Recently I had the opportunity to lead a workshop on pelvic floor biomechanics with my good friend and physical therapist, Greg Hullstrung.
In my 17 years of teaching, I’ve had the good fortune to collaborate with physical therapists who specialize in pelvic floor dysfunction and study with some of the top movement educators in the country and I’ve learned that there’s a lot about the pelvic floor muscles that’s up for discussion.
Knowing What We Don’t Know
“Ideally speaking, one should describe the function of each component of the pelvic floor muscle individually; however no such information is available. Broadly, the pelvic floor muscles can be considered to have 2 important functions. They provide 1) support or “floor” to the pelvic viscera and 2) constrictor functions to the urethra, vagina and anal canal.” (V. Raizada MD, R. Mittal MD. Pelvic Floor Anatomy and Applied Physiology. Gastroenterol Clin North Am. 2008: September, 37(3); 493-vii.)
Naming the pelvic floor muscles has even proven to be tricky. While it’s agreed that the levator ani and the coccygeus muscles are the main muscles of the pelvic floor, naming the component parts of the levator ani is where the agreement breaks down (pubovisceral?, pubococcygeus?, puborectalis?, etc.)
Part of the challenge lies in the fact that the pelvic floor muscles are subtle and hard to study in living people. In cadaver studies, some of these muscles have been damaged due to pelvic floor traumas (this is especially true of some of the cadaver studies of women who gave birth).
But for movement professionals, and Yoga teachers in particular, there are 6 Key Concepts worth keeping in mind in both our own practice and as we work with our students/clients.
1. What Happens in the Pelvis, Doesn’t Stay in the Pelvis. For starters, resist the temptation to isolate the pelvic floor from the rest of the body. The support that the pelvic floor provides (or does not) affects how the foot hits the ground, the stability of the knee, the condition of the hip, whether the low back gets chewed up, and it even impacts tension in the neck and shoulders. Think locally but act globally.
2. It’s Not What You Know, It’s Who You Know. In life and in the body, connections matter. Look no further than the obturator internus (a decelerator of hip internal rotation, hip adduction and hip flexion and whose fascia provides an origination for the levator ani) for proof of the pelvic floor’s connection to the lower body. Who else would seem to be an influencer/influenc-ee of the pelvic floor musculature?
3. What’s In a Name? Everything. Pelvic floor or pelvic core? Christina Christie and Rich Colosi are physical therapists based out of Chicago who suggest a great way to get your head out of the pelvis: assess and train the pelvic core. The abdominal muscles are the front of the pelvic core, the paraspinals provides the back, the respiratory diaphragm provides the top and the pelvic floor is the bottom. Does that shed more light on some of the bottom-up and top-down influencers?
4. Don’t Engage Your Pelvic Floor Unless You’ve Had a Really Long Courtship. In some cultures, it’s cool for one person to tell another, “Engage So-and-So” even though no relationship has been cultivated. And hey, sometimes that works out. Just like artificially engaging your pelvic floor muscles works out sometimes. Perhaps a better strategy is to ask those muscles: what turns you on? You know what we’ll hear: actions. So if you suspect someone’s pelvic floor isn’t turning on, don’t yell at it (engage! activate! lift!), instead, learn what movement patterns turn those muscles on and then trace their movement patterns to see whether they’re getting those motions (or not).
5. Nobody Drives in Neutral. A lot of well-intentioned energy is spent helping people ‘find neutral’ as if positioning the spine in a neutral position is the end all, be all. While it’s nice to find neutral, remember that just as nobody drives their car in neutral (they pass through it to get to other gears), nobody functions in life with a neutral spine. Over-training a ‘neutral spine’ can remove the there-by-design, anterior (forward) tilt of the pelvis. Taking away the anterior tilt of the pelvis removes the bony support that the pubic bone provides the bladder, asking the pelvic floor muscles to pick up the slack. Literally.
6. The Final Word on The Pelvic Floor/Core… There is no final word on the pelvic floor/pelvic core. For that matter, this observation would hold for much of what is ‘known’ about the human body. So as we apply this information – and gather more – in our best efforts to be of help to the clients/students we see, it’s always helpful to keep an asterisk handy and to get comfortable saying “I don’t know” and “it depends.”