If you believe in what you do, and you are selling someone on becoming a member of what you do, such as buying a 10-pack of classes or scheduling their next session with you, you can learn to look at this as you giving them a gift to stay in touch and helping them stay on track to reach their goals.
Telling Your Business Story
This is what I believe in, this is why my company exists, and this is my deeply personal reason for doing it! My personal story of how movement and movement science connect for me is…
This is telling your business story. The goal is to do this in a systematic way across all of your marketing. This is the underlying melody behind all of the notes in your marketing symphony.
Sustainability in The Pilates Industry
Customer communications are the most powerful form of marketing. What you say before and after a session is your most powerful form of marketing and it’s where so many Pilates instructors fall short. I’ve never met a Pilates professional who isn’t doing the work for the right reasons.
If you don’t have your marketing and your business practices tightened up, you can’t do your work in a sustainable way. The way you can shine your light more brightly is to be efficient and effective in your marketing so that more people get touched by your greatness! Without efficiency, you are at risk of burnout. This is one of my concerns about working with Pilates professionals.
These are stars who burn brightly and then fade unless they have a unique sustaining patron. But you don’t need a patron to make a profitable Pilates business. There are a lot of successful Pilates businesses out there, and they all share something really important to give to the world.
People don’t buy what you do, they buy why you do it.
Simon Sinek
10 Benefits of Leading With Purpose
1. Gives meaning to the work you do
2. Makes you more money: Visionary companies have beaten their competitors by a 16:1 margin on the stock market (from Jim Collins’s “Good to Great”)
3. Attracts your ideal customer. When you talk about your authentic self and why you do what you do, it becomes like a magnet for your perfect customer.
4. Differentiates you from the competition. The competition is not just for other Pilates studios. It’s also all the other exercise and movement-based methodologies that are out there competing for people’s time and attention.
5. Attracts new employees. If you are good about talking about your ‘what’ and ‘why’ you do what you do, it becomes much easier to recruit and retain talent. This is probably one of the biggest things holding back small businesses today.
6. Motivates your existing employees
7. Guides employee behavior, making them more competent, committed, and contributing. When your employees are upselling, cross-selling, or doing the necessary work of running a business, they are doing it in a way that isn’t ‘slimy’ but is actually coming from a great place!
You must believe in what you do, and the goal is to sell someone on becoming a member of what you do. Maybe this is buying a 10-pack of classes, or scheduling their next session with you. You can learn to look at this as giving them a gift to stay in touch and make sure they stay on track to reach their goals.
It’s just like that Joseph Pilates quote, Feel the difference after 1 session, see the difference after 10 sessions, and change your life after 100 sessions.
8. Sets clear guard rails on what your company does and doesn’t do.
9. Creates the foundation for the public image of a company
10. Increases your impact on the world.
We should all be hungry to touch more lives, and this is what effective marketing will enable you to do.
This is Not a Channel-Driven Approach
This system is not how to use Tik-Tok or any other social media channel to build your business.
Don’t fall into channel-based tactics and strategies. You will overwhelm yourself. Everyone should be on Instagram, it is the natural place and home for a Pilates professional. However, just mastering Instagram will take you the rest of your life. It is constantly changing.
You are not an Instagram expert, you are a business owner and entrepreneur. So you need to understand how Instagram fits into the bigger picture, but don’t get confused about channels, versus strategy.
When we focus on the bigger picture, we can apply these skills across all of our marketing.
By Polestar UK MentorKristin Loeer.If you are interested in learning more about Kristin’s approach to working with the breath in Pilates you may be interested in the upcoming workshop “The Movement of Breathing” which will be hosted by Polestar Pilates UK in November 2022.
I have never met a client who was not confused or insecure about the nature and function of their breathing. In fact, I have never met a client who, when asked about it, did not assume that they are “probably breathing badly”. People are exposed to plenty of breathing cues in Pilates and Yoga classes. Outside of the studio, there is also an abundance of breathing practices and breathing apps.
So why is there such confusion and lack of confidence about breathing? And secondly, I dare ask, do we, as movement professionals who cue breathing all the time, feel all that confident about it ourselves?”
