscles to pull front, back, and side to side. This muscle may also increase our intra-abdominal pressure but it doesn’t press down on our pelvic floor. Rather, it displaces the pressure upward under our ribs. Our TA actually works in coordination with our pelvic floor muscles, and these two muscles naturally draw up from the bottom and draw in from the sides to give us the most stable base we can ask for with all the joints of the spine.

So, how do we work our abs properly to maximize the health of our lower back, upper back, neck, hips, and pelvic floor? Certainly, full sit-ups and crunches should be a thing of the past. A crunch is not our worst enemy if done properly, by drawing in your TA before contracting the rectus and curling up, but few people are able to perform this correctly without direct coaching, so it’s best to avoid doing them all-together if you are trying this on your own.

How do we strengthen our transversus abdominus? The easiest strengthening tool for this muscle is to use it throughout your day. This means that whenever you think of it, just draw your belly button up and in, pulling everything in like a vacuum from the bottom, up. CAUTION: This does not mean that you tuck your tail bone under to draw your belly in toward your spine. On the contrary, your back should not move from your optimal posture or neutral spine that we have talked about at length in several of my previous blog entries. Rather, use your muscle, your TA, to draw your belly button up and in. You will feel how this tightens up your lower abdomen. You will also feel the pull in your low back as the TA wraps around to attach to the thoracolumbar fascia and co-contracts with your multifidi muscles to hold that spine right where we want it. As you get more comfortable with this TA contraction, you will also feel your pelvic floor engage or “turn on,” drawing to a more flat position automatically without any effort from you.

Although the frequent activation of our TA throughout our daily activities is probably the best method to strengthen your TA, sometimes focused activation with specific exercises is the good way to start until it becomes second nature. Below, I have 4 exercises that will get you started.

1.) Hands and Knees Transversus Abdominus Lift. Position yourself on your hands and knees,relaxing your upper and lower back down until you achieve a flat back position. In this position, draw your belly button up and in as if hollowing out your mid section.

If you have access to a mirror, a side view will allow you to see the muscles activate to draw your belly up into a tighter position with no movement of your back. Again I want to emphasize that this should not involve any movement of your back, just your midsection cinching up as if being tightened by a belt or a corset. Hold your abdomen drawn up and in for a full 5 count, while continuing with a steady breathing pattern before you release.

2.) Quadriped TA Lift: In a 4-point kneeling position (meaning, on hands and knees), with elbows slightly bent, pull your belly button in toward your spine and lift your knees, ever so slightly off the ground. The subtle lift automatically activates your TA. Two keys to remember: 1. Keep breathing! 2. Just clear the ground with your knees. If you lift too far, you will flex your spine and activate your rectus abdominus.

3.) Plank holds – Posting on bent elbows and knees, keep your body straight by tightening your abdominals and glutes, pulling your bellybutton toward your spine. Hold this position for 30 seconds, being careful to not let your back sag. You want to work up to 2 minute holds, with any kind of a back ache being your cue to stop the hold. Once you can hold for 2 min.utes, progress to posting on your elbows and toes and again increase your time as you are able.

4.) Straight leg raise with hip external rotation – (3 sets of 10 repetitions) Lying on your back with one knee bent, point the toe of your straight leg and rotate your foot out. Pull your bellybutton toward your spine and place your hands on your lower belly to feel that your belly does not push out as you lift your leg. Tighten the top of your thigh, and slowly lift your straight leg up until it is even with your bent thigh. Hold for a two-count and return to starting position and repeat.

So after you have time to absorb all the information I have given above, let’s just simplify for a minute. Throughout your day, as you engage your transversus abdominus, you always want to feel things drawing in and lifting upward. If you at any time feel a pressure down on your pelvic floor or you feel your belly push outward, you need to stop and reset your abs.

