Discussion #3721

Pelvic Floor Dysfunction

70 min - Discussion


How can we use Pilates to help with pelvic floor dysfunction? In this discussion, Christi Idavoy and Amy Havens shed light on this common issue that many women face in an attempt to normalize the conversation and demystify topics like incontinence, constipation, painful sex, and others. They talk about how these problems can manifest and how we can use different exercises to guide our minds as well as our bodies.
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Mar 18, 2019
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Hi everyone, nice to have you here with us today. I have the amazing Christi Idavoy in the room with me and amazing set of girlfriends here to talk about something pretty important that happens in life for women; not all women I don't think but it's fairly common. I'd like to introduce Christi and have Christi lead the way as far as... What are we here for today Christi? Thank you Amy and thank you again for having me.

And thank you guys for being here to talk about this very important and super common subject which is basically pelvic floor dysfunction. And not so much the dysfunction but the way that the dysfunction manifest. And definitely you know wanted to have the space to really talk about women's issues as it pertains to women, but also it's important to know that men also have pelvic floor issues with similar symptoms. It is a bit different but it's definitely not something that women alone are struggling with. Really what we're talking about is incontinence.

So the leaking when we're coughing, sneezing, jumping, laughing, the uncomfortable subject which a couple of years ago I realized was more prevalent than I thought it was when I saw commercial starting to pop up on television for companies that make sanitary napkins for women now making bladder control napkins. So it was like very eye opening. And along with that you know there's the other extreme which is constipation. Lower back pain sometimes, right? But I think I think the big one is really incontinence female incontinence, painful sex, you know these topics that are oftentimes uncomfortable and things that aren't even discussed with doctors at times So I think that it's something that we need to shed light on and something that again in our Pilates environments and our movement studios people find a lot of trust and there instructors and they feel that it's a safe space, so I thought that it would be a good topic to talk about.

A fantastic topic to talk about. I know for myself I'm sure you guys are here to say that too and probably everyone watching as teachers or yourself that you might experience it but as teachers how can we help our clients. You know not be embarrassed about the subject matter, handle it, be courageous about it and get to know themselves a little bit more I would think about maybe why is it happening? So can you shed a little light on why might we be having these types of vision. Let's maybe start with incontinence first.

Okay, so it's a huge topic. Alright, it's a huge huge topic just to kind of give a little bit more background as to where it's coming from and why I thought of even going there in this environment. So the founder of PoleStar Pilates Brent Anderson, did research for about six years and looking at volitional pelvic floor contraction. So basically looking at Pilates instructors so all of the subjects were Pilates and a few sprinkled with some yoga instructors that had at least 10 years professional experience. At least been an instructor for 10 years.

More than 50% of the people in the study were either pushing it down when they thought that they were lifting it up, The pelvic floor. The pelvic floor that is with the cue engage your pelvic floor or go ahead and do what you think is going to lift your pelvic floor. So it was I can't remember the exact number and there's a great workshop that Brent does on PA if you want to go back and check that out. It was more than 50% though where they were either doing the opposite of what they thought they were doing or it had lost its mobility. So there's too much tone, so we lose elasticity and I think that something that is really really really key to understand is that when we say when we hear people say I need to strengthen my pelvic floor we need to understand what strength means with these types of tissues.

And really what we're looking at is elasticity, is that these are tissues that are part of our respiratory system and are working all day long at different thresholds depending on how we're loading the body. May be can you talk a little more about how it would... I think I'm with you on understanding that it's a respiratory muscle, that you know I'm thinking like you know if I'm told to strengthen my pelvic floor and I have been told that before, I was a very central location of like low. There was not a really invitation to think about through breathing and breath. And so carry on.

How is it a respiratory muscle? Exactly, how is it a respiratory muscle. So I mean the the kind of like 101 of the biomechanics of the respiratory system is basically remembering that upon inhalation, the pelvic floor descends so that when the lungs get full of air the organs they get pushed down so to speak, the pelvic floor releases so to speak or descends and expands upon exhalation as the air comes out, it rises back up. So it's also called the pelvic diaphragm which probably is a little closer to truth than when we think floor, we think well it's flat and when in fact it's more of a cylinder of support that has to do with a ton of layers and slings and things moving in many different directions that work synergistically in a healthy, in this kind of ideal world of pelvises or bodies where the pelvic diaphragm is working synergistically with the diaphragm that we know and love so well. And with the epiglottis which there's a lot less research and study on and I know that's something that I learned with Sherri Betz who also I'm sure has great, I'm not sure if she's got content on PA that relates to that, but really looking at how these three diaphragms are working together in harmony and that is something that is way way way more complex than our cognitive process can try and really catch up with and say okay now I'm going to engage my pelvic floor.

So you know, the other thing is that it's not an all-or-nothing. It's not like okay turn it on to maximum strength and then turn it off. Because it doesn't work that way in everyday life. You know, as we're moving around getting our activities of daily living accomplished it's at working at a low threshold but it's like a pump. You know, the gyrotonic system refers to it as the biological pump.

And all of these three layers or spheres of buttresses, diaphragms they're all pumping together all day long. The thing about them is that when we look at it through the breath, it can be both involuntary like right now we're not none of us are voluntarily breathing we're just breathing. We can also pause and hold our breath and start to control the breath and it can become voluntary that way. And so there's a fine line between getting involved with it in the sense of like okay now I'm going to squeeze these tissues I think that I am squeezing these tissues, in a certain direction versus learning how to actively observe and listen. So you know it's in our in our Pilates settings and in our movement studio setting we have a huge advantage and space where we can help people start to tune in and first observe and listen and notice what we might be feeling which is what we're going to do through this series of movement sessions that will come you know all related to this very important subjects, to really find tools to create tools of like how do I listen and observe to my body in an active way and then how do I start to get involved where I can kind of go off of what I've observed and then start to become participant by challenging the body and then noticing how that feels and saying how does the how does the movement and how does the energy get distributed through the body.

