Understanding pelvic floor

A movement perspective

I often hear instructors say thing like “and lift your pelvic floor” when they are cueing exercises. What strikes me when I hear them saying it is how sure they sound and how committed they are to telling their students when to switch on these deep, intuitive muscles. 

So it got me wondering if we really understand what we are cueing and why?

No doubt we all want the best for our clients, we want them to be strong, flexible and to be able to move with ease. And the word on the street is that Pilates improves pelvic floor tone, so we should be cueing it at every given moment right? .. or should we.

In my experience, cueing muscles does not work for everyone, and when it comes to pelvic floor, since I can not see the muscles working, how am I to know what effect my cueing is having. Even if I cue ‘lift’, how do I know that the client is not bearing down, bracing or holding shallow? And if I do not know, because lets face it, we don’t, then what is the purpose of my cueing? And, in fact if my client is not connecting with pelvic floor tone correctly and instead is bearing down, aren’t I doing more harm than good by cueing over and over again?

Through exploration, practice and reflection, I have found that the pelvic floor responds to the whole body and is part of an intricate, intuitive and fluid system. The fibres of the pelvic floor are multi directional, the layers circular or spiral and the tone dynamic and ever changing. There is nothing rigid nor static nor holding. The very nature of pelvic floor is that she is toned both in a deep squat and in standing, when laying on your side and in a cartwheel, but in each position, the tone changes as does our relationship with gravity. Pelvic floor does not need to be cued, she needs to be explored in both sound and breathe, in relaxation and in movement. 

Going deeper:

Pelvic floor is so much more than a stabiliser. Our pelvic floor is part of our intuition, our expression, our sexual being. Pelvic floor can surrender or resist. Pelvic floor is primal, functional, whole body connection and our relationship is both personal and profound. So, next time you go to cue pelvic floor, stop and ask your self if you can step inside the body of the person you are teaching, do you really know what he or she is feeling, is their relationship with pelvic floor the same as yours and are you willing to open a conversation or is your talk skin deep?

In order to recognise small changes in effort, the effort itself must first be reduced. More delicate and improved control of movement is possible only through the increase of sensitivity, through a greater ability to sense differences

Moshe Feldenkrais

Yes, we should understand pelvic floor, as we should understand whole body muscle, skeleton function, but cueing muscles does not make anymore sense in a class situation as it would when you walk down the street. Do you have to tell your pelvic floor when or how to contract when you sit to stand, when you put one foot in front of the other? I hope not, and if you do, you need to seek specific professional help, not Pilates instruction. 

So, what do you do if you have a client with pelvic floor dysfunction and your are not absolutely certain you have the answers? Send them to a pelvic floor specialist. A pelvic floor specialist will do an internal examination, make sure they are able to connect and relax, give them cues that work for them as an individual and then they can come to you for appropriate exercises. Then spend time with them one on one. Explore different cues, discuss what they are feeling, get personal and find exercises for them that allow them to connect while breathing.

Where do we come in? 

As movement educators, our job is to understand what exercises or movements are appropriate for people of different populations. So instead of assuming that everyone responds to the same pelvic floor cues, or that they need you to cue, or that they even understand what you are saying, learn better techniques for people with over active pelvic floor, under active pelvic floor and prolapse. Open the discussion with your class/client to start to explore what they need and how you can help. 

Understand your own body:

Visit your local pelvic floor specialist so that you know the process your client will go through. Explore, reflect, explore some more. Be open to changing your practice, expanding your understanding and stepping out of your comfort zone.

Teach breath:

Sounds simple right? Pelvic floor connects with breath, and in a World of stress, anxiety and extended sitting, we have lost our ability to breathe deep. Many of us shallow breathe or hold breath. Teach your client how to breathe deep into the belly when they are sitting or standing. And I don’t mean lateral breath. I’m talking deep, fill every inch of your body breath, taking 6 seconds to breath in and 6 seconds to breath out. Fill your rib cage, your belly, the very bottom of your lungs on the inhale and then fully exhale. Teach your clients that pelvic floor switches on automatically when we laugh, cough or sneeze, each being a forceful exhalation. If they can not control their bladder during these actions, now is a time for discussion and potential intervention to get it right. 

Play with sounds:

As you exhale play with sounds HHAAAAA, SSSSHHHHH, FFFFFFFF. Recognise how different sounds or different positions of the tongue in the mouth change the feeling of core tone as you exhale. 

Teach awareness rather than cue tone:

Consider discussing what your client may be feeling rather than telling them to switch on. Since our pelvic floor tone changes depending on what we are doing, bringing awareness to how the tone might feel can be a great way for people to appreciate how the body works. Ie when you are squatting feel how your sits bones, pubic symphysis and tail bone are expanding. Pelvic floor is toned to support your organs. Feel what happens as you start to stand up. All those bones come closer together. Pelvic floor is toned still but may feel different. Can you, while you are squatting try and pull the bones together, and then let them ‘relax’. Do the same when standing. Feel the difference. The many layers of our pelvic floor means that we feel things differently in varying positions. This is what I mean by ‘dynamic’. Pelvic floor is not just ‘drawing up’. It is a widening, a closing, a lifting, a lowering, a condensing and expanding.

Long term health:

For those clients with healthy pelvic floor, our job is to help them maintain strength and flexibility not by cueing tone, but by teaching movement, in all ranges, involving all joints and muscles. Remember, pelvic floor is one small part of a whole dynamic, fluid system and for pelvic floor to maintain, regain or improve tone, the whole body must move, dancing with gravity, exploring primal postures and poses.

So, if pelvic floor health requires us to be moving in all directions, through all planes, from the floor to sitting to squatting and standing, it makes sense that Pilates is the perfect exercise for people to enjoy dynamic health, because it’s what we do best.