The Art Of Mastering Movement

The Core: Part Four – Week Five of Pilates

View of the female pelvic floor from above

My first experience with pelvic floor exercises came when I was working with Alan Herdman in London.  Alan and I were in the middle of a side over exercise when a beautiful woman walked by and thanked Alan for teaching her about her pelvic floor because her client base had increased dramatically over the last month.  I, of course, had two questions, what did she do for a living and what did he teach her?  Alan’s answer to the first question: she was a high priced escort.  I was too embarrassed to ask the second question so I looked it up.

The pelvic floor is the group of muscles known as the levator ani, or in Latin, anus lifters.  It is composed of the puborectalis, pubococcygeus, iliococcygeus and the ischiococcygeus.  These muscles line the base of the pelvis from the pubic bone in the front to the inside of the tailbone and across the pelvis from one sit bone to the other.  The pelvic floor is important in maintaining the “fit” of the pelvis and sacrum puzzle pieces, supporting the bladder and reproductive organs and pressurizing the abdominal cavity.  This pressure supports the low back but is only beneficial when all members of the pelvic floor are working together harmoniously.  As mention in the first article on the core, the members of the core are the transversus abdominus, multifidi, pelvic floor and diaphragm.  When these muscles are imbalanced the system is forced to compensate and this has far reaching consequences for the low back.

The pubococcygeus is the most anterior of these muscles.  It is important for sexual function and is sometimes injured during childbirth without knowing it.  Dr. Kegel designed the exercise in which the subject engages the anterior pelvic floor for a given length of time and then releases it.  While a Kegel or “bracing” may be an acceptable way to sensate or find the anterior pelvic floor musculature, it is not recommended for daily use.  This is for two reasons:
1). The Kegel does not address the breath.  Since the diaphragm and pelvic floor work together during a breath, if the breath is held while engaging the pelvic floor the diaphragm will not be able to participate fully.  This disrupts the harmonious functioning between the members of the core.
2).  Integrating the breath underlines the kinesthetic relationship between the top and bottom of the core and incorporating the breath is more likely to bring about using the pelvic floor in everyday activities more quickly and effectively in your life.

The posterior pelvic floor or pubrectalis tends to be ignored in comparison to the anterior pelvic floor.  However, it can sustain significant injuries (it has been known to rip during childbirth) and its function is also important to low back health and function.  Imagine the pelvic floor like the foundation of a building.  If there is not support for the backside of the building, pretty soon what is above will soon start to slide down.

The iliococcygeus and ischiococcygeus travel from the outer bones of the pelvis to the coccyx, the evolutional remnants of a tail at the very end of the spine.  These two muscles tip the base of the spine backward, in direct opposition to the muscles of the back.  The pelvic floor is locked in a dance of stabilization with the muscles of the spine.

The four muscles of the pelvic floor must be constant and dynamically active to support a pain free loading of the pelvis.  When healthy, the pelvis has remarkable mechanical abilities to transfer weight and movement seamlessly up to the trunk and down to the feet.

Exercises for the Pelvic Floor
1. Diamond Sit – Seated on the floor or hard bench/chair.  Visualize the four corners of the pelvis (pubic bone, coccyx, left and right sit bones) creating the shape of a diamond on the floor or chair.  In between those four points lies your pelvic floor.  If you would like, you can place a soft, 4-5 inch diameter ball in between the four points to better feel your pelvic floor.  As you inhale, visualize the diaphragm and pelvic floor moving downward.  As you exhale, visualize the diaphragm and pelvic floor moving upward.  Visualizations you can use are your pelvic floor moving with the quality of a jellyfish, or lava lamp, or any image that conjures something strong and supple without too much tension.
After you have done this exercise for awhile, notice that as you engage your pelvic floor on the exhale, you may also feel your abdominals engage.  The research scientists Sapsford and Hodges, that we have discussed before, did a study that showed the pubococcygeus engages with the transversus abdominis.  Can you feel that connection?
2. Sitting and Standing – This is an exercise I learned from Eric Franklin.  Seated on a chair, notice the two sit bones touching the chair.  As you lean forward the sit bones move apart, and as you move back to a seated position, the sit bones move together.  Inhale forward and exhale back.
After you have done that for awhile, lean forward with sit bones apart, move forward off the chair onto your legs, bring the sit bones together and you will stand.  Reverse the sequence to sit.  Lowering yourself to the chair, the sit bones will spread, touch the chair with your pelvis and go back to sitting the sit bones will move back together.  Bonus if you write me in a comment and can tell me when in this exercise the pelvic floor is eccentrically(stretching) and concentrically(engaging) working, and with what breath pattern.  Let’s see how many of you read this!

References

Franklin, Eric.  Pelvic Power. Princeton Book Company. Hightstown, NJ.
2003

Lee, Diane.  The Pelvic Girdle. Harcourt Publishers Limitied.
Edinburgh, UK. 2000.

Sapsford R.R, Hodges P.W., Richardson C.A., Cooper D.H., Markwell S,
Jull G.A.  Co-activation of the abdominal and pelvic floor muscles
during voluntary exercise.  Neurophysiologey and Urodynamics 2001:20.
Pg. 31-42.

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