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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Mom needs her Transverse Abdominus

I’ve mentioned the Transverse Abdominis in some of my other posts, but I want to emphasize how important this muscle is to the abdomen, especially for postpartum women and still more important for postpartum women with Diastasis Recti.  The Transverse abdominis or TrA from now on, gets little love and attention from the fitness industry. Most folks want to work the outer, more visible 6 pack abs and obliques and rarely end up working the muscles of the “deep core” –the TrA.  Not working the TrA is especially problematic for women with Diastasis Recti who essentially have a malfunctioning layer of outer muscle because the linea alba is too stretched to anchor the muscles in place so they can do their job as designed.

To understand why the TrA is so stinking important, we’re going to have an anatomy lesson.

First, a piece of vocabulary: Fascia.  For our purposes, fascia is the tissue that connects muscles to other muscles or muscles to bone.  It is not muscular tissue.

Here is the TrA.  It is the deepest abdominal layer closest to your guts.  As you can see, it’s like a corset attaching your ribs to your pelvic bones in the front and all the way around

back.  It’s a stabilizer muscle meant to keep you upright.  Notice the muscular tissue does not extend all the way to your midline.  Instead, the muscle becomes fascia across the midline.

The next layer on the outside of your TrA is shared by the rectus abdominis musclesabdominal-muscles-diagram (6 pack) along the midline and the internal obliques further away from your midline.  It is important you know that these muscles are connected together in the same layer with facia, so remember it for later. This layer is the most problematic one for those with Diastasis Recti.  The problem lies in the linea alba, the fascia that connects the left and right recti sides in the middle.  The linea alba is too stretched out to hold the recti close together.   What’s more frustrating, tissues of the rectus abdominus run up and down–not side to side.  So no amount of working these muscles will pull them back together toward your midline.

The outermost layer is the external obliques.  They attach across the middle, again, with fascia.

Here’s where the anatomy gets a little complicated.  Somewhere just below your belly button there’s this area called the arcuate line where these 3 layers of fascia holding these muscles together switch their arrangement.  And it matters if you have Diastasis Recti, so stay with me.

Below the arcuate line, notice that the fascia (or sheath) that holds the sides of the deep TrA together connects over/outside the rectus abdominis?  This means, if you contract the TrA, it physically hugs the rectus abdominis together and in.  This is fantastically helpful for the rectus abdominis and the stretched linea alba.  Here it is quite literally a natural corset that squeezes your recti into you.  Yay!acurate line color

Above the arcuate line, notice that the fascia of the TrA no longer goes directly over/outside the rectus abdominis anymore.  Instead, its fascia connects underneath the rectus abdominis.  So the TrA and its fascia can no longer physically hug these muscles in.  However, contracting the TrA still holds back all the contents of the guts behind it, relieving that next layer of rectus abdominis and injured linea alba of some of the work its not currently capable of doing.

So remember that the internal obliques share fascia in the same layer as the rectus abdominis?   Take a look at the cross section above the arcurate line.  This is how most of your abdomen is organized.  See how the fascia of the internal obliques wrap around the rectus abdominis?  If you contract the internal obliques heavily or if you work them to the point that their resting tension is super tight, it actually pulls the left and right recti apart, which will further widen the damaged linea alba that we want to come back together.  The recti can’t fight this tension because they don’t have fibers that run left and right–only up and down.  So they can’t contract and pull against this tension.  Does this mean you shouldn’t ever work these muscles?  No.  That’s impossible.  You need to use these muscles, but you shouldn’t be focused on them in your exercise routine or you will likely make your Diastasis worse.  (This is why most people with Diastasis Recti are told to avoid sit ups, crunches, V-ups, Russian Twists, etc.)   Also, if you are doing any kind of abdominal work whether in daily activities or working out, the focus should be on engaging your TrA.

So the take away message here:  It is absolutely vital for the health of your abdomen to engage your TrA while doing abdominal activities. I hope you can quite literally see why now.

Ok, so it’s important.  Now what?

Focus on strengthening your TrA for the activities that you want to participate in.  If you’re reading this blog, I hope you’ve already taken my advice to go see a women’s health physical therapist (and if you are any sort of athlete who wants to pursue athletics, preferably you’ll see a therapist who has experience with athletes).  So I’m assuming you’ve done some rehabilitative exercises under the care of a physical therapist.  After doing quite possibly a trillion heel slides, marches, and toe taps lying on my back over the course of a year, my core was much stronger, but I was crazy bored and on a plateau of strength gains.  I was sick of doing an hour of rehab work then having to do my workout later because there was no full body challenge or real energy system challenge.  Let me be clear, rehab exercises are vital and make a huge difference.  I was just ready for more.  I needed to see how my rehab was directly linked to the physical activities I want to pursue.  The blow-before-you-go method helped me make rehab super applicable to my favorite movements.  Here’s a video I’ve already done to demonstrate how to engage the TrA before movement.

This blow-before-you-go method should be used before any movement if you want to locate and strengthen your TrA, even picking up baby, hauling in groceries, or getting something heavy off a high shelf.  There are some movements, however, that engage the TrA more than others.  These movements aren’t typically considered abdominal focused, but can really emphasize the TrA a workout when you focus on engaging it.  Learning to engage and strengthen the TrA might slow you down at first, but will likely lead to future strength gains in a variety of movements.  Some of my favorite movements to engage and strengthen the TrA are deadlift, sled pushes, uphill sled pushes, bench press, single arm (alternate your arms!) farmer’s carry, breaststroke in the pool, and ski erg or skiing-fashion pull downs from a cable machine.  The video below shows my current focus on strengthening the TrA enough to do a pull up safely.

And if you just want to focus on TrA strength with some supplemental movements (that are not heel slides or marches), here are 2 of the exercises I do on the regular now.

  1. Bridge plus double clam shell.I got this from Ashley at www.getmomstrong.com.  It ends up getting the TrA, hips, pelvic floor, and more.  Lay on your back with your feet elevated (start at lower elevation to make easier).  Exhale while pulling belly button to spine and pulling your pelvic floor muscles up and in.  Then start your bridge.  When you reach full height, push knees out.  As the knees go out, try to maintain the intensity of your pelvic floor contraction.  Knees go back together, lower yourself down.  Rest.  Do your reps slowly–there’s much to focus on in just one rep.  I started without a band and since have graduated to one of the lighter circular bands in my set.  If you notice the linea alba bulging, your TrA is probably not ready for this one.  Work on bridges from the ground and clam shells separately.

    2. TrA balance.  20170513_125001It doesn’t look like much, but it is.  Anchor a band on something and then back up.  The tighter the band becomes, the harder this is.  Engage the TrA.  Hold on to the band keeping a 90 degree angle at the elbow and keep elbows tightly at your sides Heels come off the ground as you shift your weight toward the balls of your feet.  Think about hovering your chest over the balls of your feet.  Do not hinge at the waist, but notice the bum does stick out a little bit.  Now hover in this position and focus on making your TrA keep you upright.  My glutes, quads, and hamstrings often want to take over the stabilizing work, so I have to purposefully relax them to force the TrA to do the  majority of the work.

    One of the most helpful tools for TrA engagement is a mirror.  Complete these movements in front of a mirror, especially when starting the blow-before-you-go method.  Sometimes it’s hard to tell from feel if the TrA is fully engaged, but I can always tell when I see my abdomen.  If your gym doesn’t have mirrors, go buy a cheap full-length mirror, store it in the restroom, and use it during workouts.

Alright, now go make your TrA totally B.A.