After all, we may have learned that thoracic breathing is the way to go. Or we were told that deep diaphragmatic breathing is important. We may feel compelled to remind people to take deep breaths during movement because we see their tendency to hold their breath. Then again we may wonder about the exhale because if we do not breathe out we can not take in fresh air either. When we add Pilates to the equation and start talking about inhaling and exhaling in relation to movement we can easily overwhelm our clients, if not ourselves.
The Breath as Autonomic and Conscious Process
The reason why the subject of breathing causes never-ending confusion is that breathing is both a very finely tuned autonomic process, as well as under our conscious control. Hence it can be altered, but we may wonder whether it should be. This will always have a very complex impact on the rest of our being.
Just like digestion or heart rate, breathing is orchestrated largely by our autonomic nervous system. The autonomic nervous system is influenced by our life experiences. It is constantly responding and adapting to external and internal changes. Its main concern at all times is homeostasis and survival.
The Breath As A Tool
As mentioned, unlike heart rate and digestion, breathing is also under our conscious control. I can choose to lengthen my exhale or to hold my breath. I do not have the same control over my heartbeat or digestive processes. This makes breathing such a powerful tool. We can use it when we want to become calmer or more alert and of course, it gives us the opportunity to optimize movement through breath.
I am a practitioner, who specializes in somatic trauma work. My belief is that it is important to remember that while we can alter our breathing and create powerful change through it, breathing is a carefully and deliberately orchestrated nervous system process. No matter how inefficient or dysregulated a client’s breathing pattern may seem, in my experience, it is never random. There is no such thing as “lazy breathing”, “wrong breathing” or “I forget to breathe”.
There is nothing the nervous system does without good reason or without its key concern being survival.
This does not mean that we should not work with our breath. It means that we need to go about it gently and respectfully. We need to be aware that there is a reason for the client’s current breathing pattern, and that if we try to alter it, there may be pushback from the client’s nervous system. We can bring about positive change indeed if the nervous system recognizes that this change in breathing is helpful. On the other hand, if we are not careful we might promote a messy interference with the nervous system’s autonomic process, which does not serve the client well.
Here are my six top tips for how to work with the breath in both private Pilates sessions and group classes:
1. Observe The Breathing Pattern
Particularly in private sessions, we have the opportunity to observe our client’s breathing both in stillness and motion.
Let’s not be too hasty with our wish to help them use their breath better. Let’s be curious about what their body is naturally doing. Also, consider how breath might change automatically as we work with using other cues. It is very possible that your soothing voice or their awareness of their body’s movement against the ground settles their nervous system. This alone might regulate their breathing without you having to address it directly.
2. Make Breathing Cues Relevant To The Client.
As with movement, respond to what you are observing rather than using generic, popular cues.
Some people do indeed breathe shallowly. Others have already been told they do so and are now stuck in compensating patterns of excessive abdominal breathing. Many people inhale more than they exhale, however, there are also a fair few people who stretch their exhales and barely feel the need to inhale. The point is that no one person breathes the same and we need to be careful not to generalise and give people cues that are not useful to them.
3. In Group Classes: Offer Different Breathing Cues To Explore.
In group classes, it is much harder to observe and attend to individuals of course.
We need to be aware that not one breathing cue will work or be right for everyone. Let’s provide different options so that they can explore and be inspired by the cues that feel good to them. You might ask them to become aware of how much they breathe in compared to how much they breathe out. You might suggest they try out opposite options within an exercise to let them decide what feels right for them. Also, give people the option to ignore the breath-related cues altogether. They may simply not be in a place where they feel safe to explore their breathing patterns.
4. Use Positive And Invitational Language
Whether you work with individuals or a group, when it comes to breathing I strongly recommend using invitational language.
Let’s remember that the nature of our breathing is closely linked with our sense of survival. It is important to put the client in charge of their breath. Encourage them to be present and curious with their breath. Reassure them that while they may want to try out making changes, their natural breathing is not wrong and they can return to it whenever they want.
5. There Is No Failure.
A client may simply not be able to access the shift in breathing we are encouraging them to find.
This may bring about a sense of failure in the client. Let’s remember that the nervous system always has the final say and if it does not deem a change safe it will not allow it. You can communicate this to the client by explaining how their body is “saying no” to this today and how over time it can change its mind”. Encourage the client to explore and “play with this again later.”