So we're really looking at at movement integration, we're really looking at at integrating movement and I don't know that that answered your question. Well, it certainly. Yes it did. Another question that may be a myth possibly and maybe this can be clarified with incontinence, so what if a woman is not had a child. I've not had a child, I've noticed it occasionally you know not a lot yet but like a laughing spell or like just a little pee moment of oh it just happened.

So, what are your thoughts there? So a woman hasn't had a child versus perhaps a woman maybe just one child or what if a woman's had several children she may not ever get incontinence problems, right? or it's pretty mixed? Exactly. So how can we-- It's super mixed and also you know I'm not referencing any research right now I did mention Brent if you're interested in those kind of like more official facts stuff, go check out Brent Anderson's research.

Anecdotally, right I know women like you Amy that haven't had children that are like rockstar, acro, yoga instructors (Amy mumbles) Just like Amy. Women that have had eight children and say that they don't have any issues. You know women that have had c-sections or vaginal birth it doesn't, there doesn't seem to be any hard fast lines like what you're exactly what you're pointing to. I think a lot of it has to do with stress definitely. I think a lot of it has to do with how far removed we are from the way that nature intended the body to be used So if we look at it kind of almost like the anthropology of movements in a way.

You know, we're not we're sitting in this kind of you know this way, which is great we're sitting on the floor but if we think about how much people sit in chairs, the toilet that the toilet's a disaster. It's so convenient but the truth is that sitting in that position does not help us eliminate, it does not help us maintain the elasticity 'cause we're we're not putting the body into that position as often as we would if we didn't have the couch and the chair and the car and the toilet and the.. As I think about it sometimes I'm like well I'm not a sedentary person, I move a lot right but yet no I'm like yeah I use the toilet, I use the car, I've got furniture in my house, it's not so much sitting, it's not sitting on the ground it's not getting on and off of the ground. I think that that's really huge and then you know going back to looking at just kind of like when I'm at the pharmacy or in a supermarket or something and I'm just kind of noticing like how many laxatives are there on the market. It's huge, it's a huge industry constipation.

So if we're straining and we're pushing that's creating a lot of pressure in these tissues that again if we were squatting, if maybe our stress levels were lower if maybe our food were more whole and not so processed perhaps you know we wouldn't be seeing these issues as widely as we do in our society. Stress is the... We talked about that when we were getting ready for this and also fear. And fear may be around that like the a woman of a certain age, the expectation that she may have incontinence coming her way there's maybe a subliminal little message of uh oh is it gonna happen and those kind of quiet thoughts that sit in here, who knows what they're doing physiologically to us you know. Absolutely.

Well after surgeries or other things. And along with-- stress and trauma that way. Fear, stress trauma all of that affects the way that we breathe. And so, you know if someone if you experience fear if like something happens you go It's like we hold the breath. So things get stiff, we lose that kind of yeah I've flow right that kind of like just like every other thing on the planets in the universe incontinence is always moving.

Fear, startle, trauma all of that changes the way that we breathe. And so, you know the more time that we spend up here and in our mind, and in our thoughts and in our fears and in our.. Did I say this? And what if I said that? And what if what I said really rubbed her the wrong way and now she's gonna think that.

And this is dialogue that's going on all of the time that's definitely doing something to our tissues and creating traffic jams so to speak. Energetically, physically, it's really I really just want us to encourage each other to say it's okay that you're having those feelings. Again, reminding each other you're not your feelings that they're gonna come and they're gonna pass and you're gonna have a ton of different feelings in this life. So if we keep on having all these reactions to every single little thing that comes up in the mind and during the day, of course the body is like what are you doing? I can't function this way.

So really letting go, trusting you know, trust really gets rid of the fear. And it's so much easier said than done. It's a daily practice for sure. And I think what just came to my mind of you know, learning specific exercises then in our arena in a Pilates class or yoga class or you know a PT office or something but that then helps me develop trust with myself in order, to kind of quiet that or shift that. So what are some exercises that we can do.

I know you'll get to that in the movement classes that you have planned but maybe can you talk about a couple. And then, the physical therapists out there that do manual pelvic floor therapy, I'm kind of curious about if you could speak to that at all Yeah, so I think that's -- If haven't heard it there is a real thing that happened you know. Yes exactly. Can I go in to fix a touchy subject matter but really but they get it you know touching. You know touching you know that might be the way that body gets through that stuck place versus on the exterior of moving back.

Exactly and I'm so... Number one I think it's super super super important when we're talking about these subjects that we remember our scope of practice. You know, that we know what is appropriate within our scope where movement experts right and I am going to get to a lot of movement on this segment and if someone is having serious issues and serious symptoms and they're really concerned, it would be best to refer them to seek out a pelvic floor specialist. So they are physical therapists that specialize in women's health and in the internal work right which is a very real thing and so you know maybe we don't have these therapists in our network, it's important to just kind of put that and give that information and say I really think that you've been having this issue for this long. You know the exercise is that we've been doing maybe aren't really making a shift, so maybe it's time to seek out an experts help.

