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8 Ways to Help Yoga Students Engage Their Pelvic Floors
As I travel around sharing “Explore Your Pelvic Floor and More” Yoga Therapy workshops, I emphasize the importance of adequate training and education of pelvic floor muscle (PFM) engagement with proper synergistic timing with other muscle groups with awareness, movement and breath. I also share the fact that over 30% of women do not engage their PFM’s correctly even after their first consultation of one on one training (WHO, 2002), therefore potentially running the risk of causing more harm than good by practising the engagement incorrectly.
I received a great question from a yoga therapist at the International Association of Yoga Therapists annual Symposium on Yoga Therapy and Research where I was presenting this same workshop. Shannan asked, “how can a yoga therapist help a student know if they are properly engaging the pelvic floor muscles?” The simple answer to this question is unfortunately, you can’t, exactly. Accurate measurement of PFM function and strength is difficult, even with the current tools of measurement we have such as direct skilled manual palpation or use of clinical observation skills with measuring devices such as ultrasound, EMG recordings, or MRI’s (Bo et al, 2005). However, these methods are not within the scope of practise of a yoga therapist. So the question can be re-phrased for the yoga therapist: “how can a yoga therapist help a student optimize the probability of an effective PFM engagement?”
Here are 8 ways:
1) Education: A brief (but accurate) anatomy lesson of the PFM’s explaining the difference between activating the compensatory muscles (gluteals, hip adductors, abdominals) vs. the actual PFM’s can help your student understand what a PFM engagement ‘is’ and understanding what a PFM contractions is ‘not’. Part of the education process is increasing awareness and connection to one’s own PFM’s. **(Addendum added June 19, 2015: The anal and urethral sphincters are part of the superficial layer of the PFM’s; they are not compensatory muscles of the PFM’s. However, I feel it is important to note that when one is asked to engage their PFM’s, they may potentially simply clench the gluteals and anal sphincter, or think that ‘stopping the flow of urine’ by contracting the urethral sphincter is solely what a PFM engagement is; and it is not. It is part of PFM engagement; but not in its entirety. Education about the deep layer of the PFM’s, (which includes the levator ani (LA) group) and the engagement of LA as a lift of the perineum, is important to note so that the student doesn’t think that a PFM engagement is solely just sphincter action).
2) Visual Cueing: As part of the individualized home program, I highly recommend students actually ‘see’ their own pelvic diaphragmatic rhythm, followed by the PFM engagement, with a mirror to the pelvic floor (no clothes) in a variety of positions. This is done in the privacy of their own home, on their own time, and as they feel safe and comfortable. This can help improve the efficacy of PFM engagement, as one can often times actually watch the pelvic diaphragm excursion with the breath pattern directly and observe whether or not other muscles are compensating upon engagement.
3) Mental Imagery: Have your student observe and simply become aware of his or her own pelvic diaphragmatic rhythm followed by the visualization (mental imagery) techniques we used in the workshop. This can help optimize the chance of a more accurate PFM engagement. These mental imagery exercises should be performed once the student has an adequate understanding of anatomy and theoretically understands what a PFM engagement is, and what it is not.
4) Feedback: There are a variety of methods to help the student receive feedback as to whether or not the perineum area is engaging. Visual feedback as in #2 above can be useful as well as tactile feedback. The student can either palpate his or her own perineum area, or use the ‘belt method’, or an accordion folded blanket as tactile feedback to the perineum. Leslie Howard uses a folded belt and places it horizontally across the two ischial tuberosities while sitting. I like to also use the prone position with an accordion folded blanket lying vertically under the body and looped back around the pelvic floor (as if giving yourself a wedgie)! As the student breaths, he or she can feel the feedback of the pelvic diaphragmatic rhythm from the blanket.
5) Watch for Compensatory Movements: As a yoga therapist, you can watch for any unfavourable compensatory movements as your student is trying to engage the PFM’s on exhalation. If you notice the pelvis moving, the abdominals excessively contracting, or the gluteals clenching, there is a chance they are not engaging PFM’s effectively. Please be reminded that with some of the functional movements that we performed, the pelvis IS allowed to move and the abdominal activation is more and the gluteals are allowed to activate. But for the purposes of simply trying to help your student ‘find’ the PFM’s and engage them appropriately, start with the basic foundation poses/movements we completed so that the focus can stay with the pelvic diaphragmatic breath rhythm.
6) Experiential: Naturally, the students need to practise practise practise. Tips such as “Less is More” and asking them to experience what a PFM is ‘not’ can also be helpful. **(Addendum, June 19, 2015: For example, to have students explore how ‘NOT’ to do an adequate PFM engagement: first ask them to clench the gluteals, squeeze the anal sphincter, pretend to stop the flow of urine by activating the urethral sphincter and contract the abdominals. Then, compare that with a gentle lift of the perineum upon exhalation, without use of the gluteals, excessive sphincter action or abdominal activation).
7) Practice: The yoga therapist should practise on themselves. Practise the cues, self palpation, positions, visualizations/mental imagery, movements, breathing, and any other methods included in the workshop. The more familiar you are with your own lived experience of PFM engagement, the better you will be at successfully explaining it and offering effective verbal cues to your students.
8) Referral to Pelvic Health Physical Therapist: It’s a GREAT idea to refer your student to a licensed pelvic health physical therapist (PT). A pelvic health PT has the proper training and skills to more closely monitor and measure PFM engagement, and it is within a pelvic health PT’s scope of practise to do so. The two of you can work together as a team to optimize your student’s overall success in healing and pelvic health and wellness!
This article is not intended to act as medical advice, nor to diagnose or replace your current treatment. Please seek clearance and guidance from your licensed healthcare professional prior to participating in any of the tips, advice, practices or movements mentioned in this article.
To learn more, check out our online courses and practice videos with Leslie Howard on Yoga for Pelvic Floor Health
Reprinted with permission from http://physioyoga.ca/
Shelly Prosko, PT, PYT, CPI is a Physical Therapist and Yoga Therapist, Shelly is dedicated to bridging the gap between yoga and modern healthcare philosophies and believes it is essential in order to create and sustain optimal health. She received her Physical Therapy degree at the University of Saskatchewan, Canada, and her medical therapeutic yoga training at Professional Yoga Therapy Studies in North Carolina. Shelly has been integrating yoga into her physical therapy treatments since 1998, addressing a wide variety of conditions including chronic pain. Currently, she travels across North America offering specialty Physio-Yoga Therapy workshops, lecturing at Medical College programs, instructing at Yoga Therapy Trainings, presenting at International Conferences and actively promoting the integration of yoga therapy into our current healthcare system. Shelly is dedicated to inspiring, empowering and educating health professionals, yoga teachers, therapists, students and people in pain about ways yoga can be used safely and effectively to address a variety of health issues and improve quality of life. Please visit www.physioyoga.ca for more information.