Your Pelvic Floor isn’t Weak, it’s Uncoordinated: Kegel vs. Piston Breathing

As I learn more about coaching pregnant and postpartum women in Brianna Battles’  coaching course (seriously, it’s rich with practical scientific content), I have practiced teaching the piston breath to lots of people.  And I know I need to polish my presentation because some people just look at me like “What’s the big deal?  Breathing and kegels are not new.” So let me try to explain better why this is different and has been such a game changer in female biology.

The Piston Breath is a concept I learned from Julie Wiebe.  I hit a plateau in my recovery about 9 months ago.  I just wasn’t seeing any positive changes in my abdomen, pelvic floor, or my athletic capacity.  Then I learned about the piston breath and neutral alignment.  Slowly I began to implement the strategy, and after about 8 months of practice, my diastasis reduced by about 50% in most locations, I leak less, my guts feel less sloshy, and I can now run short distances without peeing myself.  I’ve been breathing and kegel-ing for most of my adult life.  Piston breathing is a game changer and a much more complete strategy.

When you take a breath, your diaphragm moves down.  Your pelvic floor and deep core muscles should relax to allow your guts to come down in response to the downward push of the diaphragm.  But if your pelvic floor has a vice grip hold on your vag/anus and you’re constantly trying to maintain a rock-hard abdominal contraction, your guts will get squeezed with every single breath all day long.  This is one reason that leaks may occur (squeezing the bladder) and a diastasis won’t heal (too much pressure on the weakest part of the abdominal wall).  Piston breathing coordinates the pelvic floor and deep core muscles (transverse abdominis) to relax in response to the diaphragm moving down and to contract in response to the diaphragm moving back up.  The pelvic floor and transverse abdominis work in conjunction with the diaphragm so that pressure in the core is managed well.

The kegel is an important tool for strengthening the pelvic floor.  I needed it and some folks need it to remedy weak pelvic floor muscles.  For many folks, however, the problem isn’t weakness.  Think about the number of Cross Fit competitors at the games who’ve never had children and are rippling with muscles and they are peeing all over boxes during workouts.  Is it likely that their pelvic floors are weak?  Possibly, but not likely.  It’s more likely that their pelvic floors are too tight or uncoordinated.

The piston breath, unlike the kegel, is about coordinating a system of muscles–not strengthening them.  Static holds of a small set of isolated muscles (kegels) can’t possibly allow optimal results for dynamic movements, yet many women hold a constant kegel throughout the day, throughout an entire run, or throughout an entire workout in order to feel secure.  This will take its toll on pelvic health, often yield no relief from symptoms like leaking, and stifle athletic improvement.

Automaticity and specificity of coordinated movements is a better goal.  This takes practice.  Lots of practice.  And then it becomes automatic.  So try for a few minutes a day to lay or sit or stand in neutral alignment (check out my post Easter Egg Alignment) and focus on piston breathing.  Inhale and relax the abdomen and pelvic floor.  Exhale contract abdomen and pelvic floor.  Try this throughout the day and then integrate it into your larger movements and workouts.  In the video below, I demonstrate how to do both the foundational piston breath (aka blow before you go) and the more dynamic piston breath.

Once you have the hang of piston breathing, try to make each contraction “task specific” as Julie Wiebe says.  Meaning rather than contracting with the force equal to a bear trap with every exhale, match the contraction strength to the current task.  Are you picking a toy up off the floor?  Only a subtle, gentle contraction is necessary .  Are you attempting a 1RM deadlift?  You’ll need a bit more contracting power.

I have a bladder prolapse, a rather troublesome diastasis recti, and umbilical hernia.  Piston breathing has not only allowed me to continue in training, but has transformed my training into a mechanism that has helped heal me instead of injuring me further. I have been doing weightlifting, power lifting, some impact work, modified gymnastics, and substantial conditioning.  Piston breathing integrated into training has improved my pelvic and abdominal health.

If you’re struggling to figure out how to implement these strategies, find a pelvic floor physical therapist who works with athletes, a coach who has been educated about postpartum issues, or better yet, find both.

Here’s Julie explaining this concept with more eloquence if you need further convincing from a brilliant, experienced, athletic, professional scientist lady.

 

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Easter Egg Alignment

If you’re in the process of recovering from Diastasis Recti and any sort of pelvic floor dysfunction, you’re likely doing strengthening exercises like crazy.  This is great.   Muscle weakness contributes to miserable symptoms like low back pain and incontinence .  Many postpartum ladies (myself included) just want someone to hand them a list of 10 exercises that will fix them.  And we’ll all do these exercises until the cows come home.  Some ladies will be successful, and others like myself will get stronger, but still have a residual abdominal gap, weakness, and instability that refuses to budge.

I’d like to share a piece of mama rehab that you may not have considered.  The illustration is my own, but the alignment ideas are from smarter ladies than I who have worked in the fields of sports and women’s health physical therapy for years.  So let me hit you with this: Doing rehab exercises for even up to 2 hours/day may not rehab your body if you spend the rest of the 22 hours/day walking, standing, sitting, and breathing in ways that strains your abdominal wall and pelvic floor.  Alignment is complicated, especially because bodies are so different in proportion.  So what I really hope to do here is give you a brief illustration that encourages you to find a women’s health physical therapist who can help you with your body’s specs.