And I personally had that experience. So I met Brent Anderson in 2009, 10 years ago now. And honestly I didn't think I'd heard pelvic floor specialist, sure whatever. You know, I didn't really understand you know what was going on in that room, what they were doing. And so, while I was there working at the Polestar Center, there was we had Dr. Pamela Downey, a pelvic floor specialist in the office and I was having this chronic pain, lower back pain no leaking no issues down there that would even make me think you need to see a pelvic floor specialist Christi.

So I was getting myofascial release therapy, I was having Brent helped me out and see with his structural manual therapy skills and it wasn't getting any better. I was doing all the movements that usually would get me out of trouble. I was traveling a lot, so I kept thinking well it's all of the sitting and it's all of this which may have very well been so but you know the Pilates and all of the manual therapy and all of the myofascial release just really wasn't giving me any relief. So he said I think it's time to go see Pam. And I was like okay, cool sign me up, right?

So awesome she's in the office. Pam Brent says I need to see you when can I get on your schedule? Alright tomorrow, okay great. So it involves a lot of trust and gloves. (both laughs) Let me tell you though when you're having that kind of chronic pain and discomfort, that is not letting you get good sleep and do what you need to do, thank God that we had.

So she did some external stuff to see if we could mimic the pain or I don't really remember the details this was years ago. And then she went internally and they've go internally both vaginally and through the anus. So she found the spot um way up in there. (both laughs) Literally right? And it was like whoa, tear jerkier trigger point.

One session, right all fixed up. Amazing. So it was like. It's a very complex area of the body especially for women more so than men. We have a lot more going on down there and if all we're doing is a kegels exercise or even cueing 'cause sometimes you know I'm always cleaning up my cueing and and realizing like well that doesn't seem to be serving me anymore or this isn't really I didn't really mean for you to do it that way.

So how can I better describe the movement. so you know it's just like started to stop saying engage your pelvic floor or lift your pelvic floor or you know I've heard cues like as if you were pulling out a tampon, which I'm really not a fan of because I don't really like the images the bad elicits especially when there's men in the room. Just like some women don't use tampons. Some women don't use tampons. They don't like the idea of a tampon.

There you go. So words matter a lot. You know words matter a lot and then when you come to realize that so many of us can't even distinguish the difference between engaging the anus versus engaging the vaginal wall versus engaging the perineum, which is like in in yoga you know engage your mula bandha, is it really serving us? Is it really pointing at the experience that we're trying to solicit versus working on the breath and letting go and again going back to trust, trusting the nervous system. So I wanna circle back to that because elasticity was a word that you used early in our talk so far here.

And when we were getting prepped for this elasticity came up. There's a lot going on I'm hearing about elasticity and recoil and you know the little mini trampolines I got one kind of, Kristi has one, I wanted to get one too. But how fun that is. So much fun. And just even the feeling of more playful and that releasing, relaxing kind of re boundedness of that activity.

So you know I've tried to do jumping jacks and some of my mat classes at the studio and it where I have my studio there's a lot of I'm gonna say older clients, older in this model or that example they're over 60, 65 and up. And I was kind of in that like let's do the classical stuff and do some jumping jacks and I had you know really clear pushback from a few girls that I didn't think I would have because they'd been clients for a long time. And I wasn't considering enough I'll admit that and to realize that they might be having a pee issue right this moment. How embarrassing that would be in their class with their friends. You know right yeah and then one clearly came up after class and said I won't do it the reason, why is I'm working on some incontinence issues.

And I really felt kind of, oh my gosh I'm so sorry. She was fine but I stopped doing that in that class because it wasn't appropriate. But in other environments where it might be or maybe there's a more willing crowd that might be okay to try knowing lips might happen to do some jumping jacks. So can we can women run, should they run, should they jump, should they do these you know because of it I think we've been told don't do it. You might leak a little.

But how do they train not to if you don't do it. Exactly. How do you train the tissues? If you don't stimulate the tissues-- And challenge them to learn something new. And challenge them to restore what they know how to do.

And that's the thing is that I think sometimes you know we're nerds here, like we love to think about all this stuff. We'd love to analyze it and you know thank God there's all those scientists doing, the research and the Pilates environment so cool. You know what I mean. And a lot of times all of that mental process and all of the intellectualizing of things interrupts our ability to just be human. And that's something that we're developing a lot now.

I mean Juan Nieto who also has amazing workouts on PA just did a huge conference in Spain and it was all about play. The whole theme of the conference was about play. And so to your point Amy of like is it... It's okay. You know it's like is incontinence normal?

It seems like it. It's common. It sure is common. It is common may be not normal but-- Exactly, it's incredibly common but so then let's normalize it. Let's not be scared to talk about it anymore.

You know what I mean let's not be scared to talk about it put a pad on and jump. You know it's okay. Is it okay to fart? It's okay better out than in. Yeah, again hold in.

Again, so much of it is is just the way that we've been socialized to be proper to you know not be rude. That has really done a number on us. Rather than to take care of it. Oops excuse me. Exactly, rather than to be.

To let things be and to sure you know oh sorry, excuse me or step outside or put the pad on if you know you know we're gonna do that part of the class where maybe you know maybe we take a break and we all put a pad on or maybe it's the cardio class and if you know that about yourself come prepared. If you know what that means come prepared for class. But I think definitely we need to jump. We need to run, we need to skip, we need to do jumping jacks because if you don't use it, you lose it, right that is true. That if we stop getting on and off the floor, we're not going to be able to get on and off the floor.