Is Exercise the Fountain of Youth (Part II)

So, is exercise the fountain of youth??? It may be the closest thing we have to it. Lots of things change throughout our lives including our cars, jobs, and houses, but our bodies are the one constant that is with us for the long haul. We can’t trade it in or upgrade it so taking the time to learn about how we can keep our engine running smoothly with appropriate nutrition and exercise is worth it. I don’t plan on going in depth on nutrition, but anyone with direct questions is more than welcome to ask by posting a comment on the blog, and I will be happy to answer your questions. No one can deny that our food choice has a profound effect on our energy levels and overall health as we age.

Physical activity also has a profound effect on our engine, so much so that it can help to maintain our cardiovascular system, our mental health, and it can prevent or control symptoms like osteoporosis, arthritis, prolapse, and incontinence. Why are we all so willing to take multiple pills to control all or some of these symptoms when we can simply learn specific exercises to control them?

Let’s start with osteoporosis which is defined as “the reduction in mass of bone per unit of volume, interfering with the mechanical support function of bone.” It is said that this bone loss begins after the age of 25 and speeds up after menopause. How do we prevent it? With resistance exercise! Find a physical therapist near you who can teach you appropriate strengthening exercises for your legs, arms, back, and appropriate postural strengthening exercises. Some of these exercises can be as simple as squats at the kitchen sink, shoulder blades squeezes “down and in,” as well as resistance training for your upper and lower body using your own body weight, tubing, or hand weights. Bottom line: Resistance exercise can help prevent osteoporosis.

Arthritis is defined as “inflammation of a joint.” Arthritis can cause significant stiffness and pain, but don’t let it scare you. The best way to fight arthritis is to move the joint to flush out the inflammation and increase circulation. Out with the old, in with the new! Arthritis will cause you to be stiff and sore in the morning or after prolonged sitting but you have got to keep working the joint to prevent the inflammation from just sitting there. Warm showers in the morning improve circulation and blood flow, and exercising throughout the day to move the joint is important. A physical therapist can show you how to strengthen the muscles that support the joint to prevent excessive wear and tear. One the most common mistakes I see among patients with arthritic knee(s) is stopping squatting down or avoiding stairs because it hurts. The avoidance will only serve to further weaken the knee joint as the muscles supporting the knee are no longer worked. Rather, performing controlled squats with weight on your heels, not going past a 90 degree knee bend may control, if not improve your knee pain.

The next two conditions of incontinence and prolapse can also be controlled with an appropriate exercise program. Specific exercises are presented clearly on our Hab It: Pelvic Floor DVD which provides physical therapy guidance through four separate workouts aimed at helping strengthen pelvic floor and support muscles. Let’s talk about prolapse and incontinence, two very common conditions experienced with increased age.

Prolapse, “the falling or dropping down of an organ,” is often described as a heaviness within one’s vaginal opening or a feeling of “lack of support”. The prevalence of prolapse symptoms in women post partum and perimenopause is staggering. The numbers seem to be increasing as women are talking more openly about their symptoms and looking to do something about it. Can you believe exercise can control this as well? Picture our organs – your bowel, bladder, and uterus – suspended by ligaments and cradled by our pelvic floor muscles. The organs are being pulled down by gravity our whole lives and then hormone changes that occur with pregnancy and menopause, as well as the trauma of childbirth, can change the ligamentous support for these organs. That leaves our muscles to hold everything in place. A physical therapist or the Hab It: Pelvic Floor DVD can show you several exercises and appropriate postural alignment to help support your pelvic organs to prevent or improve your prolapse symptoms.

Incontinence is “the involuntary loss of bowel or bladder control.” Did you know that an estimated 20 million women experience involuntary urine leakage? This is no small problem. A few simple exercises every day could resolve a great number of these cases and could improve many others. A women’s health physical therapist in your area or the Hab It: Pelvic Floor DVD can coach you through a specific exercise routine to strengthen the appropriate muscles. Exercises will include drawing your pelvic floor up into your pelvic outlet and holding it for endurance as well as short, quick contractions; strengthening your lower abdominals (transversus abdominus) while drawing your pelvic floor up toward your belly button; and also strengthening the support muscles of your deep hip rotators, your lower back and your inner thighs.

