This morning my dad called, asking if he should be worried about his hypertonic pelvic floor (at 85-years old). Then he said he wasn’t sure where his pelvic floor was, but that it was probably down between his knees by now.
For those of you who don’t know, your pelvic floor is the muscular bottom of the bony pelvis
which makes it much more likely to be between your hips than between your knees. If your pelvic floor is currently between your knees, turn off your computer immediately, find a camera, and email me the picture. I’ll be flying to your house today. (Do you like how everything is To Scale in this picture? What the…?)
I’m glad that my dad was alerted at the last email. It’s primarily women who tend to seek treatment for their PF issues because most know that they have one. A pelvis, I mean. Men, on the other hand, find the word pelvis to be similar to vagina in the fact that the both contain the letter “v”. Rest assured, gentlemen. You can have a pelvis and still be macho. In fact, the state of your manliness, if you catch my drift, depends on the state of your vagina-free pelvic floor.
Healthy functions (including sexual performance) is not only dependent on appropriate blood flow to the goods, but also the correct amount of tension in the surrounding muscles. Tighter is not better when it comes to pelvic function. Want better sex? Or hip health? Normal pressure in the gut? Read on, Mr. Mister, read on. That means you too, Dad.
The last post I did was about hypertonicity (too much tension) in the pelvic floor. So, where does hypertonicity come from? Here is a partial list of things that are shown to increase the tension in the pelvic floor:
For a long time, tension patterns in the pelvic floor were linked to a history of sexual abuse and/or general abuse, but with further data collection, researchers have found that the vagina actually fires automatically in any sort of stressful situation. How’d they find that out, you ask? Seventy-seven women were lucky enough to be chosen to have their PF and their trapezius muscles (just to the right and left of the neck) hooked up to electrodes while watching all sorts of movie clips — some scary, some e-rot-ic, some a combination of the two, and some benign — people-running-through-flowers I guess. Turns out that pelvic floor tension is part of our regular defensive mechanisms. Long ago, the chances of you encountering fight-or-flight moments were few and far between. These days, being cut off by a Jetta-driving teenager who is texting and eating their lunch is enough to not only get your adrenaline surging, but your pelvic floor tensing as well. Who knew?
Let’s face it. Some of us drive our cars better than we drive our bodies. The pelvic floor takes a beating for sure, and in response, it tightens to protect its precious cargo. From small loads, created by habitual straining due to constipation, to the repetitive pressures created by athletics (running and cycling are doozies), to the major blunt traumas of a one-time not-so-smooth vaginal delivery or sports injury — chances are you can find, in your history, an episode (or twenty) where you sent yourself into protective mode. And, you might have never come out of it. How would you, if you hadn’t known to?
Excessive tension in the core
Many movement and health professionals understand that the pelvic floor and the core fire together. And when it comes to biological functions like bathrooming and coughing and vomiting and laughing (ever done all 4 of these things at once? Good times!), it’s essential that the timing and force production of the core and PF are synced up.
When evaluating motor skills of the abdomen vs. pelvic floor strength, the pelvic floor often tests poorly. Why? Years spent trying to hold in our urine, or our farts, and living with modern stress loads while holding in our urine and farts, have messed up the natural timing (read: neurology) of this particular area.
When the pelvis reads as “weaker” than the core, once again, the logical solution seems to be to fix up the strength of that pelvic floor. Logical statements, however – while valid – are not always true. While it would make sense to bring the level of strength in the PF to match the strength in the trunk, what happens when the trunk is, like the pelvic floor, also too tight? In most cases of pelvic floor disorder, not only is the pelvic floor’s timing off due to chronic tension patterns, tension in the abdomen is also great. Great, as in too much — not great as in thumbs up.
But wait! If you had a lot of tension in your abdomen, you would have washboard abs, right? Nope. Tension in the abdomen has nothing to do with strength (Tattoo this in your mind: Tension does not equal strength). Chronic “sucking your stomach in” habits are found more often in those who feel they have something to hide, right? If you’ve got military posture, been slightly tucking your pelvis to give the appearance of a flatter stomach and butt, lifting your chest (at-ten-tion!), or have simply done one too many core exercise session, the tension in the diaphragm and psoas is higher than it should be. Read through these posts to measure the length of your psoas and evaluate your tucking-in-lieu of actual transverse abdominal contraction. And, another test:
Lie on your back, placing your hands on your lower abdomen. Cough and see if the lower abdomen bulges. Ideally, a cough should produce an upward motion, not a downward one.
