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Strengthening the Pelvic Floor

This is where I dropped the kagel bomb this's that part um I talk a lot about the kagel which you may or may not know um how many of you were given the cable to dio when she became pregnant? Whether it wass via a practitioner or a health magazine or an exercise class or your girlfriend or your sister the prescription for cables are rampant, meaning that you can't even really be a woman anymore right now without being told that cables go on to your to do list and what I like to talk about is something that's not very rarely talk about which is what you really need your pelvic floor to be able to d'oh oh, well let's, go straight here. What I talk about is, um what no one really talks about is our kegels ever contra indicated for anybody. And why do we need kegels in the first place? What air kegels replacing? Why don't we have the strength to be able to do kind of the one thing that humans are required to dio which is give birth like that's something that our entire species depends on li...

ke why aren't we strong enough or able to do it so that's my perspective on the cable it's not like kagel that's not really my perspective my perspective is your pelvic floor is supposed to be doing something it's supposed to be receiving a load that it's currently not kegels are the solution that we've come up with with trying to duplicate the loads but we've the pendulum has kind of swung now and what we're seeing is a lot of a pelvic floor hyper tone necessity too much tension in the pelvic floor that is disrupting our ability to deliver vaginally like there needs to be a lot of intervention in some time it is not an option because this pelvic floor is not yielding and where it's not yielding is surprisingly enough in people who well and a lot of different people but like the newer literature is in people who are very fit people who did lots of exercise so for me what I like to investigate is like what is it about the load so I just wanted I brought my bad demonstration yes men watching this you just define the word kagel for for them and for everybody who doesn't know what the word kagel is it's a pupil cox of the jail contraction everyone can do one right now imagine that you had to pee really bad and there's no bathroom in sight what you what you would do it would kind of tense the pelvic floor to close your ureter like you either not gonna pee but you can also have what I call the backdoor kagel so you can also do a rectal kagel so anything that allows or prevents the flow of your bowels or your elimination systems from happening that's kind of quickly what's referred to as a cable. Um and so what you want with your pregnant pelvic floor is a specific thing he wanted strong enough to hold your organs right. Holding your organs is numeral, you know, not just during your pregnancy, but also after okay, that's, can your long term progression for what you want your public floor to dio but we also want her pelvic floor to support our activities. So you want to make sure that you can walk without leaking? You want to make sure that you can do whatever it is that you like to do, that the inability for the pelvic floor toe function well is interfering with we want it. We want to make sure that's not a problem, but at the same time, we also need the pelvic floor to be able to yield at an appropriate rate and at a pro and an appropriate amount when the time comes, which is when you're in delivery and that's, the stumbling block that a lot of people are running into her pelvic floor is the limiting factor when it comes time to delivery, so we want to be somewhere in the overlap, we want to be able to do what we want to dio, but we also I don't want what we want to do to become a problem down the road so I like tio do my pelvic floor demonstration so this is your pregnant pelvic floor doing what it does most of the time which is sit in a chair yeah, all right, so there's your first banana if I stand up the load in my pelvic floor is the weight of my you know, newer pregnancy so the pelvic floor does not generate the same load all of the time the load that's placed on the pelvic floor should initiate a response of the pelvic floor that matches the load so your pelvic floor or the contents of your pelvic floor which are your pelvic organs and your abdominal organs whenever you change position that's a greater loading time you accelerator d accelerator fluctuating the load so as you get up you can see how that the bad customs scoop underneath it. This is a plastic material, but if it was pelvic floor it should stop that bold from happening. It should come meet the banana where it is or in this case, your new pregnancy weight but unfortunately where our pelvis spend most of their time is in this position where there is no changing load there's no acceleration there's no de acceleration you might get up a few times, but your mass is, um improving great ning increasing all of the time so you're slowly adding more bananas but the amount of training you give your pelvic floor is very low because you don't do lots of movement or you do do lots of movement but you do lots of movement after not doing lots of movement for most of time so you take a pelvic floor that really hasn't felt the increase in load and then you take it for a dog or a big walk and your pelvic floor is like, well, I can't keep up with this low that's coming on so are masses coming on pretty slow but eventually you have a super big load and if you don't have habits that regularly frequently throughout the day place load on the pelvic floor in the pelvic floor has lost the chance to adapt but your mass is still coming on rapidly and that's really during pregnancy why we bring in the kagel right so it's like ok, well then you need to start working the pelvic floor because it's not strong enough to carry this mass but why wasn't the pelvic for strong enough in the first place? It's not because you are pregnant it's because you're not moving while you're pregnant, you're not moving frequently while you're pregnant and I'm not talking about I exercise every day I'm talking about