As the holiday seasons arrive into New Year’s resolutions, there is no doubt a lot of turmoil in our routines and an openness to reevaluate what is working for us physically, relationally, socially, etc. Have you considered getting your bowel health in order? I’m sure you’re wondering why I am even bringing this up, but as a pelvic floor physical therapist, this is something I screen in all of my clients because it can tell us the story of not only what is physically implicated in and around pelvis, but it also tells us about our gut health, nervous system and much more!
Having irregular bowel movements (BM) both in type and timing can affect how we absorb nutrients, the pain we experience in and around our pelvis, and the stress and strain we place on our pelvic floor muscles. I wanted to provide some tips to improve the pooping experience and continue progressing toward your health and movement goals.
If one of these sticks out to you more than others, then consider adjusting one thing at a time as this process is a habitual and behavioral activity that responds well to consistency. If you continue to have issues with regulating this on your own, or are experiencing difficulty emptying your bowels, straining or pain with BMs, or having loss of bowel control, a pelvic floor physical therapist such as myself, can evaluate those issues and provide relief. I am helping people overcome their pelvic pain, pelvic heaviness and leaking with exercise and daily life in our Decatur clinic. Call us to get you scheduled or learn more about our services.
Dr. Krystal, PT, DPT, CMTPT, RYT-200
If you are currently pregnant or thinking about building your family, this blog is for you on how to approach exercising. It can be concerning if you’re not used to regularly exercising just how far to push or what to do. You may be all in or you may be hugging the couch. Either way, I’m here to tell you the benefits of rolling out your mat, lacing up your shoes, or picking up that iron. As a physical therapist, my role is to not only put out fires that are already affecting my clients, but to educate them on potential fires in the future and how to prevent them. There is strong recommendation that in the presence of an uncomplicated pregnancy, pregnant persons currently not meeting exercise guidelines should demonstrate a progressive adjustment toward them.1 Why?! First of all, physical activity is associated with positive health benefits for the mother, the baby, and the labor and delivery process. After all, this is quite a physical event you are embarking on. Second, this is the best chance at decreasing or preventing musculoskeletal related pain during your pregnancy. We are going to go over the terms that are used in the literature and break them down: type, frequency, duration, volume and intensity.
From several sources 1,2,3, the general recommendation is to participate in a variety of types of physical activity, like cardio training, strength training, and gentle stretching or yoga. I would gravitate towards what comes naturally to you first, and start sprinkling in 1x/week the other forms that you’re not used to. To emphasize strength training here, this training is going to become essential in the 2nd-3rd trimester focusing on the posterior chain, or your entire back side from head to toe. This is because your center of mass is going to change, creating a natural but increased low back curvature and tendency to round the middle/upper back. As the bump grows, there tends to be a pregnancy waddle that should be minimized to focus on extending your hips and keeping butt and legs strong.
Here are some examples of exercises that combat this:
For both pregnant and non-pregnant persons, it is recommended to get 150 minutes of moderate intensity physical activity a week. For the average adult, theoretically, if you did all 150 minutes on the same day, there would be no significant difference between that and increased frequency with less time. However, during pregnancy, it is recommended to perform physical activity most, if not all days of the week, with smaller durations. Duration is the amount of time spent doing the activity. If you are just starting out an exercise routine, I would highly recommend beginning with a shorter duration and higher frequency, 10 minutes a day for 4-5 days a week and each week adding 5-10 minutes to your duration or adding another day.
Here are some examples of an ideal frequency schedule:
Volume refers to the amount of physical work you produce in a workout. In strength training, it refers to how many sets, repetitions and how much weight you use. For example, 2 sets of 15 at 10 lbs is less volume than 5x5 at 20 lbs2. For endurance training with walking and running, volume refers to distance covered or the speed of movement. I would recommend beginning with a low volume as you start your routines3. Starting with 2x10-15 at a weight you complete all repetitions with good form is a great place to begin. For cardio, you can spend 30 seconds or so doing a faster pace (covering more ground) and back to a comfortable pace for 2 minutes and repeat for your selected duration.