If you find that you measure “positive” for all three assessments, time to relax the belly and release all those tense muscles!
Unhealthy surrounding tissues
Trigger points, points of extreme tenderness or weird “lumpiness” in the specific parts of the body are common in those with hypertonicity of the pelvic floor. Here’s a picture of some typical areas with excessive sensitivity to pressure and/or lumpiness:
What makes these areas lumpy and sensitive? No one knows how it gets this way, but muscles that are tight and non-innervated tend to pull on connective tissues (called fascia) in a way that gets the fascia all wadded up, so you’ve got this tight, cold (cuz there’s not much blood there), dehydrated, non-uniform muscle/fascia tissue bundled in chunks around your body. When you push on a big wad instead of smooth, supple layers, the pressure on the sensory organs becomes higher, which means you feel it more. I know, I know. Not pushing on it would seem like a good idea, except that those wads are telling you there’s a problem that needs to be fixed. Those areas are your body waving a red flag in your face. See me! Feel me! Touch me! Heal me! There’s a proverbial The Who concert happening in your pelvis right now. Make sure you’re showing up to listen!
How do you fix it? You’ll notice that the areas highlighted are those that you’ve seen in some of our Down There Rx..ercises. All starting to make sense now, ya? Gently working to bring awareness and use (and blood and release…) to the hamstrings, gluteus, adductors (muscles in the groin), piriformis, lateral hip, abdomen and deep hip rotators can instantly improve the state of the tissue. Also, a skilled somatic therapist/body worker can help you by gently working on these areas. Or, you can do it yourself! There are lots of great self-fascia aide kits like Yoga Tune Up® therapy balls that give you a step-by-step method to find those deaf, dumb and blind spots.
Sorry. Once I start down the path of metaphor, I can’t but help but extend it.
So what do we know so far?
In many bodies, pelvic floor muscles aren’t working because they are too tight, not simply too weak. Do a quick evaluation on your personal experience with chronic stress (for whatever reason), habitual physical habits, and tension in the gut. Do any of these relate to you? Give yourself a poke or two (go ahead, I’ll wait) and check out your body for soreness. Make a note of this data as well.
Restoring length to the pelvic floor is a combination of not only what you need to do, but also what you need to do less often.
Here’s my (read: your) to-do list:
1. Become aware of the state of the tissues in related areas (i.e. abdomen, hips, glutes, SI joint, hamstrings.) Are they sore? Stiff? Tight? Work on these via touch and gentle corrective movement.
2. Sit better. Watch this “how to sit” video to make sure you’re not overloading your sacrum all day by sitting on it.
And, to use different muscles and joint configurations, check out this post for various sitting postures that are more beneficial that the blasted chair-couch-car seat you sit on all day! (click)
3. Sit less. Frankly, no matter how you sit, it’s likely too much. (Take the “How Much Do You Sit Quiz HERE!) Lots of regular walking throughout the day (with a posterior push off) keeps the pelvic floor in balance naturally. A few exercises can’t fix the lack of use stemming from all-day, 9-5 sitting. Figure out how to take walking breaks every hour, even if it’s just for a minute or two. Walk first thing in the morning, again at mid-day and once before you go to bed. This has been shown to aid in increasing circulation to the pelvic floor.
4. Start using a squat toilet. You don’t even have to use muscle strength. Just popping your feet up a little higher than usual will help open the joints and muscles of the hips and pelvis, making elimination easier. If you’re straining at all while using the toilet, then I can’t recommend this enough. You don’t even need to buy anything at first. Just haul a couple of boxes or turn a waste-paper basket over to put your feet up.
5. Meditate. I know you know this can help you, but for some reason it’s the last thing people can make time for. Seriously. If you’re dealing with hypertonus of, well, anything really, it means that your mind is tense. You can’t fix your body without addressing the mind. Sorry. I’ve tried it and it just doesn’t work. No, you don’t need to take a course in meditation, buy a special pillow, or stop eating meat and drinking beer. How about just lying on the floor, setting your phone alarm for 10 minutes. Lie there. Do nothing, including sleep. It’s not about resting, but about taking 10 minutes to actually feel the state of your body. When things hurt at night, they’re typically hurting you all day long, you’re just really good at distracting your mind from the pain. Take 10 minutes to listen to what your body is telling you. Are your habits working for you, yes or no?