It's just it's it's that simple. So I think yeah to go back around to the whole bit about incontinence, it's uncomfortable you know it happened to me to for the first time like last week and then I was like oh gosh is that because I'm getting ready today. We're talking about how talk about it like in public. So it's like the universe is like maybe you need to know a little bit more about what this feels like. You know and it was kind of that moment of like didn't make it to the bathroom.

That moment where you're like oh my gosh it doesn't feel like anything, like nothing yeah. There it is. Yeah, yeah I don't know. But I think it's just interesting as we're movement teachers here I was just thinking on that class again and some of those clients that were in that class. If they're willing if people are willing to do compare contrast also.

Like okay, you know yourself to have this happen in those activities. While we're introducing some protocols to strengthen or regain the elasticity, regain the system let's journal it a little bit or write down this is when the happens versus put the pad on, notice really being notice, you know not taking notice and what if in a month or so of a real specific guided exercises it's better. Exactly. And they don't need the pad anymore. And then we can empower our clients that you can get through this.

It's okay. And you never know they might then tell their daughter or their mom or then aren't we sharing and teaching in a different way too and making a big impact. And also breaking down that deep just demystifying the incontinence issue. Don't demystify it just be truthful about it. Exactly.

It's psychosocial go there. The psychosocial impact. That's what it's all about. So we've we've been socialized to think that certain things are acceptable and other things are just absolutely not acceptable at all. And we need to really rewrite our own script.

And I think the only way that that happens is by sharing, is by being candid, is because knowing knowing that you know according to all of these rules and laws and protocols and I was raised with a manual of urban etiquette on the table. And my grandmother she was born in 1916, it's the way she was raised and it was also like yeah you can sit on the floor and have dinner watching TV you also need to know how to sit through a five course meal and whatnot and all of the , you know, all of these rules that were raised with to be nice pretty girls. We also need to know that within all of that we may feel like oh gosh I'm really the oddball out according to that framework of what's acceptable and what's normal and yet when we start to kind of take off all of those garbs that we wear all of these roles and identities of what's proper and what's not you start to realize, oh wow there are a lot of freaks out there that are just like me. And we start finding each other. And we build community and we can start to rewrite what that looks like.

You know and I think that right now we're living in some very exciting time because so much change is happening right now. And it's happening because a lot of the ugly things that have been festering are bubbling up to the surface. We just can't ignore them right now. If you turn on the news, if you see any news where the U.S. is on there these days there's a lot of ugly stuff but it's always been there. It's not new, but if it doesn't come up to the surface it's not gonna change.

So I think that we are the beacons of change especially as instructors we have an incredible gift and power and how selfish of us if we don't share our stories. If we don't when you teach you've signed up to put yourself out there. You're basically on stage, whether you're teaching I don't know math or in a school you know, teaching is public speaking. So it's a very unique environment where I think that we can really impact and then create a lot of change and what health looks like and what's normal right? What is normal?

So you asked me earlier to talk about some exercises that women can do. And again we're gonna do lots of movements, there'll be lots of exercises but you mentioned journaling and that really made me think about some exercises that are maybe not so physical but are more helpful to kind of guide the whole mind mind body situation. So journaling is a very powerful tool. And you know it can be as simple as having a notebook or you know a journal next to your bed or if you have a nook or whatever safe space you've created for yourself and you know sometimes mine is hiding in the bathroom. I have a three year old.

So yeah I've got a journal in the bathroom. Where ever you can get it, you know what I mean that space of it can even be stream of consciousness something that has really helped me is the mantra of like write as if no one's gonna read this. So that we don't have that that critic and that kind of fragmented sense of self as we're doing it so that we're not judging ourselves while we're doing it. But I really like writing down the things that are creating the fear or the fears themselves. You know the self limiting thoughts.

Like what are the thoughts that creep, that pop in to my mind, these beliefs that we have about ourselves that aren't making me feel good. I write them down, and then I destroy them. By ripping up the paper. I rip up the paper sometimes, I'll flush it down the toilet as again you know hiding, we've gotta take a really long shower. Fire is awesome, you know if you can safely burn them and watch the flame that's really liberating to do fire ceremonies.

I've even done this as like a small event at the studio where I'll just guide a short meditation to help us get into a space where we're more identified with our breath, with our self you know and then from that space right and then burn it. It's a very very powerful exercise. Breathing, you're just allowing the chest and the shoulders to relax, allowing yourself to slump. To just kind of not have the perfect posture and notice and you know sometimes you'll do that and you'll be like oh there's that ache that's probably why it's not a good idea to do that. But again it's the the power of allowing yourself to have that space of simply observing.

It's like falling back and simply observe and notice what does it make me feel? Oh that one doesn't feel so good, okay. Don't resist, because the you get what you resist, right if Say that one again. You get what you resist. What you resist persists, exactly.

What if, I'm following all of these I love what but what I'm hearing a couple clients that's too that's might be a little weary- fairy. They want more like teach me an exercise. I know those are exercises but what or okay I just thought of a type of client, no judgment on it but the type of client is very quick, she's in a hurry she's got a lot to do and I've got 45 minutes of my class and then I've got to run to the next thing and that type of personality. Squat Okay great. All the way down, squat.

How many times? As many as you have time for. As many as you have time for. If it's painful, if you can't quite get down there hold on to something, you know like the foot bar on a reformer, squat all the way down roll up a mat put it under your ankles these are some of the exercises that we're going to be doing. Squat because actually believe it or not a lot of what our pelvic floor or pelvic diaphragm exercises are going to involve ankle mobility.

