Many people experience pain in the SI (sacroiliac) joint and low back. Often when you…
Have you ever wondered what happens to keep your spine, pelvis and hips stable while you exercise, or perform daily tasks? Probably not, unless you are an anatomy nerd like me. I am amazed by the symphony of muscle coordination that occurs for us as humans to squat, or bend over to pick up an object. Thought I would share how the pelvic floor relates to your deep stability muscles, all the way to your vocal chords; and how they must all work together for healthy function.
The pelvic floor is a group of muscles that work together as a functional unit to provide support, control, sexual function and stability to the pelvis and spine. The respiratory diaphragm is an essential partner with the pelvic floor, creating the top of the abdominal canister while the pelvic floor forms the bottom. Your vocal chords work as the third or very top diaphragm. These muscles must function in coordination with one another for proper control of pressure mechanics to exist. When you inhale the three must coordinate, Vocal folds open, the respiratory diaphragm contracts down toward the pelvis, and the pelvic floor must elongate to accommodate for the pressure change. As you exhale, the pelvic floor gently contracts as the upper diaphragms return to resting position. This must also happen when you lift heavy objects, cough or laugh. If the coordination of these three is out of sync, you leak urine, develop prolapse, back pain or pelvic pain because you are not able to control for the pressure mechanics in the pelvis.
The other very important core muscle is the Transverse Abdominus (TrA) muscle, often called the “Lower Abdominals”. This is the deepest of the abdominal muscles and forms a girdle or corset. When this muscle contracts, the abdomen flattens and the fascia in the lumbar spine tightens providing stability to the pelvis and spine. This muscle contracts in anticipation of movement. Meaning, before you ever begin to lift an arm to put a dish away, your TrA is activating to provide stability before your arm moves. This is critical to prevent low back, hip and pelvic joint injuries and joint dysfunction. The TrA often must be retrained to contract in coordination with other muscles in the pelvic girdle before you can move to more traditional “core strength” exercises. It is very important for the pelvic, respiratory and vocal diaphragms work alongside the Transvers abdominus and multifidus muscles, which we will discuss next.
The deep muscles of the spine, called the Multifidus are also part of the core muscles. They lie deep in the spine, and attach at each single vertebral segment. The Multifidus muscles work in coordination with the pelvic floor, and TrA to provide stability before movement of the arms or legs. This is another muscle that must be trained in sync with the others, so you can find the muscle before moving into more traditional core exercises. They form the back wall of the abdominal canister, supporting the spinal segments and sacrum.
Any weakness, or over activity of any of these muscles causes a dysfunction of the entire system. There is an intricate balance in this muscle group that allows for proper pressure mechanics providing motor control and joint stability to prevent injury. These healthy movement patterns are unique in each person and allow for pain free function. Because each person is unique their program of exercise must also be individualized to them. This is why Physical Therapy can be so helpful in regaining good motor control and function. At Foundational Concepts, we spend a full hour with each patient individually to ensure success in therapy.
Symptoms of leaking urine with exercise, pelvic heaviness or pain during or after exercise or with daily movements are a sign that something is wrong. It is important to see a pelvic PT who can assess the problem, regarding your individual system, and prescribe the appropriate exercise program. Many people are unable to correctly contract the pelvic floor, TrA or Multifidus muscles when asked to. Also, many of us do not breathe correctly with our diaphragm, and certainly are not coordinating it well with our core muscles. If you carry a lot of tension in your neck, or are weak this can impact the vocal folds and the whole system. It is imperative your provider is considering the whole body from your head to your toes.
If you have concerns, or just want to begin a core exercise program, my best advice would be to come in and see one of our specially trained therapists. They can help you determine if you do have weakness, or over activity of these muscles, and whether you are correctly engaging them. This will maximize your effort and time spent on exercise and give you the best results. Having a strong core, sets up a solid foundation for building global muscle strength. Focusing locally and connecting with your deep system will make your exercises safer and easier.
-Sarah Dominguez, PT, MSPT, WCS, CLT, CMTPT