Hab-it Exercises Forums Ask Tasha! Update & Questions

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  • #765
    Sarah K
    Guest

    Hi Tasha-

    I went to a urogynecologist on Friday. She diagnosed me with cystocele grade 2 and rectocele grade 1. I was given a referral to a local PT who specializes in POP. My first session with her is June 4 th. I have been doing Hab It about 5 times a week. About twice a week I do two of the workouts. I have a few questions…

    Is the order of exercises important? I know with heavier lifting (squats , cleans, snatches, etc…) our strength coach insists on an order. Is it okay if I mess up the order? I was doing them without the DVD while we at our beach house over the weekend. She evaluated my kegel strength at. 2/5. Obviously, I have some work to do. I really don\’t like \” scoring\” that low, but know it will take time to get better.

    Is it okay to mix in some exercises for workout 1 with #2 or #3? There are some that I really enjoy but don\’t always have the time to complete the entirety of both work outs.

    Posture- this is the biggest challenge for me. It is a constant thought and I feel like I am making minor adjustments all day long. This is actually what is causing me the most fatigue and biggest challenge. My question is – is there eve a time to just sit back and relax? At the end of the day once all 3 kids are in bed I want to just curl up on the couch! Is this okay or should I force myself to sit properly bc I am still early PP (5 weeks). Is it beneficial to always focus on spilling in my TA?

    Stretching- is it okay to do stretching, too? I\’ll stay away from yoga until I have completed at least 5-6 weeks of your DVD, but can I just stretch? I\’m pretty tight at the end of each day.

    Sleeping position – is there a postion you recommend? In a normal setting I sleep on my stomach but haven\’t been for a while bc of pregnancy and now BF\’ing. When I lay flat on my back I almost feel like I am pushing the prolapse forther out. We have a Tempurpedic mattress so you just sort of mold into it.

    My symptoms are less than before. I Had one day when I didn\’t feel my cystocele symptoms at all. A small, but welcome, improvement. I suffed from lower back, hip and groin issues fora long time and did a lot of your exercises in rehab. Of course, once I felt better I stopped doing them. Hopefully a life long commitment to these will help fix up a few of my other issues, too

    Thanks in advance for all of your help.

    Sarah

    #767
    Rebecca
    Guest

    My question has to do with the performance of Kegals. i have read and am practicing Kegals by lifting, squeezing and pulling up all three areas, the urethra, vagina and sphincter areas, but it sounds like from what I read here that you suggest stopping the flow of urine activity and puling up the TA muscle. Is this correct and if so why the not contracting of all the areas?

    #770
    Tasha Mulligan
    Guest

    Sarah,
    Let me roll through your questions. You can do the exercises in any order. My goal was to engage all the muscles of the pelvic basket in each workout, so if you do these on your own without the dvd in front of you (which is great!) then just think through pelvic floor, TA, multifdi, inner thigh, and hip external rotators. Hit each of these atleast once and you are good.

    On your posture question – it is a constant work in progress. I find myself making minor adjustments in the grocery line, in my car, etc. Remember the posture I am asking you to hold is a dynamic position. You can’t lock back in any joint – neutral spine posture requires muscle activation. It will gradually become your “normal”. Believe me this is of great benefit to you now and in the future for injury prevention and you won’t shrink as much as an old lady 🙂 This being said, allow yourself to just let go and relax on the couch at night – Absolutely! This will not set you back. You can sit or lay for an hour or so at night without worries that you are doing harm to your body. One of my favorite things to do at night is to lay on my stomach. This is such a great position to stretch all those flexion muscles that have worked throughout the day and to help stretch your spine into slight extension.

    As for stretching – absolutely. This is only positive for your body balance, blood flow, nerve conduction, and more so go for it.

    Sleeping position is up to you. You are not at the mercy of gravity when you are laying flat so sleep however you are comfortable. I seem to move around a lot at night. I also like my stomach, but recognize this isn’t the best position for my neck, so I spend time on my back, side and stomach. The physical therapist in me needs to point out the importance of alignment of your legs when you are on your side. Avoid having one leg pulled up higher than the other to avoid rotation of your spine at night. This is key for back pain or SI joint patients.