Specific exercise programs for all of these symptoms (osteoporosis, arthritis, prolapse, and incontinence) are like regular tune ups for your body. I don’t want to pretend that the solution to any of these problems is simple. You have to be a student of your own body and commit to regular exercise routines to reap the benefits. No one can do it for you. The reality is that you are the driver and you want your body’s engine to run as smoothly as possible for as long as possible. To do this, tune ups are required along the way!
(All definitions taken from Taber’s Medical Dictionary)

Revisiting the Belly “Pooch”

I decided to revisit the belly pooch topic because I was fielding a lot of questions regarding how to keep the muscles of our midsection engaged while sitting.  I made such an effort to describe appropriate standing posture but, given that many of us spend a lot of time throughout the day sitting, it seems I left out some important information – sitting posture.

 

My comment on the previous “belly pooch” blog was that the posture you hold throughout your 24-hour day plays the biggest role in shaping your midsection.  If you sit for the majority of your 8-10 hour work day, you cannot sit back on your buns and tail bone with a rounded back and rounded shoulders and expect to look tight and toned the minute you stand up.

 

So how exactly do you sit with appropriate posture and engage your core muscles? The first step is to get to the front edge of your chair.  If you have ever been coached to scoot your buns back in your chair and then work to press your back against the seat back, “sitting up straight”, please forget everything you have been taught.  The problem with this is that it is far too much work and you will fatigue and go back to a slouched/slumped posture because it “feels better”.  The reason why this is too much work is because your hips are at the same level as your knees.  When your hips and knees are at the same level or if your hips happen to be lower than your knees – such as in a car – you have to work to overcome your hamstring tension that rounds out your lower back.  Remember, a healthy low back is a back in neutral spine with the natural lordotic curve, not a flat back or rounded back.  So the key is getting your hips higher than your knees when you are sitting.  Most office chairs are adjustable, so simply sit to the front edge of your chair with your feet on the ground and pay attention to your hip height vs. the height of your knees.

 

The second step is to roll forward onto your “tripod.”  Your tripod is made up of your 2 sit bones and your pubic bone.  If you roll forward on your tripod, your tail bone is actually lifted as it is supposed to be and free from contact on the chair.  If you are rolled back on your buns or feel any pressure on your tail bone, you are not in good sitting posture.  You will know that you have found your sitting tripod as long as you feel pressure up front on your pubic bone.

 

Once you find your tripod sitting position, your body will automatically be in neutral spine with a natural lordotic curve of your low back.  The best part is that as long as you are on your tripod, this position requires no extra work from your muscles.  You will notice that when you are in this position, you sit up taller, taking your midsection out of the slumped posture you are usually in.  With your midsection stretched out and your chest up, you can now focus on engaging your transversus abdominus muscle to draw your belly button in, essentially tightening up the corset around your neutral spine.  It is this conscious effort of engaging your transversus abdominus that will gradually improve the tone of your belly pooch. 

 

To finish your posture up through your shoulders and neck, simply open up your hands.  Making sure your thumbs are pointing up throughout your day (you never want to look down and see the back of your hands) will ensure your shoulders are open and where your shoulders go your head will follow!

 

So a quick review of appropriate sitting posture:

1.      Sit to the front edge of your chair with hips higher than your knees

2.      Find and sit on your tripod

3.      Engage your transversus abdominus

4.      Open up your hands

 

Initially following all of these steps will take a conscious effort but, if you are consistent, it will become an unconscious habit.  Not only will it help your belly look better, but you will feel better, take in more oxygen, reduce the stress on your back, shoulders, and neck and, who knows, maybe you’ll be more productive throughout your work day!

Workout Review: Insanity DVD

I promised a review of the Insanity workout DVD, which I am happy to provide, but I do want to state that this workout has a significant amount of jumping and squatting.  In order to safely complete this DVD with a compromised pelvic floor, you have to be very aware of your body positioning and have established a good mastery of your three deepest stabilizers.  Within this review I provide substitutions for the exercises that I identify as having poor postural positioning or that place excessive stress on the pelvic floor.  This review is in response to a specific request and is not intended as a recommendation of this DVD for all Hab It or Advanced Program subscribers.

