As a women's health physiotherapist we can sometimes be overly cautious with activities that increase your intra-abdominal pressure (IAP) because of the risks we think this may pose to your core system. That is your pelvic floor and if post natal your tummy gap.
Your core system, as we have discussed previously in other blog posts, consists of your diaphragm at the top, your pelvic floor at the bottom, your deep spinal muscles at the back and your deep layer of abdominal muscles at the front. If we think of the middle of you as a balloon, then any increase in pressure within 'the balloon', from say coughing, bending, laughing, lifting should not cause a loss of pressure via the pelvic floor which may present as urinary leakage or worsening symptoms of pelvic organ prolapse. So if the core was a stable balloon it would disperse the pressure, spread it around, but not leak air or burst.
In a study by Weir et al (2006) it was found that in women with no pelvic floor symptoms the IAP increased more with moving from standing to lying on the floor than it did doing an abdominal crunch, and walking increased the pressure more than an abdominal crunch. The highest increases were seen with coughing, bearing down or lifting more than 35lb from the floor.
More recent studies have shown that the IAP increases more with coughing than doing a curl up in women with urinary leakage and pelvic organ prolapse (Simpson et al, 2016).
So what does this mean?
It means maybe we shouldn't be fearful of challenging our movements and doing what we enjoy even if we have pelvic dysfunction. Maybe it is the way we are doing it that is causing the symptoms to increase and not the actual increase in pressure. Clinically what we are finding is that often just by changing your strategy of movement symptoms can be reduced. How you do certain movements is just as important as what you are doing. In the words of Antony Lo "Do something different".
Try this:
Change your breathing strategy. Are you holding your breath? Are you moving on only the inhale or exhale? Try it differently, on the in-breath maybe let your ribs expand, or let your tummy and pelvic floor soften.
Don't hold tension or brace by holding everything in. Try 'letting go' a bit.
Try changing your position, maybe let your feet turn outwards, let your knees move inwards or outwards more, bring your hips back or forwards, let your ribs drop down.
Can you feel a difference?
Should we be restricting exercise in the hope that we can reduce pelvic symptoms?
No, I don't think so.
The benefits of exercise have long been known and the current recommendations by NICE (The National Institute for Health and Care Excellence) advice 150 minutes of moderate intensity exercise per week, plus muscle strengthening activities that 'work all the major muscle groups' on 2 or more days of the week. What if strengthening the whole body: lower limb muscles, upper body, back muscles, abdominal muscles and incorporating, but not necessarily working in isolation, the pelvic floor muscles leads to a reduction in pelvic symptoms?
This is not to say an assessment with a specialist Women's Health physiotherapist should be overlooked if you are having any symptoms of pelvic floor dysfunction, be that leakage, prolapse or pelvic pain. Having an assessment and then strengthening appropriately and safely is what is needed.
Please get in touch if you have any questions or pelvic symptoms and want to get back to doing what you love symptom free.
Bally
References:
Antony Lo, The Physio detective http://physiodetective.com
NICE Guidelines, https://www.nice.org.uk/guidance/ph44/chapter/1-recommendations
Simpson S, Deeble M, Thompson J, Andrews A, Briffa K (2016) The International Urogynecological Association 27(10), 1507–1512
Weir LF, Nygaard IE, Wilken J, Brandt D, Janz KF ( 2006) Post operative Activity Restrictions Any Evidence? American College of Obstetricians and Gynaecologists Vol 107, No 2, Part 1, 2006
Image 1: From Pixaby
Image 2: My Pilates Teaser at Mycore Pilates, Hitchin
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