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Entries in neuro-muscular coordination (6)


How to do a Kegel

A Kegel is a type of pelvic floor contraction, first described in Western medical literature by Dr. Arnold Kegel in 1948. Contracting the muscles of the pelvic floor (one's bottom) strengthen and tone them and can have beneficial effects for many women experiencing stress incontinence. (Other types of incontinence don't respond so well to these exercises alone.)

To find these muscles and to learn to perform a Kegel, stop the flow of urine while urinating and then allow the flow again. If you are successful, you just did a Kegel; you've located the muscles that you want to work with and you've executed the movement that you want them to do--contract and release. It's okay to do this several times in order to embody your learning.

However, the exercise itself should *not* be done while urinating. Doing the exercise this way runs the risk of creating a detrusor (bladder muscle) dyscoordination and more incontinence or leaking.  Too, Kegels are most useful if done standing as this is the position in which most women experience incontinence or leaking. Try doing pelvic floor contractions in various positions--lunge to each side, lunge forward, bend in plies. This will enhance neuro-muscular coordination between the large muscles of the thighs and buttocks with the muscles of the pelvic floor.

It's recommended to hold pelvic floor contractions for 10 seconds. This is an arbitrary number that will likely cover the amount of time it takes for a bout of laughing, coughing or sneezing.

To engage the more difficult eccentric movement of the pelvic floor muscles, don't just let go when done with holding a contraction. Slowly and deliberately lower the intensity of the contraction, releasing with control. This is much more difficult than the concentric movement of contracting the muscles and it will garner you much greater reward.


Popular myths surrounding incontinence or urinary leaking

The three things that most people do when they find that they are suffering from any sort of incontinence or urinary leaking are to decrease their fluids, increase their frequency of urination and to stop exercising.

They figure that if they're leaking fluid that they must be taking in too much or that decreasing intake will somehow make it less likely to leak out. They figure that if they have been urinating every three or four hours and leaking in between, then maybe they can stave off that leaking by going more frequently. They figure that if they have been leaking on impact when exercising, then maybe they should stop exercising. All of these are rational; all of them are wrong and set up the bladder for more incontinence.

If a bladder is already compromised, it may be that there are false signals relayed to the nervous system indicating an urge to urinate when the bladder is not full. Often this is from irritation within the bladder or from dyscoordinated neuromuscular activity of the bladder with other surrounding structures. In any case, the strategies of drinking less and urinating more are strategies of dehydration. This is never healthy systemically and actually makes the bladder worse off as it atrophies over time. The bladder has a muscular layer, the detrusor, and like any muscle, needs to be worked to stay healthy. Unlike other muscles, the detrusor is only worked when filled and stretched. The detrusor is stretched by the bladder filling up to functional capacity, by drinking fluids and urinating infrequently.

There are studies that show that any exercise done regularly, even if it doesn't address the pelvic floor itself, will improve the condition of the pelvic floor over time. If there is leaking on impact, the leaking is not caused by the impact; it is caused by the neuromuscular dyscoordination. One might consider switching to a low-impact exercise or wearing pads while continuing the higher-impact exercise.

So, counter-intuitive as it may seem, the best course of action when one starts leaking or experiencing any sort of incontinence is to drink more fluids, urinate less frequently and keep exercising (or exercise more). Work that bladder!

You might want to check out the List of Bladder Irritants in my Treasure Trove (tab in navigation bar).



Neurology & the pelvic floor

I'm always stressing the central role of the nervous system in the functioning of our bladders and pelvic floors.

Eric Franklin, PT:  "In the opening stages of training, the building up of strength is almost wholly neurogenic. An actual change in muscle substance is called a myogenic change, and this only happens after a relatively long period of training."

Janet Hulme, PT:  "Even muscles you are not aware of being able to control, like the bladder, are affected when you change muscles you can control."

Diane Lee, PT:  "Exercises for PFM are not intended to improve strength! Coordination and endurance is key!!!"

Dumoulin & Hay-Smith (2010) found in randomized trials "support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence." as compared to no treatment, sham treatment and placebo.

Neuromuscular coordination is the goal of pelvic floor or pelvi core rehabilitation.




Tissue Talk:  tensegrity

Here's a fascinating and creative take on functional structure:

Tensegrity is a term popularized by Buckminster Fuller when he built the first geodesic dome. These buildings transfer loads through tension beams which are connected in triangles. The integrity of this tension system is crucial to the stability of the structure (tension integrity = tensegrity). When a force pulling in one direction is equally opposed by a force pulling in the opposite direction, stability is achieved for that direction only. For complete rigidity of a structure the various lines of force form a series of isosceles triangles. These are called tensegrity structures. Our bodies do not require this amount of rigidity, in fact our function would be limited because of it. However, the linking together of muscles through their connective tissue bonds (fascia, ligaments, and bones) can create momentary tensegrity systems that assist in the transference of force without too much compression through the joints. Exercises, which connect muscles both individually and collectively, provide tensegrity for the direction of load being imposed.

---Lee, BSR, FCMAT, Diane, An Integrated Model of "Joint" Function and Its Functional Assessment, 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Proprioceptive Neuro-muscular Facilitation (PNF) tests and treats patterns of movement that utilize all of a joint's movements through all three dimensions. Since most muscles' tendons and their attending structures (fascia, nerves) attach to their nearby joints, taking a joint through its functional patterns that include abduction/adduction, extension/flexion, and internal & external rotation challenges all of the structures' strength, mobility, range of motion and, most importantly, neuro-muscular coordination. The points in the movement that present as weak, ratchety or painful reveal dyscoordination of a system of structures through that particular part of the pattern of movement. This need not show up in testing single muscles in single planes of strength such as is done in kinesiology. And building strength alone will not provide results. The system as a whole must be reeducated in how to behave as a system. PNF provides systemic functional reeducation.


Tummies & Posture

The pendulum keeps swinging back and forth between two camps. There are those who say that we should pull in our tummies to keep our abdominals strong and promote core strength and there are those who advocate for not pulling in our tummies, that we should maintain our lumbar curves. Right now we are in an era of 'let it all hang out'. Actually, the two camps are not entirely mutually exclusive, yet both are wrong.

We do want to activate our transvers abdominus throughout our day, while maintaining our lumbar curve and while allowing our tummies to move with our breath. This means pulling in our tummies slightly, about an inch, while not maintaining a rigidity to that hold. The transverse abdominus is a component of the core, which provides stabilization for functional movement and contributes to balance and proprioception. We do want to strengthen our core. But more importantly, we want to engage our core in concert with functional movement. In this way we educate our bodies in neuro-muscular coordination. A strong muscle without neuro-muscular coordination is a bully to its neighbors.