I view any opportunity to review an exercise regimen as a great opportunity for me to teach you how I work my way through new workouts and eventually, with some minor adjustments, am able to make any workout a pelvic basket strengthener.  To do this, you first need to recognize if an exercise is too stressful for your pelvic floor.  You will know that it is too stressful if you feel a significant downward force within your pelvic outlet.  Examples of exercises that create a significant force on your pelvic basket are those that don’t allow for much shock absorption, such as jumping jacks (your legs remain relatively straight), running in place, high knees, or butt kicks (no forward lean, so the impact is straight down), mummy kicks (again, your legs remain straight so there is minimal shock absorption), and switch kicks (because you are landing in a posterior pelvic tilt instead of having neutral spine).

In other instances, exercises may be too stressful on your pelvic floor if you find yourself in a short breath hold as you complete the exercise.  This breath hold action blows down significant pressure on your pelvic floor since you recruit your RA during exertion which locks your ribs down.  This leaves only one direction for the increased intra-abdominal pressure to go and that is down.  If you cannot complete an exercise while breathing out throughout the most difficult parts of the exercise, then it is too advanced for you at this time and you need to strengthen that muscle group through a different exercise before trying it again in a couple of weeks.

Keeping these thoughts in mind, let’s look specifically at the Insanity workout.  Beginning with The Fit Test:  The  power jacks are good because you shock absorb as you land in a squat with an extended tailbone.  Power knees are fine.  Power jumps are good because, again , you land in a squat with tail bone extended.  Globe jumps are good because you land in a shock absorbing squat.   (Note- when squatting or jumping with your landing absorbed in a squat, be sure your weight transfers to your heels and you sit back into your squat while keeping your chest up.)   Low plank oblique is a good test of your transversus and quadrates lumborum.  On the other hand, I would avoid the switch kicks because of the posterior tilt of your pelvis and substitute plank hold mountain climbers for this exercise.  Both these exercises work hip flexors as well as cardio.  The final two exercises on the fit test are suicide jumps and push up jacks.  Both of these exercises are fine depending on your fitness and strength levels.  If you breath -hold at all during these exercises, adjust to make them more appropriate for your fitness or strength levels.

Plyometric Cardio DVD

The entire warm up is not great for your pelvic floor.  Knowing this, you can get your body warm through treadmill running, biking on an indoor trainer, and more.  I would work your warm-up as he does through 3 progressive steps of increased intensity.  For example, if you choose to bike for the warm up you may begin at a certain level of RPMs, then increase that level for the next round, and your final round may be a series of seated and standing sprints.

All the stretching is good for your body as long as you continue with a steady breathing pattern throughout.  Moving into the main part of the Plyometric Cardio DVD, there are four exercises for which I have substitutions.  The standing mountain climbers are tough because you are working high knees while running in place.  You can substitute plank hold mountain climbers for this exercise.  Also, the Switch Feet exercise is tough on your pelvic floor because your legs stay straight and don’t absorb any shock.  I love to substitute lunge jumps for this exercise, taking care not to let my knee-bend go past 90 degrees on the front and back leg when I land in my lunge.  The football quick feet drill is tough on your pelvic floor as well.  I like to substitute a prone exercise (lying on my stomach), tightening my buns and TA to work a hip extension flutter kick with my toes pointed.  Then, as he instructs to shuffle right , I plank on my right side and work my left leg abduction until he says move left, at which point I switch to a left plank and perform right leg abduction.  For every other command I am on my stomach working either arm flutter overhead while holding a tight core or a leg flutter, also holding a tight core.  Finally, the Cross Jacks at the end of the cardio DVD can be changed to plank to side plank rotations to avoid yet another exercise where you are jumping up and down with relatively straight legs.