you didn't get lots and lots of movement um regularly enough where you get the benefit of exposing the load, or maybe the load that you expose was very, very high, but sporadic, in which case it had to overreact and grip toe hold, which then kind of gets us into this category of you, strengthen your pelvic floor to the higher impact activities. And now the pelvic floor is stronger than what we call natural meeting what's found in nature, because the frequencies of what you do are greater than what would be found in nature, I guess, for the pregnant female. All right, so it's not about the kegel being good or bad. Whether it's, good or bad is moot. It's exploring why would you need cables in the first place? If you feel already that you're leaking or if you've already had your baby and things haven't gone back where they are, look at the frequency of the movement in the first place, and then I like to delineate between movement and means specifically, the types of movement that offset this pelvic floor react so your weight is pushing down here, which means your pelvic floor always responds this way to skeletal muscle, always contracts attachment points inward. This is the mechanical contraction of the pelvic floor if these were fixed points. Meaning that this bone this is your sacred this is a really super simple rendition of the front of your pelvis and your sacred, which is its own independent bone within the bowl of your pelvis here all right, you see how the sacrum it can move independently if the pelvis wasn't set up like this, then really you could have this tension and it wouldn't cause anything else but because this is a movable piece, this is allowed to get tenser and tenser so there's not really a limitation to the tension that you can develop I mean, there isn't some point, but you can get two tents very quickly if you don't have the balancing muscle group on the opposite side and so the about it most of your arms and body parts missing set this down here most of your body limbs like if I was his tensing intense ing, intense ing intense in my arm or tensing intense ing in tensing intention my hamstring gravity would undo that tension from the gravity would pull my arm back down grab it would pull my leg back down but the gravitational effect on the sacred miz different so there is nothing that polls the sacred this way gravity can't pull the sacred this way, so even if you relax when you're done cabling if you kagel a lot or you do lots of high intensity tight moves that cause the pelvic floor to react with tension the natural balance sir to this tension is everything that attach is to the say come on the back side of it so you have to be regularly hopefully at equal amounts of loading the pelvic floor be offsetting it with basic things like hip extension loaded a hip essential which come frequently this through walking so walking is this kind of it's something that humans I would be doing a lot more of then they would do now walking not in positive heeled shoes is also what I'm talking about when I talk about walking um and when you start to look at the pelvic floor through those eyes you can see that there is a solution that has no country indications with it there's a solution that doesn't come with creating a problem down the road by solving one problem right now so that's my position that's my big kagel bomb it's not really that big and explosive it's just a different perspective it's a bigger perspective about humans going is there a way that we can move where we can get what we want now without not getting what we want later on so that's all I have to say about that is there any kagel questions way have carry kelly I'm ten months postpartum I had pubic synthesis payment and now I still have soreness around my sacrum also most of my stiffness in my neck and shoulders from nursing just you were just talking about the sacraments I'm popping that one in sure and you're gonna talk about sitting not on your sacred I can just right now someone that you could do right now kelly because you say yes carrie carrie at home is make sure I talked about everyone having that slightly tilted pelvis we'll think about the tilted pelvis when you place it in a chair is that you end up placing get some fashion over this that's okay um she did you end up placing direct pressure onto the sacred so if your sacred miss sore it could be because you're actually pressing on it all of the time so a very simple adjustment is to just roll forward and up off of the sacred so what you can do is grab something like a rolled towel that you haven't home placing on the share I'm in a place that this way so you can see when you sit like this I'm actually sitting and putting a lot of pressure on my cock six my tailbone but also the lower part of my sacred and why wouldn't I? I'm pressing on it, I've got the a chair fist, you know, smack me in the back side so backing yourself up a little bit and untucked king immediately reduces the pressure I mean it's free it's simple it's noninvasive you can just get off of it and then of course there's sitting less but should you have to sit there's a way to sit better so this will help you if you put your finger everyone should be able to kind of feel where they're cox six is if you put your hand it helps if you put your hand into your pants you can feel the slope of your inter glue teal'c left also known as your butt crack if you bring that down you should be able to get a sense of where your sacred miz and when you sit down that should never be underneath you that should always be pulled up and out behind you so that's a great makeover and then the next piece would be to start moving around with a pelvis that is not tucked so that you are developing the post cheerier mass that eventually stabilizes the sacred for you you want your steak him to be stable, the more it's moving around because it's on ly pulled on one side and not equally balanced on the other side the more you're going to feel the friction and the pressure within that joint in the more it slops around is basically what's happening and then when you add a load that is potentially damaging, it all kind of sees is