Module 5 – Proper mobility and therapeutic exercises

The focus of this section is to get your body moving well as a whole so that your pelvic floor can work more effectively and do it’s job without issues.

Introduction to mobility and therapeutic exercises

Welcome to module 5!

I have no doubt that you have learned so much to date and that you have begun to implement all of the tips and strategies that I have suggested in all of the other modules. You may have already seen some significant changes in your mindset and have perhaps even seen a difference in your ability to have less and less of the issues than ever before.

There is no doubt in my mind that if you chose to skip through all of the previous modules and chose to just check the exercises out, that your rate of success will be weak at best. I have been guilty of doing things like that. You know… read the end of the story to get to the point. Each time I did that, I totally missed out on the point and never really got what I truly needed. There are no short cuts to a healthy, fully functional body. I urge you to go back and implement the tips and strategies that I shared with you. Don’t skip over them or just read about them… DO THEM consistently!

Make sure that you check with your health care provider to make sure that you are ready to do these exercises. Always listen to your body and never try to over-do things. Start slowly and progress according to your abilities at this point in your journey. If you do not feel safe doing these exercises on your own please reach out and schedule a one-to-one session with me to guide you with the proper techniques.

The exercises in this section are not meant to be used as a specific workout in a specific order. The creation of a personalized plan is something that needs to be done in a one-to-one setting where I can have a clearer picture of your history, your current abilities and your future goals.

You can infuse these exercises into your current workout or choose to do a few of the exercises throughout your day, during breaks at work or at home.

If you like to do group fitness classes, I want you to feel confident in your ability to say no to some of the exercises that the instructor will tell the group to do. Many of the exercises that are done in a group will not be the wisest for you. You will now have some exercise patterns that you could infuse into those group classes when you need to modify or do something safe for you. I love to take group fitness classes when I am not teaching them. I don’t care how hard the teacher may energetically encourage me to do crunches or jump higher or pull my belly button to my spine. I just grin and do what is wisest for my body. I sure as hell don’t want to worsen my prolapse because I don’t want to hurt the teacher’s feelings!!!

One day the fitness industry will catch up with the true needs of women. Until then, you need to keep having fun in those classes but stay true to what builds a fit body and keeps your female anatomy healthy, functional and safe during your period of healing and beyond.

How many times do I do these exercises?

Great question! And my answer is: That depends!

As a general rule you will repeat each exercise until failure, or that moment just before failure. If you repeat the exercise beyond 12 to 15 repetitions and there was not that great of a demand, you will want to increase the resistance level by using weights, tougher bands or doing a more complex version of the exercise. If you find that you can barely do 2 or 3 repetitions in good form then you will either reduce the level of tension or just face the fact that your starting point is those 2 to 3 repetitions and with time, over the next months, with consistent commitment to repeating those movements, you will find yourself capable of doing more and more.

As you will notice, I have kept the pelvic floor contractions section to the end of the program. I have done that on purpose. I believe that if you implement the lifestyle changes… the posture… the breathing…. the mindset… the nutrition… your ability to relax and relax your muscles and then your commitment to moving functionally, moving well and often, that you may never really need to spend a large amount of time on them. I also firmly believe that if your house is not in order, if your body and mind are not on track, it won’t matter how many pelvic floor contractions you do or how well you do them, they won’t help! Pelvic floor contractions are like putting a band-aid on an open gushing wound. Arguably, totally pointless if your body is in a”broken state”!

It starts at our feet

Another great foot exercise, to add to the exercises shown in the video, is one that will strengthen your arches.

Stand barefoot with your weight on the middle to outside of your feet.
Keep your toes flat and press down with your ball of your foot under your big toe. As you do this you should feel a subtle lifting of your arch. Hold for 3 or so seconds and then repeat. Build up to 10 repetitions. Follow this exercise with a calf stretch.

Do your best to keep your toes flat. If you are having trouble not scrunching your toes then lift them. You will want to eventually work toward being able to keep them down.