Cardio Power and Resistance DVD

My recommendation is the same on this DVD.  Go ahead and substitute a solid warm up of your choice, since running in place creates a lot of vertical force on your pelvic floor.   The one exercise that I substitute on this workout is the hurdle jumps.  My adjustment is to substitute a squat in between every hurdle jump instead of the fast feet.   Every other move on this DVD, which is a lot of squatting, is great as long as you are squatting in a “tail bone extended” position, that is chest up/butt back and weight on your heels.

Cardio Recovery DVD

There are no recommended adjustments to this workout.

Pure Cardio and Cardio Abs DVD

Again, I recommend you create your own warm up, finishing with high intensity effort to get your heart rate up.  The other substitutions on this DVD include:  Substitute mountain climbers for Switch Kicks.  Substitute lateral shuffles, down in defensive basketball position, for Football Sprints (you can also add your 12 inch band around your ankles for this drill).  Substitute Power Jacks for Stance Jacks.  Substitute lunge jumps only for the Sprints and Lunges exercise.  Substitute Hooks and squats for Hooks and Jumps.  Substitute plank hold mountain climbers for Standing Mountain Climbers.  And finally, substitute a Prone (on your stomach) hip extension flutter kick with toes pointed for Switch Kicks.

I recommend you choose any of the plank exercises within the Advanced Program on our Hab it site in place of the Cardio Abs workout.  You can follow his same timing to switch up exercises, alternating between any bridging and plank exercise on our program.

Core Cardio and Balance DVD

This DVD has so many substitutions, that I often work through the Plyometric Cardio DVD in its place.  If you would like to try to work through the exercises, here are the recommended substitutions:  Substitute Bridge with Single Leg Extensions for Switch  Heel Kicks.  Substitute Prone hip extension Flutter Kick for Mummy Kicks.  Substitute Lateral Band Shuffles for Football  Shuffles.  Substitute squats for the Fast Feet following Log Jumps.  Substitute Standing straight leg raises and Power Jacks for High Knee and Power Jacks.  Substitute Squats/Hooks for Fast Feet/Hooks.  Substitute Plank Hold Mountain Climbers with Deep Pulse Samari Squat for Switch Kicks with Hop Squat.  Substitute Single Leg Squats for 4 x 4 Hops.

Max Interval Circuit/Fit Test DVD

Again I would recommend creating your own warm up to get your body moving and heart rate up.  After the warm up, I recommend that you substitute plank hold mountain climber/lunge jumps for Pedal Power Lunges.  Substitute Lateral band quick shuffles in a 90-degree squat for Football runs/Cross Jacks.  Substitute Swiss Ball slalom for High Knee Obliques.  Substitute Quadratus Lumborum side planks for Side Suicide Jumps – a bad exercise because of the forced breath-holds and compressed position with your ribs close to your pelvis.

Max Interval Plyo DVD

Again, create your own warm up for the given warm up time on this DVD.  One of the first exercises, the Pogo, is a great exercise for you to work balance, but simply eliminate the single leg hop.  Also, on the Power Pushups, do not do this exercise if you have to breath-hold.  I am unable to complete this without a breath-hold, so I simply work the push-up followed by a R/L/R/L mountain climber.  And finally, eliminate the jump with the knee drive on the Kick Stand Touch the Floor drill.

Max Cardio Conditioning and Cardio Abs DVD

Again, create your own warm up.  Looking at the Football Runs – substitute quick side lateral shuffles down in defensive basketball stance for the Fast Feet portion of this exercise.  Substitute prone hip extension flutters for Standing High/Low Sprints but continue with his instructed plank hold mountain climbers in High Knee/Low/Floor Sprints.  On the Squat  Twist exercise, just don’t hop your feet in and out.  Skip the fast feet on the Forward/Back Suicides.  Substitute standing  rapid hip extension (hands on wall, chest up, rapidly extend your right hip back with slight bend in your knee, holding your TA tight so that it is pure hip flexion and no lumbar extension.  Repeat on same leg for number of jump rope repetitions.  Switch to next leg on next repetition) for jump ropes in 8 Jump Ropes/8 Hop Squats.