intense is up to protect itself and so you're working not only against the weakness but also your habits that you've cultivated because of the weakness she had chronic pelvic floor pain when standing that began during a private pregnancy but got worse after delivery and she said it never went away and carrie car carly kind of followed up and said ask the question what about the baby being overdue can that be due to pelvic floor tightness or failure to go in labor well well um was the first one to question you know she was a sharing yeah well I would just say to her back your hips up and drop it right you can start that right now sit differently right now you're already on your way look att do that forward bend look at that the hamstring tension down the back of the leg and that's all going to improve on the second one yes you know there's very actually surprisingly very little research into delivery there's very little research about what makes it happen what stalls it it's on lee now I mean it's it's very hard, very invasive to research so my perspective is of course anything can affect anything else but you know there's there's no conclusive questioning that's ever gone into that although now I think more because with bursts are becoming greater interventions people are starting to look at like where is this coming from with what's starting off the need for these types of things we have one from d j pay to how would you know if your pelvic floor was a problem during delivery? Seems like something a doctor might not identify specifically meaning if it was too tight, no there's, no way really there's no way to know unfortunately, um you can't take the measurement while you're in there. There are really great physios if you do have a hyper tunis ity a problem that has been diagnosed um after the fact or before the fact before you're pregnant, there are excellent physios who specialize in pelvic floor release they help you identified some of the habits and the tensions I'm a lot of people when they do kegels from for pelvic floor healthy often do them incorrectly, causing more greater attention than just that. So there's there's people out there who can help but unfortunately there's there's just no way to collect that kind of data. I just I wanted to address the same thesis pain because way talked about sitting just just so that the viewers at home are familiar but just in terms of pelvic structure because the sacred is tethered to bonded to the aa slightly moving joint at either side of the pelvis, the position of the sacred and the way it's hanging out forward or back or twisted or maybe even shifted off to the side is going to effect the way the sides of the ilia relate at this disc junction and so that's that's synthesis pain I just want to make sure that that that carry over is is clear and so the sacred position is definitely going to affect tension er's here and why you may feel the lingering soreness there and then to that effect of how can I know about them in my biggest fear is tearing you're absolutely my biggest fear and so we're going to do a self pelvic floor massage that actually stole right from t s usually taught it to me two years ago I was like why didn't I think of doing this before so thank you for sharing that with us and so at a minimum there are some self release work that we can do to prepare those tissues for their fur pliability from the outside in not not from inside out the baby is the only thing that's going to get that inside out pressure but in a minimum we can start to just play around with the elasticity and understand the tension is down there uh what by using actually yoga to nepal well and it's also interesting there's no way to take a measurement of the pelvic floor specifically in labor but what they do know are the trigger points that tend to go hand in hand with pelvic floor tension so if you're working on the ball and you find it it's deep adductor tension those sore spots on the hamstring around the sacred around the hips those air all risk factors meaning that when we see someone who has hypertension pelvic floor they also tend to have sore spots so you could be preventive in the way of just worked as keep working at all out and that's you don't have to wait to measure, you know, sometimes waiting for data points like how would I know it's like are you are you soar around this area? You know? Can you streamline it? Are you tense and other places area? Because I'm feeling the end pay he's been riding well for this please take my question with katie or both of you she wanted I mean my eighth week of pregnancy and I experience acute pain around my lift lab beom and low about when I get up we'll switch sides on the bid. Can you suggest some exercise or solution? I belong to the cid entering population, by the way, not a mover? Well, I think some of the stuff that we've already really talked about it's kind of those like that's those were such a good place to start and I know that when I say stand like this or you say adjust your body like this or do this on the ball that dole's don't get put in the categories of exercise I would like to tell you that those air all exercises it's not a sweaty cardio fitness c type exercise but is a necessary movement nutrient that you may or may not be missing and when you're part of the sedentary culture, which most of us are the idea that now that I'm pregnant and in pain you want me to go exercise, I have to do some exercises I get such a limiting factor if you can think about it in terms of lifting my leg, you know, as jill demonstrates, when I'm on this ball is an adductor contraction it and it has a nutrient profile that brings about healing it just is not coming packaged in the way that you're expecting it to even even like standing right now I can make about nine hundred different small movements happened I think I could do a workout right here and none of you will even know if I could try to pull my legs apart I could try to pull them together I could try to spin them outwards I could try to spend them in words I could try to kick them backwards forwards I can do different tension er's all over my body that are actually