Right interesting. It's really far out, but maybe you've already experienced it or you know it about yourself you have trouble squatting all the way down in that kind of flat back kind of way you roll up something and put it under your ankles and boom everything else falls into place. Ankle mobility, foot intrinsic are all about because again we're looking at elasticity, we're looking at integration of these systems, looking at all of the work of the fascia, the fascia is everything as Dr. Carol Davis says, our bones are crystallized fascia. She even said to me once about connective you know we call it connective tissue as I was teaching this little workshop at my studio called freeing the fascia which is wasn't such a good name because nobody really understood what fascia is or how to pronounce it but again for us geeks it was fun. It is a good one I like the(mumbles) So we're gonna be doing a little bit of that too in the workouts where we can do our own trigger point, release along these fascial trains to help the elasticity because if there's scarring whether it's from surgeries or bruises or falls or emotional scars or you know breathing patterns that have created restrictions around our diaphragm, create restrictions elsewhere.

So when we start to free the fascia, when we start to free these systems everything communicates a lot more beautifully, there's more harmony we start to notice that our symptoms change. We feel more freedom in our movement but to go back to what Carol Davis said to me that day she said well even calling it connective tissue is a fallacy because that implies that things are separate. They need to be together somewhere. Exactly. Right interesting.

So it's one thing is becoming the next. Where it's a it's a continuous spiral of becoming this versus fragmenting and then connecting. Thank you. I have a feeling we might have a few questions from some people right here. So we'll go on to asking some audience members for some questions for Christi.

Okay, who has a question for Christi. Anyone? I have plenty more but we're gonna I'm gonna pass this to you. I almost a little bit embarrassed, I'm a teacher and like I suffer from my own pelvic floor issues but I've never I thought like jumping on the trampoline and running would be more of like a lymphatic system. I didn't think about it as like helping my tissues so I do put on the pads, like you said like extra large and they get soaked and I don't run because I never thought about no one's ever told me like you should do that.

So can you talk more about why that would be beneficial for me because it just kind of triggered me. I was like well I never heard about that. Absolutely. So again if you know if we go back to thinking of the system of diaphragms through the torso and that you know through the trunk that we are we need for them to work synergistically and restore function, we are also have a diaphragm in the foot. The arch of the foot has is that we actually have three arches in our feet and the it's you know completely in line and related to everything that sits above it.

So when we're not moving through the system in this kind of... You know we're born to run. Humans are born to run. We are like the only mammal that has the as much endurance possibly as humans to run. Like nobody can run like a human can.

It's a means of transportation. So you know it's probably no wonder that when we stop running as a means of transportation and walking we start seeing all of this dysfunction. So again I think that the takeaway is that if we continue to shy away from the things that are producing, the symptoms that are not acceptable that are embarrassing, that the psychosocial part of it, again will start to interrupt what natural function needs to look like. So it goes back to the sense of you know, really trusting your nervous system if we think about homeostasis right. So it's it's the homeostasis is the state that everything in nature is moving towards.

It's like a healthy cell vibrates at the same frequency as healthy earth. It's in the studies, the book is called 'Earthing'. It's a great book Ashman, James Ashman was a keynote speaker at a Polester conference years ago that PA also was there. I remember that. You know again it's like, every single one of the trillions of cells in our body on this planet, the trees, the flowers everything is seeking to reach the state of homeostasis.

And we need to trust that. We need to know that every single thing around you within you under, above everywhere is conspiring so that you are whole and healthy. So it's really like all this conversation about what's right and what's not right and if we start to cultivate our ability to listen and observe more, we're going to strengthen our intuition and that's what's going to guide us versus the embarrassment and the fear and the other stuff. But again just to circle background to your question I think it's really just about if you don't use it you lose it. So if you if you don't run it's good for you.

We need the impact. We need the vibration, we need the oscillation to stimulate all of this kind of rebound elasticity that we need. So if you can't if somebody has knee issues, structural issues that you know prevent them from running, jump board would be another option? Exactly. Trampoline and anything we just but it has to be it has to be closed chained.

Yes, so if someone has structural issues jump board is a great option. Again you know jump board we are in a supine position we're lying on the back so it's a great start. It definitely helps to rebuild and restore function for people that can't run or jump. If you can use a rebounder a small trampoline, a small trampoline off the end of a trap table, if someone doesn't have enough balance to do it that way even sitting on the physio ball. Again it's like how can we start to give the nervous system this information in a way that doesn't disrupt other systems.

Like if someone has a knee issue you know, it has it has to be appropriate within what they're able to do but I think the the real key is to work on giving the nervous system information that requires it to react. Because everything that we do is very unpredictive. In the Pilates environment in the yoga environment I want you to press down through here and reach out through there and notice this and then turn that way. So the mind you know, where it's predicting what's gonna happen versus like I'm just gonna come over and shove you and you've got to react. My question has to do a prolapse bladder and how that affects the exercising in regards to the pelvic floor and because if I was doing jumping jacks I would modify it because the prolapse, right?

I'm trying to strengthen my pelvic floor but like Kegels they don't do it because at one point my pelvic floor is hyper engaged. So how do you find that fine line? Great question. So prolapse just to make sure we're all on the same page, prolapse is basically there's a herniation in the tissues of the pelvic floor and the viscera starts to come through and it puts more weight. So there's more pressure.

And so because there's some herniation in those tissues there's less elasticity and you're saying that there was also too much tone. It was hypertonic. So we are that's a very complicated question. And first of all I would definitely say go to a pelvic floor specialist. I'm not sure you've done that already, okay great.

