In Part 1 of this post, I dug a little bit into some key pre-requisites for good pelvic floor function: pelvic alignment, rib cage alignment and breath mechanics. What I didn’t discuss, however, was the fact that these pre-requisites can be tough to get right. Why? Because your rib cage and pelvis are attached to a bunch of muscles that pull them in different directions. When these muscles are not at their optimal tension, it can be difficult to get your rib cage and pelvis aligned. So, today in Part 2 I’m digging deeper into the bits above and below the pelvis that directly and indirectly influence pelvic floor function, and I’ll explain how to keep all these supporting players in check.
Beyond the basics – thinking outside the pelvis
1) Starting from the ground up, let’s look at your feet. If your feet are turned outwards or inwards from your midline, chances are, the rest of your legs all the way up through your femur (thigh bone) are a bit out of alignment relative to your pelvis too. Some of the deep external rotators of the hip have fascial connections to the pelvic floor, and so the femur position can impact tension on the pelvic floor.
2) Next, calves and hamstrings are often tight from a combination of wearing positive-heeled footwear and lots and lots of sitting. The hamstrings attach directly to the pelvis at the sitz bones and when they’re tight, they tug on the pelvis and tip it backwards into a posterior tilt. It’s difficult (if not impossible) to achieve a neutral pelvis and stacked alignment if the calves and hamstrings are wound tight.
3) Glutes. Your glutes are powerful hip extensors, but when we sit all day (in a hip-flexed position), they become lengthened and loose a lot of their oomph.
The pelvic floor muscles run from pubic bone to sacrum (tailbone). Your glutes should counterbalance the pull of the pelvic floor muscles on the sacrum and help pull the sacrum away from the pubic bone and out of the pelvic bowl. This in turn helps to maintain length in the pelvic floor. When they’re not strong enough to counterbalance the pelvic floor, the pelvic floor gets shorter and tighter as the sacrum starts to get pulled closer to the pubic bone.
Your glutes and your pelvic floor are best friends. You can kegel till the cows come home but if you aren’t balancing your pelvic floor with glute strength, your pelvic floor is not going to behave optimally.
4) Last, but not least, the psoas. The psoas is often thought of as a hip flexor, but it does so much more (and it’s broader functions are beyond my scope right here). It’s a huge muscle that attaches to the last thoracic vertebrae and all lumbar vertebrate runs all the way to the top of the femur. When the psoas gets tight- from sitting, or chronic stress, it can cause the rib cage to thrust into the “bell rung up” position, knocking the pelvis and rib cage out of their stacked alignment.
Here are some starting points to help bring alignment to the pelvis and strength and function to the pelvic floor.
1) Bring awareness to your standing stance throughout the day.
-Try and straighten the outside edges of your feet whenever you look down and think about them. They should be close to parallel.
-If you’re tucking your pelvis under, try and untuck. If you’re thrusting your ribcage, try and bring it down.
-Consider your alignment from head-to-toe, and aim to stack your ears in line with your shoulders, pelvis, knees and ankles.
- There is no such thing as a “perfect” alignment, but this alignment strategy may be more optimal for the coordination and function of your core and pelvic floor. Try out these suggestions and see how they feel!
-You won’t be in great alignment 100% of the time, but if you can start adjusting your alignment tendencies when you are aware of them, it will become more reflexive to find these positions when you aren’t thinking about it.
2) Find length in your calves and hamstrings.
- You can perform isolated stretches of calves and hamstrings.
- Squat! Practice hinge and squat exercises where the lower back and tailbone remain neutral (watch out for butt wink!) in order to lengthen the hamstrings and calves and strengthen the glutes.
- Avoid wearing heels. I’d be a hypocrite if I told you to go toss all your shoes and switch to 100% barefoot-style or flat shoes, but it’s not a bad idea to bring awareness to your footwear choices. Wherever practical, choose the ones with the lowest heels for your everyday shoes, and save heels for special occasions.
3) Add more glute strengthening work to your exercise regimen.
- Those same squats and hinges that we mentioned earlier are going to help here too!
- If you’re just getting started, some other ideas include monster walks or lateral band walks, hip thrusts and single leg deadlifts (bodyweight or with an external weight).
- Consider glute-loaded movements in multiple planes (front-to-front, side-to-side) and on one leg and two.
-WALK MORE. Specifically, focus on using your back leg to propel you forward during each step and maximize your glute and hamstring engagement.
4) Relax your psoas.
Try out the constructive rest pose developed by Liz Koch. This one doesn’t feel like “exercise”, so it’s a great one to save for the end of a cool down or a chunk of time when you want to lay around doing nothing, while doing “something”.
- Lie on your back with your knees bent and your feet 12-16 inches from your bum. Your legs should be relaxed with your feet hip-width apart. Your knees can be parallel or fold inwards to lean against each other. If you are pregnant and uncomfortable on your back, you can use pillows and yoga blocks to create a diagonal support to bolster yourself at a15 degree or more angle from the ground. --- Whether you are on your back or bolstered at an angle, make sure to keep your spine neutral and your pelvis untucked.
- Place your hands on your belly or the floor and relax for 15-20 minutes.
-Let gravity do the work.
5) Practice Piston Breathing.
- The piston breath (or connection breath) trains the coordination and optimal function of the core and pelvic floor. Check out the description of piston breathing I included in this previous post.
Okay. So… that probably seems like a lot to keep track of. I admit that yes, it can be a lot to keep track of at first. My recommendation is to travel from head to toe, working on one area at a time (not necessarily to perfection, but just to become aware of it, and get used to how things feel as you work to gain a more balanced alignment). Over time you will get a sense of how everything is connected, and as you are able to understand or visualize these connections, feel free to come back to this post for another look.
Think of something I left out? Please let me know. And of course, please get in touch with questions or comments!