6. Bring Awareness To The Impact
If the client’s breathing does change, allow them time to experience this without adding any further new information or cues.
It can take a few minutes to explore this and to become aware of the holistic impact this change has had. They may feel calmer, stronger, or experience more flow in the movement. This positive shift is really worth exploring! It has the potential to integrate and perhaps become the new normal. They may become emotional, anxious, or irritated and feel their movements ‘disintegrate’. It is important for the client to experience whether this shift is positive for them or not. They can revert back to their previous way of breathing if they need to.
If you would like to learn more about my approach to working with the breath in Pilates you may be interested in my upcoming workshop “The Movement of Breathing” which I will be running for Polestar Pilates UK in November 2022. For more information please contact me @kristinloeer_movement .
“If you can relate to overwhelm, anxiety, or perhaps being ‘tired and wired’, then read on for ways in which Pilates as a practice can help you, and support your positive mental health.”
Sarah Edwards is a Doctor of Education and Comprehensive Polestar Graduate of Polestar Pilates UK.
Pilates is often promoted as being great for ‘core strength’ or ‘reducing back pain’, both of which it certainly can do. (I know, as back pain was the main reason I took up Pilates in the first place). Through personal experience and in teaching clients in private and group settings, I now know that Pilates has consistently supported me in managing my own anxiety. The practice can be instrumental in supporting the positive mental health of others.
Prior to teaching with Polestar and while I attended my weekly Pilates class, I was working as a Teaching and learning director in higher education. I completed a Doctorate in Education, raised a family, and I also experienced a number of traumatic experiences regarding my children’s health. Not surprisingly, I was diagnosed with Generalised Anxiety Disorder.
Thankfully, Pilates really brought me out of that very busy headspace and, at times, my overwhelm. My experiences led me to train with Polestar as a Comprehensive Practitioner. I also trained as a mental health first-aider and, safe to say, I haven’t looked back.
Joseph’s Mind-Body Method
Joseph Pilates advocated a mind-body practice much before his time. In many aspects of holistic health, the context of “typical daily life” has changed in drastic ways. Modern lifestyle habits including chronic sleep deprivation, poor nutrition, and even social media use and ‘doom scrolling’, have fuelled the anxiety epidemic. Mental Health disorders, including anxiety, have also increased as a result of the COVID-19 pandemic. While the context has changed, the practice of Pilates, for the main part, hasn’t.
How can Pilates specifically help? If you can relate to overwhelm, anxiety, or perhaps being ‘tired and wired’ then read on for ways in which Pilates as a practice can help you, and support your positive mental health.
1. Regular Practice
Pilates as part of your regular schedule will interrupt your overthinking and helps ‘press pause’ on any overwhelm. In our digitized, and always “on call” culture, we need to step away from our devices, and literally and figuratively “switch off”.
2. Break The Cycle
In turn, positive movement experiences can help break the chronic stress cycle. Chronic stress affects the nervous system, and influences related anxiety disorders. Stress can also have profound physiological effects. The long-term stimulation of the fight-or-flight response leads to the constant production and secretion of hormones such as cortisol. Long-term excessive cortisol is associated with a variety of consequences, including diabetes and cardiovascular disease.
3. Connect With The Breath
Pilates focuses on breath (it’s the first Principle of Polestar Pilates). Focusing on the breath, and particularly an extended exhale can help access the parasympathetic nervous system. This sends signals to the brain that all is well. The parasympathetic nervous system is responsible for the “rest and digest” function of the body which is why you can likely hear your digestive system at work once you relax!
4. Practice Embodyment
A skilled teacher will give you both internal and external cues that allow you to move in a mindful way. When you focus on the internal sense of your body (interoception) you cannot be thinking about your overwhelming to-do list. Teachers who have also embraced an element of psychological fitness training (such as with Polestar) can also help clients come out of their ‘thinking brain’ by stimulating the vagus nerve. This can support reducing stress, anxiety, and even depression.
5. Empowerment
The benefits in strength, posture, and mobility you gain from Pilates can help your self-confidence (we call this self-efficacy) and your self-esteem. Any positive movement experience will release endorphins, and hormones that will reduce pain and stress, and improve your mood.
