I have a lot to say about the pelvis and the pelvic floor. The pelvis is a biomechanical wonder and the pelvic floor is a multitasking genius and can do things that would put a contortionist to shame.
It’s pretty important to all people, especially pregnant ones, and especially pregnant or postpartum folks who want to maintain or return to fitness or high level athletics.
But neither the pelvis or its associated musculature exist in a vacuum. The pelvis attaches to muscles that originate far above and below in the body, and the relative tension of these muscles contributes to how the pelvis aligns in the body and how well the pelvic floor can do it’s jobs.. And so, since the pelvis is pushed and pulled upon by everything connected to it we need to extend our discussion of pelvic alignment and pelvic floor health to the whole body.
Before we go on, what is a “strong” pelvic floor? Certainly a strong pelvic floor is one that provides good control of the bladder and bowel and does an adequate job of supporting all of the organs that sit above it. A strong pelvic floor is appropriately responsive to the demands of your daily life and sports. A strong pelvic floor is not synonymous with a “tight” pelvic floor and the pathway to a strong pelvic floor is not a million isolated pelvic floor contractions (“kegels”). It is also important to note that not only is a “tight” pelvic floor not a super strong pelvic floor, but it’s one that comes along with a range of unpleasant symptoms such as pelvic pain, incontinence, constipation and painful sex. I think you’ll agree that those are outcomes we’d like to avoid.
Throughout this post, we’ll talk about factors, spanning the whole body, that play a role in supporting optimal pelvic floor strength and function. Three great starting points are pelvic alignment, rib cage placement and breathing. But, in order to achieve these desired starting points and capitalize on their setup, we have to look beyond the pelvis and discuss a few more structures that attach to the pelvis from above and below.
Getting started – the big three.
First, let’s talk about pelvic alignment. In other posts, I’ve talked about ‘alignment’ in the context of the whole core. In that context, I’m often referring to a “stacked” or “ribs over hips alignment” that puts all of the core musculature in an optimal position to work as a team. But if we narrow in on what the pelvis is doing within that stacked alignment, we find that it should be in “neutral” in order to set up the rest of the team for success. Neutral can be defined in a couple of different ways. I think the easiest way is to pretend your pelvis is a bowl, tip it forward and backward as if to dump out the water, and then find a spot in between where the water is level. This approach should yield a gentle curve in your lower back (you’ll watch that curve become flattened and then exaggerated as your rock your pelvis back and forth).
If you want to get more technical, you can align the two bony points of your hip bones and the bony point of your pelvis along your midline in between and below your hip bones (this is your pubic symphysis, technically a cartilaginous joint). The two hip bones and the pubic symphysis should align vertically relative to one another.
After pelvic alignment, we also need to consider rib cage placement. Julie Wiebe, PT describes rib cage placement using an analogy to a bell. If your rib cage is thrust up and back, your bell is rung up. If it’s rounded down, it’s rung down. And if your bell is rung up or down, it’s noisy. In order to achieve good rib cage placement, that will enable optimal coordination between the diaphragm and pelvic floor, you want your bell to be quiet.
Once you have found a good stacked alignment with a neutral pelvis and quiet rib cage, the next step is to consider how you breathe. During a normal breath cycle, the pelvic floor mirrors the diaphragm (check out the animation below). The diaphragm contracts (and ideally descends towards your pelvis) to draw air into the lungs and the rib cage should expand 360 degrees. In response, the pelvic floor lengthens and descends. On exhale, everything reverses; the diaphragm and pelvic floor rise.
If you are an athlete, active womxn, or otherwise place a high value on your physical fitness and long term pelvic health, download this guide to learn 4 key considerations to guide your childbirth preparation.
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle’s Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (doula services) within the greater Seattle-Metro Area.