We are going to keep it simple for intensity which is how hard you are working. Heart rate is not going to be an accurate measure during pregnancy, so we are going to use a talk test and/or rate of perceived exertion (RPE). Throughout any activity, you should be able to carry on a conversation and complete sentences without being breathless. I like to use a scale of 1-10 for RPE and I think a 1 is sitting on the couch and a 10 is finishing a marathon. Moderate intensity for your RPE may be between 4-6. A lot of this exercise stuff is going to be based on how you feel while doing it, so it’s important to monitor for lightheadedness, nauseous or sharp pain. It's best to adjust or stop the session if these symptoms continue or you just feel lethargic.
Bottom line: For those who are beginning an exercise program in pregnancy, the goal is to get to 150 minutes a week of moderate intensity activity. Until then, doing physical activity more frequently with smaller durations is a good place to start with an intensity that is tolerable to talk. There should be a variety of activities like cardio, strength training with emphasis on posterior chain strength, and gentle stretching or yoga.
If you’re not sure where to start or how to progress, that is precisely what we help with at Athletes’ Potential. As always, we will also confer with your OBGYN, as you also should, before beginning new physical activity. Give us a call to schedule your appointment!
Krystal Fannin, PT, DPT, CMTPT, RYT-200
We are in the day and age of information overload. You can practically have your questions answered by the first 3 links that pop up after you enter your search. Not only will your questions be answered, but anxiety may begin to creep up when you have to sift through what serves you or what does not for your particular situation. When it comes to pregnancy, childbirth, before and aftercare, resources and information abounds. At Athletes’ Potential, we desire to provide clarity, support and empowerment through your walk in life including the birth journey.
Jasmine Bradfield is a traditional birthworker and doula currently pursuing her Midwife certification, and is local to Atlanta. Having doulas and/or midwives present during the birth process as continuous support is brimming with evidence that there are positive outcomes related to improving the birth experience. This also means decreased medications, decreased c-sections, increase in spontaneous vaginal births, shorter labor duration and decreased negative feelings about childbirth, to name a few. 1
Jasmine, what is one thing you want our audience to know about doulas/midwifery?
Birth is a normal physiological function of the body, and there are many different ways to support each unique life occurrence. I always say the best birth is an informed birth.
Every birth is different. No matter what you read, what you hear, or what a family member went through. So I like to start service with a ‘Birth Plan’ that helps the new family set the preferences for how they realistically imagine their birth may go. Then we sit for Childbirth Education. This is a meeting where we chat about pregnancy, childbirth and newborn common occurrences and complications.
Knowing this information prior to birthing day helps families decide what is best for them, and not feel as pressured to travel through the unknown. If a provider presents an intervention, as a family they may ask the provider to step out for a moment so that we can all discuss what is best for them without influence or persuasion. Doing this also allows the family to make informed decisions that they are less likely to regret and also feel empowered.
Support is the first thing that comes to mind when I think of those guiding the birth process. What are the top three ways you support your clients?
Education: Simply sharing what is unknown and filling the gaps between client and providers.
Ex.: Childbirth education, Birth Planning. Postpartum Care
Self advocacy: Empowering birthers to use their voice to say how and what works for their body, birth and budding family.
Ex.: I will not speak for a family, I will not make decisions. I will however ask the questions that remind the family of their wishes. I will offer space between the provider and family so that the family can discuss in private and decide as a unit how to proceed.
Emotional/Physical support: This includes touch, conversation, movement, and self expression preparing the body for the endurance of birth
Ex.: Oftentimes there are movements that will assist with the progression of birth. If the baby is high in the womb, I may suggest lunges. If we are later in birth and we still have some time to dilate, maybe we shift to a supported goddess. Emotional blockage can also stall birth because stress inhibits the body to relax. Sometimes opening the door for conversation or silence even may be the support needed. As a doula I am trained to see the times that support is needed to assist in the comfort, informing, and progression of birth.