Sarah Edwards @positivepilateswithsarah is a Doctor of Education (with specializations in Teaching and Learning), a Comprehensive Pilates Instructor with Polestar, and a Mental Health First Aider. She is particularly interested in promoting Pilates for mental health and runs one-to-one, and on-demand classes from her recently completed garden studio in England (gardening being another of her passion projects)!
References:
i Vora, E. (2022) The Anatomy of Anxiety. Harper Collins publishing.
ii Mental Health First Aid England, 2020.
iii The Parasympathetic Nervous System (2022) Brittanica Science. Available at : Sciencehttps://www.britannica.com/science/parasympathetic-nervous-system (accessed 8th August 2022).
iv The Counselling Directory. What is the vagus nerve? Available at http://www.counselling-directory.org.uk/member-articles Accessed 24th August 2022.
v As a Mental Health First Aider (1) I am trained to recognize when someone is struggling with an anxiety disorder, depression, or psychotic episode and to signpost them to appropriate help. It is not within my scope to diagnose these conditions.
BA: As Pilates teachers, how do we make what we do in one or two hours a week potentially influence a positive neuroplastic change? We know that one or two hours a week may not be enough to influence this. What else needs to happen, and what needs to be influenced in that one or two hours a week?
KS: Giving people good appropriate challenges is really important for this process. Also, I try to stimulate them in multiple ways. The use of imagery is incredibly impactful and profound for people to help them embody these new experiences. Imagery helps them build different relationships between a movement and their perception of that movement or their relationship to that movement.
Many of these things are built into the Polestar curriculum actually! Utilizing imagery, utilizing tactile cueing in order to tie in sensory nerves and proprioception thus integrating the brain on another level.
Kate Strozak
Now more than ever I talk to my clients about their sleep habits. I remind them it’s out of the scope of my practice, and that I am not a professional sleep consultant. I encourage them if they feel like their sleep could be better quality than it is right now to reach out to a sleep professional and get some help in that arena. It’s when we are in our deep states of sleep that a lot of these neuroplastic changes occur in our brain.
Being “Chatty” With Clients
Another important thing is mindfulness. Prior to studying neuroscience, I was inclined to be chit chatty and casual with my clients. In part, thanks to Alexander Bohlander and my experience with him in his meditation workshop at the Polestar experience I dove deep into studying mindfulness and meditation. It’s fascinating the effects of these on the brain and profound in terms of stress reduction and sleep quality. If you are doing something that supports the quality of your sleep you are, therefore, hopefully then supporting the process of neuroplasticity. So it’s a very long-winded answer to say there is a lot!
BA: That is excellent Kate! I just learned this year from an Andrew Huberman podcast about the idea of neuroplasticity occurring typically when we’re sleeping. We challenge the body and challenge the nervous system during the day, challenging ourselves to learn. I’ve been using this with the students at the university as well. Especially the ones who are struggling with retaining information or integrating and synthesizing information. It’s so interesting that it’s the sleep that is going to allow you to synthesize this information. This leads into the “interleaved” learning where we’re stressing you a little bit to recall information to make it challenging and difficult. At first, you can’t remember what it is, but when you go back and look at it again after the stress of trying to remember it (and a good night’s sleep), it is amazing the amount of synthesis that happens on the following day or two of processing that information.
Creating Demand And “Struggle”
The same thing is true with movement of course and some of the things you mentioned. If I could get my client to remember what we did last week, “do you remember where your body was when we had that really good experience? “Can you show that to me again?”, and maybe they fail, that’s ok. They are trying to figure it out and recall it, but that’s the internal feedback and the mindfulness that we’re talking about that allows information to be synthesized. They need this demand and the struggle of the recall. And don’t just give it to them and show them, let them struggle with it, we don’t want to make it so easy. We want them to understand that struggle is good, that failure is good, and that these are learning processes that will help them in the long run. If we don’t challenge them with that struggle we don’t challenge the nervous system to change.
KS: Absolutely, there is no incentive to change if you are not being challenged or having that moment where you have those slight releases of cortisol and adrenaline. Your palms start sweating and we have to have those moments, it’s part of the human experience.