Imagine your rib cage as the top of an Easter egg and your pelvis as the bottom.  The best way ribs over pelvis eggto securely contain the most amount of Easter candy (your guts plus occasionally a small person) in an egg (your abdominal cavity) without some squishing out is to place the opening of the top directly over the opening of the bottom.  Any hinging of the top (ribs) or bottom (pelvis) forward or backward will release candy (smoosh guts out).  If you have not already, please read my post The Abdominal Pressure System.  Our abdomen works like a pressure system to support us and help us breathe.  Those of us who struggle with DR and Pelvic Floor weakness are really struggling to contain our guts under a healthy pressure.  When you then stand, sit, walk, and breath in ways that squish your guts further outside your egg, you strain the very abdominal wall and pelvic floor that you’re trying to rehab–the parts of you that are supposed to contain your guts under pressure.  Let me show you some ways that we do this wrong.

The orange egg below is in what I’d like to call the mom slouch.  Here’s why it’s a problem.  The front of my rib cage is now angled in.  This migrates guts that should live happily near the southern border of my ribs further down, making the mom pooch stick out more.  This puts more pressure on your abdominal wall than necessary.  Guts gotta go somewhere.  Also, when your pelvis is tucked like this, your Pelvic Floor and your Transversus Abdominus–the muscle under your 6pack that we desperately need to be firing–doesn’t engage fully.  Please stop and take the time to read this article by Julie Wiebe about bum-tucking treachery.   As a CrossFitter, I’ve been told to tuck my bum for exercises and athletic posture.  As a coach, I’ve told others to do this.  It’s a very common cue in CrossFit arenas, and I can’t say that its a bad position for male athletes.  But it most certainly is not a beneficial position for pregnant and postpartum women.

And here’s what I’ll call the archy boob salute.  This one might be less obvious because I don’t have large breasts to emphasize it.  In this position the front of the rib cage is thrusting upward.  The back of the rib cage and spine follow forward often encouraging an arched back.  A lot of women do this to emphasize breasts and booties.  It’s also not a great position for pregnant and postpartum ladies.  At it’s bottom, the linea alba attaches to the front of your pelvis; at it’s top, to the front of the ribcage.  If you lengthen that distance out constantly by thrusting the front of your ribs up and the front of your pelvis down, you’re not giving the linea alba the position it requires to recoil back to a healthy position after carrying a baby.  Now if you add a load to this position like in an overhead squat or kipping pull up, you’re not only stretching the linea alba to the max, you’re adding weight to it in a stretched position.  Yikes!  Archy boob salute and the mom slouch also do not allow optimal breathing.  Check out this video by Julie Wiebe that illustrates how alignment affects breathing.

The green egg below is my attempt to display neutral alignment (it’s not perfect yet).  In this position, I’m trying to keep the opening of my ribs hovering over the opening of my pelvis, allowing my guts the most space that I anatomically can give them in order to reduce unnecessary pressure on my abdominal wall and pelvic floor to allow for healing.  And according to Julie Wiebe, this puts my pelvic floor in a more ready position, activates the Transversus Abdominus (you can feel the difference), and allows for the most optimal breath.  This has been a process.  I found it much harder to change my daily alignment than any specific movement modifications I’ve had to make because it’s all. day. long.  I have yet to enjoy any really noticeable gains in my linea alba (I’ve been at this for 3ish months), but my breathing is better, and I’m certainly leaking less.  I found it helpful to leave reminder notes to cue me throughout my house and show my husband what my alignment should look like so he can cue me when he sees the bum tuck.

We should also strive for neutral alignment while sitting.  This is especially important for those of you who have to drive or sit for work everyday.  Look what happens to my pooch when I sit with my pelvis tucked and ribs caving in (left pic).  Not great news for the linea alba and diaphragm.

One of the ways you can mindlessly cue your pelvis to untuck while sitting is using a rolled up sitting alignment toweltowel on the chairs you sit in at home, work, and in the car.  Place it slightly behind your sit bones.  This will help your prop your pelvis and prevent that tuck.  These positions changes are also valid while you’re pregnant.  Many preggers ladies like to throw shoulders back, thrust ribs up, and tuck the bum to cope with the belly.  If you’re not at a high risk for Diastasis Recti and you’re not experiencing symptoms like low back pain or leakage, then you can probably get away with this posture.  If you are having issues, however, I suggest making a few adjustments to see if you see some improvements.

It may seem that all these changes are overwhelming.  I like to think about the impact that it will have if I achieve neutral alignment for even just 50% of the day.  I hope this helps. Good luck and may your pants be drier, your abs and pelvic floor safer/stronger, and breaths deeper.

 

The Abdominal Pressure System

I was told once by a doctor that the symptoms I was experiencing from Diastasis Recti had nothing to do with my pelvic floor issues.  My abdomen and pelvic floor together were trying to contain my guts and failing.  How is that unrelated?  I have since found new doctors and physical therapists who have acknowledged and emphasized the entire abdomen as a pressure system.  The pelvic floor, abdominal wall, and diaphragm should all be working together to contain innards and maintain stability.  Here’s an introduction to the abdominal pressure system using a weird model I constructed using items around my house.

If you suspect that your pelvic floor and abdomen is not working in conjunction with your diaphragm when you breathe, go see a women’s health physical therapist who will be able to asses what your pelvic floor is doing when you breathe.  Until then, try laying on your side with a pillow under your head and knees comfortably bent.  Put one hand on your abdomen.  Take a deep breath as you relax your pelvic floor and allow your abdominal wall to expand out.  As you exhale, think about bringing the muscles surrounding your vagina and anus into a gentle squeeze as your abdominal wall retreats back toward you.  As you practice this breathing drill, it should become more natural and automatic.

Please check out these related videos for more information.