Exercise and the Pelvic Floor – How Do I Switch It On Exactly??!!

Is this you?

Have you had a baby and scared to jog? Can't jump on a trampoline with the kids? Can lift heavy weights but can't do skipping?

A Common Problem

These are really common problems that I see regularly. In fact 4.8million Australians have had trouble with their bladder or bowel in the past! 50% of women in the mid to late 40s have had some form of urinary incontience. 70% of people who suffer from it DO NOT SEEK TREATMENT!!! (source)

Unfortunately there is a lot of information and advice out there, often unhelpful advice. Do I squeeze hard or do I go gently? Do I hold it on for 10secs or is on/off quickly enough? Do I need to do it every day or 3 times a week enough? All of these questions are good - and to a certain extent they are all correct.

Image courtesy of Continence Foundation of Australia

Where is my Pelvic Floor?

Basically the pelvic floor muscles attach to the bottom of your pubic bone and go under the pelvis towards your tailbone. They are the muscles that control to 2 passages in the male pelvis and the 3 passages in the female pelvis.

So What's the Problem?

Here is the thing - in most people, the pelvic floor works without you needing to think about it. most people are able to walk around or sit or go about their daily lives without wetting their pants. But when it comes to exercise, people do all sorts of funny things to turn these "core" muscles on..."navel to spine", "squeeze hard", "hold your breath", etc etc. These are inefficient strategies.

What Really Happens - How Does It All Work?

I like to think of the body as working in 3 steps to do an exercise or movement.

Step 1: Think about what you are going to do - this is obvious! You form a thought about what you want to do and your brain gets everything ready...but sometimes the brain's processing is not quite right

Step 2: Prepare for action - you consciously and unconsciously prepare to do something - you change your posture and your little stabilisers (your "core" for want of a better word) preactivates.

Step 3: You do it! This is when you use your big muscles to generate the movement you want to do.

Too many people use their big torque-producing muscles to do  the work of the little muscles - e.g. Squeeze your gluts, tighten your abs, tense your back, etc - these muscles are not designed to hold you together - they are designed to M O V E.

Your little stabilising muscles are designed to keep all the joints in your body (from your little finger to your little toe) in an optimal joint alignment so the big muscles can produce lots of torque (force) around the joint.

Your Pelvic Floor is just one part of the team that keeps you together. If it doesn't do its job properly, then you end up with wet underwear, a prolapse, a herina or worse!

What Should I Do?

You need 3 key ingredients to make your Pelvic Floor work properly.

1. Isolation and Dissociation - these are fancy words but basically I want you to be able to use your pelvic floor without having to squeeze other muscles to get them to work. Please note that other muscles will also work when you do the Pelvic Floor Contraction correctly!

2. Activation - This is not just the amount of strength you have but how you can control that strength. You need to be able to contract your Pelvic Floor from as low as 5% contraction up to 100% contraction strength. So you have to practice being able to do this. It is no good owning a car that only works well when it is traveling 80km/h and you live in the city. In the same way, you Pelvic Floor is not that useful to you if you can only get it to work when you squeeze really hard! Learn to control how much you can squeeze it so your brain can choose how hard it needs your Pelvic Floor to work.

3. Endurance - You need to be able to do lots of contractions at various activation levels. One popular program is 10sec hold x10reps x10 sets  - this takes forever and you will be tired - i give this from between 5% activation level up to 100% activation level - most people can't do 10 sets...I am nice and just get them to do it for 3 sets throughout the whole day!

Important Points:

1. It is a common problem - seek advice and help if this happens to you!

2. Before doing exercises, prepare your posture and choose the right activation level for the task - as little as possible, as much as is necessary.

3. You should switch on the Pelvic Floor BEFORE switching on the big muscles that move things!

A video...

I came across this video today which I thought was quite good.

For More Information...

• Visit me at The Physio Detective - www.myphysios.com.au - and find out more about how we use Physiotherapy, Massage Therapy and Pilates and Exercise Rehabilitation to help you get your Pelvic Floor right
• Visit http://www.continence.org.au
• Seek advice from a medical professional - it may be common but it doesn't have to be normal!!!

Why don't you leave a comment below and continue the discussion?