At Athletes’ Potential, we are experts at getting our clients back to the activities they love after injuries or life events such as pregnancy. What advice do you have to our postpartum moms within the first six weeks after delivery that can set them up for thriving?
Recovery. The body has gone through a transformation and needs rest to heal. Although it may be difficult to resist the need to get back to work or reduce girth of the belly, the body truly needs to restore itself. A physical therapist can help you understand the extent of change in the body so you know when and where active movement can begin.
We believe that if you have a body, you are an athlete. In preparation for the delivery process, what are some ways you suggest preparing our birthing Mom for this enduring experience?
Pregnancy is the preparation for the marathon of birth. I suggest body work such as massage, physical therapy, chiropractors, yoga or some form of pregnancy safe exercise. I love prenatal yoga for pregnant people. It is one of the only times you will find a room full of people experiencing what you are experiencing at the same time in a social setting. Pregnancy can at times feel isolating and you want to prepare the endurance of the mind too.
What are ways to work with you?
-My website is www.atlantabirthwork.com where we offer courses, classes, and birthwork services.
-Social media: @atlantabirthwork
-You can join my in-person prenatal yoga class at The Yoga Hive http://www.theyogahiveatlanta.com/copy-of-schedule
-And I love to chat via email email@example.com about potential birth workshops, education and speaking events.
Thanks for reading,
Dr. Krystal, PT, DPT, CMTPT, RYT-200
Are you like 50% of women who have an anatomical pelvic organ prolapse? That means you may have one and you do not even know it, and that is okay! However, if you are experiencing symptoms such as heaviness in the pelvis or a bulge, this new sensation can be troubling. I’m here to tell you to have no fear because there is a lot we can do to help! One of the best things you can do is begin or return to strength training - however it needs to be at the right intensity and load for your body right now. You may be thinking, “I don’t want to pick up that heavy thing, that’s going to make my prolapse worse.” Well I am here to tell you that it will not make it worse under the right circumstances. We’re going to go over what prolapse is, why strength training is important, and 3 modifications you can implement during your resistance training.
What is pelvic organ prolapse?
Also known as POP or just prolapse, is when there is a descent of one or more of the pelvic organs toward the vaginal opening. What this is NOT is your organs falling out of the vagina. Rather, due to life circumstances such as multiple vaginal births, hysterectomy, advancing age, we can lose the internal support structure that suspends our viscera along with general core weakness. There are different kinds of prolapse where it affects more of the anterior wall of the vagina, posterior wall, or the superior wall like the roof. Regardless of your presentation, we will work to find the best ways to relieve symptoms and get you stronger.
Strength Training Helps
You may have been told that you should be careful or to not lift weights at all as it will increase pressure in your abdomen and you may bulge more. Although anything is possible, with the correct training on breathing techniques, load management and positioning, I’m here to tell you lifting weights is not only possible but it’s necessary. Having a strong core and legs in the long term will put less pressure on your pelvic floor because what was once a heavy or straining activity (i.e. getting up from the floor, picking up your toddler, picking up heavy items) will be easier with your gained strength. The pelvic floor muscles do not work in isolation and strengthening the external pelvic muscles will help reduce symptoms and increase quality of life!2
3 Modifications to Try
By now, you can see there are plenty of options to try to keep you doing your workouts even though you may have a prolapse. Our goal in physical therapy is to keep you doing your loved activities as long as possible and feeling your best. People often ask if they need surgery for their prolapse and it depends on how much this taking away from your life in terms of bowel/bladder/sexual function and overall quality of life.3 Some individuals do well with a pessary fitting, which is an internal device that can help support the vaginal walls, or anecdotally, some women find relief with wearing a tampon, menstrual cup or flex disc while exercising to decrease symptoms successfully.
I am helping women overcome their pelvic heaviness or bulge symptoms at our clinic in Decatur, GA. Having a specific plan for your unique situation will lead to the best results. Give us a call to schedule your appointment!