I don’t know about all of you but I was very prone to just having casual conversations with my clients. When the client has done footwork a million times with me, which in and of itself presents another problem, but if I’m talking with them about something, I’m taking them out of their experience and out of their body, so I limit that. I’m not cold or stoic and not available to them but I really get them to focus on what they’re doing and to really be present and attentive to their movement.
If I’m talking with them about what they are doing this weekend, they start thinking about it and they are not aware of what their body is doing at the present moment in time.
Kate Strozak
BA: I really appreciate you saying that. Our friend Polestar Educator Juan Nieto calls it “being the butler”, and I call it “gum holding”. The point is that we get into a chatty, chummy kind of relationship with them and were really not challenging the nervous system. We become a “paid friend” in that situation. If they are doing the same thing they always do with you, you are not challenging any improvement or any change other than maybe being a listening ear. Even worse when we bring our own problems to our clients.
Supporting Neuroplastic Processes
In group classes when there is flow and purpose, there is more internal reflection going on and feedback that is more likely to create change than in a chatty one-on-one session. We can create incredible challenges and demands on the nervous system when we’re working with a group of ten people. If we’re not having that same intensity with our clients one-on-one they are not going to have the same neuroplastic challenges.
KS: And if you’re not supporting these neuroplastic processes then what are you doing? The neuroplastic process is just a really fancy way of saying that you’re helping to create a repatterning, working on movement efficiency, or working on a tissue adaptation. If you’re not really supporting those processes you’re not really supporting the longevity of the Pilates work you are doing with them. So maybe Brent, you, and I are suggesting to everyone that our challenge to you is to try to support more quiet and focus in your pilates sessions. If your client` is really keen on talking and carrying on a conversation, you might not be challenging them enough! There is a time and place for all of it as you know!
BA: Let’s see how chatty they are when it’s time for jackknife…time for hip circles!
KS: Yes! Can you juggle while doing feet in straps?
BA: What is your gut feeling about imagery influencing neurobiology?
EF: It must be happening. We know the influence of imagery on a variety of psychological states and obviously, we know its influence on movement. For any of that to happen, you are changing things in your neurobiology, from neurotransmitters to hormone release. But we haven’t looked at it directly yet at the cellular level, which is where we want to go next!
BA: One of the interesting things about the idea of neuroplasticity is how our experiences modify our neural pathways. The synapses change and some of the neuromodulators change because of our experiences. Something I am reading about is the belief that neuroplasticity happens at night time when we are in our sleep. We have these experiences during the day and when we are in deep sleep the nervous system processes them. It actually moves through that neuroplastic part, the hard part of changing biology.
It is interesting to use that knowledge to see if people in their sleep are in conjunction with their imagery and movement experiences. To see if those who have a good night’s sleep have better neuroplastic, bio cellular, and neuro-cellular change than those with poor sleep and the same interventions.
“the fastest way to change your movement is to change your mind”
Eric Franklin
EF: I would be pretty sure about that because I always say “the fastest way to change your movement is to change your mind”. That’s because synaptic waiting and synaptic change happen so fast. You change your mind about the movement and the movement changes. That’s a very fast approach. Changing muscles takes longer, and changing the fascia takes even longer.
It doesn’t mean those are things you shouldn’t do. If you want something that works fast then images are a great way to create relatively rapid neuroplasticity. It is not just to brag about imagery and say it’s so cool because it’s also about motivation.
People get stuck in end goals like “I have to work out and train until I get my six-pack or until this or that releases”. Or “I have to get some more collagen laid down in that area…”. Instead, give them some motivational things. Give them some imagery so they can immediately feel a change. Of course, that is not going to change the fascia immediately. It will need a lot more repetition, but it’s very motivational.
BA: You are the pioneer on a lot of this, and especially for making it known. Back when I met you 25 years ago at IADMS our thinking was more about “hard-wired”, suggesting everything was structural. People thought “my plie is limited structurally, I have tight heels”. Then we play the bone rhythm game and all of a sudden they can move into another 10 to 15 degrees of ankle dorsiflexion. Releasing the hips just with the image of the sitting bones widening.
