Have you ever felt like you can't participate in a sport because of your pelvic floor dysfunction? Or have you heard that you should avoid certain movements and activities to protect your pelvic floor from harm? According to the Physiodetective, Antony Lo, it's time to re-think the way we handle some common women's health issues, including stress urinary incontinence, pelvic organ prolapse, chronic pelvic pain, and diastasis recti. Using his "bulletproof" strategy for core and pelvic floor rehab (which is aimed at crossfit-ers, but can be applied to anyone), we can return our patients to running, lifting heavy weights, or even doing crunches!
One of Antony's core tenants of rehabilitation is utilizing a variety of movements to accomplish the same task. For example, if your squat feels awkward or painful when you use the "traditional" approach of feet hip width apart, toes forward, back straight, etc., try something different! Turn your toes out, widen or stagger your stance, practice a high bar or front squat instead of a low bar squat.
As long as movement is controlled and pain free, it is not bad for you! This also implies that there is no such thing as "correct" alignment or movement, just some that are more efficient than others.
Of course, as the task at hand gets more advanced, such as performing a 400 pound deadlift vs. picking a child's toy up from the ground, there is less room for variability. However, training in numerous ways can better prepare you for your big performances - As Antony says, the more ways you can perform a task, the more resilient you are, which makes you harder to kill, and therefore more awesome!
Another important point of Antony's is exercises we traditionally think of as dangerous to the pelvic floor can actually be as safe as any other, as long as you are in control of the movement. Take a bicycle crunch, for example - an exercise that crossfit athletes perform often, but we as therapists often shy away from as it puts "too much" downward pressure on the pelvic floor. Recent evidence has indicated that this is not, in fact, the case.
Studies have shown that crunches, V-sits, bicycles, etc. all create less intra-abdominal pressure than everyday tasks such as standing up from a chair, lying down supine on the floor, or even walking.
Additionally, there is a tendency among pelvic floor physical therapists to stress avoiding breath holding. Though the exhale on exertion technique is useful in many instances, it is impossible to lift heavy weights without holding breath. This suggests that technique may matter more than the breathing itself - if we are having difficulty controlling the intra-abdominal pressure with breath held, we need to look for the "leaks" in the system to correct them.
This leads us to the more practical component of bulletproofing the core and pelvic floor - how to perform a pelvic brace for optimal performance. Antony's evidence-based belief is that...
It is absolutely necessary to tap into the nervous system to effect big changes.
Once you have seen a pelvic floor physical therapist to manage pain and learn how to activate muscles, it is vital to put your new skills to use by re-educating the neural pathways that connect the brain to the core and pelvic floor. This can be done by first utilizing a pattern of "lighting up" the core muscles. Once the pathway has been activated and the muscles are ready, add to this a cue - it can be snapping your fingers, slapping your thighs, hearing a word, anything. Adding your cue to the activation pattern will trigger your brain to use the pathway automatically in preparation for a movement. Then, when you are ready to perform, think about "spreading the load." This means feeling where your breath resides in your body as well as which muscles are dominantly active and spreading that as far as you can to have numerous avenues of regulating pressure. After performing your cue and spreading the load, you're ready to move without symptoms!
Get out there and lift heavy, my friends!