This blog is designed to convince you of the importance of focusing on a “one step at a time” approach to regaining control of your pelvic floor. The muscles that make up your pelvic basket are often unknown muscles. Quite simply, many of you know you have biceps and quadriceps, but have you heard of your obturator or your puborectalis, or even your gluteus medius (which is a different muscle than your gluteus maximus!)? Rehabilitating the pelvic floor begins first with discovering many of these smaller muscles and then training yourself to contract or engage these muscles through slow, subtle, controlled movements. The minute these movements become too big or too fast, our bodies automatically recruit our bigger muscles that like to take over. The problem is that these bigger muscles offer movement but not stability. This type of strengthening has its place but not in pelvic floor rehab.
Let me give you an example to clarify this point. Your multifidi are small muscles that lie deep under your back extensors and attach to individual segments of your spine. The Prone Multifidi Extension exercise that I coach you through in the 1st workout on the Hab It: DVD, requires very subtle movements designed to recruit and isolate these small multifidi muscles. This small rotation of your pelvis achieves segmental extension of your lumbar spine and, more importantly, your sacrum. The minute these extensions become too big, creating movement beyond your pelvis, you automatically recruit your big back extensors and glutes which like to take over. This allows a good percentage of your multifidi muscles to take a break, which results in us losing our muscle isolation and our segmental extension goal.
It is with this in mind that we need to slow down, isolate, control our deepest stabilizers, and get these pelvic basket muscles firing efficiently. Remember, I have talked in depth about the “root of our core,” the deepest three stabilizers of our body in previous blogs. http://hab-it.com/blog/?p=257 It is important that we regain control of these stabilizers before working bigger movements that will allow us to return to our normal recreational activities. So I caution any of you rushing through your pelvic floor/pelvic basket strengthening. You will continue to have symptoms UNLESS you learn to recruit your deep stabilizers first. This is why it is important to allow your body 4-6 weeks of training with the Hab It DVD, which will help you find and engage all the muscles of your pelvic basket, before rushing back to running, hiking or any other recreational activity.
Once you have developed good control of your pelvic basket, your work is not yet over. It is now your job to maintain this strength and stability for years to come. Just think, this means you will have better posture when you are 80 years old, you will prevent future back or hip problems, and you will prevent a re-occurrence of your pelvic floor dysfunction. Take note that continuing pelvic floor exercises for life doesn’t mean that you have to lie in front of the DVD for 20 minutes 3x/week, but that you are conscious of working pelvic floor exercises into your daily routine. This could be in the shower, before you get out of bed, or whenever it works for you. If you fail to remain consistent with exercise and posture, your pelvic floor symptoms will remind you just like a good coach!
Tasha, I just found your site — thank you so much for all the information here! I’m 17 months postpartum with my second child and have felt since her birth that things “downstairs” are not the same.
I’ve been very sedentary and know I need to get back into some whole-body exercise. I’ve been thinking about getting a treadmill or a stationary bike (recumbent or upright), and maybe setting up a standing desk for my home office. I saw one of your comments that elliptical machines are not great. Would you consider doing a blog post about types of cardio machines?
I like your thoughts on “getting moving”, they all sound great. I will write up a specific blog on cardio equipment that may help you in your decision on how to move forward. I will tell you right now that swimming and biking are best for your prolapse. And running, if done with solid base strength of your pelvic basket, can further strengthen the muscles you need to support your prolapse.
Thanks for this post Tasha! I know I need to go back to workout 1 from time to time to keep things in check. And that last paragraph is great. I needed that. Sometimes I get so obssessed with my pf & discouraged that I have to pay so much attention to what I’m doing, but its really for my overall health, not just my prolapses.
Hi I am 28 years old with 1 child and I had a difficult labor. I was recently instructed to do kegels by my doctor. I recently purchased your DVD Hab-it because of good reviews and I am learning how to do the kegels. In your video you stated to use your finger to determine if you are squeezing the right muscles. I did this and I noticed that i can squeeze the same muscles by squeezing in two different locations. One way causes a little more tightness than the other. In no way am I squeezing my glutes while practicing this. So, Is there only one way to squeeze during kegels? Also, what do you think about using the kegel balls that are placed inside? I was thinking that I could use this to measure my progress as I gain enough pelvic strength to hold the balls inside. Besides the prolapse, will your DVD help to tighten me again?Thank you in advance for your response.
