Before we talk about the pelvic floor, we have to back up!
Lots of fitness and health care practitioners talk about improving “core strength”.
But what is “Core Strength”?
Do you have it?
And, if not, how do you get it?
More importantly, how do you get it or get it back especially
if you have already been through pregnancy & child birth?
And it’s not just pregnancy and child birth that contribute to a loss of core strength. Many other situations can also lead to a loss of core strength. Any injury can cause these important stabilizing muscles not work properly or at all! Falls, accidents, jobs with repetitive or demanding physical demands, heavy lifting, stress, and many disease states, which impair muscle control or lead to deconditioning, can contribute to the process of disuse and weakening.
One simple way to describe core strength is the body’s ability to stabilize the trunk in order to safely and securely move the body or the arms and legs in a coordinated and smooth and skillful manner! Each individual is born with their natural level of skill and muscle function. Their unique baseline of tone, flexibility, strength, balance and coordination can then be improved with directed work in coordinated movement, exercise or athletics.
Coordination can be described as a proficiency in a multi-movement task or a string of multiple related tasks. Each person has their starter set of skills and abilities. And so, we all have a starting point and we all have the ability to build and develop and improve in skills or any of it’s components. Typically, individuals who are highly proficient in controlling the movement of their bodies in space, in a skill, or in sport, have a higher degree of core strength.
Specifically, in the body, core strength is comprised primarily of three (or maybe another) major muscle groups that support the most central aspect of the trunk around the midsection.
- From the front/side: Deeper abdominal muscles: transversus abdominus, & internal/external obliques;
- From the back: the multifidi along the spine;
- From the bottom: the pelvic floor muscles and;
- From the top of this region: the diaphragm, resting above these other muscles and tightly linked to breath control, significantly contributes to the proper function core stabilization. When the diaphragm is being used incorrectly with poor breathing patterns, the associated core muscles do not optimally stabilize the body.
And so, the core muscles of the transversus, multifidi, and pelvic floor, as well as the obliques and diaphragm, form a secure box around the center of gravity and are super important in the control of all movements of the body!
Coordination of these muscles means that when a person is moving their body, these muscles work in such a fashion to be ‘turned on’ only when they are needed for maximal body efficiency, and they will be used both prior to the movement and variably throughout the chosen movement pattern, ensuring a smooth, steady, balanced, and coordinated movement of choice. As you watch an Olympic skater, the smoothness of highly coordinated movements are evidence that many muscles are resting and off moment to moment, and only those that are needed are working. In the novice skater, there is a stiff holding throughout the entire body, with activation of almost every muscle they can muster to activate throughout the entire movement! True coordination implies that muscles turn on and off in a highly efficient manner and are on and in use only when they are truly part of the job, and the rest of the time, they are resting!
Let’s return to pregnancy and child birth!
The abdominal and pelvic floor muscle groups are lengthened considerably during pregnancy and child birth. In addition, the midline ligament of the abdominals can be weakened and the pelvic floor muscles often tear or are cut. In a cesarean section, the abdominal muscles additionally are cut. It is easy to see that stabilizing and having good ‘core strength’ may be a challenge in light of the elongation and possible tearing or incisions through all of these muscles. When a muscle is over-stretched it is able to generate less force. When a muscle is cut or torn, it will have less elasticity and impaired control at the scar, and with any injury or damage, it will incur a loss of strength.
People are referred to physical therapy every day for far less invasive and far less dramatic injuries, even comparing the changes that are already present at the end of the first trimester! Many back pains and sacro-iliac instabilities can be aided and assisted DURING pregnancy, yet many women suffer in silence or ask and do not receive direction to PT throughout the entire pregnancy and worse yet, after!!!
It is ideal to seek the assistance of a manual pelvic floor physical therapist who is trained to work with women during pregnancy before, during, and after pregnancy because they can:
- Address the condition of the soft tissues affected in the belly, pelvic floor and back, reducing limitations or restrictions among muscles, fascia, nerves, tendons, and ligaments,
- Address the coordination of your motor control to see if you are able to turn important muscles on and off properly, avoiding abnormal movement patterns which allow ‘cheater’ muscles to turn on and take over (which causes problems down the road every time!),
- Address the bony alignment of the spine and pelvis, and if necessary, teach the patient to use a combination of positions and self-muscle activation to encourage the body to restore proper pelvic boney alignment, and
- Address proper balance among the muscles and soft tissues at the joints in question, so that the muscle activation at all joints can work optimally & pain free.