Krystal Fannin PT, DPT, CMTPT, RYT-200
1Gorji, Z, Pourmomeny, AA, Hajhashemy, M. Evaluation of the effect of a new method on the pelvic organ prolapse symptoms. Lower Urinary Tract Symptoms. 2020; 12: 20– 24. https://doi.org/10.1111/luts.12277
2Maher CF, Baessler KK, Barber MD, Cheong C, Consten ECJ, Cooper KG, Deffieux X, Dietz V, Gutman RE, van Iersel JJ, Nager CW, Sung VW, de Tayrac R. Surgical management of pelvic organ prolapse. Climacteric. 2019 Jun;22(3):229-235. doi: 10.1080/13697137.2018.1551348. Epub 2018 Dec 21. PMID: 30572743.
What do you think of when you hear the word core? I think of something that is central, vital, or the most important part of something. We can also think of the innermost layer, take fruit for example. Cutting an apple and removing the core, or coring a pineapple. You get the idea. Commonly, when people refer to their core, they touch their abs, their front abdominal wall. And that is just one piece of our innermost muscular layer.
What is your core?
It consists of four major muscle groups that work together through our movements. Beginning with the obvious is our front abdominal wall, however the deepest layer is the transverse abdominis muscle. This muscle has horizontal fibers parallel to the ground that wrap around to the back. There they meet one of the deepest layers of spinal stabilizers called the multifidus muscle or multifidi for plural. I imagine that these two muscles make an internal corset around our trunk for stability. If we think of the core as a cylinder shape similar to a soda can, we’ve described the sides. The top consists of the diaphragm, a thin flat muscle, which relatively moves up and down with our breath. The bottom of the cylinder is our pelvic floor muscles.
What is your pelvic floor?
This is a trampoline like structure, consisting of three layers of muscles at the bottom of the pelvis and our cylinder. The pelvic floor functions to stabilize the spine and pelvis, support the abdominal organs including our reproductive/urinary/bowel systems, controls sphincters that prevent leaking of urine/feces/gas, allow healthy sexual function, and circulates blood flow back up to the heart.
How do they work together?
When we breathe in, our diaphragm contracts, descending down into the abdominal cavity, which is why we may feel our belly rise or our bottom ribcage expand. As we exhale, our diaphragm returns back to its original dome shape into the thoracic cavity. Our diaphragm and pelvic floor muscles work together in functional movements like a piston. As one descends, so does the other and vice versa. This creates stability and protection to all of these muscles and structures.
Why should you care?
The pressure that we manage in our intra abdominal cavity will go to the area of weakest support. In this image, the front abdominal wall commonly begins to lengthen and without proper counterpressure, that can lead to increased stress to the tissues surrounding our linea alba where our abs attach. If this is left unchecked, this can lead to a diastasis recti (DR), hernias, pelvic floor dysfunction, low back pain, and hip instability to name a few things. Having balanced forces across the torso with our everyday movements is vital for protecting your body and keeping you moving your best. However, after periods of not training, pregnancy/postpartum, prolonged sitting postures, can leave us vulnerable for these issues listed above.
If you feel like you’re experiencing the symptoms above, difficulty getting your body to “bounce back” postpartum, leaking with running and workouts, give us a call to identify your specific imbalances and begin a path toward recovery.
Dr. Krystal Fannin PT, DPT, CMTPT, RYT-200
 The “pop can” core. Digital Image. J Smeaton. Apr 2019. [Accessed 2022 August 30]. Available from: https://www.depthtraining.ca/the-pop-can-core/.
 Breathing variations. Digital Image. S. McLaughlin. Aug 2019. [Accessed on 2022 August 30]. Available from: https://www.alignforhealth.com/self-care-for-pain/category/core%20stabilization
Did you know that our bladder is one of the most trainable muscles in our body? This is for the good or the bad. Not that anything is that black and white, but sometimes with our lifestyle and behaviors, we can teach our bladder habits that are holding us back. Does this sound like you?