We love your work and have supported it from the beginning, and that was a big breakthrough for us. That experience led to part of my dissertation looking at the idea of creating successful movement experiences for people in chronic pain. Having that successful movement experience shifted their paradigm and we created that by using imagery they could process. This is key as a lot of times doctors use imagery that the client can’t process and is thus unsuccessful.
EF: It’s very nice of you to say all these things. To this day, we first look at the kinds of functions that are built into you structurally. Then we add functional exercise on top of that. If you are told that your bone structure won’t allow certain movement, that’s already negative imagery. This alone could be part of why it is difficult. You hear “oh my bone structure doesn’t allow…”, and if you think this, why even bother?
If you are told that your bone structure won’t allow certain movement, that’s already negative imagery. This alone could be part of why it is difficult. You hear “oh my bone structure doesn’t allow…”, and if you think this, why even bother?
BA: “I’m built this way…”
EF: If you tell someone “you’re not built to do that very efficiently”, they may think “ok, I won’t even do it in the first place”.
BA: Or, they might try to do it in a way that can potentially injure tissue. I love this idea of these two areas in particular that you’re focusing on right now. The idea of understanding biology in conjunction with imagery and the behavior, belief, or perception of how we mix the two. This connecting of behavioral science with the physiology and biology of things we’ve suspected for a long time because we see the change. A lot of times the change is immediate, and when we think about the long-term acquisition of it it’s like you said, the tissue adapts with practice and repetition.
When someone can implement an image that helps them on a regular basis in their movement practice, you will start to see the shift in their motor control. We know the neuromuscular system shifts and is always seeking efficiency with the task, so we will often see that.
The most exciting part of this is working with fascial gurus to understand the mass of science coming out about the communication system that exists inside of our fascia. In one study they removed fascial tissue from a living animal, put it in a dark room, and it continued emitting light photons for minutes after it was removed from the living organism. Just think about these tubulars that are talking to all the cells. The cells are very dynamic in their synapses, at least we know that – really, really exciting!
EF: A lot of the research in motor imagery supports that if you rehearse the movement before you do it, afterward it’s better. That is very interesting, but what about going further back even into the emotional aspect? What about working with the limbic system and how it affects all that movement and working directly at the endocrine and cellular level and doing imagery there. So instead of just looking at the results and then trying to find explanations, go directly into the tissue with imagery and see if that’s measurable. No one has ever done that, why not?
Maybe not measuring the amygdala and stress response on the cellular level. Maybe that’s a bit complicated, but there are other things that we’re going to look at -and to go further back, not looking so much at the result, but at the much earlier stage where these results are being created. Look at the imagery – what is it doing there? That’s the next step.
BA: The neuromodulators can also be measured, like the serotonin type 2a and dopamine. Those things are tied to motivation and satisfaction. I would find it really interesting to learn how a successful movement experience with imagery that they’ve embedded changes the whole neuro response. Specifically with the serotonin type 2a, which is thought to correspond to contentment or satisfaction, and dopamine, the motivation modulator.
EF: Dopamine only gets released when you’re planning or thinking about what you want to achieve. As soon as you achieve it, the dopamine is gone. The serotonin for the contentment part, to give one answer – movement is good if it feels comfortable to you. If you enjoy doing the movement, then there must be efficiency on some level. There are several perspectives on efficiency and good movement. The inner perspective is:
“What is your experience of this movement?” and the external perspective is “What is the experience of the beholder?”.
For example, you go to this incredible ballet performance or Cirque du Solei and they’re doing these incredible things. You say, “That was so amazing, so beautiful”, but meanwhile on the stage they are wrecking their bodies.
There you have the conflict full on. A lot of things they were doing were dysfunctional, pushing their bodies way beyond what they should be doing. They were hurting badly on every level, but the audience thought it was beautiful and incredible movement. They are basically ending their career right out there on stage.
Looks Good / Feels Good
BA: That’s a great topic, that “external versus internal”. Where is the feedback coming from? Who is giving the feedback that it was amazing? The observer or the mover? It’s the “looks good versus feels good”. When we teach, we provide external feedback “Move the pelvis in this direction”, “Allow this to happen”, or “Reach there”. The internal feedback is the question “How does that movement feel?”, “What do you observe with that?”, “What happens when you use this imagery versus that imagery?”.