    Finally, you are right that all of these exercises should have been included in your low back rehab. These are your deepest core stabilizers and are key for pelvic stability, low back stability, and for rehabilitation of groin, hamstring and more. Hopefully your journey through pelvic floor rehab will be of greater benefit to you than you ever expected!

    Tasha

    #771
    Tasha Mulligan
    Guest

    Rebecca,
    My instruction of stopping the flow of urine was simply my attempt to give a visual that would best help women contract the sphincter muscles of their pelvic floor. The figure 8 sphincter muscle around your urethral opening and your vagina cannot be distinguished in separate contractions, but your anal sphincter can. I would NOT recommend a focus on squeezing this anal sphincter because often the result is also a tucking under of the buns and tail bone and that is exactly what I don’t want. The “stopping the flow of urine” contraction doesn’t seem to produce this same tendency to tuck under so I like it.

    This contraction is step one to be followed with step two, which is pulling your pelvic floor up into your pelvic outlet. It is this action that will draw your belly button up and in as well as you note the all important co-contraction of your TA and Pelvic Floor.

    Hope that helps clarify.
    -Tasha

    #772
    Rebecca
    Guest

    Thank you Tasha your information is helpful and I appreciate you being candid. I have been reading and looking all over your site learning more and trying to do the neutral posture for a few days. However now my concern is that when I try this neutral position I can literally feel the bulge coming down in my vagina area. That does not seem good to me. I know without seeing me you can not tell if I am doing it correctly, but I have tried to follow your instructions to the letter and it still happens. I am thinking that something is wrong or that my bodies problem will not respond positive to the neutral position. What can you tell me? I am trying to decide by reading here and studying if I should purchase your DVD, would really like to. But purchased another one from the WW site and feel it was money that was wasted. Very cautious here.

    Thanks again for both answers to my previous posts, so helpful.

    #774
    Tasha Mulligan
    Guest

    Rebecca,
    I understand your caution, you definitely got burned on your last purchase. Take your time and continue to read. As for your posture…you aren’t getting to where you need to be. You should feel your prolapse lift slightly when you find and hold neutral spine posture. Where do you normally find yourself when you are not in neutral spine? Do you tend to stand with your buns tucked under or in a gymnasts hyperlordotic posture? Give me some feedback on this and I may be able to coach you through a couple of cues that you are missing.

    We also have the posture education section of our dvd up on our PTpartners YouTube channel. You can watch it at http://www.youtube.com/watch?v=hcTEUKp7zsY&list=UUiJkhaape5HgBDnv7qXgoaQ&index=5&feature=plcp

    -Tasha

    #776
    Rebecca
    Guest

    Thanks for replying I am sure you are very busy lady. I believe I have it figured out the neutral position. I was literally focusing on pulling in my belly button area and I recognized that made the bulge feel nearer to the surface. I have figured out that when I use my TA muscles and pull up and contract from the lowest part of my stomach area , I pull up without any bulging signs. Learning to pull up and contract the TA muscles seems to be working for me. Such a relief to me!! I am a 64 year old woman, mother of 8, and feel very blessed to only now have this problem. I feel for all of you ladies out there that are young with these issues but seems to me that Tasha’s therapy is working for an old body like mine, you young girls have a great chance of success.

    As an experiment I started today to do your exercises on Youtube such as LB- Bridge with ADD Squeeze,LB- Quadraped Leg Extension and LB- Quadraped Spinal Flexion. Will do these for a few days and see what happens. Hopefully these are all safe for my pelvic floor.

    Thanks again Tasha for your time, effort and interest in all of our health. Getting closer to the DVD.

    #777
    Tasha Mulligan
    Guest

    Rebecca,
    I’m glad you made the subtle change required to feel how neutral spine posture will HELP your prolapse. The UP portion of the transversus abdominus contraction is very important in the “up and in” cue. I also really like your added visual of pulling from the lowest fibers of your TA. This makes sense and I will add it to my verbage.

    Also, the low back exercises that you will follow on YouTube are all safe for your pelvic floor. Remember no breath holding with any of these exercises, perform all in neutral spine, including sitting on your sitting tripod (neutral spine) for adductor squeezes.

    You are on your way to great progress!