When you attempt to build strength without addressing these four very important aspects of bony and soft tissue function, you may be unsuccessful and become quite frustrated. For example, women are often told to do ‘kegels’. But, many women do not know if they are doing them properly or how to check to see if they are doing it properly, even before they have babies and likely damage to that area. Many women have underlying issues that lead them to do them incorrectly. If done incorrectly, the pelvic floor will not be strengthened at all. And in fact, the situation can worsen. It is no wonder that over 30-40% of women in the child bearing years suffer from some degree of urinary loss. The number may be much higher in reality.
And so, what do you do with this information?
- Seek the assistance of a pelvic floor therapist if you have any questions at all. Most therapists are available to discuss issues with you to help you decide if you could benefit from their help.
- If you have even just a small leak, you should seek guidance. Other problems include: a need to urinate frequently, strong urinary urges, discomfort or pressure in your abdomen, pelvic pain, inability to use tampons or have intercourse. Leaking even with jumping, sneezing and coughing is never normal. It’s just all TOO common!
- There are hormonal factors in our female lifespan that can contribute to these problems worsening at the peri-menopausal time, and so it is especially helpful to address it as soon as you realize you may have a problem.
What do you have to LOSE?
- The investment of time and possibly financial resources, but also,
- Less spending on pads,
- Fewer trips to the bathroom,
- Fewer times you will miss out on all the fun that involves running and jumping activities with family & friends!
- You may also prevent the possible progression of this problem and need for surgery in later decades!
- These are good things to lose!!!
What do you have to gain?
- Confidence and strength and a renewed ability to move physically with control!
- These services are provided by PT’s specifically trained to make it comfortable.
- Generally speaking, the earlier any musculo-skeletal issue is addressed, the less time that is generally needed in therapy. The younger you are when you start, the more pliable and elastic the soft tissues are as well. Pre-menopausal gains will come a little quicker and easier than post-menopausal gains, although women in peri and post-menopausal years, who are motivated and consistent with their therapy programs have excellent outcomes!
- You will learn how to use your muscles properly, strengthen properly, move your body properly, and reduce uncomfortable symptoms.
- You will gain tools to advance your abilities and prevent return of symptoms. Many of my patients never need to return to therapy.
- For patients that do need a return check-up, they know to come sooner and the therapy stay is typically considerably shorter.
- If you have tried therapy already, and you are still having issues, please reach out to discuss your situation with me to see if there’s anything that we do differently that can help you progress to the next level of healing!
There is SO MUCH to learn & You will be happy that you did!
I look forward to seeing you at one of my workshops!!!
Bladders & Babies & What’s a Pelvic Floor?!?!
Tuesday, May 21st, 6:00 – 7:00 pm
Monday, July 8th, 6:00 – 7:00 pm
Next Level Healing ~ Dealing with Abdominal & Pelvic Pain?
Thursday, May 23rd, 6:00 – 7:00pm
Wednesday, July 10th, 6:00 – 7:00pm
**To Sign up for any of these workshops please contact 610-295-9256***
Both Workshops are located at Rodale Aquatic Center
Check in at front desk for directions
College Drive @ Cedar Crest Blvd @ Cedar Crest College,
~Lori D. Haring, PT, MS
Lori is a physical therapist who, for the past 16 years, has specialized in the treatment of pelvic and abdominal disorders. She herself has five children, and was prompted to initiate learning in this area of study merely to help herself after incurring a child birth injury. She changed the course of her career from that weekend forward and is passionate about this topic for the betterment of overall health for both women and men, but also for the reproductive and musculo-skeletal health of women which should be more automatically addressed as routine care in our current health care arena!
Beyond pelvic floor training, she has advanced training in the areas of myo-fascial release, cranio-sacral release, visceral mobilization, vascular mobilization, and neural mobilization. These combined modalities allow for the proper tissues to be treated at the right time and cause minimal disruption to your life due to the gentle and non-invasive methods to which they are applied. Through this work, many women and men are able to tap into their innate and ever-present instinctive healing mechanisms to truly heal these injured tissues from within.