EF: Starting way back, my experiencein exercise classes and dance classes was all about positional alignment. You were told about the shoulders and ankles. Shoulder blades down, endless stuff like that, “Lift pelvis”, on and on until I felt immobilized, literally! Is this correct now? Am I supposed to move from here? Well, I can’t really move because I’m going to wreck this great posture.
I was thinking that it feels very conflicted and it eventually donned on me that you can’t teach movement through a position. They contradict each other. Movement is movement, and a position is a position. We are not a statue on a wall. That’s where it kind of started for me. If you want to align onto a wall, stacking the body like bricks, I think that works pretty well for a wall… but I’m not made for not moving.
In fact, we are very bad at not moving – that’s basically the crisis we have right now. We are more sedentary than our ancestors. We are very adapted to a lot of moderate movement for hours daily. That’s what we’re adapted to and that’s why I was wondering about this postural teaching. If you try to move while you try to keep a position, you are going to create conflict and it expresses itself in tension. As we know, tension is the enemy of movement. If the movement from the beholder looks tense, and there are different ways it can be expressed, like discomfort, the suspicion should be high that this movement is not efficient.
PD: The good and the bad is that there is a lot of buzz around the pelvis, and pelvic floor. Then, like everything else, it gets a little diluted or a little “translated”. I always like to come back to what we really mean by certain things. That’s one aspect of what I’m really trying to put out there now. Let’s all try to have a similar vocabulary and understand really what we are after.
There are way more people coming via the internet, with more open-mindedness about how women are during the birth experience. For example, people are seeking services after delivery with different health professionals. Most people are coming into the system because of excellent trainers picking up on dysfunctions and referring them appropriately. That’s what I get really excited about. It’s not really a medical model, but it’s out there with educators.
BA: It’s such an important aspect, that continuum of care that we’ve always talked about. A lot of times people get very territorial. It’s like, “the pelvic floor is my territory, my profession, my training”. What we don’t realize is it’s a continuum of health just like everything is. At some point, clients are going to be doing at-home exercises, going to the gym, and attending movement classes. The more people are aware of that whole spectrum of pre, during, and post-rehab, the more able we are able to achieve our ultimate goal. To allow people to participate more wholly in life.
We’re dealing with things like incontinence, vulvodynia, weak abdominals, and hernia of the abdominal wall postpartum. These are all things that significantly impact people’s well-being. This is what I love about my relationship with you. When I’m screening someone, I completely understand the impact that pelvic floor pathology can have on intra-abdominal pressure with someone with low back pain, but when I rule out pretty much everything that has to do with the physiology and structure of the spine, I can say “I really think this person needs a pelvic floor consult, can you look and see if there’s something missing.”
PM: You touch on something that’s really important in the healthcare model. A lot of our healthcare professionals seeing patients on the front line have just minutes with their clients.
BA: I’d love for you to talk about the latest research out there on dealing with stress incontinence. What are some of the latest research? Do we know what is not working? What are some things you do as an internal therapist to be able to understand that better?
PD: From a functional standpoint we still don’t have a lot in the literature that is functionally driven, I’ll put that out as a disclaimer. A lot of this is still in case study format, not random control studies. But what we can talk about is just like anything else. People assume. That’s the big part, the assumption when they are told to do a Kegel (and what does that really mean?).
Arnold Kegal designed a perineometer, a device inserted into the vagina that was flexible. Women that had stress incontinence were given this device. It looks like a blood pressure cuff device, and the needle would go off when you had a good squeeze. So instead of pushing it out, which would not register anything on the device, you would get biofeedback from getting a contraction. Arnold Kegel really focused on strengthening the pelvic floor universally to help with stress urinary incontinence. Usually at the level of the urethra.
On the pelvic floor, there are layer one and layer two muscles. We have the pelvis and these small muscles, and on the other side is collagen that is very strong and not very elastic. When the pelvic floor is strong it can act like a trampoline and rebound with the intra-abdominal pressure that is coming down to meet the bladder and other organs. This is the endpoint the anatomists say. The levators are our main postural muscle; which holds our innards up as we walk around, and gives us continence.