    Tasha

    #780
    Sarah K
    Guest

    Hi Tasha,

    I just had my appointment with my PT. I guess I was expecting more and was slightly disappointed. I did do bio feedback and it was helpful to watch the screen as I did my keels and note how my body felt when I was doing them correctly. She did tell me my pelvis is not in line, my right leg is higher than my left. I have heard this in the past with previous injuries. She said I need to fix that with stretching for the most improvement for my pelvic floor. Other than that, she told me to do 100 ten second hold keels a day and come back in two weeks. we did talk about neutral spine and she made sure I was contracting my TA properly.

    Needless to say I will be continuing your workouts and just adding more kegels on days I do not do Hab It.

    Question for you about breathing. I have to watch the DVD again, but I thought your instructions were to suck my stomach in while inhaling and let it relax while exhaling. I remember thinking that because it is opposite if all the hypnobirthing breathing i did while pregnant. Am I correct? This PT advised me to inhale while pushing my stomach out, exhale and lift my diaphragm and do the kegel.

    Do you mind clarifying your thoughts on this?

    Thank you!

    #782
    Tasha Mulligan
    Guest

    Sarah,
    I am sorry about your PT appointment. Hopefully your PT will be working very “hands on” with you to correct your SI rotation to help correct your leg length discrepancy – you should expect this. If you have been told about this leg length in past treatments, it is unlikely that stretching on your own will correct this.

    Second, I disagree with the direction to complete 100 Kegel contraction each day. That is old school, and you will be better off to perform just the 8-10 two step Kegel that I teach and then add in more adductor squeezes, multifidi lifts, and/or an extra plank exercise. It is not just your pelvic floor that is weak, it is your entire pelvic basket that needs to be re-trained.

    Finally, on breathing. You are describing diaphragmatic breathing. This is a great relaxation technique, but should only be performed lying down with the goal of increasing blood flow to your pelvis and the muscles that support it. I can’t stress enough that this is a relaxation technique. For those of use needing extra pelvic stability, we are holding our TA with activity, co-contracting for extra pelvic organ support. Holding your TA and holding neutral spine allows for maximum chest expansion. So while exercising your thoughts should be to inhale with chest expansion and upon exhalation, your TA should draw in even further. You are right, this is different than hypnobirthing because, during delivery, in order to breath your baby out, you are focus on complete relaxation of your pelvic floor. With this you are using the draw down of your diaphragm on inhalation as a gentle, natural downward forces moving your baby down(belly breathing, not chest breathing). As your baby moves low enough within the birthing canal, then your exhalation, which naturally recruits your TA, further applies a gentle downward pressure, like squeezing a tube of toothpaste, guiding your baby gently through the birth canal.

    Keep in mind everything works hand in hand. Your neutral spine posture keeps your chest elevated allowing for maximum chest expansion on every breath. And your TA stays engaged on inhalation and exhalation to hold the bottom of the “snow cone” tight, working along with your pelvic floor during activity.

    -Tasha

    #839
    Sarah K
    Guest

    Hi Tasha,

    Thanks for the response. It makes total sense. I am looking for a new PT, but may just continue your dvd and then use the athletic trainers at my work to help with my SI rotation.

    I am now 9 weeks PP and see definite improvement! It is very encouraging. I am taking things very slowly which is a bit bothersome, but better safe than sorry. I do your DVD about 5 times a week. On most days I do two of the workouts. I plan on getting the advanced workout next week. I have started walking slowly, too. I find it completely boring, but don’t want to push too hard, too soon. I plan on going back to yoga this week. I am going to a gentle yoga class and will talk with my instructor about my situation.

    The improvement I see is great compared to where I was 6 weeks ago. I find it difficult to feel so great one day and two days later have the return of my symptoms, but some good days are better than none!

    Thank you again, for your insight and DVD. I feel like I have long road ahead of me, but do not feel like I will never be the same again.

    Sarah

    P.S. It is a small Hawkeye world. My old teammate and roommate told me that you tutored her during our freshmen year! We have some mutual hawkeye friends, too. Go Hawks!

    #847
    Tasha Mulligan
    Guest

    Sarah,
    I can’t believe they let me tutor anyone!