Hip flexor stretch

Inner thigh Stretches

Inner thigh stretches can be beneficial especially if you have been struggling with incontinence and you have been using inner thigh contractions or squeezing your legs together as a strategy to avoid unwanted or sudden leakage. I am going to recommend that you go against your instincts and stop gripping with your inner thighs. The relaxation that can happen during the stretches will be helpful to reduce some of your issues with pain; leg, hip, back and discomfort during intercourse if the pain is due to muscle tension or imbalances.

Trust that in the long run things will improve once you change your strategies.

The following 3 stretches are options available to you to release tension and restore length to your inner thighs and your pelvic floor. You do not have to do all 3 stretches. These are options. You might, though, find that the variety and the combination of the stretches feel good.

Never stretch to a point of pain. If your body senses danger it will brace itself and you will not get the benefits of the progressive improvements in muscle pliability. Take your time and remain in the position as long as you feel comfortable. The 1st stretch, the supported bound-angle or butterfly/diamond shape stretch is gentle and can be used during a meditation. A good indicator that you stayed too long is that it is actually painful to get out of the stretch. Remember that more is not better. There is no need to get so flexible that you could be in the Cirque du Soleil. Hyper-mobility is not our friend.

Hips

Shakira said it best: Your hips don’t lie!

It’s true. If you are not that great at moving your hips, guess what…. you will benefit from the exercises that I suggest you add into your movement ritual.

If you have thought of taking belly dancing, Zumba, Salsa dancing or any form of dancing, GO FOR IT! Being able to move our hips in all directions as fluidly as possible will have a major impact on the functionality of your pelvic floor and let’s face it. Dancing is so much fun! The benefits can include feeling sexy again!! Sign me up!!

I recall one pelvic floor therapist ( American version of a PF Physiotherapist) who claimed that hip circles stimulate the pelvic floor muscles more that ”Keegles” can. Hey, if these cool hip circles can keep my pelvic floor muscles happy and properly stimulated, once again….Sign me up!

The next video gives you a few different ways to incorporate hip circles into your movement diet.

The following windshield-wiper style movements will enhance your hip mobility.

Functional Glutes

Your Glutes are your body’s powerhouse. We want our bum muscles to work efficiently to help support our entire body and especially to make sure that they ”pull their weight” so that the Pelvic Floor muscles don’t have to work over-time.

As touched upon in the lifestyle module, if you have a posterior pelvic tilt, or tucked bum, your pelvic floor ends up in a weakened state just like a trampoline would be if you unhooked a few of the strong coils that keep the evenness of tension.

You can re-enforce this poor posture or create a weakened state in any of the possible postures when you take on the bad habit of continuously contracting your Glutes. I totally understand your instinct to contract your Glutes as a strategy to not pee yourself when you sneeze or laugh or jump. I get it, but it is NOT a long term solution. It actually aggravates things.

I will explain how to test to see if your Glutes are capable of proper contractions and then make sure that you have some tips and strategies to create functional Glutes.

I do not specify the number of repetitions and sets of each exercise in the video. As a general rule, you do each exercise until the moment before you can no longer perform them in good form or to failure. If you go beyond 12 to 15 repetitions without any real effort you will need to use a tougher band or level of resistance if you are using machines. Start with one set of 12 to 15 then, as you progress you can do 2 or 3 sets.

As mentioned in the video, if you do these exercises consistently for a few weeks and you do not see improvement in your ability to contract your Glutes on demand please connect with me so that we can discuss any further strategies.

Mobility - The importance of squatting

Prepare your body for squatting by making sure that your ankles and calves are ready for the movement. The following 4 videos have preparatory exercises and movements that will help you develop pain-free, effective squats.

Squatting on a regular basis will change your life!

