Pelvic Floor Through The Ages

The muscles you’re missing in programming for female clients by Lisa Gimenez-Codd

You plan movements to progress your clients strength, mobility and movement, working out how to hit specific muscles.  Every move you plan will work a group of muscles that probably aren’t even on your radar…. 

The pelvic floor. 

“but that’s just for pregnant ladies and when they’ve had their babies, isn’t it?” 

 Well, no. The pelvic floor is a group of muscles forming a sling connecting the coccyx with the front and sides of the pelvis It’s a key muscle group for all men and women although I am going to focus on females here 

People are often surprised when I say your pelvic floor works from the second you lift your head off the pillow!  (Shown in the EMG trace image below) Women who have NEVER had pregnancies can suffer setbacks as a result of pelvic floor issues.  It’s not just about those with ‘weakness’ in their pelvic floor muscles either.  

Regular gym goers, personal trainers and athletes can all encounter pelvic floor issues.  These can take the form of persistent low back ache that’s not relieved by movement adjustments or therapies, feelings of heaviness in the pelvis and incontinence. 

Muscle tightness elsewhere can directly impact someone’s pelvic floor response and control – for example, tight adductors. 

Women that tend to wear tighter clothes most of the time, feel they need to “hold their bellies in” all the time or frequently wear high heels can be affected by pelvic floor issues.  Holding those abdominal muscles taut for prolonged periods means the pelvic floor is ‘switching on’ most of the time too, rather than contracting and relaxing as the woman moves.   

This can often mean that, when she comes to laugh, cough or sneeze, the muscles simply don’t have enough left in the tank to respond.  In terms of training, this could mean that her pelvic floor does not respond well to heavy lifts and/or impact. 

Obviously pregnancy does have an impact here too. 

During pregnancy, hormonal changes, increased weight in the abdomen plus changes in alignment (as the mum-to-be’s centre of gravity changes) all put pressure on the pelvic floor. 

Post-pregnancy, changes in a woman’s hormones & alignment continue.  Often the connection between diaphragm, abdominal muscles, pelvic floor & spinal muscles (the “Core 4”) becomes ‘disconnected’ as a woman adapts to motherhood and a changing shape again.   

Being a Mum involves a LOT of lifting, carrying and holding.  Correct lifting technique and alignment goes out the window, especially on the back of sleepless nights and further pressure is placed on the pelvic floor. 

Then there’s menopause.

If you’re thinking this doesn’t affect you as you don’t deal with pre/post-natal clients or athletes, let’s talk about pelvic floor changes in ‘the F ranges’.  Here I’m talking about women in their 40s & 50s.   

Many see menopause as an event that happens at a fixed point in a woman’s life.  In reality, it’s defined as the point where a woman hasn’t had a period for 12 months.  This doesn’t happen overnight.  The transition in female sex hormones happens over a 10-15 year period which means that many women start to experience changes in their late 30s and early 40s. 

As estrogen in particular starts to reduce, the elasticity of tissues reduces.  This can have implications for other areas of your programming but in terms of pelvic floors, this is a time when a woman’s control over her pelvic floor can be compromised. 

Women who have had a hysterectomy have not only had major abdominal surgery but potentially been placed into instantaneous menopause (if ovaries were removed).  Here it is vital that your programming re-establishes that link between the “Core 4” and you incorporate pelvic floor friendly moves. 

 

How will you know whether this is an issue?

First of all, screen your clients thoroughly.  Even then however, clients may not disclose issues and even answer “no” to questions on pelvic discomfort and leakage – because they are EMBARRASSED. 

She’s unlikely to tell you her pelvis is uncomfortable, or that she’s experiencing leakage.  So how will you know? 

Watch for  

  • breath holding in exercises 
  • dashing off to the loo before and during training 
  • does she hold her abdomen in taut most of the time 
  • persistent low back ache 

Constipation and obesity also have a direct impact on pelvic floor health. 

Talk about it – a lot.  I know this can feel uncomfortable, but the more you talk about it the more comfortable both you and your client become.  They can then appreciate that whilst issues such as leakage are common, they are NOT normal. 

 

What is a “pelvic floor friendly move”?

Most moves can be pelvic floor friendly with a bit of thought.  It’s about knowing your client – if you’re not sure play it safe!  Any move that causes your client to hold her breath, bear down (often sit-ups, crunches and planks do this in those with a “core 4” disconnect) or increase pressure outwards onto the abdominal wall will pressure the pelvic floor. 

Start with the breath – reconnect breathing, diaphragm, abdominal contraction and release with pelvic floor movement. 

Simply put, as the diaphragm descends (inhale) you want the pelvic floor to relax – time this with the eccentric part of your movement.  As the diaphragm lifts, we want the abdominals to brace and a slight lift/contraction of the pelvic floor – time this with an exhale on the concentric part of the movement. 

Above all else, where you suspect pelvic floor dysfunction at any level, refer to a female health physiotherapist. 

By Lisa Gimenez-Codd of OptiMum Health

Lisa has created a fantastic course on Menopause for LTB members (including those on the 2 week free trial).  Check it out here.