I recently had the pleasure of attending a Pfilates Certification. The course included a lecture by the creator of the Pfilates program, Dr. Bruce Crawford, a renowned uro-gynecologist, based out of Northern Nevada. It was refreshing to hear a surgeon so excited about rehabilitating the pelvic floor in a non-surgical way!
Dr. Crawford realizes that the “Shhh, don’t ask. Don’t tell.” mentality towards the pelvic floor and pelvic floor dysfunction is still rampant, and asks every one of his patients to tell all their friends and family to speak up. Pay it forward, if you will. I applaud this attitude and ask the same of my clients on a daily basis.
Some of the informative “pearls” that I got from Dr. Crawford are:**
- 1 in 5 women cannot voluntarily engage their pelvic floor
- isometric exercises (ie. Kegels) are fraught with non-compliance << no surprise here! These types of exercises are non-functional and boring!
- certain muscles induce a partial engagement of the pelvic floor, and can can get as much as 40-60% co-recruitment of the pelvic floor when activated. << In other words, when you incorporate these muscles into your exercise program, you have an overflow to the pelvic floor even when you’re not actively engaging it
- there is a SINGLE layer of connective tissue that covers the cervix, wraps around the base of the uterus, then descends around the front of the rectum to the perineal body. It is ONE single layer! Connective tissue is NOT a dynamic structure and is therefore subject to failure. << think of it like a tear in your nylons. Not so supportive (or sexy) when they’re torn.
- 40% of all women age 45-85 years will have a significant pelvic organ prolapse
- 25-40% of all prolapse repairs will recur within 5 years! << Dr. Crawford would be the first to tell you that surgery is NOT a cure. If you don’t strengthen your core in rehab, you can prolapse again! He joked that any good orthopaedic surgeon would send you for rehab before and after an ACL repair, why aren’t women being sent for rehab before/after prolapse repair?
- bladder prolapse can be a hidden cause of renal failure <<caused by the direction in which the bladder falls. Highlights the importance of a pelvic exam.
- the structure and function of the pelvic floor is not only impacted by pregnancy and childbirth. Other contributors are obesity, aging, chronic constipation, chronic lung disease, chronic corticosteroid use and more.
The Pfilates program is a set of exercises that aims to incorporate the muscle groups that have the greatest overflow of co-contraction of the pelvic floor. Emphasis is put on breathing and awareness of contraction and relaxation of the pelvic floor, aiming to increase plyometric contractions while in different exercise positions. It is safe and easy and has been designed by Dr. Crawford to improve sexual function, improve bladder and bowel control, prevent the need for pelvic surgery and help recover pelvic floor function after childbirth and surgery.
Dysfunction of the pelvic floor is not reserved for post-partum women or seniors. It may not even give any signs or symptoms of urinary incontinence. Daily, I see women and girls of all ages, shapes, sizes and fitness levels with a pelvic floor (and thus a whole inner core system) that is not working at it’s optimal efficiency. The fall out for these is not necessarily a surprise leak with a cough or sneeze, but more like low back or hip pain, instability in the shoulder, chronic groin strains and ACL (Anterior Cruciate Ligament in the knee) tears. Remember, your arms and legs are attached to your trunk. Having an inefficient inner core system , is like shooting a cannon from a canoe. If you don’t have a strong core (and I’m not talking abs here), you don’t have a stable base of support from which to use your arms and legs, and eventually, this can lead to trouble.
I incorporate postural alignment, breathing awareness and pelvic floor contraction into all my core exercises for clients. It can be customized to your pain complaint or injury as I add in all my manual therapy and exercise therapy skills into the mix. The Pfilates exercises have added another tool to my exercise toolbox, and I look forward to incorporating it into my current and future client’s programs. Thank you Dr. Crawford for making the trip out to Canada!
**Informative pearls were taken with permission from Dr. Crawford’s lecture and reading materials from the Pfilates Certification course