6. Reduce exposure to scary stuff. While your mind might be aware of the difference between real and fiction, your body, evidence shows, does not. I treat my eyes and ears in the same way as I treat my one-year old’s. If he can’t watch it, then I don’t either. You know that filtering your food and air are important. Put those same parameters on movies, music, words, and relationships. If something’s toxic, it’s toxic — and your body will react in a way that protects you in the moment while leading to long-term damage.
7. Check for other tight muscles. (psoas, sucking, quads, neck/shoulders)
Tight muscles love company. Well, not really, but they tend to come in clumps. You’ve evaluated your psoas, right? Check your gut and let that go. Same goes for your neck, jaw, and knee caps! Watch the video on this post (click) to see if you’re quads are also jammed up!
8. Evaluate diet.
If you’re bearing down a lot or have dealt with chronic constipation, make sure you’re getting plenty of water, fiber and fat! If those are all good, then that chronic constipation is likely stemming from your body’s tension. I’m going to suggest some abdominal massage here: Look into abdominal massage! But, I’m going to be writing more about this, so check back for more info beyond recommending it 🙂
9. Align the pelvis. Ah, perhaps the foundational piece! The joints of your hips, knees, and spine can alert you to the lengths of the muscles that attach to the pelvis. And you can’t fix the pelvis until you stop pulling it away from where it works best! Read through this blog and learn more about the pelvis, where it should be, etc. Also, consider the pelvic floor video (coming soon as a phone app. Word!) Down There for Women. And, there’s one for the fellas too: Below the Belt for Men. (Please note, the exercises are the same on both titles. However, our research showed that no matter how much they loved their wives, men were not down with watching their vagina-y exercise DVD. Women, on the other hand, don’t care. Interesting…)
10. Get some glutes. Seriously. Put “Butt for Christmas” on next year’s list. This one can really help you out!
11. Reduce physical and psychological stress. This one is tough if you’ve been using high impact or high intensity exercise to deal with stress. You’re going to have to pull it back a notch while working on correcting the pelvis. Find one or two things you can do to reduce your daily stress. Leave the iPhone at home every now and then. Take a walk. Listen to quiet music. Bring ear plugs to work. There are so many ways you can reduce your stress, please don’t write this one off with a “there’s no way I can do anything about my life” attitude. Your health depends on you doing something about it.
Wow. This post ended up super-long as well! Time for me to take my pelvic floor for a little stroll.
Peace, love, and psoas.
From Chronic Pelvic Pain and Myofascial Trigger Points. The Pain Clinic, December 2000, Vol.2. No. 6:13-18.
“To visualize how the pelvic floor responds to stress, one need only look at the movement of a dog’s tail: when the dog is happy, the tail wags loosely from side to side; when the dog is stressed, the tail is tightly under its legs. It is the pelvic floor muscles that control the tail. In fact, the pelvic floor muscles are still attached to the rudimentary tail [in man], the coccyx, which is pulled forward when contracted, thereby compressing its penetrating organs. Therefore, man’s pelvic muscles, as the dog’s, may be the ultimate representation of the mind/body connection, for they are constantly responding to fluctuations in feeling.” – Jerome Weiss, MD
So many articles went into writing this, but here’s a few if you’re interested in reading more!
Bø K. Urinary Incontinence, Pelvic Floor Dysfunction, Exercise and Sport
Sports Medicine, Volume 34, Number 7, 2004 , pp. 451-464(14)
J. van der Velde, W. Everaerd. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behaviour Research and Therapy Volume 39, Issue 4, April 2001, Pages 395–408
J. van der Velde, E. Laan and W. Everaerd. Vaginismus, A Component of a General Defensive Reaction. An Investigation of Pelvic Floor Muscle Activity during Exposure to Emotion-Inducing Film Excerpts in Women with and without Vaginismus. Volume 12, Number 5 (2001), 328-331.
Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. M.P. FitzGerald and R. Kotarinos. International Urogynecology Journal.Volume 14, Number 4 (2003), 269-275.