So coming from where he identified squeezing these muscles, which led to improvement in stress urinary incontinence, we’re now fifty-plus years later still talking about Kegels. So I really call them a pelvic floor muscle exercise, because there are a lot more dynamics to it. At Herman and Wallace, where I’ve been teaching for many years, we teach an exam to look at these muscles from the vaginal side and the rectal side. We also gather a bunch of other information regarding diagnoses, moving beyond this simple squeeze and release.
We know the pelvic floor is mostly slow oxidative fibers, 70-80 percent of it. So if you’re just teaching a quick on and off, even in a cueing situation, you’re not doing the majority of what these fibers do for a living. A squeeze also has a quick component. You have to be quick to get the intra-abdominal pressure. In our practice, I would say I’ve become way more interested in identifying what part of it. It all squeezes together, but with proper tactile and verbal cueing, I can get the person to understand it functionally.
Moving into a little anterior tilt, I can say “sit in neutral, perform the pelvic floor lift, feel where that feels in your body. Is it more rectal? Is it closer to the midsection of the perineum near the sitting bones, or do you feel it up front? Then take a moment and lean back in your chair, almost with a posterior slump and squeeze again. Now, where do you register that portion of the contraction?” Remember, it’s all contracting the same but your sensory awareness is going to be different. Then finally roll forward toward the front. I give a cue like “pick up a blueberry with your vagina”, “lift the clitoris”, or in men, “lift the penis”.
If you’re looking up front, you’re going to feel perhaps the three different areas of the pelvic floor. Stress incontinence could be affecting more upfront so we can give it a more anterior cue. It has nothing to do with breath, it just has to do with the squeeze and the isolation of the squeeze.
BA: You bring up really important points. The one that’s the biggest is how little we know about our pelvic floor anatomy in general. I’ve read a couple of papers now regarding how many women have no idea what their genitalia look like, and don’t want to know. It’s sort of like a taboo, and heaven forbid you to say the words clitoris or vagina in mixed company. One thing I would love to have you explain a little bit more is the relationship of the sphincter muscles, both the anal sphincter and urethra sphincter, in comparison to prolapse and a vaginal wall breach.
We are realizing something interesting after looking at hundreds of ultrasounds. It’s not that they don’t have an active contraction of the pelvic floor. It’s that they think the vagina muscle is lifting the pelvic floor. So you might see a little bit of activity in the vaginal wall but you wouldn’t see the pelvic floor lift up. In some of them, we would see the glutes squeeze because they weren’t quite sure where the pelvic floor was or what the muscle was that they were lifting. Others were in their own minds thinking things like stopping the flow of urine.
Thinking of that integration you’re talking about, I would love to have a little more explanation on the relationship of the urethral sphincter to incontinence. What is its relation to the pubococcygeus and pelvic floor? How does it relate in the sense of incontinence, or “continence” if we look at it in a positive way?
PD: So what we really need to know is that part of the musculature is under autonomic control. This means that our urethral area is on “close” or tightened. That is mediated through loops going up to the brain and when we go to the toilet or decide to squat and pee we tell the brain “ok go ahead and relax”.
Through that complex system, the autonomic releases the intrinsic sphincter and we also release our volitional sphincters. It’s a very coordinated effort. That’s why potty training takes so long for human children and what’s important to know is that the autonomics are working to keep us continent. We don’t think about contracting them all day long. Otherwise, we wouldn’t be able to function.
What we do have control over is the override. In the volitional set, we can delay urination at any point, or with that cueing I just mentioned, getting more where the urethra is, more to layer two where all of that pouch is. Through this, you can elicit a more direct contraction and really tighten and reinforce around the urethra.
This could be utilized if you’ve had damage from an obstetrical tear, a decade of chronic coughing due to allergies, COPD, pulmonary issues, or bronchitis where you’ve blown out a lot of things over weeks. So you can reinforce the contractions and help what’s already happening in the autonomics by adding to this deeper layer, the volitional muscle set versus the autonomic set.
We use technologies like cookies to store and/or access device information. We do this to improve browsing experience and to show (non-) personalized ads. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.
Functional
Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