promoting reactivity and alive nous in my body and I could do this in bad I can do this when I'm on bed rest too I can use but it can push my arms into the bed I can push my elbows into the debt I could be on one side so I don't know the woman with the lady had a low back pain but you know there it sounds like there's there may be some hyper tony city and you're so is your iliac kiss and we're going to do some stuff that does definitely address so is and we're going to address it in a couple of different ways so so stay tuned you may find relief and what I've got coming this afternoon and tomorrow and what kelly is going toe doctor kelly start he's a pt physical therapist he's also going to be addressing this this say krill mechanic as well so just to follow along with what you will with the cake that you've started to open really get even more granular about that sacred position in in the context off exercise what's so great and I mean like, you know, exercise as a as a container of a practice but what all of us are talking about is that you know, your your exercise practice it isn't necessarily it's not something that separate everything that you do should be contributing to your overall carriage and this is really the most caring thing that you can do for yourself I just view movement as and all the little like widgets that I use this is just I wouldn't not brush and floss my teeth without my flaws and my oh I have a new diamond head on my sonic care it's incredible I wouldn't not use my toothbrush and flaws but if I didn't have it I would use grass you should see the little cardboard pieces in my car when I don't you know it's like you gotta get in there with some tool uh on a regular basis to make a difference and that tool can also be your own hands and it could be anything in your environment we're talking last night the plane floor is one of the best props that you can have and everything nice got access to a floor hopefully but they're suspended like this course cal I know salatin skeleton is after the skeleton go ahead katie from the chat room just to briefly review the diagram up that we have up and just let everybody know what represents what I was a little bit of put this right here so this pelvis is in the same orientation is this model so this is the this is the front attachment of this line of pelvic floor like front to back fibers and I'm talking about in the back attachment is the sacred bottom of this triangle so you can see this running here to hear this is this line here and when this is innovated or working the net effect over time is to bring these endpoints closer to each other and I'm not talking about miles or even inches it's the amount of overlap in the pelvic floor the distance travel is very very small it's not like you can really wag your sacred but it's enough when it comes to yielding to interfere with the natural yielding process okay, thank usually that helps. All right um let me move on you know yeah, I have a quick question about cables and I do really appreciate the perspective that you're taking up just even mike what is a kagel why're they useful? Why could they be problematic? Etcetera? That's really great information but I wondering if some people are still wondering ok should we do them and I get that you said you know e I mean it's on like you're suggesting do them but then also you want to walk or do something else but you know, I just should pregnant women be doing them like so for example, in a birth class that I took they were like definitely a hundred a day period minimum and I know that was precisely the kind of thing that doesn't talking about is the blanket exercise prescription without knowing anything about the person or how they're doing them and that's kind of the problem and this is a very important exercise to prescribe and there is no um assessment that comes to know whether or not this is meeting you are not I feel kind of like about cables in the same way I feel about war thought ix um do you do do you put on orthotics preemptively meaning I don't have any foot or near hip pain but should I get orthotic anyway just in case if you are noticing maybe some some areas of weakness in your pelvic floor based on you know are you leaking when you stand up or sit down do you already did you are you have a prolapse going into your pregnancy or what not um are you not doing anything else because everyone says yes key day here that I'm supposed to be doing all those things but I'm not going to but then she also said not to do kagel so I'm not going to do those either so that's not what I'm saying what I'm what I'm trying to demonstrate is this is where kegels come from this is a different picture and now you have to kind of pick the behaviors that you want to do I can't really tell you whether or not you should be doing kegels or not because I don't know anything else about you and what you've been doing before um I don't know anything about your delivery I there's just too much to know but I do think that it's important to open up this conversation because there are people who can who will know you better perhaps you have health care team that you can be discussing a different perspective with to see, you know, if they're familiar with it and and go from there because what I don't want people to take away is that kegels are bad and your pelvic floor is going to spontaneously become strong enough for your delivery without you're changing your behaviors, what I'm talking about, his here's, the more natural mechanism of pelvic for strength that, you know, as of right now doesn't have any country indications associated with it where I don't think you could say the same thing about hagel's, I did zero kegels through both my pregnancies, if that makes like if as a case study of one, I did not d'oh one cable, but I did walk four to five miles a day and do my squats, so with squats um again, the squats kind of the same thing as that barefoot foot thing that I was talking about. Um, there's gonna be a lot of people, probably in the chat room, I you know, I learned I'm supposed to squad, but my me is really like, I don't know, I don't have any range of