    As for your recovery, you are taking a very mature approach – don’t rush things. I like that you are easing your way into it. You are walking, which is great. Really focus on posture while walking – read my blog “Work extension while you Walk” and really focus on your push off. You will carry this same focus on your push off into your running eventually. Your other challenge will be projecting your voice as you coach. This is a tough one to do without bracing which can force pressure down on your pelvic floor. You will work your way through this, but it will take some experimenting to hold your TA. The Advanced Program is highly recommended to get the most out of your TA for these higher level activities and I’m glad it is on your list.

    Finally, lets stay in touch on your SI rotation and apparent leg length. Sometimes, even with correction, your stabile SI position won’t hold. If this manifests as hip pain or low back pain, it will effect your pelvic floor function as well. Let the trainers work their magic and continue to check your leg length often and see where you are.

    -Tasha

    #928
    cyn
    Guest

    Tasha.. I have loose SI ligaments and a number of other problems in the hips that I’ve been working on for years (without resolution PT and on my own)
    Does this have consequence for the pelvic floor attachment and control?

    I would like to ask if you would say Anusara yoga’s posture for the pelvis is what you have in mind
    Anusara’s first postural adjustment starts with the pelvis. I think the instructions are very much like your postural instruction on the DVD.
    They say: Begin standing…tilt the pelvis bucket top forward so the lumbar is curved in the back..securing femurs secure in hip sockets, then pull up the muscles of the floor starting at the coccyx> pubic bone and upward lifting the pelvic floor * maintaining * a neutral curve for the sacrum.

    #930
    Tasha Mulligan
    Guest

    Cyn,
    Those loose SI ligaments make your pelvic basket stability all the more important. My thoughts on Anusara’s posture is that I would begin at the knees, because if you lock your knees, you may still have a lordotic curve of your low back, but you effectively shut down your TA. So be sure you have soft knees, this turns on your quads and adductors – also very important components of your pelvic basket. From this dynamic position (no joints are locked), squeeze your pelvic floor as if you are stopping the flow of urine. Do not begin your squeeze posterior as this will immediately pull your coccyx forward. Once you have tightened your sphincter muscles then work to draw your pelvic floor up into your pelvic outlet. Because your neutral spine posture is dynamic, you will feel your multifidi muscles of your low back working to hold the extension of your tailbone as your TA works with your pelvic floor to draw up and in.

    It is this fight of the TA and pelvic floor pulling and the multifidi holding the extension that provides ultimate stability of the root of your core. Those multifidi are so important, holding the attachment site of the muscle so that the pelvic floor doesn’t get to a position where its muscle fibers are shortened past the point where they can fire effectively.

    -Tasha

    #932
    Patty Enns
    Guest

    Hi Tasha! I hope you won’t mind this long post & a few questions. Your website & DVD have been such a blessing. I think I’ve read almost all the blogs and posts! I guess I should be thankful for the prolapse because now I know that for 50 years I’ve been standing incorrectly….tucking my buns under….and finally just gave up on good posture. Now I’m standing straight for the first time in my life. However, as a result, I have low back problems, and no matter how far I lean forward on my sit bones, I cannot feel my pelvic bone at all! But at least now I can sit without pain!

    And, finally I found this Q&A with answers to so many of my own questions. I am 57, with a Cystocele that seems to be getting worse, despite being about 5 weeks into the exercises. I’m taking it slow. I’m up to Workout #3. I was glad to find out about resting in the evening, and sleep positions. I have an injured foot, and just couldn’t find a way to keep it up in a proper sitting position. Now, at least, I can rest it in the evening.

    I still have quite a few questions. I am having a really hard time relaxing the PF down when doing the standing 2-step Kegel, while standing in a neutral spine posture. It seems having the TA engaged just won’t allow the PF to relax at all. Suggestion?

    Is it common to feel the PF engage/tighten when doing the TA lifts in the hands/knees position?

    Sometimes it feels like I’m doing the 2nd step of the Kegel just in trying to stand correctly, as I feel the PF engage/tighten when I pull in my TA while correcting my posture (which I seem to have to do every few minutes.) Is this normal?

    My chiropractor has given me core muscle exercises to do on the Swiss ball (that my husband bought for me when I told him about your DVD!!). The first set is to “march” while sitting on the ball. Are these exercises going to be OK to do along with yours, or will they activate the wrong muscles?

    Thank you again for your positive encouragement. I appreciate any answers you can give.

    Patty

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