(I have mild bladder prolapse as per my MD)
I have just recieved your Habit dvd. I am in the unfortunate position of preparing for back surgery in approx 6 weeks. Fusion of l5/s1 after living with years of pain from a transitional vertebrae articulating on my pelvis and causing pseudoarthrosis. Its been a long journey where I endured a painful pregnancy and have worked very hard with PT to no avail to obtain relief and I also had a prolapse.
Just looking for thoughts on if any of the exercises will be suitable/unsuitable post surgery (once I get the ok to exercise again) and also if you think that posture would be affected therefore negatively affecting the pelvic floor. I have been told that fusion of s1/l5 does not result in much loss of movement of your back as it is generally not a high movement area, but obviously i have enough instability to be causing problems. My surgeon and ob/gyn see my pf and my back issue as two seperate issues, I am keen to get a womens trained PT thoughts? I am seeing a physio for my back but not a Women’s physio. I was seeing a womens physio for pf but felt that they were not as knowledgable on the skeletal problems I was experiencing so struggling to “bring it all together”
Thankyou in advance for your thoughts.
I can speak in general terms and not specifically to your case because I have not had the opportunity to evaluate you in person. So, in general, if you have been experiencing significant low back pain, you essentially have lost the stability of the back side of your pelvic basket and therefore your pelvic floor support.
I often describe our pelvis and lower abdomen as an intricate basket weave of muscles that all work together as the root of our core. It is the core, this base which provides the stability for all other movement of our body.
So, I would be optimistic that in resolving your low back pain, you will be able to move forward with strengthening your multifidi, your transversus abdominus, your inner thighs, your deep hip rotators, and your pelvic floor. The improvement of the strength of all of these muscles that provide the front, back, and sides of your pelvic basket as well as the floor should improve your low back stability as well as your pelvic floor support.
Best of luck to you!
Thanks Tasha for your quick reply and reassuring words 🙂
I have often wondered if my back pain and instability have contributed to my prolapse- lack of body strength etc as I went from being very fit to overweight and pregnant with backpain- a horrible snowball effect. Its funny because the other day I all of a sudden had a really bad day with my back and the next day the prolapse was much worse so I cannot help but see them all connecting. 🙂
You have it right. All of the areas of the “pelvic basket” are interconnected. They are an inter-dependent group of muscles, much like the basket weave that I describe. Picture in your mind a woven basket…if any part of that basket is not able to pull tight then the entire basket is compromised. For this reason, my low back patients will receive strengthening exercises for their pelvic floor, adductors, transversus abdominus, and deep hip rotators as well as multifidi strengthening…AND my pelvic floor patients will receive exercises for their multifidi, transversus abdominus, adductors, deep hip rotators, as well as their pelvic floor. Very similar rehab, just a slight shift of focus to whatever muscle group is the weakest, but all must be addressed.
Furthermore, not only do you need to learn to isolate the individual muscles of your pelvic basket, but then you have to learn to co-contract these muscles as a unit. This is what the progression of difficulty through the Hab It Workouts provides, and then the Advanced Program takes this coordinated contraction to yet another level for advanced activity.
Great insight on your part LK!
You talk about two different squeezes. I would describe those as the sphincter muscle, much more superficial, squeezing as with the quick flick that I teach and then the sphincter muscle squeeze with the deeper addition of the drawing up of the entire pelvic floor. This second muscle action requires the coordinated action of your entire pelvic basket with emphasis on your TA and multifidi. This second squeeze should add more tightness to your squeeze, but it is this lift that requires practice to hold. It is good to work both of these contractions.
The second part of your question, re: Kegel balls. I don’t typically recommend any type of device or added weight in training the pelvic floor. These muscles are designed as endurance muscles that are required to be on all day, every day to help support your vaginal walls and pelvic organs. By adding weight you are really training the sphincter muscles only. I
Hope this helps.