The pelvis is said to be the keystone of the human architecture. It literally provides support to our physical life. It reinforces our vertical spine and at its best helps to provide optimal function and fluidity to both the upper and lower half of our bodies. It plays a huge part in finding our center of gravity. The muscles of the pelvis operate hand in hand with the diaphragm, assisting our lungs with breathing. It encompasses the lower half of the core playing a huge part in our stability. It is known to be the source of great pleasure and pain both physically and emotionally.
Where Life Begins
In Tom Myers & Dr. Eden Fromberg’s workshop, “The Female Pelvis and the Cycles of Life” we spent a weekend in deep appreciation of the pelvis, recognizing the pelvis as it exists and functions in our daily life and literally as the point where life begins. Tom Myers, director of KMI-Kinesis, Inc. has worked and taught integrative body work for over 40 years. Anyone looking to improve their understanding of anatomy should definitely check out his book Anatomy Trains or even better one of his classes (www.anatomytrains.com/courses). Dr. Eden Fromberg is the Founder and Director of Holistic Gynecology New York (www.doctoredenfromberg.com) and Lila, Yoga, Dharma & Wellness (www.lilawellness.com). Her integrative perspective on the complex area of the pelvic floor, female pain and sexual dysfunction has been extremely beneficial to patients, midwives and birth centers internationally. Although much of what was covered in the workshop involved the anatomy, function and overall trials and tribulations of the female pelvis some general info applied to the male pelvis as well. The material was informative for anyone in the movement world. However, the majority of the info seemed geared towards those who worked as doulas, midwives, physical therapists, chiropractors, massage therapists or manual manipulation therapists. With that said, I learned a great deal. As a female Pilates instructor, with my own pelvic floor issues, who specializes in pre and postnatal Pilates and who works mostly with women and clients with injuries, more is always better when it comes to understanding the pelvis.
Uniting Two Schools of Thought
I respect the fact that both Tom Myers & Dr. Fromberg are supporters of bio-intelligent medicine which brings together an osteopathic /natural system and the modern /science based system. The modern system consists of greater intervention (i.e. prescription meds, surgeries, medical suppression of symptoms) and the natural system focuses on how the body functions naturally. A good example of this is pain relief. Whereas the modern system would immediately recommend pain meds, the natural system examines the cause of pain and would educate the patient to understand that pain serves a purpose and that learning to deal with it naturally (i.e. diet, meditation, yoga, various physical & mental therapies) can prove the most beneficial in the long run. This includes pain during one of the most significant functions of the female pelvis, childbirth. During pregnancy, the modern system teaches the mother that pain is bad and the solution is just an epidural or C-section away. As a result there is a 30-40% rate of babies being born by C-section in this country. Dr. Fromberg believes that number should only be 5%. Tom Myers believes doctors should be teaching mothers not to just focus on the birth. They need to understand that “having a baby is like preparing to run a marathon. The responsibility depends on the mother’s training and the doctor’s abilities. It’s a team effort.”
The modern system’s emphasis on immediate relief often disregards long- term effects. For example, it has been shown that the scaring from a C-section can later cause both head and neck issues which can include pain, tension and even migraines. I also found it fascinating to learn that during a vaginal birth the microbiome (vaginal bacteria) of the mother is passed to the child providing multiple health benefits to the child. During a C-section the bacteria from the environment of the hospital is passed on to the baby. According to Dr. Fromberg, studies show that children born by C-section exhibit more cases of autism & asthma. That is not to say that C-sections should not be performed only that the reason behind them might need further examination. As a Pilates instructor my focus is of course on core instability challenges a woman faces during and after pregnancy and especially after a C-section. I have personal empathy for them after having had an abdominal myomectomy (basically a C-section) to remove fibroid tumors. I learned quickly those muscles don’t just bounce back. It takes time, patience and effort. New moms need to understand that although they may be ready to return to exercise after 6 – 8 weeks, it takes 18 weeks post birth for fascia to recover. Fascia is so important in regards to stability so jumping right back into your old exercise routine is not usually the best option. Be nice to yourself moms. Let yourself heal before pushing too hard. Your body will thank you for it.
When Strengthening the Pelvic Floor Becomes Necessary
Another major medical procedure performed on women that was covered in depth was the hysterectomy. During this procedure the uterosacral ligaments, the cardinal ligament and the round ligament are all cut. Once the uterus is removed these ligaments are not reattached. They are left completely detached which obviously creates pelvic floor instability. The intricate hammock of muscles, fascia & ligaments of the pelvic floor attach to the bony structure of the pelvis so if these muscles are damaged or compromised not only our pelvic floor suffers but the bodies overall stability is at risk. Symptoms of pelvic floor instability include pressure or fullness in the bladder, rectum or overall pelvic floor. Further weakening can lead to urinary and fecal incontinence, urethrocele (prolapse of the urethra), cystocele (prolapse of the bladder) and rectocele (prolapse of the rectum). A week or overstretched pelvic floor with the uterus intact can also lead to procidentia (prolapse of the uterus). These symptoms are not only brought on by various pelvic surgeries but also by damage caused when a baby is delivered through the birth canal, or overall core weakness.
