Pilates and prolapse

[Gloria]

Hi Tasha I wanted to ask your opinion on doing reformer pilates with a bladder prolapse. I have been told that the majority of positions on the reformer are “safe” but I wondered in particular above an abs exercise that involves raising both legs and the aim being to sit in a V position…I wondered about how safe this is in terms of prolapse and also the pressure on the rectus abs…

[Tasha Mulligan]

Gloria,
I strongly discourage any activities that recruit the rectus abdominus until you have worked your way through the Advanced Program and have mastered recruitment of your transversus abdominus and pelvic floor.

Any double leg lowering activity will force pressure down on your pelvic floor. It requires too strong of a contraction of your rectus abdominus, locks your ribs down and the pressure has only one direction to go.

As I work my way through various programs, like Insanity, various yoga and pilates classes, and more, I am always very aware of any flexion work. Try all these exercises with caution and listen to your body. Most flexion activities that bring your ribs closer to your pelvis will force significant pressure down on your pelvic floor – as will a breath hold that can happen if an exercise is too difficult for our strength level.

Train smart for your OWN body!

Tasha

[Gloria]

Hi Tasha, thank you so much for your reply and I have taken your advice on board. I wanted to ask you a question regarding your DVD which I have only recently discovered and started using faithfully! My question is a basic one about the kegel contraction – you describe it as a 2 part contraction where you first pull your pelvic floor up to effectively a flat position, and then the 2nd part you describe as zipping up from your pubic bone and I’m not sure I am getting this part. Does this 2nd part mean contracting your TA? If this is the case, does contracting the TA not place downward pressure on the pelvic floor? Sorry for these basic questions but I just wanted to make sure I am doing these exercises completely correctly as I have never been told about anything other than pulling up the pelvic floor for a kegel contraction. Many thanks

[Tasha Mulligan]

Gloria,
The 2 part Kegel starts with contracting your pelvic floor as if you want to stop the flow of urine and the second step is to draw your pelvic floor up within your pelvic outlet as if there is a string attached from your belly button down to your pelvic floor and your continue to pull it up through 8 counts. I may have also offered “zipping up” as another description to give another visual of what you want your pelvic floor doing. This elevation, drawing your pelvic floor up as if a string is attached from your belly button down to your pelvic floor OR zipping up is a descriptive command to help you get your transversus abdominus co-contracting with your pelvic floor. This is key to a successful rehabilitation!

Remember your transversus abdominus (TA) funnels down within your pelvis, narrowing in circumferencde as it approached your pubic bone. This funnel shape allows the transversus abdominus contraction to force pressure up under your ribs rather than down on your pelvic floor. You can visualize this if you think of it like a snow cone. You can’t squeeze the snow cone too tight or the ice will pop right out of the paper cone. Your TA acts the same way with intra-abdominal pressure and this is why a co-contraction of your TA and pelvic floor are so important. These two muscles work together against anything locking your ribs down (rectus abdominus and obliques).

Hope that clears up your visual.

-Tasha

[Jenny Murphy]

I have a question also about bladder prolapse. I really want to train as a reformer pilates teacher, however I have a stage 3 GU prolapse after the birth of my son two years ago and want another child so can’t have the repair operation yet. I don’t how many of the excersises are potentially damaging for me or if this is even something that’d be possible at all for me while I have the prolapse. Being a reformer pilates Teacher really is something Is love to do and don’t want to wait for the operation before I begin to train. Do you think this I can do with a prolapse and if so what to avoid…

[Tasha]

Jenny,
I would encourage you to read through my Educate yourself section, specifically my High Intensity Exercise topic where I review lots of workout moves and give recommended modifications. A thorough understanding of your Rectus Abdomens (RA) firing vs your Transversus Abdominus (TA) firing is very important for all of us health nuts. Things in Pilates like 100s and the double leg lower kick in the RA without question and would be a no-no.

I would never discourage you from becoming a teacher, but you want to arm yourself with as much information as possible. Who knows, maybe you will be that teacher that provides modifications or has a keen eye for an unwanted RA recruitment which means that exercise is beyond that clients level.

Tasha

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