• Jo Dyson

moving beyond basic 'pelvic floors'.....why, and how???

If a patient came to me for treatment having had a knee replacement, one of the first exercises I would start them on would be a static muscle contraction of the thigh, what we call an 'isometric' contraction. In fact, after a new knee, it's taught as soon as day 1 post op, because an isometric contraction is one of the most basic actions a muscle can perform. Over the next 3 months, their rehab would progress to include actions like squats, step ups, deadlifts, lunges and we would work to prepare them for their return to sport. Now lets relate that to our pelvis. An isolated pelvic floor contraction is basically an isometric contraction of the pelvic floor, which is muscle tissue, much like your thigh. Would the static quad contraction alone, without progression, have got the lady with a new knee back to tennis? Or running after the grandkids? NO. No more than isolated pelvic floor contractions will get YOU back to running around after your kids, exercising without leaking urine or feeling heavy downstairs thanks to a pelvic organ prolapse. Or facilitate a fantastic recovery from pregnancy and birth. Your pelvic floor is part of a system, or a team. It DOES NOT work in isolation, and should not be exercised or 'rehabbed' in this way. It works in perfect timing with your diaphragm, your abdominal wall and your back muscles. For us to effectively treat continence problems, or prolapse, we MUST move beyond the easy, most basic exercise that is an isolated pelvic floor contraction. We need to re-integrate the pelvic floor back with its team mates and get it talking to the brain again. Pregnancy and soft tissue trauma from birth really off-balances this system but we can totally re-set it with the right input again. Is a leaky pelvic floor a WEAK pelvic floor?

It's not just about making muscles strong....there is a bit on a mis-conception that a leaky pelvic floor is a weak pelvic floor....this may not be the case! It may be that the timing is out, that is, the communication between brain and pelvic floor just needs some fine tuning for it to all work properly. Or perhaps alignment is not optimal - a poorly stacked rib cage/pelvis combo will not make for a well functioning core unit. Making subtle changes to alignment can make a powerful difference to being symptomatic of prolapse or leaking. Basic pelvic floor 'squeeze and lifts' are a good place to start if you've not long delivered a baby....and there is plenty of evidence to support their efficacy. But we can do more. Re-integrating the pelvic floor back into the system in which it is a part of is fundamental and is achieved through whole body, functional movements where we bend, lift, move, stretch and BREATHE all at the same time!!!

You may think of Pilates as a mat based class. My postnatal Pilates classes does involve mats, yes. But as well as lying down on them we stand, bend and use resistance generated our body weight/exercise bands to re-create movements we use in real life, and work our pelvic floors in a way that's relevant to how they actually work. THAT is how to get a fully fit floor, and get your body ready for the activities you love, so you can enjoy them without worrying about sudden leaks or the discomfort of a prolapse. Look out for my next blog.......Follow my Facebook page to be sure you don’t miss it. Mother Nurture Pilates | Physiotherapist led Antenatal and Postnatal Pilates classes | Leighton Buzzard, Bedfordshire #postnatalpilates #womenshealthphysiotherapy #leightonbuzzard #mothernurturepilates #antenatalpilates #pelvicorganprolapse