Rotations for a healthy Thoracic Spine and Diaphragm

Sacro-Illiac helper

Symphysis Pubis friendly exercise

Core

We use our core constantly through the day. Without our core we would not be able to stand upright, lift, lower push or pull things. We basically would not be able to move. We need a certain amount of intra-abdominal pressure, or core pressure, to keep your spine safe and healthy. Too little pressure when we chose to lift, lower, pull or push something or move our body and we’re likely to suffer from disc herniation and back pain. Too much pressure and we’re likely to suffer from hernias, pelvic organ prolapse and pelvic floor dysfunction. We must learn how to manage the intra-abdominal pressure to ensure a well supported spine, a healthy pelvic floor, or to recover from organ prolapse and/or incontinence.

This is our abdominal pressure canister.

Our core consists of four major muscles

  • the diaphragm ( our breathing muscle)
  • our pelvic floor
  • the transverse abdominus ( the girdle that wraps around our belly and attaches on the spine)
  • the multifidus ( muscles that span along the side of our spine)

Notice that I did not include the rectus abdominus a.k.a. the 6 pack muscles nor did I include the oblique muscles. Those are certainly part of the abdominal group of muscles but are not part of the team that makes up the core.

It’s all about a balance in pressure…We must have movement and coordination from the top, middle and bottom to adequately manage pressure. Here are a few ways that this pressure can be properly regulated.

Understanding the link with breathing

The diaphragm and the pelvic floor are intimately linked during breath. When we inhale both the diaphragm and the pelvic floor expand and move down. When we exhale both muscles recoil back to their original position. They mirror each other. When we take deep breaths that move into the entire rib cage; front, side and back as well as allows gentle movement of the belly there will be just the right amount of downward pressure to allow the pelvic floor to do its excursion. Notice that I said ‘’gentle movement’’ of the belly. Deep belly breathing where the belly bulges out disrupts the pressure gradient and will create too great a downward pressure. This excess pressure over-taxes the pelvic floor and thus in the long run weakens it.

Holding our breath during effort increases the intra-abdominal pressure. The simplest advice is to never hold your breath when you do something physically demanding ( lift, lower, pull, push…). Always exhale. Learning to activate the core muscles to be able to brace properly for the amount of effort is the safer route to take when you want to do something physically demanding.

Holding tension in the pelvic floor

When you hold even the smallest amount of tension in your pelvic floor, this prevents the pelvic floor from expanding with the inhale, essentially shutting down a major part of the pressure regulation system. You need pelvic floor expansion on the inhale and shortening on the exhale

Too many women try to avoid wetting themselves by doing Kegel like contractions as an exercise or as a preparatory bracing prior to effort. All too often the inappropriate timing of those contractions and the over-training of those muscles ends up shutting down the natural movement of the pelvic floor thus making it weaker over time. Without natural movement and function, you set yourself up for prolapse and leaks. For those who are faced with proplapse or leaks the healing journey cannot start until you break those habits.

Drawing in your belly button effectively shuts down the system.

We cannot adequately manage the intra-abdominal pressure if we constantly pull in our belly or if we wear pants that are tight around the belly. As much as we long to have a flat looking belly we do ourselves a huge disservice by attempting to get that by drawing in our bellies all day. There is also a bad habit that has been encouraged by the fitness industry for far too long; The cueing of pulling in the belly button to engage the core muscles prior to and during ‘’core style’’ exercises like planks and crunches ( by the way, please never do crunches to train your core anymore!) Since the pelvic floor works with the deep abdominals, most people that draw in their belly button also hold tension in their pelvic floor. This perpetuates both pelvic floor issues and diastasis.

Bearing down is detrimental.

Learning how to brace properly with the proper breath pattern is crucial so that we don’t bear down during effort. We want to make sure that our core acts like a solid canister and that we do not allow bulging of the belly and downward pressure to happen as a strategy. Careful attention to the shape of our belly during effort can help us with the proper loading without harmful pressure on the pelvic organs and muscles.

To prevent the bearing down from happening, you have to exhale from the bottom up. The thing is, you can’t exhale from the bottom up if you never get a good inhale down. We must first lengthen to contract. Through this progressive system, you will eventually, effectively, do any movement you want safely.

Pelvic Floor Contractions

Aquafitness as an exercise option

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