If it does, these are extremely common sentiments. However, there are ways to overcome them and treat our bladder and pelvic floor in the most compassionate way. As a pelvic floor physical therapist, here are my recommendations in accordance with the American Urological Association guidelines:
Consider making these adjustments and see if they help your symptoms. I will say that specific adjustments are needed for each individual depending on their lifestyle or where you fall on the incontinence spectrum. Seeing a local pelvic floor physical therapist, like myself, can assist you on the right exercises to be performing and steps to overcome urges or stress related leakages you experience.
Thanks for reading!
Krystal Fannin PT, DPT, CMTPT, RYT-200
For some, that “four months pregnant” appearance can last for months to years. It is a common question that postpartum moms ask from an aesthetic standpoint, but as a pelvic floor therapist it can indicate the integrity of the abdominal wall. The timing at which this appearance can improve hinges on your genetics, daily posture, the degree of physical changes (and trauma) your body goes through, what your current health, nutrition and fitness levels are like. This blog will not go into how to lose that baby weight or achieve a flat tummy, rather how to rehabilitate the abdominal injury that is diastasis recti (DR).
What is a diastasis recti?
DR occurs when the rectus abdominis, your 6-pack muscles, separate in the front of the body. This commonly occurs during pregnancy affecting over 60% of childbearing women, but can also be found in persons with stomach obesity. As the abdomen increases in size, it stretches the front abdominal wall leaving the linea alba (connective tissue between your abdominal muscles) vulnerable to separation. The degree and severity of DR are unique to each individual and with each pregnancy, however, this can lead to a bulge or “pooch” in the abdomen. This is noticed more so when doing sit ups or crunches.
Why should I care?
Although it is normal having to have degrees of abdominal separation, if it is large enough and does not resolve on its own it can lead to recurring low back pain, pain during sex, constipation, pee leakage and other pelvic floor issues. This can spill over into your workouts, playing with your kids, etc.
How do I check for DR?
You can lay on your back with your knees bent. Place two fingers at your belly button pointing down toward your spine. Lift your head slightly to engage the abdominals like you are initiating a crunch. If more than two fingers can fit in the gap, then you likely have DR. Repeat this check two inches above the navel and 2 inches below.
I have DR - What now?
I would recommend pausing on activities that put undue stress on the abdominal wall like crunches, any plank variation, full push ups, toes to bar and pull ups. That does not mean that you will not be able to do these activities again, rather it will improve your capacity to load your body once the abdomen is working better. If not, the chances of experiencing the above symptoms are great.
Based on your unique presentation, we will go over specific exercises to enhance the function of your entire core (bonus, it may aid in flattening the tummy!), breathing techniques, posture hacks, and ruling out related pelvic floor dysfunctions. We will build a plan together to not only get you to feel your best, but to move your best!
Thanks for reading,
Dr. Krystal Fannin
Back pain is such a common complaint that we treat, but what if I told you that back pain can be caused by pelvic floor dysfunction? First, it is important to remember that pain does not equal damage. Second, it is not unusual to experience pain in a different area from where the dysfunction lies. This could be referred from another area or a secondary effect to moving in a weird way due to the dysfunctional area.
Cause and effect in this case is very similar to asking “Which came first, the chicken or the egg?”. What we can state confidently, is that your back and your pelvic floor go hand-in-hand. Studies show that folks with low back pain have decreased pelvic floor function compared to those without back pain. Could this be pelvic floor inhibition due to the back pain? Can weakness or over-tension or control issues of the pelvic floor be causing the back pain?
For many, the pelvic floor is very nebulous. What is it anyway? Where is it? What does it look like? Do only women have them? Males do have pelvic floors, but the anatomy is different. For this post, we will referring specifically to the female pelvic floor. But guys- you too can have pelvic floor dysfunction! This image below is a great look at the female pelvic floor and it’s close relationship to the other pelvic and lumbar spine architecture.
The pelvic floor helps to support the weight of your organs, helps with toileting and sexual function, and influences posture and control through pressure within the core. Weakness, over-tension, spasm or damage to the pelvic floor will change the support of the sacroiliac (SI) joint and the forces that we create through the lumbar spine.