motion, I have an artificial hip, and I I have been told not to squat or when I squat. I have so little strength that when I squat I end up bearing down when I squad because I've gone too far and I'm and I don't know enough about the squat, so I do and I'm a huge proponent of the squad, but I'm also a huge fan of smart progressions, smart frequencies and smart loads meaning to jump right into the full squad because you've seen me do it or you saw jill do it and go well, you know, my doctor told me to not do anything really stressful, but here I am down in my squad and I'm grow and I'm groaning because I went way beyond my strength and now when I come up, I have to create a veil salva that's, not the squad that we're talking about. What we're talking about is that there is a need and a hip range emotion that you should have, but of course you would have I gathered that knee and hip range of motion were you squatting throughout your lifetime? So so look at the squads and start doing your mobilizing exercises that make your ankles and your knees and your hips more mobile start with smaller squad's you know, just getting up and down off of a seat is technically a squad can you get up off a chair without creating a lot of downward strain or struggle and if not than a smarter progression for you is to just stick with the chair while doing your mobilizing exercises, maybe get into a squat position on your back or on the bed where you're still doing the same work without the same load that maybe your pelvic floor is not able to take so that's my official position on squats, I love them again. The squat toilet to me is that is the easiest thing you can do when you're pregnant. It just low product profile fits around your toilet, and if you just put your feet up on it requires no straining or bearing. You don't have to hold your own way, but you are introducing a range of motion you are tugging on that operator, all those tissues that you've been working with, you know, in a low load profile that really makes good results accessible to everybody because those are usually the questions I feel like on the outlier. You know, when you hear a recommendation, I have this or I have that and you're and I don't want you to be scared of moving, but I also want you to be mindful and be your own. Be your own information keeper like you know your limits and at the same time you can always ask, is this a fear based limit like I'm afraid of hurting myself? Or do I really have a legitimate concern that I just need a little bit more information about how to safely progress? All right think outside your chair way sit a huge, huge huge amount and sometimes all it takes to get more movement into your life is just sitting on the floor or on some really cool pillows because just sitting on the floor is an exercise, right, you would go to yoga class or stretching class or prenatal class t get down on the floor because for some reason you need permission and a ten dollars fee tio to sit down on the floor. I just you want this whole structure, and so I'm giving you permission to just sit down on your floor and assume ten or fifteen different positions you can't hurt yourself it's free it's mobilizing you don't have to leave your home, it doesn't require any extra time you're not going to break a sweat and it's huge so huge that you probably can't even believe that you're not doing it right now, it's like I just I don't I never said on my floor before it's all the way down there, why would I sit on the floor when I have this chair right here so thinking outside your chair sometimes it means standing but it also means sitting in this is just I think I have eighty different a poster with eighty different variations here that you can just cycle through them that's all you need to do a lot more move more I mean it's really that simple? I I'm a big fan of doing less and getting more results than just doing more all right, so it's about simple things putting on a different pair of shoes in the morning is not doing more it's doing less and it's what you're it's you know you think you have to stretch your calves, you have to go to class a stretcher calves, but just not wearing the shoes that short in the cavs is in fact stretching your calves and you can do it for twelve hours a day so it's just about shifting the way that you think, what are we going to learn in a baby carriage? We are going to be a move stand behind this chair this is like, uh I'm gonna achieve you show I'm tryingto block my bailey we're going to be going over the lining of your birthday suit, the soft tissue canister, all the different layers of your abdomen and how to and and your back as well and how to help your core musculature to be in service of your carriage now your carriage and delivery and they're after and it's not what you think it's not about sit ups, there are some very under looked muscles that you are going to discover, uncover and awakens really awesome material after that, and also we're going toe integrate the shoulder carriage into that core carriage as well. After that, dr kelly start and his wife juliette start are going to come on and talk about the athletic pregnancy and dispel some massive exercise myths. So that's, what we've got going on this afternoon. Thank you, jill and katie, we have had some intense discussion and storytelling around pelvic fools online, you know, I've even I've even been putting a bit in there, it's one of those topics that is just is just so intense for all of us. You really lifted the lid on how to structure and care for the way its way I want to stay strong, so I thank you so much and I'm going to summarize our online there's been so much online, but our well has had something to say, which I think goes for a lot of ascent starts with I'd never thought of trying squat motions while lying down as a starting place that was while you were doing the options of the chair and then she says. Definitely had low back pain during my first pregnancy. Who wasn't so bad for the second, because I'd read a lot of katie still so much to learn and improve, though she is fantastic. So thank you again. That was terrific, terrific stuff.