Kegels & squats are no doubt great ways of strengthening the pelvic floor for pre/postnatal clients or anyone in need of greater pelvic support. Tom Myers notes that although the anatomy of an ideal squat is in parallel with legs, hips and feet aligned along the mid-line a squat is useful whether done “properly” or not. It is great for both stretching and strengthening the pelvic floor muscles. Other important anatomical issues to note are the strength or weakness of the anterior & posterior adductors, gluts, psoas, piriformis & obturator internus (OI). The balance of strength and flexibility of these various muscles can either help or hinder the stability of the pelvic floor and overall pelvis. The psoas & piriformis are partners in the balance of nutation and counter nutation of the pelvis and work hand in hand with the SI Joint. If one of these muscles is too tight or too weak it disrupts this balance and makes something as seemingly simple as walking a much greater challenge not to mention how it messes with the SI Joint. Strong adductors will strengthen the pelvic floor but if they are too tight they will pull on the pelvic floor creating weakness and possibly even pelvic floor prolapse. Tension in the muscles & fascia of the OI, which are part of the hammock that makes up the pelvic floor, can not only creates tension & pain in the pelvic floor region but can also make delivering a baby vaginally far more challenging. For any woman who plans to deliver vaginally, finding ways to relax and stretch the OI is crucial. The workshop focused on the benefits of manual manipulation & pelvic floor PT to achieve this but applying appropriate pressure using small balls can also be helpful. It is important to remember that pelvic floor weakness is just one part of the issue. Tension due to tight muscles or an overworked pelvic floor can also wreak havoc so more Kegels is not always the solution. These particular issues are common in female athletes, fitness trainers, yoga & Pilates instructors and often victims of sexual abuse. Muscle tension can not only cause nerve impingement, nerve damage and deadening, but also sever pain, numbness and even eventually muscle weakness. Symptoms also include pain and difficulty urinating, constipation, pain sitting, walking, exercising and sexual pain. The effects can be equally disruptive as those caused by having a weak pelvic floor.
Pregnancy Isn’t the Only Culprit
Obviously, a large part of this workshop was devoted to the female pelvis and issues around pregnancy. I am a huge supporter of anything that brings greater attention to all women’s health issues. I’m encouraged by the recent surge of services in the health, fitness and medical industry catering to pelvic floor health before and after pregnancy. Progress and understanding in this field has grown immensely. However, there is a large population of women who have never had babies with pelvic floor issues. I should know. I’m one of them. I must admit, I was slightly disappointed that this workshop did not more consciously include those concerns as well.
It has been my experience that there is an overall acceptance and eagerness to address these issues regarding pregnancy. However, many are not willing to accept or are ignorant to the realities when pregnancy is not a factor. This includes the health, fitness and medical industry. Regarding my own issues, I’ve been told by two different gynecologists that what I was experiencing was all in my head and that it was just a part of being female or getting older. One doctor said she would be willing to write a prescription for psycho-therapy but not physical therapy. Sadly, many women would just accept this reasoning because they want to believe their doctor knows best or because knowing that your doctor thinks it’s all in your head only makes it that much harder to talk about. Inevitably it can become a very emotional and psychological issue that keeps you from talking about it, worried that others might think you crazy as well. After over twenty years of dealing with this problem, I finally found someone who recognized and understood the problem and she was willing to prescribe PT (physical therapy not psycho-therapy) as a solution. Unfortunately, after I started my therapy my insurance contacted me to say they would no longer continue to pay for treatment because they “did not consider it a valid condition.” If I had had a baby they would be able to treat it as injuries caused by childbirth but since I’d never had a child, according to their definition of pelvic floor dysfunction, my issue did not exist. I can’t help but find it strange that when erectile dysfunction came to the surface the modern medical community jumped right on that. Proof we still lag behind when it comes to women’s health.
On the positive side, help does exist. Although, traditional modern medical communities may not be willing or able to provide treatment, there are private practices like Dr. Fromberg’s and therapist and educators like Tom Myers who have solutions. The drawback is that they are not always covered by insurance so treatment can be expensive which can also add to the stress these conditions already create. Still, it’s a start and with greater education, awareness, and willingness to talk about it we can only expect the possibilities of treatment to improve and hopefully become accessible to all women.