As Fitness Professionals should we consider the implication of exercise on the group of muscles known as the pelvic floor?
The short answer is YES! Every movement in functional daily living and exercise involves this often neglected group of muscles at the base of the pelvis, writes Louise Field, founder of Adore Your Pelvic Floor.
To work effectively, the balance of resting tone, strength and flexibility are required.
As a Fitness Professional I am more than aware that we are not exempt from pelvic floor dysfunction. Between the ages of 18 and 40 I was fortunate to have had five boys, including one set of twins.
Postnatally, I worked on regaining my posture and transverse abdominal function, and began teaching my regular classes from nine months post-partum.
I had not had a full gynaecological check and unbeknown to me, my fascia had torn during the last delivery. Eighteen months later I suffered a bladder and bowel organ prolapse.
This could have naturally occurred over time due to my torn facia during regular functional daily activity; but I have to consider that my job role is physical and the regular projection of my voice whilst teaching would have placed additional load to my pelvic floor group (PFG).
This raises the question, as Fitness Professionals, do we offer the respect our PFG deserves in relation to our job role?
The PFG are required to react constantly with every breath and movement we take. Should this precious group of muscles be ignored just because it is not visible?
Bladder and bowel continence is fundamental to our well-being and confidence. If the warning signs that the PFG are not functioning together are left unaddressed, it is highly likely that muscle dysfunction will escalate.
If we are at risk, so is our client
As Fitness Professionals we have a responsibility to our clients to enhance health.
This often neglected group of muscles should not be overlooked just because it cannot be seen. A client may not mention their issues of incontinence or pelvic pain, but there are typical signs to indicate who may be at risk. Observing these signs allows the Fitness Professional to prescribe appropriate exercise with the confidence that any issues are not being compounded. This leaves the client feeling reassured.
External red flags indicating that pelvic health is at risk or may not be working at its optimum:
Pelvis alignment – There are 45 muscles attached to the pelvis. If any are dysfunctional, it can create an impact to the PFG, be it posterior/anterior tilt or internal/external rotation to one side of the pelvis.
The diaphragm – Shares the same neurological loop (our parasympathtic nervous system – part of the autonomic nervous system which balances the action of the sympathetic nerves) as the transverse lower abdominal, the multifidus, and the PFG. With every breath, the diaphragm depresses, the transverse abdominis eccentrically contracts with the multifidus and the PFG relaxes. This necessary chain reaction can be interrupted with poor posture or pelvis alignment.
But it goes further than this! On average we take 20,000 breaths a day, without exercise. If a person lives with pain, the body’s natural reaction for self-protection affects breath, as it does with asthma, anxiety and clavicle breath. Without this natural neurological reaction within the core the PFG does not get the chance to benefit from the relaxation it requires.
Other contributory factors leading to possible impaired pelvic health function include:
Fallen Arches – Create rotation of the knee, which in turn can affect the femur and the hip. The muscles of the PFG are connected to the pelvis, which can change the resting tension of the PFG.
Valgus (knock knees) – The knee joint will affect the alignment of the hip, in turn affecting the muscles of the pelvic diaphragm.
Overactive Gluteus – The Gluteus Maximus is responsible for hip extension, external rotation and abduction. If it has to assist in the stability of the pelvis it becomes an overactive muscle causing problems with tension within certain areas of the pelvic area.
Visceroptosis – The word viscera refers to internal organs. Visceroptosis is a prolapse or a sinking of the abdominal viscera. The viscera contained within the abdominal cavity are the stomach, kidney, liver, intestines, spleen, pancreas and colon. In ideal conditions these organs are nicely packed and wrapped and function in their normal anatomical position with the help of transversus abdominis, obliques, multifidus, and the quadratus lumborum.
Impaired pelvic health – Who does it affect?
Anybody! Children, teenagers, young women, mums, women of a certain age and men. Habits from childhood can follow us into adult years. Trauma to the pelvis can create its own problems for pelvic health. Lifestyle, inactivity, posture, pain, breathing mechanics, alignment, learned habits, load... the list goes on.