So you have all of their protocol. I've worked with some patients like this. My own experience to be completely honest it was much older women and so it's like what are we they're there so deconditioned that it's very challenging to kind of get them jumping and put them on a trampoline and things like that. It just wasn't not not appropriate but I was working a lot with inversion. so thinking and this is all stuff that we're gonna do in the movement classes as we progress is working with gravity to help to send the organs back into place.

In the yoga system the inversions are the royal poses. So like the headstand is the king of the of the asanas of the physical poses because of the so many benefits that that they provide. Among them, is returning the organs to their to a healthier natural place. And then so, you know my I feel like I've got this like a yoga brain and my Pilates brain and the gyrotonic and they all it's all mush. And so it's like thinking of like okay all those benefits of the inversions in the Pilates environment now we can invert the posture and load it and start to give those tissues some feedback while the person is upside down.

And you can do that in a more basic way where you know if you also have hypertension, glaucoma, detached retina, any one of the for indications for inversion you know things like feet and straps on the trapeze table. So it's basically thinking of like magician but with the pelvis on a half arc or on a spine correct or where the pelvis is elevated, tower bar footwork or maybe like parakeets but not the full-on parakeet. More of the kind of restorative parakeet where the pelvis is going to be a little bit elevated. Inverted V where you know the head is under the pelvis and then kind of like I can't even think of an exercise. Inverted V but maybe instead of doing it in the way like of an elephant's with the hands on the foot bar, we're doing it with the hands on the rails or on the long box across the back of the reformer.

So now the spring is providing resistance for the hip flexors while we're in the inversion. And so these are all things that we're gonna explore, starting from a cultivating awareness place and then working up to the more like you know, if I were working with you I'd say okay come on we're gonna go upside down and we're gonna do footwork in a headstand and and work on with that and let's see what happens if you do that as part of your practice for a couple months . Do you start to find that your jumping jacks can get restored. I don't know but we're gonna figure it out. It's interesting today I had a client and I spent 10 15 minutes trying to get it to activate it to pelvic floor and there was just nothing.

I mean no matter what cue I used or even my tactile cueing and then I had to stand up and stretch her calves because her calves were so so tight. Ooh actually I had her on the trapeze table doing footwork and I had a go into a stretch for her, it's going to dorsiflexion for a stretch With the tower bar. With the tower bar. And she could not. There was absolutely I mean miniscule amount of movement in her dorsiflexion.

I mean she's in plantar flexion thinking she was in dorsiflexion. So that just tied it all together for me because obviously it's a her dorsiflexion that she can't get into that's preventing her from activating her pelvic floor. That really helped me understand that. Definitely related. I mean you know my question would be how like how do we know if they're actually engaging pelvic floor or not.

Is it by looking looking at the for like TA engagement, like where you can see that there's kind of the drawing in or bracing. Not bracing but just you know, like if you just exhale slowly and you get completely empty and you can feel that kind of lift where were you going off of what she felt or where you going off of what you were what you could see. What I could see. I saw almost more of a a doming versus a sinking down So again I think that so great that you notice the ankle bit. And I would say even a little more efficient perhaps than the tower bar, would be to do the Achilles tendon stretch on the chair with a very heavy spring.

So that now you've got the spring really facilitating the dorsiflexion and then you know if she's having such a limited time with the dorsiflexion, we also if we give her more feedback into plantar flexion which would be pushing down on the heavy spring on the chair well then there's those if those tissues shorten more they're going to be able to elongate more. It's always working, the opposition to help inhibit what's not allowing her to access the dorsiflexion. It's like the tissues need like jumper cables. They just need to be reminded. Speaking of jumper cables you know that is stuff that pelvic floor specialist would work with.

So going back to the question about prolapse and stuff there is electric stimulation, biofeedback the manual therapy that we spoke about already. And I think also the other thing I really wanted to point out, is that these tissues they function subconsciously involuntarily all day long. So when we are cueing verbally someone to do something that needs to be happening in a subconscious way, that's so advanced. Because first we need to be able to observe and notice what it feels like as it is before we can start getting involved with it consciously. And you know again, my I started teaching and studying yoga and you know this is a subject that's always been very interesting and close to my heart because it's the root system it's the earth element, it's the first chakra.

It's the house literally right it has to do with security, our basic needs being met. So those practices where you are consciously now manipulating your bandhas or these diaphragms those are super advanced in pranayama and in a yogic lineage but here we are you know what I mean as instructors living in in a city or whatnot you know we're not in a cave, where we're not stimulated and just observing all of these things and it's like when you look at ancient texts of the Chinese and and the Hindi's and they've mapped out the entire nervous system without opening bodies up. It's all from experience, from observation. So to ask someone to do something like that we have to realize what we're asking them to do is incredibly advanced and may lead to frustration both on the instructors part, on the clients part and the feeling of inadequacy. I can't do that.

So just being mindful of how do we develop more tools, so that we can give the nervous system the feedback it needs for those things to happen and then you can say oh my gosh I just noticed it versus thinking I'm gonna do this. Thank you. I gonna add this. Just listening to the example of a heavy spring on the window chair for dorsiflexion, imagining a client who might be a little like you know this may be the tones too they're hypertonic. And just the trust that they have to go in and allow to happen they know it's heavy, you've told them it's going to be heavy but just the sense of just easing into letting it go and releasing you said earlier, of just releasing that hold on it.

Like just thinking about that heavy spring and just kinda I can see how that really can relate. One example. Who else has a question? Oh another question. Like just right now talking to you.