If you have addressed your lumbar spine without much change in symptoms, go a different route! Keep in mind, there are other signs of pelvic floor dysfunction, other than leaking urine or back pain. They include painful sex, frequent constipation, the feeling of heaviness in the vagina with jumping/running/bearing down etc.
Addressing the Pelvic Floor
There are 3 areas to cover that address your pelvic floor in a functional way -- position, breathing and bracing. All of these can be applied to any athlete in any setting.
Position- Keeping the ribcage stacked over the pelvis is an important position to maintain, regardless of activity. This sets the canister (“core”) up for optimal function- meaning the diaphragm, pelvic floor, abs and back muscles can work harmoniously to lift the most weight, support the spine and minimize pressure on the pelvic floor.
Breathing- Diaphragmatic breathing is essential for pelvic floor function and decreasing pain around the low back. The pelvic floor mirrors the movement of the diaphragm, so it is a simple way to relax a tight pelvic floor. Also, two major muscles that run from the ribs to the pelvis also have connections to the diaphragm. So deep breaths can work as a gentle mobilization!
Bracing- How do you prepare for heavy loads or challenging positions? If you simply hold your breath and go, you are missing an opportunity to create more tension! Or if you are holding your breath for a position that should not require that much power, you are increasing the workload on your pelvic floor and back for no reason. For example, preparing to lift a couch versus preparing to lift a pencil.
Put simply, if you are lifting something heavy, holding your breath is fair game. IF you do it correctly. If you experience symptoms- low back pain, leaking, heaviness- then do not hold your breath until you seek help for how to correctly brace. Knock the weight down or the mileage down to a place that you do not have symptoms and work there until your tolerance improves.
If you notice you are holding your breath with lifting a small object, such as your purse, then let’s talk breathing. Breathing out on exertion for a task like this will help the pelvic floor contract reflexively and can keep symptoms at bay. Try it out!
Big picture: Back pain does NOT equal back injury. It is very likely that back pain can be decreased and function improved with addressing the pelvic floor as it work with the low back muscles. Check out these simple ways to check your position, breathing and bracing. Often times, pain is a product of HOW you are moving.
If you take a crack at it yourself but just can’t seem to find improvement, reach out to us at Athletes’ Potential. We work with people like you every day to get them back to high functioning lives without pain and with a better understanding of how to move their body.
Thanks for reading!
Dr. Jackie, PT, DPT
Although your pelvic floor and your feet may seem as though they are different and non-related structures, this is not the case. The connections are fascial, neural and biomechanical. Your feet are your foundation; how they contact the ground dictates all movements at your ankle, knee and hip. Soft tissues and fascia in your feet have vast connections to the legs, hip and back. The feet and pelvic floor, despite the distance from each other, also share neural input!
Fascia is the thin covering of your muscles that looks like a spider web. The posterior fascial line runs from the bottom of your feet, up the back of your legs and torso and to your head. Along the path, the fascia connects to the ischial tuberosities, or the “sit bones”. Muscles from your pelvic floor also attach here! So tension along this fascial line will directly impact your pelvic floor. Essentially, any joint the fascial line crosses and soft tissue in the area can be effected. A great place to start is the feet! Use a lacrosse ball to mobilize the fascia and tissues in the bottom on your foot and around the ankles.
The nerves that are responsible for function around your pelvic floor—sphincters, PF muscles, deep hip rotators—are also responsible for the function of your intrinsic foot musculature. Signs of foot weakness may by indicative of pelvic floor weakness, and vice versa. So, strengthening the foot musculature and stimulating these nerves may help with pelvic floor function. Unfortunately, many athletes wear big, padded shoes which decreases the amount of work the foot musculature must do! Neglecting to walk around on bare feet is robbing your feet of their natural ability to stabilize and form to the surface but also decreases in amount of neural input.
We suggest barefoot walking and running to increase the input through your feet and begin to re-strengthen the small foot muscles. The best way is to find a grassy area, about 50-100m in length and run repeats barefooted. Your feet will be challenged much more than when running in squishy shoes, so ease in. You will also notice that your running form is probably different (better). Heel striking when barefoot in quite painful, so the body will automatically shift to more of a midfoot strike—which is good!
