Inspired by Pelvic Floor First
I attended the launch of the Pelvic Floor First campaign that was presented by the Continence Foundation of Victoria in November 2011. As a Women’s Health, and Musculoskeletal Physiotherapist I was delighted with the name of Pelvic Floor First. Inspired with the presentation I woke in the early hours writing a practical educational workshop called PELVIC FLOOR FITNESS targeting the Fitness Industry on the importance of the functional application of the pelvic floor muscles.
In clinical practice using the Real Time Ultrasound for biofeedback I became aware that women’s pelvic floor muscles were not being acknowledged and recruited with exercise. Observations using the real time ultrasound revealed that women were not recruiting the pelvic floor muscles instead were pushing down upon the pelvic floor risking pelvic organ prolapse.
Women were trying hard to improve their physical fitness, placing great trust in their personal trainers and fitness instructors. However, were saddened to hear they were not being properly guided on how to best recruit their pelvic floor muscles for exercise. I became aware of the gap in knowledge regarding the correct recruitment of the “core” of which the pelvic floor muscles are an essential component.
Pelvic Floor First was a brilliant choice to encourage the pelvic floor muscles to be well elevated in the pelvic cavity to counteract the inevitable increase in intra-abdominal pressure in fitness based exercise.
This repetition of intra-abdominal pressure and constant loading of an unrecruited pelvic floor has the negative consequence of pelvic organ prolapse and/or stress urinary incontinence.
Mandy (fictitious name) returned to her local gym 8 months after the birth of her third child. After 3 months of enjoying multi weekly gym visits Mandy presented frustrated that she still looked 6 months pregnant. Mandy experienced mild stress urinary incontinence and abdominal discomfort with exercise.
Mandy’s typical abdominal routine included sit ups which she enjoyed doing. Mandy performed these sit ups with her abdomen swelling outwards and on real time ultrasound observation her bladder descended downwards into her vagina.
Mandy was horrified that she had been working out for the past 3 months potentially developing a prolapse and worsening her stress urinary incontinence. She was upset that the fitness instructors had not corrected her poor technique and wondered why her pelvic floor muscles were not discussed considering she was recovering from the birth of her third child.
Mandy was then taught, in physiotherapy, how to correctly recruit her pelvic floor muscles and perform an appropriate and safe partial sit-up. When viewing on real time ultrasound, whilst doing this exercise, Mandy maintained an elevated pelvic floor with no downward movement of her bladder.
Mandy left with the motto “Pelvic Floor First” before exercise.
Real Time Ultrasound is a wonderful biofeedback tool where you get to see your deep core muscles work on the screen.
It is vital for all fitness professionals to see and feel how their core muscles are recruited so they are able to teach this to their clients.
Abdominal muscle cylinder (core) includes the transversus abdominus, pelvic floor muscles, deep lower back muscles (multifidis) and diaphragm. The four parts of the abdominal cylinder work synergistically together to best support the spine. This is referred to lumber pelvic stability in the literature and often spoken of as “neutral” spine.
The deep abdominal muscle transversus abdominus, surrounds the trunk and acts like a natural back brace. The pelvic floor works to regulate bladder and bowel control, support the pelvic organs and is important in sexual function. These muscles work in unison with the diaphragm and other spinal stabilising muscles to provide core stability.
Scientific research has shown that during an episode of low back pain these important deep stabilising muscles, the multifidis, can switch off and waste away long after the pain has settled. They do not automatically return to ideal function on resolution of pain. This is why it is vital after an episode of low back pain that your deep stabilising muscles are assessed. This information should empower fitness professionals that if they are able to teach neutral spine and cue clients correctly recruiting their pelvic floor muscles before exercise they may be reducing recurring episodes of low back pain, stress urinary incontinence and prolapse symptoms.
This information below about Pelvic floor muscle strength training should EMPOWER all Fitness professionals to be comfortable about discussing with clients the pelvic floor muscles and possible associated pelvic floor dysfunctions such as incontinence and prolapse symptoms.
Did you know that
- 65% of women sitting in a GP’s waiting room have some type of incontinence – less than a third will seek your help
- 1 in 3 Australian women suffer from urinary incontinence
- 43% of subjects with incontinence and prolapse depressed their pelvic floor on ultrasound when instructed to lift (straining strategy)
There is :
- Level 1A evidence, Grade A recommendation, Fourth International Consultation on Incontinence (Abrams et al, 2009)
“Pelvic floor muscle training should be offered as first-line therapy to all women with stress, urge or mixed urinary incontinence”
Morphological changes after pelvic floor muscle strength training (RCT):
- Increased muscle thickness, 1.9mm
- Decreased hiatal area by 1.8cm squared
- Shortened muscle length by 6.1mm
- Elevated the position of the bladder by 4.3mm
- Rectum elevated by 6.7mm
- Increase maximal urethra closure by 11.1 mm2.
- Reduced hiatal area and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness
- Inhibition of detrusor contraction
Obstetrics & Gynaecology (2010), Hoff Braekken
As a fitness professional be EMPOWERED and PASSIONATE about including Pelvic Floor Fitness into your exercise programs. Your clients will love that you are respecting and interested in their deep postural muscles.