The Cardio Abs workout is not recommended.  Instead, I recommend substituting any Advanced Workout plank–and-bridge exercise in alternating pattern for the same duration as this Cardio Ab Workout.

Max Recovery DVD

This workout has no substitutions.

Remember, the Insantiy Workout Program is intense.  Listen to your own body.  You may find that some exercises that I did not list, have a negative effect on your pelvic floor.  Be your own best trainer and make adjustment according to how your body feels.  This is not a workout for everyone – be smart in your workout choices and remember to cycle on to high intensity workouts and back to stabilization.

Maximizing Blood Flow = Healthy Pelvic Floor

There have been several questions lately in our “Ask Tasha” section that highlight the importance of maximizing blood flow to the muscles of our pelvic basket.  I tend to be in a “Go, Go, Go!” mind set most of the time and my blogs and workouts reflect that.  However, a recent E Book called FemFusion Fitness for Intimacy made me take a deep breath and realize the importance of “letting go.”

Brianne Grogan, a fellow Women’s Health PT, has done a great job in this book to highlight the importance of releasing the tension within your pelvic floor muscles.  She talks about her own personal journey and this book highlights her focus and plan that helped her restore control over her pelvic floor.  Similar to my story, she brings personal and professional experience to pelvic floor rehabilitation that can be so powerful.

She talks about how “chronic tensing or clenching of any muscle does not allow the muscle to rest and recover from exercise or activation.  This can lead to muscle fatigue, and in some cases, muscle spasm and pain.”  She stresses that we all must “learn how to relax muscles so you can effectively and efficiently control them.”

Maximizing blood flow to your pelvic floor by learning how to not only contract the right muscles, but also to allow them to relax, can help to improve incontinence symptoms, prolapse symptoms, low libido, and pain with intercourse.

If you want further evidence of the power of increased blood flow to the area, simply try Briannes’s Core Breathing and her Pelvic Rocking paired with this breathing technique.  Feel for yourself the difference this increased relaxation and increased blood flow to your pelvic basket makes. Just try it lying down since you are completely relaxing your pelvic floor.  This is my favorite section of her book because I felt like it added something more to the exercises I was already doing!

Her book highlights three sections:  Relaxation, Fitness, and Intimacy.  I love how Brianne addresses intimacy and sex in a way that allows you to visualize the muscles involved.  She takes a topic that can be hard for some women to discuss and helps you to recognize healthy activation of the pelvic floor muscles.  She talks about the importance of your inner core (TA, pelvic floor, multifidi) and not just the outer core (rectus abdominus and obliques) that everyone can see.

When I read the book, I immediately recognized the added benefit of her relaxation section to a thorough pelvic rehab program and I very much appreciate her professional angle on sex and intimacy that even the most bashful reader can digest and work with.

Although Brianne and I differ slightly on core strengthening moves, I respect that she has seen great success with her program as a whole and she is now sharing it for the benefit of all women.  I appreciate Brianne’s professional commitment to progressing the general public’s knowledge of women’s health and I highly recommend her Ebook, Lady Bits.  It is a great read.   One that you can revisit over and over to remind yourself to snap out of the “to-do list” mentality.  You can find Brianne’s book at http://www.amazon.com/Lady-Bits-Understand-Elevate-Naturally/dp/0692464514/

It’s available in paperback and ebook form. In the paperback version of Lady Bits, the relaxation section is in Chapter 21. Specific pelvic floor release visualizations and exercises are described from page 264 through page 273 (including the “pelvic drop” practice).

Starting Fresh

Welcome back to everyone and to me!  I took some time with my family this summer and some time away from my blog, but as school starts, so does my return to regular blog entries.  As the summer comes to an end and we get the kids started within a new school year, it’s a great time to establish a new routine for ourselves.  I love summer because it leads to so many spontaneous workouts for me as I chase my kids around.  But the fall is great too because it brings us back to structure, and since our kids are all starting something new, why shouldn’t we?

