How do I teach men about the pelvic floor?

I need some guidance…..

It is regarding the pelvic floor and the issue of whether men and women have the same anatomy and then therefore does the contraction of the pelvic floor  different between men and women and does it essentially feel different.

I guess my take/my understanding that was realistically men have pelvic floor muscles and women have pelvic floor muscles…they are relatively in the same area for men and women and ultimately function the same way but how we describe it to men might be different than how we describe it to women…I know that men have a the cremaster muscles (which women do not have, right?) but other than that, is there really that much difference……

I recently heard that men and women cannot be told to “kegel” engage their pelvic floors the same way and this just seems a bit silly to me……but maybe I am missing the mark on something…

Any clarification on this and HOW we should be explaining this to our training students would be greatly appreciated.  It is a question that often comes up in training courses especially if there are men in the group….
Thanks!

Kelly Dormady
SweatShop Health Club, St Paul, MN LTC

Response from Melanie Byford-Young:

Hi Kelly!
Good question. Indeed men and women have essentially the same muscles (except for the cremaster) and those muscles do both stabilization of the pelvis and sacrum, movement of the sacrum, and closure of the orifices with the sphincter muscles. They work the same. For guys, the feeling is often said to be the same feeling as pulling up their genitals like when walking into cold water. Often the cue I use is indeed very vague ‘your abs and pelvic floor will gently draw in/lift like walking into cold water’. Make sure of course that it is gentle and hardly done with any force at all. The other visuals like ‘an elevator shaft’ can work. One thing I like is to really get to the heart of what we are doing and why; we are trying to stabilize using all of our muscles together, drawing them in towards our center, which sits just in front of the S2. So if you can get the idea that the center of gravity of the body sits just in front of the sacrum, protecting the spine is done by engaging each of the stabilizers together or having them draw in towards that center of gravity.

 There are some clients who I just do not talk about the pelvic floor muscles initially because it would be too awkward and detrimental to the session. This can especially be the case if there is an older gentleman working with a younger instructor. If a client has back pain, SIJ pain, asymmetrical pain, has had prostate radiation, grips a ton in the QL or  erector spinae, or has some specific pathologies, you need to determine if the pelvic floor is working effectively or not.
Let me know if this works well enough.
All the best
Melanie

The Pilates “V”: Vital Exercise Tool or Pilates Dogma?

This question was emailed to us, but we thought others might be interested!

Hi Leslie,
I recently had an instructor teach me as part of an interview process & i try to be open to other schools but in every exercise that was open chain i had to be in the Pilates v,so i asked why?The response was stated with attitude that inner thighs help activate the corset,& it was  said as if a scientific fact.I know partly this is true,but parrallel add & abd with a ball between the legs helps activate adductors & inner thighs,but they kept repeating on & on about Pilates v as if it was the most effective or the only way that worked.
I did not want to get into a battle or even sound as if i was correcting them,but could you let me know how you would have responded as i would be interested in your thoughts!
Best regards

Lucy Garcia

Response from Leslie Braverman:

Leslie

Pilates & Gardening: Or how to hoe without hurting

This question was emailed to us:

Hi all!  I have a great client who struggles with on and off lower back sensitivity.  She is concerned that her issues will put a damper on her gardening this spring (we live in Chicago, and we take our warm-weather activities very seriously!)

Can you recommend some postural suggestions that might allow her to continue gardening, pain-free?  Also, we would appreciate exercise recommendations to prepare her for the beautiful summer garden months?

Many thanks.

Salle Huber

Hi Salle-
Thanks so much for your inquiry. Here are some suggestions for your client:

1. Work in neutral spine as much as possible. Often what irritates our back from a gardening session is the constant bending over or staying in a flexed spine position for too long. When weeding or preparing the soil, try to squat down as low as possible while maintaining a neutral spine and pelvis. If squatting is uncomfortable, buy a kneeling pad, but again try to work with a neutral spine while on the knees.
2. Vary your activities. There is always a lot of work to be done at the beginning of the gardening season. Tilling the soil or adding compost or fertilizer to the soil. Weeding or removing old plants to get ready for the new. etc. Instead of spending two hours preparing a plot, spend 30 minutes doing that and then switch to another activity like pruning trees or watering. Then go back to the more labor intensive activity. Often, we get so involved in whatever activity we are doing that we spend too much time in one position and that will irritate the back.

