Welcome to the Pelvic Floor Revolution

silouhetteAt this point in your pregnancy, I’m sure you’ve heard or read something about Kegels, or the pelvic floor. Maybe this is your first introduction to the world ‘down under’ (there are muscles where!?) or maybe you’ve heard it all before. But I bet you haven’t heard this before: Kegels – long prescribed as the best exercise to tone the pelvic floor – are most likely NOT the be-all, end-all of pelvic floor health. Yep that’s right.

New research is showing that Kegels, when coupled with a weakness in the glutes, may actually contribute to pelvic floor disfunction. Before we get into the hows and whys, let me break down the terminology for all of you who aren’t familiar with the topic.

1) Pelvic Floor – a group of muscles that sit at the bottom of your pelvis like a hammock. Or, if it helps to envision your pelvis as a bucket, the pelvic floor are the muscles that create the bottom of the bucket. They surround the vaginal walls, the perineum, and the anus. When they are working properly, these are the muscles that help you control the flow of urine, prevent you from passing gas, and contribute to the strength of your orgasm. But they are also the muscles that must release in order to give birth. And yes – men have these muscles too – they cause “shrinkage” in cold water, if you know what I mean.

2) Kegels – These are exercises that are done by tightenting your pelvic floor.  Imagine an elevator travelling up inside your pelvis to the 5th floor, all while holding in a fart. That’s basically a Kegel; the point being to continually get stronger and tigher, pulling these muscles in more and more as you progress.

3) Isometric contraction – holding a muscle tight and strong for an extended period of time, not allowing it to change lengths or release. Iso = same, metric = length.

As a Pilates instructor, I’ve talked about the pelvic floor a LOT in the last ten years. It’s not uncommon to hear me musing over the way these muscles work at the dinner table (my dear sweet husband has certainly gotten used to his anatomy-geek wife! He barely bats an eye at this point!). For years I’ve told my clients to keep their pelvic floor muscles engaged, at about 30% contraction, as often as they can….and I said this because this was what I was taught. However, as I learned more about the body, this logic confused me. There is no other muscle in the body for which we prescribe an isometric contraction, all the time. Why would we do that with the pelvic floor?

When I teach anatomy to my future Pilates instructors, we discuss the importance of muscle balance: contractions that both shorten the muscle (concentric) and lengthen it (eccentric), as well as how each mobilizing muscle (agonist) works with an opposing muscle (antagonist) to create harmony of movement. For a joint to move effectively, with optimal efficiency and ease, the muscles on either side of it must take turns contracting and releasing in tandem, creating equal and opposite actions. In an ideal situation, it’s as if the muscles are creating a perfectly balanced tug-of-war; and though the tug-of-war is constantly shifting and moving, it’s always balanced. When a joint is balanced in such a way, we create a sense of stability for the joint at hand – our risk of injury and chronic pain is minimized. Most of the work I do as a Pilates instructor is carefully studying the movement habits of my clients, to see where there is an imbalance, or pathology. Then, I am able to choose exercises that will help them not only correct, but maintain muscular balance in various areas of their bodies over time.

Many new Pilates instructors, mindful of the term “stabilize” (which we use all too often) and lacking an experienced eye, will often confuse stability with rigidity. They hear terms such as “stabilize your pelvis,” and immediately think that holding the pelvis in a certain position (whether it be neutral, or the slight posterior tilt we refer to as a “scoop”) will achieve that goal. However, thinking back to the image of a balanced tug-of war, we realize this is not the case. The body and all of its components are meant to move – a concept that originates in the very cells of the muscle fibers, where a contraction is optimized only when myacin and actin have enough leverage to create traction; in other words, those little grippers inside the muscle that create contraction can only grip well when they have enough length to grab onto. Therefore if we approach stability from the standpoint of isometric contraction (holding still), we are not allowing the muscles to do their job, and in essence, creating inherent weakness. We are intended to be dyanamic, moving bodies, with the ability to react and respond to changing stimuli from outside our bodies. If someone accidentally bumps into you, and you try to stabilize by standing perfectly still, you will fall over. On the other hand if you try to stabilize by letting your body absorb the blow, take a step, and then recover, you probably won’t lose your balance. With these concepts in mind, I’ve tried to teach my clients to adapt their positioning for optimal stability as they move through the exercises.

So, to treat the pelvic floor as if these muscles function differently than every other muscle in the body perplexed me. To teach my clients to hold these muscles in a constant state of contraction when I was teaching something else for every other muscle group felt incorrect, but I couldn’t find any research to inform my instruction differently. The reality was, I just didn’t know any better. And now I do.

So without further delay, let me introduce you to some revolutionary information, presented by biomechanics expert Katy Bowman of Aligned and Well, who explains it better than I ever could. I invite you to read the two articles below and chime in – I’d love to hear your thoughts! If you read no further remember this: to prepare for pregnancy and post-natal rehab, stop Kegeling, and start squatting. Your body with thank you!