Now is the perfect time to set goals for yourself and change up your workout routine – as a matter of fact, let it be your goal to change your workout routine every season.  This is a great way to continue to challenge your body.  Will this fall inspire you to set a goal of strength, endurance, agility, or power?  Ask yourself these questions.  You havet 3 months of great outdoor workout time before winter hits, so use those limestone trails and open fields wisely.  How will you challenge your body this season?

Remember, we must continue to challenge our muscles, our tissues, and our bones to keep them strong.  If you are a runner or swimmer or biker and you go the same pace and the same distance every day, you are certainly making your body more efficient, but at some point you reach a plateau and no longer benefit from “the same.”

“Different” may come in the form of shorter, higher intensity workouts, or more focus on strength and stability exercises.  You can also try new activities like water jogging with an aquatic belt if you are a swimmer, mountain biking if you are a road cyclist, TRX on those nice fall days, or snow shoeing or cross country skiing as winter descends upon us.

We all need to continue to challenge our bodies and our pelvic stability so that we remain strong and IN CONTROL!

The Positive Side Effect of Pelvic Floor Weakness

The positive when facing any challenge can be what you learn along the way.  So what can you learn through the process of regaining control of your pelvic floor?  To begin, you immediately learn about the root of your body.  The pelvis and lower spine form the base of your skeletal system upon which all other building blocks are stacked.  You also learn that there are muscles that enclose the front, back, sides, and floor of your pelvis and lower spine that provide the deepest layer of stability to your body.   Recognizing the importance of each of these muscles that enclose your pelvic basket and how to activate them is the basis of modern day training for injury prevention, helping achieve a balanced body as you age, and training for peak athletic performance.  No matter what your goal, it all starts within the root of your core.  Be thankful that through your prolapse you have found all of these muscles and can now activate your deepest layer.

 

What else do you gain as you work your way through pelvic floor rehabilitation?  You learn about neutral spine posture, both in sitting and standing positions.  Beyond that, you develop an understanding of the attachment sites of muscles and the advantages of holding your muscles at the perfect length and the perfect tension.  Neutral spine posture does this for you. How awesome that you not only have learned how to find and hold neutral spine but also that you feel the difference it makes in supporting your  pelvic basket.  Without even knowing it, this same neutral spine posture is preventing future back problems, neck problems, shoulder problems, and more.  It allows you to take in deeper breaths with greater rib/lung expansion, it allows for maximum blood flow and nerve conduction, and it limits joint compression forces that can increase dramatically throughout our body when we shift from our neutral spine posture.

 

So thank you pelvic floor weakness!  We all now know more about healthy muscle activation and posture than we ever did before!
Now that’s positive 🙂

Own Your Body

Nobody knows your body better than you.  Every woman’s body is different, so it is your responsibility to learn what works for you and what doesn’t.  Take the time to learn what makes you feel healthy, energetic, and strong.  What foods, what exercises, what activities will help you feel good?  It will be different for all of us, but developing a confidence in your own ability to take control is the final step in pelvic floor rehab.

 

You can develop this confidence by 1) Reading more of my blog entries, and asking questions to help you better understand;  2) Self exploration of your own anatomy to truly understand the anatomy you are seeing in books and on the internet;  3) Trying different exercises and deciding for yourself which ones you feel the most and which ones have a positive effect on your pelvic floor symptoms; 4) Staying consistent with what works.  If you are consistent, it is easy to identify the variable that may be responsible for a temporary increase in symptoms at any given time.

 

With this recipe for success you are setting yourself up for a great feeling of control.  It’s a wonderful feeling to know that you understand your body.  I want to close this blog with a couple links that highlight women who have found this understanding.  You can feel the strength and the energy from these women.  Take the time to click on the links below and fast forward to the comments following these blogs as great examples.

 

http://prolapsehealth.com/forums/topic.php?id=1031

http://hab-it.com/blog/?p=293

http://www.hab-it.com/?topic=great-improvement