So you mentioned the breath and I know for me I'm someone that always I hold my breath a lot. But just sitting here or standing while I'm working I noticed I'm always like trying to pull in and up all the time. So someone told me that. So now I feel like I'm always holding my center in all the time. Like I gotta put my jeans on otherwise most time that hangs out and then it's like so what is the proper answer to that.

Or should we be doing it all day long. I think we had asked when we were planning it to. You like should we be walking around with the in and up action happening. (woman speaking off microphone) I think I'm constantly hurt. Again you know and Joseph Pilates said," if you want to be " in shape, act like an animal." I have a photocopy of this 1940-something interview with Joe if you want to be in shape act like an animal.

So if we pause and think our cheetahs and dogs and cats and dolphins you know are they walking around thinking about how their body functions? No, so I think that we're asking our minds to do these incredible tasks that it's just not cut out for it. And so it creates stress and anxiety and depression and worry just let it hang out. Let it go, let it hang out. And that's the other thing you know is like this whole washboard abs culture, you know what I mean is is it really natural, is it really healthy, do people really look like that.

You know what I mean? I don't think so. I haven't been to many. And I live on Miami Beach, so we've got a lot of them. Is the city of hard bodies but again that requires like a lot of hours at the gym every single day.

And then if you go to other places in the world where people are just a little more natural, where they're they don't have gyms, they don't have Pilates or yoga studio they don't have stair are no studios right and the line most of the rest of the world. And yet people are climbing and walking and carrying their groceries and they have to carry their water and you know I don't think anyone has time to... How fortunate are we it's a luxury to be able to go around and think about what my belly's doing. That means that yeah my basic needs are being met. You what I mean, I'm like in a really good place if I have space in my brainwaves to think about that stuff.

So again I think if we put it into context and you just kind of pause it's kind of the way I relate to food, I'll ask myself you know we're people eating this a thousand years ago. And if is the answer's no, I'm like I'm probably not going to eat too much of it. You know, maybe I'll have a bite and maybe I don't know you know don't want to be rude. But it's it's definitely. If you keep going back to those kind of like again cultivating that and sense, cultivating that relationship with the earth.

With what what is our purpose. Like what methods and that's it that's huge. That's a big big big question but yeah I don't that, just relax. Does anyone have another any other questions? Oh yes you can.

I think from my experience of contrology and Pilates I think it is sort of a like a rite of passage almost when you know that your body is going to homeostasis when you start to question about how much you're trying to control with all the good intention in the world. You know and with with all of how it helps people. It helps you to do these exercises and it helps you to have control. And then your body tells you when there's too much control and you need a little bit more release. I think and I think well the reason I mentioned is because when clients come in it's very much the mentality of controlling things.

And that's good but it can be I think it can be challenging for the client. You know for us it's really empowering but I think for the client it can be you know challenging especially when they're older and they you know there's so much flipping already and fear. Yeah well especially if they're older there's all the sense fear of falling. And it is it is contrology. It is the the study of control and then so that the thing is then to refine that it's saying well how much.

(woman speaks off microphone) Go ahead and share that. That Joseph Pilates quote. I often use the one that you don't need a sledgehammer to swat a fly. Exactly. And I think that really relates to like how dense the tissues are in our pelvic diaphragm.

It's you don't need a sledgehammer(laughs) at all. We like to say you know it's like how hard should I be working or how big should my circles be or how much as much as possible as little as necessary. So we're finding efficiency 'cause it's like you know when you first learn how to ride a bike and it's like teeth or grinding and the shoulders are up at your ears and then finally you've figured out how to ride the bike and now you're waving, no hands. So it's constantly evolving, it's constantly changing. So again it goes back to just being present and present and observing and noticing how much do you need today.

And it's not linear, right? The change is not linear. So it doesn't move in one direction. I guess this is like a question to the student. What is the exact cue or feeling that you should feel for your pelvic floor?

So I know have being a student and a teacher I didn't even know what that feeling was because I couldn't feel my pelvic floor muscles. So I was always frustrated. I was the frustrated one and I would just say yeah I get it but I don't I never really got excited I was like too embarrassed to admit it but I was in a workshop one time and it might even with Madame Black I think she had to like imagine a pencil between your sitting bones I mean rolling up a number picking up and in and it clicked with me. So I do and I hold it maybe for like 10 seconds and then I let it go. Is that a proper feeling or like is it what is there a feeling you tell your client that they should feel to connect with.

Oh great question. And I was hoping someone would ask that. So the feeling thing. I always like to say, you should be feeling exactly what you're feeling. So there's no wrong there's nothing wrong to feel.

There's no wrong way to move, they're different. There's lots of differences. I really like getting away from the right and wrong, notice again notice what you feel let it be what it is. That cue of you know lifting up the pencil if you know if it feels good, it feels right then go with it. Again keep in mind that over 50% of the people in the study with real time ultrasound, we're doing what they thought they felt was right and it wasn't.

It was the opposite of what was. Just keep that in mind. So if you can do something where you get some biofeedback, that would be great just to have a sense of what you know what's going on. Another thing that I've learned from my students one of them says that it feels like the jellyfish. That you know again we live in South Florida there's tons of jellyfish especially this time of year.

So it's that you know she describes it as like a feeling of a jelly. It also feels like an orgasm. Alright, it also feels that I mean, maybe not like an intense climax but like a subtle like oh there's, oh there's that thing right. So I think it just requires a lot of exploration and tuning in to all of the many different things that we might be feeling down there. So I did have physical therapy for my pelvic floor external and internal.

