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Entries in pelvic floor (3)

Tuesday
Mar192013

Two-tone

Skeletal muscles have tone and strength. The two are often confused because in normal parlance we say that someone who has built their muscle strength, by say, weight lifting or physical activity, is 'toned'. This is not what we are referring to when pointing to muscle function.

'Muscle tone' refers to the work the muscle is doing when it is at rest, while the work that muscles do while working, or exerting force, is called 'strength'.

All muscles maintain some working fibers, even while at rest. This reflects a certain amount of electrical and chemical communication that constantly happens in order to maintain basic functions such as proprioception, balance or just structure. Those muscles that have some responsibility for posture have more slow-twitch fibers and will have greater resting tone. Slow-twitch fibers are the "white meat" of muscle. Like birds who must fly hundreds of miles to migrate, they are working much of the time to keep up some tone for endurance. The need for postural and structural support never sleeps. When some fibers need to rest, others jump in to take over. The pelvic floor is postural and is prone to hypertonicity. Hypertonic fibers are those that do too much work while at rest. A muscle that doesn't rest can't work as well and can produce pain. Most patients who show up at American pelvic pain clinics or complain of urinary symptoms present with hypertonic pelvic floors.

Muscles at work are characterised as strong or weak. Both can be hypertonic (or hypotonic, for that matter--meaning too flaccid at rest). When women are given a vaginal digital exam by a urologist in order to assess for strength, it can be difficult to accurately assess the strength of a hypertonic pelvic floor. If the muscle contracts but doesn't adequately relax afterwards, the physician will feel little difference in tension and proclaim the muscle group to be weak. What the practitioner actually felt was the result of hypertonicity and the jury is still out on the strength or weakness.

A female urologist (one who is trained on female anatomy & physiology) is more likely to be aware of this issue than the more traditional male urologist. Nearly all urologists are male urologists.

I have had patients who become concerned that exercise will worsen hypertonicity. This could not be further from the truth. When we work a muscle, we contract and relax it, over and over. In working the muscle we train the relaxation part of the cycle as much as the contraction. In fact, working the muscle is one way of treating hypertonicity.

For the pelvic floor, there are two more ways that we can aid relaxation of the muscles. One is to give a slight push out, like giving a little push to get a tampon out. It should never be a forceful or strained push; use very little effort and don't expect to feel anything different from doing it. The other way to relax the pelvic floor is to lie in rest pose--on one's back, with knees bent and soles of the feet touching each other. This minimizes the electrical activity from the large muscles of the thighs and buttocks that tends to spill into the pelvic floor. This electrical activity is normal, but too much of it promotes hypertonicity.

Wednesday
Dec262012

Sensory awareness

Since sensory awareness drives motor control, promotes sensory integration and helps to develop relationship with one's body, I've been adding sensory awareness exercises to my Core & Pelvic Floor Workout classes these past couple weeks. It is a trend I will continue.

This past week my participants and I were noticing how very minute shifts in our position--pointing a foot or leaning--can elicit profound changes in sensory perception. When one has increased awareness one enhances one's ability to control those muscles and the surrounding structures. As Janet Hulme, PT, avers, "Even muscles you are not aware of being able to control, like the bladder, are affected when you change muscles you can control." Perhaps this can be one definition of the subconscious life, connecting the unconscious and supposedly uncontrollable with the conscious and controllable. In politics the Chinese call this approach 'using the back door'. In biology it's sometimes called neuroplasticity.

Try this:

Move ever so slowly to a sitting position, paying particular attention to how your sitz bones (ischia) are moving. You should notice that as you sit, your sitz bones are spreading, moving away from each other, until the moment before sitting. As you release the tension to let yourself give your weight to the chair, the sitz bones move toward each other slightly. Do it several times in attemp to feel it.

Squat down and perform a slow, side to side swing of your buttocks. Notice the pull you feel on your opposign sitz bone. In other words, when you are swinging to your right, you should feel a slight pull on your left sitz bone. When you swing to your left, you feel that pull on your right sitz bone.

These simple exercises, and others like them, can aid in restoring normal sensation and function, when practiced over time.

Thursday
Jul262012

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.