In terms of exercise ideas, definitely working the core muscles, (abs, glutes, spinal muscles etc) will allow your client to remain more pain free during her gardening activities. Try adding in some squats or some waiters bows to see if she is able to maintain a neutral spine in a squat position. Waiters bow is a core exercise where you sit on the edge of the cadillac or a couple of reformer boxes (in other words a slightly higher seat than a normal chair) The feet should be firmly planted on the floor though. Have your client hinge forward from the hips maintaining a neutral spine.

Certification student, Patricia Sinclair, demonstrates the waiters bow

The arms can reach forward slightly as the spine hinges forward. Once there is

Standing upright, before hinging to return to bench

enough weight in the feet, the client should be able to stand up. Then reverse the waiter’s bow to sit back on the edge of the cadillac or the boxes. These movements should be performed slowly with control so that no momentum is necessary and there should be no change in the spinal alignment as the client shifts from sitting to standing. Using the pelvic floor, transverse abdominals and multifidus muscles are essential to doing this exercise with control and fluidity.
Using a squat to get down close to the ground or to lift plants or heavy objects can help prevent strain to the back muscles. Again, make sure the abdominals are engaged and use an exhale to perform the lift or the difficult part of the movement. Check out some other great exercises in this article by Leslie Braverman; Pilates and Posture

Patricia demonstrates a good neutral spine while squatting to lift a pot.

Taking periodic breaks to stretch is also a great way to check in on your body and make sure you are not over doing things. Gardening can be a true delight, but it is important to gage your strength and endurance so that you can enjoy your garden throughout the growing season!

What, exactly, is “the core?”

It’s surprising to me how common the term, “the core”, has become. I hear people talk about it all the time. “I’m going to pilates to work on my core,” or “I think my core is really weak.” But, what exactly is “the core?”

Specifically, “the core” is describing the joints (articulation of two bones), ligaments and muscles that stabilize the rib cage, middle and lower spine, sacrum and pelvic region. When we exercise, “the core” refers primarily to the muscles that control or stabilize this region.

Imagine your trunk, specifically the region from your ribcage to your pubic bone, as a three-dimensional cylinder. If you wrap a large sheet of paper around your trunk, you would have the sides of the cylinder. Then imagine, if you could put a top on the cylinder just under your rib cage and a bottom on the cylinder underneath your sit bones and pubic bone (as if you were sitting on it.) This is the area that is your core.

The core muscles around this region need to co-activiate in order to create and maintain intra-abdominal pressure. That’s seems technical, but mostly what it is saying is that all the muscles in this region that are close to the bones need to work together to create the right amount of pressure to create stability in the trunk. This stability is important because without it your joints and discs are allowed to move too much. Too much movement at any particular joint will create unwanted sheering and will not allow the loads of weight bearing and movement to be transferred between the trunk, pelvis and legs effectively.

Now, imagine you are a long distance runner and every time you move your legs to take a stride, one or two parts of your spine move more than the other parts. In essence, you “give” too much at one or two joints thus creating a lot of friction and sheering at these regions. Over time, these joints will begin to break down, and you may end up with spinal degeneration (i.e. facet syndrome, spinal stenosis, degenerative disc disease).

The primary muscles of your core (that make up the imaginary cylinder) are the pelvic floor (the bottom of the cylinder), the transversus abdominis (the front and sides of the cylinder), the diaphragm (the top of the cylinder), the multifidis (the back of the cylinder) and some of the deep fibers of the psoas muscle.

Learning how to use these muscles correctly during exercise will help develop your core strength and minimize injuries to your spine and pelvis. Cool, huh?

Stay tuned for more information about core stabilization and exercises that help you strengthen it most effectively!

Flat abs without back pain

This question was sent and responded to through email, but we thought others might be interested!

Melanie:

What are some good ab exercises that I can do without hurting my back? Do you have research to support these ideas?