Restoring pelvic health
80% of pelvic health issues can be rectified. A few simple changes with posture, breathing mechanics whilst focusing our exercise prescription to the weakest link can work wonders. A balance between good resting tone, flexibility and strength is key for this complex area.
Adore Your Pelvic Floor runs two CPD Workshops to show you exactly how. We work closely with Specialist Women's and Men's Pelvic Health Physios to achieve the best possible outcomes.
Whether in a group exercise environment or training on a 1:1 basis, we need to consider the effect of load on the PFG and whether it can function effectively. Likewise, due consideration should be given to intense core training to ensure we do not create muscles which cannot 'switch off'. Many fitness instructors, athletes, ballet dancers are unable to switch off the transverse muscle!
To find out more log in to the website above or e-mail firstname.lastname@example.org
Presenters Louise Field (pictured left) and Fiona Peel (pictured right) are delivering workshops to Fitness Professionals and Midwives in Essex, Leeds and Devon this Autumn
Additional reading: Economic impact of incontinence in Australia Continence Foundation
Varuna Raizada, M.D., Ravinder K Mittal, M.D. (2009) US National Library of Medicine National Institutes of Health
Pelvic Floor Anatomy And Applied Physiology
Schettino MT, Mainini G, Ercolano S, Vascone C, Scalzone G, D'Assisi D, Tormettino B, Gimigliano F, Esposito E, Di Donna MC, Colacurci N, Torella M. (2014) US National Library of Medicine National Institutes of Health
Risk of pelvic floor dysfunction in young athletes
Diane Lee BSR, FCAMT, Linda-Joy Lee BSc, BSc(PT), FCAMT (2004)
Stress Urinary Incontinence – A Consequence of Failed Load Transfer Through the Pelvis?
Parisa Zhoolideh1 , Fariba Ghaderi1*, Zahra Salahzadeh1 (2017) Open Access
Are There any Relations Between Posture and Pelvic Floor Disorders?
Hankyu Park, MSc PT, Dongwook HAN, PhD, PT (2015) US National Library of Medicine National Institutes of Health
The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing.
Fernandes L C1 , Santos M D1 , Bernardes B T1 , Souza V L2 , Carvalho E M1 , Resende A P M1 1. Federal University of Uberlândia, 2. Federal University of São Paulo Does Diastasis Recti Abdominis Inflence pelvic floor muscle function during pregnancy?
Andrea Marques, PT, PhD, Lynn Stothers, MD, FRCSC, Andrew Macnab, MD,FRCPCH FRCPC, FCAHS |(2010) US National Library of Medicine National Institutes of Health
The Status of pelvic floor muscle training for women
Mariusz T Grzeda, Jon Heron, Alexander von Gontard, Carol Joinson (2016) US National Library of Medicine National Institutes of Health Effects of urinary incontinence on psychosocial outcomes in adolescence
Nicole Tweddle Ballarat Health Services
Pelvic floor education for new mothers: timing the message for best effect
Antonio L.Pastore, Giovanni Palleschi, Andrea Fuschi, Cristina Maggioni, Rocco Rago, Alessandro Zucchi, Elisabetta Costantantini, Antonio Carbone (2014) US National Library of Medicine National Institutes of Health
Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation.
Glazener C, Boachie C, Buckley B, Cochran C, Dorey G, Grant A, Hagen S, Kilonzo M, McDonald A, McPherson G, Moore K, Norrie J, Ramsay C, Vale L, N'Dow J (2011) US National Library of Medicine National Institutes of Health
Urinary incontinence in men after formal one-to-one pelvic floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAP S): two parallel randomised controlled trials.
Pronob K, Manu Agarwal (2015) US National Library of Medicine National Institutes of Health
NICE National Institute for Health and Care Excellence Pelvic Floor Exercises