And the internal was the first time I felt my pelvic floor really. So I have suggested to a couple clients that they use their own hand and try to do that like that cue that you just said and feel with their own hand what's happening in there. And then that might connect. (woman speaks off microphone) Yeah kind of yeah hug or just somehow to engage Just hug it. I had doubts for it.

That's great. I think that's really great. Your suggestion and good advice or it's a community of teachers and viewers and teachers and people at home and an expert and I think cheering that it's great. Trusting oneself Trust yourself. Yes trust yourself.

And just don't not try so hard. Not try so hard. And just don't try so hard. Exactly. Yeah trust yourself and don't try so hard.

Okay, I have a feeling there might be one more question as we were chatting a little bit beforehand. Mandy? Okay, now I'm blushing. My question is the jade egg has become really popular does that strengthen the pelvic floor? I'm sure it's doing something, right?

So again pelvic floor specialists do use devices to help stimulate the tissues. So I'm sure yes, if we you know just like you were saying about putting your fingers in there to help you feel to help create the tone to be able to lift literally in this case lifting the egg, they're also called yoni eggs and they're thousand year olds So this these are very ancient practices from the east. In fact, I know that in some Asian countries they're even performances where women shoot balls out of their pelvic area. Another region. You know but then again it's like do your activities of daily living need that kind of tone.

So if you know it's all about the appropriateness and the congruency. So it's like if you're one of those performers then you probably do because your job depends on your ability to shoot ping pong balls out of your vagina. If there's a reason for it, if you feel that you know people feel that it's helping, I mean and then yes but again you know I just be mindful of doing things just because they're a fad or a celebrity says that they're doing it, that's great. If there aren't any issues, if there really isn't a reason for that I think what would be more biomechanically advantageous would be to go for a run, to improve your running technique, to improve your squat, that's in the end of the day is gonna do a lot more good at integrating the system with the rest of the body than training to perform. (all laughing) Right, that's a great question.

I have been I've been noticing that a little bit more too. (mumbles) prop to get feedback. A prop to get feedback. (woman speaks off microphone) That'd be interesting to use it use it as a prop to get feedback for doing. It's another thing in the pelvic system.

And is this really meant to be more of an incontinence trainer tool or is it more for sexual dysfunction issues? What I've been hearing around those yoni eggs a little bit more about orgasmic potential or having trouble in that arena. I don't know if it's more for incontinence or that or? I think it's used for both and again it's very important to keep your scope in mind. And one thing is to experiment and do things on your self before, prescribing things that are clearly outside of the scope.

I think we might have to have a part two at some point because I am feeling a lot of interest here and I think with our friends in the room and probably with you at home. Christi thank you so much for coming-- Thank you so much. And helping us kind of bring down the the level of anxiety on topping it but talking around the topic. Thank you so much, thank you. Thank you, thank you ladies.

(audience applaudes)

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2 people like this.
That was great. I was hoping that someone would ask the question "should we be doing some kegals every day?" x
1 person likes this.
Really looking forward to your classes on this topic. You bring so much to the table on this subject and so much more. I go so much out of this talk not just on the subject but on “earthing” and your point about bringing stuff to the surface so we can deal with it. Really, really interesting talk on this subject and beyond. Thank you.
2 people like this.
Thanks so much for this discussion. I had a prolapsed bowel right after my hysterectomy and used a vaginismus treatment kit. About the same time, I started doing Pilates. This helped tremendously with my bowel issue and also helped me to understand my pelvic diaphragm. It didn't happen overnight but don't have the bladder issue anymore. Thanks again, look forward to the exercises and part 2. Great discussion.
Kim W
2 people like this.
Hey Christi!
Thank you for tackling such a sensitive -- and oddly shaming--topic. How much of a roll do you think pelvic floor dysfunction plays in issues like IBS and Crohn's? Just curious.
1 person likes this.
So much great information! Thank you so much!

Relax, trust yourself, stop trying so hard. I absolutely love it!
Thanks so much for the encouragement ladies! To answer the question about daily Kegals; it's not so much that the exercise is an issue, as much as the fact that if we don't first slow down and engage in observation to heighten our awareness, we really don't know what tissues we are engaging. Dr. Brent Anderson's research shows that over 50% of the seasoned Pilates instructors in his study were not actually doing what they thought they were doing when asked to lift their pelvic floor or do a Kegals. The idea is that if we focus on the bones and breath and move in ways that promote elasticity the tissues will respond and be efficient.

To Kim's question on IBS and Crohn's, pelvic floor dysfunction plays a roll, and I think it is like the chicken or the egg...hard to tell which came first. I do feel that when our lifestyles include moving in all ranges and relationships to gravity illness occurs less frequently and we are more resilient. It's out of my scope of practice to speak to conditions like these, but we do know that movement heals!

Thanks again ladies, and thank you Pilates Anytime for opening up to this very large topic!
Wonderful discussion, thank you! I’m inspired to incorporate more jumping, squatting and playfulness into my teaching. I find that after a lot of Pilates or teaching I need to go to the park and have a good swing on the swing set. The big balls are great for bouncing, too. I love the ones with handles!
Can you post a link to the study Brent Anderson conducted
Thank you so much for these talks. They are wonderful. In the course of discussion you refer to movements that you will be demonstrating. I am very eager to see these. Will there be videos forthcoming, of your teaching the exercises to which you refer? And if so, when will they be released. Thank you so much. Roya
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