By now, you are told that you have pelvic floor dysfunction and the recommended exercises simply are not working. Frustrated over what to do next, questioning if this is your ’story’ going forward or if you must succumb to surgery, you have come across this blog. I want you to know that pelvic floor weakness exercises being done are better than doing nothing and then there are some things that you should be doing but you are not.

Where is the Pelvic Floor?

I suggest you pause and visit my blog that explains the most common questions related to the pelvic floor at my clinic. The pelvic floor is more than the perineum, the space between the vagina or penis and anus which is where most people think it is. The pelvic floor is the inner lining of the pelvis and is influenced by what is then attached to the pelvis which are the hips, the lower back, and the lower part of the mid-back.

Even the pelvis itself is comprised of 3 joints, 2 in the back forming the sacroiliac-iliac joints and the one in the front where they meet forming the pubic bone.

Pelvis bones

Pelvis bones (courtesy of https://orthoinfo.aaos.org/)

When it comes to the pelvic floor we, therefore, need to look at the muscles of the lower back, mid-back, lower abdominals, hips, inside the pelvis, all ligaments, tendons, nerves, arteries, and veins that reside at or through those areas. The question is, do the therapists and doctors treating pelvic floor dysfunction assess those and address them all when indicated?

Exercises Don’t Work v.s Not Doing the Right Ones?

No matter what issues you have with your pelvic floor, you have to exercise those muscles. There are active and passive exercises meaning some exercises are done by you and others are done with assistance.

There are generic exercises that you see on youtube or see devices sold on amazon (which btw, I disagree with most of them!) that focus on some of those muscles but not necessarily in the order of importance. Let’s face it, if you were to clean your room, you can clean the surface and not the closets, drawers, under the bed, the sheets, etc. (you get the picture). It is only a matter of time until you can’t find anything so it is a mess again!! THAT is the problem I have with many of the recommended exercises.

Sometimes the order in which you are recommended to do the exercises at the beginning but there is no escalation in the level of performance and the type of exercises. You become stagnant in your progress which is discouraging and that is when people resort to ‘live with it’.

Of course, there are surgical and invasive intervention cases that cannot be avoided but what are you doing after the procedure? How long are you treating it with rehab after? Do you know how to maintain what is gained? Are you monitoring the state of its health? Who is helping you monitor yourself? Are you educated in what you are even working with? What routines have you established into your daily living so things don’t fall through the cracks? These are some of the questions you should be asking yourself and have a good answer to.

Most Commonly Missed Pelvic Floor Exercises

When it comes to the treatment of the pelvic floor, while the rehab therapists involved are fully aware of the exercises impacting its health, most work is focused on the internal manual work and the recommended exercises are those that people receive when visiting a physical therapist for their let’s say back and hips.

I am often told by my patients that they felt they were wasting time doing exercises they could have done at home so they discontinued going to their pelvic floor therapist. We cannot and should not isolate a body part to exercise it as the only form of exercise when the body part always functions in connection to the rest of the body. If movement was a concert, the body parts are the musicians and the musicians not only have to know their parts but when to chime in and phase out. Rehabilitating a hip joint by itself to let’s say increase its strength or range of motion will not fix the problem if the hip joint does not do its part when the person walks. Frankly, with chronic issues, the whole blueprint of movement is compromised as a result of the limitations in place. These limitations can be based on pain, injury, lifestyle, and habits. This is what Postural Neurology is all about that never gets factored in when it comes to the treatment of pelvic floor dysfunction. THAT IS THE FIRST MISSING INGREDIENT in the treatment of pelvic floor dysfunction including pelvic floor weakness.

Postural Neurology is not concerning the pelvic floor only but all rehabilitations related to the musculoskeletal system including posture and movement.

Now that the blueprint of movement is assessed through the Postural Neurology exam, it only makes sense to put the body through the ‘mock concert’ going by the ‘concert’ example I gave above!! Let’s explore this:

All babies on this planet go through the same stages of movement development with no coaching or training; that is because we are programmed to go through those processes! So if these known ways of development in babies are known, then THAT is our ‘answer key’. If we can examine the patients to see how they compare to the ‘answer key’ then we can see where the issues lie. That is the essence of developmental kinesiology in the form of Dynamic Neuromuscular Stabilization or DNS. THIS IS THE SECOND MISSING INGREDIENT.

THE THIRD MISSING INGREDIENT is breathing and we are not talking about any breathing. I have seen videos on breathing that are downright misleading and wrong. Once again, we should go back to babies and how they breathe; that breathing is what we are programmed to do and the best fit to our “system” operation and not what is a fad or in style. Biological Breathing, as I call it, is what I find to be the most difficult type of exercise for patients and is the one that is foundational to all musculoskeletal rehabilitation including the pelvic floor.

To learn about pelvic floor dysfunction and what I recommend to my patients, visit my website and Youtube channel dedicated to pelvic floor dysfunction. If you still have questions or need help addressing your pelvic floor dysfunction, make sure to contact my office.

Dr. Shakib