If I could make a recording for you to play in your head throughout your day to help your pelvic floor symptoms, it would simply say, “Stick your buns out and draw your belly button up and in, stick your buns out and draw your belly button up and in.”
By following these simple instructions, you will set your pelvic basket to the best possible position. All of your key muscles will be at the perfect length and holding the perfect tension so that they can fire quickly and with optimal strength. These two cues will take you out of the “buns tucked under” position and will engage that loose belly pooch that a lazy posture can produce.
I can provide all the exercises in the world for you to work on to strengthen your pelvic floor and the many muscles of your pelvic basket, but the reality is that this strengthening only takes place within 20-30 minutes of our day. The remaining 16 hours that we are awake play a significant role in our pelvic floor function as well. So, the easiest way I can follow through with the progress I make through specific strengthening exercises is to hold optimal posture. A big part of optimal posture is the co-contraction of the multifidi muscles and the transversus abdominus (TA) muscle. I engage my multifidi muscles by sticking my buns out to assume a gymnast posture. I then soften my lumbar curve by drawing my belly button up and in, which engages my transversus abdominus. The co-contraction of these two muscles provides a stable lumbopelvic spine and solid anchors for my pelvic floor, my adductors, and my external rotators to pull on, offering optimal pelvic floor control!
So, set yourself up for success with these simple postural cues and consistent follow through throughout your day. “Stick your buns out AND draw your belly button up and in,” are two important steps to pelvic health.
Can you please address the issue of bracing versus pulling in the TVA for spinal stability when lifting something heavy. I recently read an article that said just pulling in the TVA actually destabilizes the spine. The article claimed that scientific testing proved bracing superior. However, bracing causes the hated bulging out of the abdomen that those of us with prolapse must avoid. It’s the question of spinal stability I’m interested in. Thanks for being there.
Hi there! Bracing is known to not only increased the pressure down on the pelvic floor but it also significantly increasing the pressure on our discs. Beyond that, when you brace, you engage your rectus abdominus, which has a flexion force, again putting your intervertebral discs at risk as patients relying on this muscle can’t and don’t hold the natural/protective lordotic curve of the lumbar spine.
Conversely, when you contract your TA you are lifting your pelvic floor and decreasing intervertebral disc pressure. It is true that the action of the TA depends heavily on a co-contraction of our multifidi, pelvic floor, and many other accessory muscles (inner thighs and hip external rotators) to truly offer stability, but this co-contraction is extremely important to the health of our spine.
The article you refer to has been questioned and does not have a strong base of support.
Thank you for your question. You have highlighted the evolution of physical therapy when treating low back patients. We used to focus on the rectus abdominus as the main stabilizer, but years of experience and patient follow up has proven this rehabilitation method to be ineffective and often counter productive.
Once again, thanks for the clear concise answer. There is so much contradictory information out there. I appreciate your expertise and use your Hab-It video. As usual, your reply makes good sense.
I was wondering if you had any helpful tips for maintaining good posture while driving and sitting on the couch.
You have highlighted a couple of the biggest challenges we all have. Those times when appropriate posture just isn’t easy or even possible. I will give you my best answer…on the couch you can attempt to place some pillows behind you to move you slightly forward, taking away a bit of the “slouch”. The other option, which I use is that I don’t sit on the couch much. For the little tv time I get, I often lay on my stomach. I recommend atleast 10 minutes on your stomach every day to emphasize extension of your spine. If you spend a lot more time watching tv, you may want to emphasize more activity in general for your overall health.
As for the car…tough one. Some of the newer cars allow you to adjust the seat tilt. With this you are able to lift your hips even with or slightly higher than your knees. This is perfect for neutral spine. BUT if you happen to have bucket seats or don’t have this adjustments, you can attempt to use a pillow placed under your sit bones and your low back to try to improve your hip angle. There is no easy solution, but just being mindful of neutral spine and drawing your TA up and in will also help a bit.
– Tasha Mulligan