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  • Karah Charette, PT, DPT, RYT

Reframing the Concept of A “Relaxed” Pelvic Floor

As more education is being shared about pelvic health, it is a revolutionary time for people to connect to a part of their body that has been stigmatized and shamed for so long.

The first wave of pelvic health was that people just genuinely did not know what it was or what that meant. This still exists today, but there is growing number of people who have some baseline idea of what pelvic health is.

The next wave was if people knew what pelvic health meant, they immediately associated it with “kegels”. I have spoken about this many times, but the reason I put “kegels” in quotations is because I want to challenge the idea of that word being used at all. Coded language ultimately perpetuates an embodied sense of stigma or shame.

The other reason we need to challenge “kegels” or pelvic floor muscle contractions, is that it is often overprescribed as the key to having a healthy pelvic floor. If you hear a fitness instructor mention the pelvic floor in class, it is all too often only cued to be contracted. Unfortunately, there are also medical practitioners that just blindly prescribe pelvic floor contractions for any pelvic floor dysfunction, even when that exercise may not be indicated at all.

There are times strengthening your pelvic floor is indicated, and if this is the case you should still have a comprehensive assessment because most people perform this muscle contraction incorrectly. However, as a clinician I am starting to see a shift in my field of pelvic physical therapy where practitioners are talking more now about the importance of being able to relax your pelvic floor.

This is wonderful and very much helping to provide the nuance that is necessary when it comes to the human body. What I am writing about today is an argument for pushing that conversation another step further.

At the end of the day, the concept of muscles being “too weak” or “too tight” could stand to be challenged. Modern evidenced based science is now telling us that what dictates our muscle state and function is the nervous system.

What this means is that the state of any given muscle in our body can change at any moment depending on the input to our nervous system. Clinically, I have seen a patient go from a 3/5 to a 5/5 in muscle strength in less than a minute just based on tactile cueing and neuromotor feedback provided. No 3 sets of 10 for 12 weeks was needed to change the strength. Novel input to the nervous system was needed.

This does not mean that strength training is not valuable. Having a regular practice of mindfully moving and working with your body is incredibly meaningful. What is does mean is that we can break free of putting ourselves into a box of “I am too weak” or “I am too tight”. Our bodies are more nuanced than this and deserve a more individualized approach.

One philosophy to change this black and white thinking is to try to understand the muscular system as having value through coordination. Strength and relaxation do not have much value if we are unable to access these qualities at the appropriate time and with specific functional movements.

The reason I care so much about this in regards to the pelvic floor and the concept of relaxation is that I am now seeing clients who get frustrated because they cannot achieve “a pelvic floor drop” or just “simply feel their pelvic floor relax”. Their sympathetic nervous system begins to get even more sensitized because of the stress connected to an anticipated and failed outcome. This stress can drive even more pelvic floor recruitment, often the opposite of what is trying to be achieved. I have even seen people forcefully try to relax and in doing so they relatively strain their pelvic floor, preventing relief of their symptoms.

Like any motor skill, it takes time and practice, and feeling your pelvic floor relax is certainly possible. However, if we return to the concept of coordination, having a relaxed pelvic floor all the time is also not the most achievable or functional goal!

Muscles are meant to be supple. They are dynamic and they are at their most powerful and healthy when they can achieve both full length and full strength. Similar to the concept of the yin yang, these oppositional acts actually reinforce one another and bring balance.

When we think of the pelvic floor, perhaps one of it’s most important roles is that it is a shock absorber. It performs shock absorption through pressure management. When we think of pressure management, we want to think of breath. Our intrabdominal system is a container where dynamic supple muscles make up the walls, ceiling, and floor, and the air inside creates the pressure.

This means our breath is intricately linked with pelvic floor coordination and health. In order to be a good shock absorber and power generator, our pelvic floor needs to have dynamic coordination with our breath. If you can imagine a trampoline, it has the property of absorbing the shock of you landing through controlled lengthening, and then that lengthening in turn creates a dynamic force the supports you back into the air. Our pelvic floor has this potential of dynamic lengthening and contraction when coordinated with our breath appropriately. This relationship provides support from our pelvic floor at all times, without needing a forceful moment of contraction or relaxation.

The truth is, neither a pelvic floor muscle contraction or moment of relaxation in isolation is a better shock absorber. It is their relationship that makes for successful load transfer, power generation, and healthy function. When coordinated correctly, you are in fact supported by your pelvic floor on both an inhale and an exhale, with the yin yang of both a contraction and a lengthened state supporting each other.

Reframing our understanding of pelvic floor health in this context is important in providing people with both more achievable and more functional outcomes. We are not seeking static states with muscles, we are seeking dynamic relationships. Dive in with curiosity and see what you discover!

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