When it comes to pelvic floor rehab, I follow a super simple, basic protocol of exercise prescription.
Clients have to be able to do exercise 1 through to exercise 9, before they can progress onto anything else in my repertoire.
This way, I cover ALL of the basic stuff, discover where there’s potential dysfunction elsewhere that’s affecting their pelvic floor further up/down the chain, and really sow the seed that “it’s all connected”.
A new client just this week affectionately touched my forearm at the end of her appointment with me and said: “That was super, Claire – you’re brilliant at what you do, and to understand how it’s all connected is just amazing”.
I humbly just shrugged it off at the time, but on reflection, to her it was a pretty special moment *pass the tissues*
Today, I’m going to spell out 5 areas of the body you’re probably neglecting in your quest to rehab clients with pelvic floor problems.
1. MOBILISING THE FOOT
Did you know that tightness in the foot can refer tightness into the pelvic floor?
If you haven’t studied foot mechanics, which I’m certain most people who work in fitness, haven’t – it really is an amazingly resilient structure.
A lot of dysfunction in the foot stems from putting shoes on our children’s feet, and if you have children yourself, please don’t feel guilty for doing this, ok?
How could you possibly know what shoes are good/bad?! Marketing sells, and that’s what you buy.
The school shoes I was forced to wear were far from benefiting my foot, and after 5+ years of foot pain in my 30’s, I KNEW it was time to change something, so I transitioned into barefoot shoes, and haven’t looked back.
However, if you add an immobile, non-innervated foot that’s been crammed in tight, heeled shoes for however many decades your client with pelvic floor dysfunction has been on the planet – maybe, you could start assessing their foot for function, and see how mobile it is, and start prescribing some foot work.
2. LENGTHENING THE HAMSTRINGS
Ever noticed why clients with pelvic floor dysfunction display with a posterior tilted pelvis?
Well, if they have a hypertonic pelvic floor, think about the 2 basic muscle attachments to the pelvic floor: front and back.
It’s the pubic bone to sacrum, isn’t it?
Clients with pelvic floor weakness often have a tight pelvic floor, their hamstrings become compromised, and in turn their hammies pull their ischial tuberosities down, taking the back of the pelvis with them.
If I may point out: there’s “stretching” and then there’s “stretching” the hamstrings.
If you’re doing so with a posterior tilt, you’re probably not doing it that effectively, so have a think about the next time you have a client to lie on their back and pull their leg towards their face.
Is there pelvis neutral here, or is it just in a post tilt again?
The leg should be able to move independently of the pelvis is what I’m getting at here.
3. STRENGTHENING THE BUTT
All of the pelvic floor magic for me, happens at the back of the pelvis…
…and I’m talking about a big old juicy butt here.
Think about the butt of the next client who comes to see you with a posterior tilted pelvis…
In fact – it’s probably pretty atrophied, and the client often has to wear a belt with jeans to keep them held up.
This is because that butt has been on holiday for an awfully long time.
Build strength back up in the butt and you’ll gain length in the pelvic floor.
Go back to the “front to back” muscle attachments of the pelvic floor again, and you’ll see how every time someone works their butt – their pelvic floor lengthens too.
It’s not so juicy, is it?Let’s clear something up here: squats have been bandied about as the “new Kegel”.
I don’t actually agree with this statement.
There’s squatting and there’s squatting, but (did you see what I did there?), one thing’s for sure, the way I teach clients to squat is to:
a) get more butt strength,
b) gain length in the hamstrings, and
c) stop relying on their quads so much.
I love the fact that you’re actually squatting right now trying to differentiate between a quad squat and a butt squat.
You did that, right? Har, har!
4. CHANGING BREATHING PATTERNS
I love it when someone comes to see me, and on inspection, they breathe, effortlessly into their ribcage, and I joyfully observe their thoracic cavity widening on each inhalation.
Problem is: I rarely, if ever see this, particularly in clients with pelvic floor dysfunction.
There are many ways we can get oxygen into our system, and if you REALLY delve deep into the different breathing patterns people present with – it’s an absolute minefield.
Ever seen someone breathe in and pull their abdominals in at the same time? That is mighty freaky.
What about the belly breathers who’ve locked down their intercostals? That’s not a pretty sight, let me tell you.
And, let’s not forget, the over obliquers! You know that emoji with the raised eyebrows and bulgy eyes? Yep – it’s hard not to make that expression when you witness this type of breathing pattern.
5. BUILDING A REFLEXIVE CORE
Are you diligently spending time telling your clients to “engage their core”, “draw their tummy in” and “pick up their floor” before they lift something heavy?
Brilliant. Problem is though – this isn’t actually reflexive – this is pre-emptive and not a pattern I teach anymore.
The transversalis muscles should fire when needed, and fire just the right amount to take the load of you’re asking it to withstand.
Got a client who mentions she leaks when they bend over to pick something up?
Ok, so my approach would be: rather than getting her to pull up her pelvic floor/core – why not assess HOW she’s moving to pick up the object up, and get her doing it BETTER for the safety of her vag, back and core?
Can you see the difference?
The clients I work with don’t just learn a series of exercises from me – they learn how to use their bodies better, because let’s face it – our system is designed to conserve energy, isn’t it?
If it can find an easy way of doing something, it will do – over and over and over again, until that movement pattern has become habitual, potentially to the detriment of a joint’s wear and tear, or a muscle’s function.
What do you think?
Did you learn something new today?
Would you like to learn more about my full-body approach?
This is what my Your Pelvic Matters online Teacher Training program is all about.
It’s a very different approach, for a very different result.
It’s non-traditional sure, but I’ve had clients lessen the symptoms of their pelvic floor by simply by releasing tight muscles in their feet and lower/upper legs.
If you’ve been prescribing ‘squeeze and release’ and ‘draw up and hold’ exercises to clients and seeing very slow progress…
…maybe it’s time you changed your approach too?
The Your Pelvic Matters online exercise program is for exercise, fitness, movement, Yoga, Pilates, Personal Trainers, Physiotherapists, Chiropractors and Osteopaths already serving pregnant and postnatal women.
Not only will it address dysfunction in your clients – you’ll learn a tonne about your own body as you work through the materials.
Your Pelvic Matters is very much a program of discovery which will in turn improve your bedside manner dealing with clients with problems ‘down there’ because…
…you’ve been there and done all of the exercises yourself in the lead up to certification.
I look forward to taking you along this amazing journey so you too can have clients “lessen their symptoms of pelvic floor dysfunction in as little as 4 days” too.