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Pilates & Your Pelvic Floor

I’ve been getting quite a few questions recently surrounding exercising with pelvic organ prolapse (POP) or other pelvic floor dysfunctions. What exercises can I do with POP? What exercises are safe with pelvic floor dysfunction? What exercises won’t cause leaking? So I do what I do best - I went to the research. Let me first say that I am not a pelvic floor physical therapist (PT). What I AM is a Pre/Postnatal Pilates Specialist with 7 years teaching experience, a Masters in human movement dysfunction, and 2 pregnancies under my belt. I like to nerd out on the science, then share it with you! Here’s what I discovered and what exercises you can do that are pelvic floor friendly:


Pilates & Your Pelvic Floor


The best thing a pregnant or newly postpartum mom can do for herself is schedule a visit with a pelvic floor (PF) PT. This may come as a surprise to you, but your OBGYN’s main responsibility is your uterus and its contents, NOT the muscles and movement patterns surrounding said uterus. On the other hand, a PF PT will look at how the muscles of your core canister work synergistically. They can help prevent pelvic floor prolapse and diastasis recti (among many other things), as well as set you on the path to recovery should these conditions develop.


Nearly one in four women in the US has a symptomatic pelvic floor disorder and one in ten will undergo surgery. Of those who undergo surgery, up to 30% will have to go under the knife again. Clearly, you want to get yourself over to the PF PT!


From here, I could go into how to find a PF PT, what happens during a session, and what outcomes you should expect, but that’s not what this post is about.


This post is about the ‘after.’


After you’ve completed all your sessions and ‘graduated’ - what now?


If you’re anything like me, you are chomping at the bit to get back to a regular exercise routine - running, yoga, Cross-Fit, Pilates, Olympic powerlifting (you do you sister) - but there’s that little voice in the back of your head…


What exercises can I do with pelvic floor dysfunction?


What if I get worse?


What if I undo all of the hard work I put in?


The truth is, there can be many restrictions placed on individuals with pelvic floor disorders, especially after surgery. Another truth? These restrictions are based on doctors’ individual viewpoints and vary widely in regards to strenuousness and duration. These restrictions are based on regulating the intra-abdominal pressure (IAP) - basically the pressure contained within your abdominal cavity bound by your diaphragm on the top, pelvic floor on the bottom, and transverse abdominals wrapping around your center. While it is thought that high levels of IAP can increase the break down of surgical repair or further exacerbate PF disorders, the relationship is not clear. Clinicians take on a “better safe than sorry” viewpoint (understandably or course), but over restricting exercise has its own consequences regarding your health and wellbeing.


So what activities are safe? Where does a new PF PT graduate start?


Coleman, Nygaard, Holder, Egger, and Hitchcock (2015) performed a study with 20 women between the ages of 22 and 59 with the goal of determining if the IAP generated by Pilates exercises were above the “Sit-to-Stand” threshold. Since you go from a seated position to a standing position multiple times a day, the IAP generated during this activity can be classified as “normal” and “safe.” This makes it a great baseline measurement to compare other IAPs with.


Eleven Mat exercises and 11 Reformer exercises were included in the study. The researchers found no statistically significant differences in the average maximal IAP in the “Sit-to-Stand” versus any of the Mat or Reformer exercises.


What does that mean? It means when averaging the IAP for all of the women during all of the exercises, the pressures generated were no more strenuous than going from sitting in a chair, to standing up.


Now to be clear, this is the average. Some women did exceed their personal sit-to stand threshold for some of the exercises. Does this make the exercise ‘dangerous?’


I don’t know; maybe; it depends.


This is why individualized exercise plans are so vital when transitioning from physical therapy.


This is why Pilates is the perfect bridge between your PF PT “graduation” and your desired exercise goals.


Maybe yesterday the exercises I’m about to share with you felt great but today you feel downward pressure. No worries. Two steps forward, one step back. Your body is different everyday.


Okay, so here’s what you’ve been waiting for - the “safest” exercises as determined by this study.


Here are the 5 Mat exercises and 5 Reformer exercises that generated the lowest IAP:


MAT:

  1. {Pre-Pilates} Supine Toe Taps

  2. {Pre-Pilates} Quadruped Work

  3. {Pre-Pilates} 100 Prep in Hook Lying

  4. Bridging

  5. Side-Kick Series


REFORMER:

  1. Footwork

  2. Supine Arms

  3. Supine Abdominals

  4. Feet-in-straps

  5. Bridging


Still nervous about starting? Come experience all 10 exercises in a Private Session at The Restoration Space. Or grab THIS PDF of Five Pilates Exercises to do Every Day.


Got a baby at home? Join me for Virtual Core Restore! One hour a week for 6 weeks - I'm giving us a time and a place to get reacquainted with our bodies. So grab that baby (if they're awake) and log on...because I know you're already wearing stretchy pants. Can’t make the time? The replay is sent out each week.


The best part of the Core Restore program is getting to connect with other moms who totally get where you are in life. We support each other, not only during our hour together each week, but in a private Facebook group where you can ask all the questions and get answers, support, and a couple extra movement sessions throughout the week (via short Facebook Lives).


By the end of the 6 weeks, you’ll have more confidence in your body and how to safely, effectively, and in a way that brings you joy!


Katie’s knowledge of the body, and in particular, the postpartum body, was a game changer while I was safely learning how to move my “new” body.” ~Jesse P.


And if you’re wondering, it doesn't matter if your baby is 6 weeks old, 6 years old, or has babies of their own, it's never too late to find a deeper connection to your body.


Learn more about CORE RESTORE.


References

Coleman, T. J., Nygaard, I. E., Holder, D. N., Egger, M. J., & Hitchcock, R. (2015). Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. International Urogynecological Journal. DOI: 10.1007/s00192-015-2638-4

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