The ankles drive the movement of the whole kinetic chain- the knee, hip and pelvis and spine. Dysfunction or pain in any of these areas can be stemming from faulty foot mechanics. For example, walking with the toes pointing outwards will cause your ankle joint to perform on a slightly different axis than it was designed. This will be demanding on the ankles and all the way up the kinetic chain.
The knee tends to be stuck in the middle and pushed around. The ankle dictates the movement of the lower leg and then influences the upper leg. The knee is just where these two units connect. So you will notice, we do not focus on biomechanics of the knee.
The hip has a direction connection with the pelvic floor. One of the deep hip rotators, the obturator internus, connects to the pelvic floor. With this connection, the amount of hip rotation will change (increase or decrease) the tension of the pelvic floor.
Putting it all together: Our feet control the movements of the joints above it. If your arch collapses (flat feet), the lower leg will rotate inward and the knee will follow. Up the chain, the thigh will also rotate inwardly which changes the tone of the pelvic floor. The angle of the knee will change with all of this, but remember it is not the driver of the dysfunctional motion, rather the passenger. Living with faulty biomechanics (however slight) can perpetuate back, hip and/or pain and dysfunction. Rather than starting with an MRI for the back or kegals for the pelvic floor, why not see if changing how you move can decrease symptoms?
A simple way to put this into practice is a slight change during a body weight squat. Move your feet to a comfortable squat position. Before sending your hips back and down for a squat, screw your feet into the floor. That is, acting as though you are moving your big toes further apart but your feet are not moving. Keep the toes on the ground! This creates torque at the hip. By engaging the external rotators, you are creating tone at the pelvic floor--remember the connection? You may also notice that the arch in your foot becomes more pronounced. Hello intrinsic foot musculature! This motion is also helpful for those with hip pain, especially pinching at the front.
In the photos below, my feet are not in a squat stance, but I am showing the subtle external rotation. You can see the largest differences at my knee caps and the direction they are facing. Also, notice my arches after the external rotation (bottom photo). They are higher! You can see a greater difference on my left foot. My whole foot stays in contact with the ground.
Recap: The foot and the pelvic floor have more connections than you may realize. They share fascial connections as well as neural. Taking the time to mobilize tight tissues and allow for more input with bare feet can have positive effects on hip, back and pelvic floor issues. The ankles largely drive the entire kinetic chain from the bottom up. So, taking care of the foundation of movement will be the most beneficial!
Thanks for reading,
Dr. Jackie, PT, DPT, OCS, CSCS
What is your pelvic floor and why does it matter? The pelvic floor is a sling of muscles that runs inside the pelvis. It works dynamically with the diaphragm and abdominals to dictate pressure during breaths. The pelvic floor also has intimate connections to the sphincters of your urogenital structures. These structures are important for 3 vital human functions: peeing, pooping and sex.
Yea, I said it. The stuff that no one wants to talk about.
Some men and women experience incontinence or urinary urgency but think that is “just something that happens” with age or high level activity. This simply is not true. Others may have pelvic floor dysfunction symptoms including low back/hip pain, constipation, painful sex or feelings of incomplete voiding.
Every time you breathe, your pelvic floor is moving and contracting. The way in which you stand and move has a direct effect on the ability of the pelvic floor or contract and work in synergy with the rest of the deep core. What if you could change a few daily habits and have decreased pelvic symptoms? Check out these 7 common habits and see what applies to you:
1. Ab gripping- Whether it is to make your tummy look flatter, for stabilization during everyday movements or due to overtraining abs at the gym, ab gripping is adding constant and unbalanced pressure to your pelvic floor. When you are simply moving throughout your daily activities, your belly should be relaxed! I give you permission to fight the social stigma of a less-then-flat abdomen and give your pelvic floor a break. Let the belly go!
2. Preventive peeing- Many people have the habit of trying to urinate when their body is not signaling that they need to void, usually right before leaving the house or on a scheduled break at school/work. This “peeing just in case” can also lead to pelvic floor dysfunction or worsen existing issues. Your bladder will now have a different set point of when it thinks it’s full! Now the pelvic floor muscles never have to be coordinated to control a full bladder and fight the urge for 30 minutes before you get home.