Hello,

The most beneficial way to strengthen your abs, flatten your stomach and not hurt your back is to do abdominal exercises that encourage proper recruitment of the spinal and pelvis stabilizing muscles: the pelvic floor and transversus abdominis muscles. To do this, you need to understand how to “recruit” these muscles (in lieu of using other muscles, which is common) and how to tell if they are staying “on” (instead of using those other muscles) while you complete abdominal exercises.
The transversus abdominis is the deepest layer of abdominals. It does not, by design, create movement. Instead, it creates stability for the spine and flattens the abdominals. It is important to make sure that while exercising the transversus abdominis, it is pulling in and flattening sideways (the fibers run horizontally around the trunk like a corset).
These muscles work best when the pelvis and lumbar spine are placed with the natural curve in the lumbar spine (i.e. when the back is not flattened into the mat) and the back muscles are not gripping.

There are several basic exercises one can practice to find the pelvic floor muscles. Since the pelvic floor muscles attach to the underneath side of the pelvis (these are the same muscles that control urination) they are felt easiest by sitting on a ball and gently bouncing up and down or by folding up a small wash cloth and sitting on it. These devices give some feedback for the individual.

To strengthen these muscles, gently connect these muscles by thinking of lifting them upward slightly. (It should feel like the same muscles that work to keep you from urninating.) It is important to be able to gently lift them for a count of 5, hold them on for a count of 5 and release them for a count of 5. They should not be working at 100% but closer to a 25% level.

Transversus should become active just prior to incorporating other muscles. When the transversus abdominis is recruited properly, you see a flattening or drawing in of the lower abdomen without any noticeable movement of the spine or hips.
To get the look of a flat, strong abdomen, you need a variety of different exercises in your routine. Some include:
1) Challenging the spine in neutral (plank, head and shoulders on the ground) ensuring the spine remains as it starts throughout the exercise
a. Toe taps
b. Dead bug series
c. Scissors with head down
d. One leg circle
e. Push ups
f. Leg pull front
2) Flexion routine- ensure that lower abdominals are set prior to and throughout the motion
a. Roll up
b. Obliques with single leg stretch
3) Extension based exercises- keep abdominals lifting up
a. Swan dive
b. Swimming
More info about the transversus abdominis:
1) acts as a corset, drawing in circumferentially as it protects the spine
2) stabilizer of the lumbar spine by virtue of:
- insertion into the thoraco-lumbar fascia, which inserts into the vertebrae,
- its neurological firing pattern (fires before movement begins so that the spine is protected and prepared
- coordinated work with the other stabilizers including the pelvic floor muscles, diaphragm, deep psoas, and multifidus
3) creates motion around the proper axis of motion, and prevents unwanted shearing or translation of the vertebra which can lead to irritation and degeneration of the discs and facet joints
4) provides compression (in a good way) so that the larger muscles have a stable base to pull from
REFERENCES:
1. Lee, Diane: The pelvic Girdle, Third Ed. Edinburgh, Churchill Livingstone, 2004
2. Richardson C, Hodges P, Hides J: Therapeutic Exercise For Lumbopelvic Stabilization: Motor Control Approach to the Treatment and Prevention of Low Back Pain, 2nd edition, Edinburgh, Churchill Livingstone, 2004
3. Vleeming A et al: Movement, Stability and Low Back Pain- The Essential Role of the Pelvis 2nd edition, at press, 2006
Articles
3. Lee, Diane (1998) Stress Urinary Incontinence: A consequence of Failed Load Transfer Through the Pelvis? Proceedings from the Third Interdisciplinary World Congress on low Back and Pelvic Pain. Vienna, Austria www.dianelee.ca <http://www.dianelee.ca>
4. Lee, Diane (2005) Recent Advances in the Assessment and Treatment of the Sacroiliac Joint- Stability & the Role of Motor Control. www.dianelee.ca <http://www.dianelee.ca>
5. Richardson C A, Snijders C J, Hides J A, Pas M S (2002) The Relationship between the Transversely Oriented Abdominal Muscles, SIJ Mechanics and Low Back Pain. Spine 27(4): 399-405
7. Vleeming,A Stoeckart, R, Volkers A C W, Snijders CJ (1990a) Relation between Form and Function in the Sacroiliac Joint, 1: Clinical Anatomical Aspects. Spine 15(2): 130-132
8. Vleeming,A Stoeckart, R, Volkers A C W, Snijders CJ (1990b) Relation between Form and Function in the Sacroiliac Joint, 2:Biomechanical Aspects. Spine 15(2): 133-136