3. Hovering- Believe me, I’ve been at music festivals and used a porta-potty that was so gnarly I didn’t want to touch the handle! What I am about to say does not apply to that situation--I would not recommend that you ever sit in that. However, when using the restroom in public, many women will hover over the toilet while urinating. This is not doing your pelvic floor any favors. Remember, the hip musculature and pelvic floor have connections so while you are holding an isometric air squat, do you think your pelvic floor is relaxed? Hell no, it’s holding on for dear life. Take your time when peeing and try to sit whenever possible. Most bathrooms these days have those little paper covers for the toilet seat. Use that! And take your time, giving your pelvic floor time to relax and the bladder to completely empty.
4. Breath-holding- As I mentioned before, the diaphragm and the pelvic floor work together. So breath holding will also increase pressure on the pelvic floor and increase the likelihood of leaks. Those who use breath holding as a strategy while moving light object or bending over, usually do so to avoid a leak or feeling of urgency. However, this increased pressure increases the likelihood of a leak! I understand that there are times breath holding is essential- lifting heavy weights. There are alternate strategies to avoid leaks in these situations—outside the depth of this post!
5. Butt clenching- This goes right along with ab gripping- relax! Deep hip muscles have fascial connections with the pelvic floor, so a tight booty = a tight pelvic floor. But tight means strong, right? No, in this sense I mean tight as in over-recruited. Your pelvic floor is on high guard all day from increased pressures and over-recruitment. Then you expect it to hold on tighter with a violent sneeze or a couple dozen box jumps? It is tired! The pelvic floor function and intimate relationship is more about timing and synergy than strength. Ladies- be careful when are trying to look sassy in those heels on Saturday nights. High heels can also cause women to unconsciously hold their pelvis in a tucked position or butt clench.
6. Poor posture- So I have said a lot about pressure, particularly imbalances and increased amounts. However, posture is often the prequel to the alternate recruitment strategies discussed above. If your diaphragm and pelvic floor are not stacked on top of each other, then they are at a disadvantage for working together. In appropriate synergy = pelvic floor dysfunction. The best way to check this is to look at your posture in the mirror or have a friend take a picture. You want your rib cage and your pelvis in line. Poor posture indicators are your lower ribs poking forward, nipple trajectory pointing upward rather than straight, hip bones much further forward than your lower ribs.
7. Sitting all day- Sitting is just bad for you, plain and simple. But it has particular effects on the pelvic floor from both a myofascial and alignment standpoint. The glutes and your pelvic floor are buddies, they like to work together. When you sit on your glutes all day, the fascial layers become compressed and unable to slide as easily. As far as alignment, who can actually sit with good posture for 8 hours? Not me. I don’t think I would trust someone that could- they are probably an alien. Those deeper hip muscles that have connections to the pelvic floor can become tensioned and tight which could lead to a tighter pelvic floor- remember tight doesn’t equal strong! That being said, as you sit slumped over a computer, your alignment of ribs over hips is likely disrupted. Then we are back at the beginning with an imbalance of pressure. Don’t you see, it is a never-ending cycle?!
** Allergies/coughing/sneezing- Ok, so this isn’t a habit per se but worth noting on this subject! Women and men with persistent allergies causing frequent cough and sneeze episodes may also see increased pelvic floor dysfunction due to the frequent pressure changes. If this sounds like you, be sure to find some medicine that works for you or talk to a physician about possible allergies. If the coughing is from smoking, well that is absolutely a habit that you can direct effect!
I think it’s safe to say everyone could find at least one habit that applies to them. Take some time to be more aware of your posture and how you are holding your muscles when they should be relaxing! Stress urinary incontinence and urgency is not normal but it is common. You never know, a few simple habit fixes may resolve your symptoms. If not, reach out to us at Athletes’ Potential, we would love to help!
Dr. Jackie Varnum PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.