Wait a second...PT and yoga?

Why am I starting a PT practice in a yoga studio?

Because…often when I’m explaining the details of pelvic floor PT to people, I say, “Well, physical therapy for the pelvic floor is really applied yoga.” I love having this opportunity to explain this in depth. Sit with me for a second, because explaining the link between pelvic floor PT and yoga requires a pre-explanation. I promise it will be rewarding. Here it is:

Pelvic floor issues can typically be divided into 2 major groups: overactive and underactive. People with an overactive pelvic floor may have difficulty with urinating, constipation, and pain with intercourse or pelvic/abdominal pain in general (not associated with intercourse). Physical therapy treatment for these folks involves learning to relax and lengthen their pelvic floor musculature. It also, often, gets pretty profound pretty quick. These folks need to learn how to manage stress and how to lengthen and balance their entire bodies (not just their pelvic floors). In some cases, people with overactive pelvic floors need the coordination of a health care team including counselors and mental health professionals, urogyns, colorectal specialists, obgyns, and others.  (Note: Having a caring PT can help with this.)

Now—people with underactive pelvic floors may have difficulty with incontinence (of urine, feces, and/or gas) or with pelvic organ prolapse (a fancy word for: your pelvic organs including bladder, bowel, uterus/vaginal cuff, or intestines have lost their original placement and support). These folks need to strengthen their pelvic floor. The colloquial expression for this is, “Doing kegels.” The exercises they started training pregnant women to do in the 70s. But please don’t read this post and just start “doing kegels.”  Studies show that a majority of people who think they are doing a “kegel,” aka a levator ani pelvic floor muscle contraction, are actually doing something quite different that may not improve their problem. People with underactive pelvic floors typically have a lack of coordination, both with breathing and with pelvic floor contraction, that requires skilled training to correct. You do you! Always! But if you find your issue is not improving—ask for help from a pelvic floor specialist.

Here’s where yoga comes in. Yoga emphasizes the breath work—pranayama—and core activation (this means abdominals and pelvic floor) which are at the heart of pelvic floor coordination. Restorative and relaxation based yoga practices typically emphasize the sort of diaphragmatic breathing that is at the heart of relaxing the pelvic floor. In contrast, high-intensity yoga practices emphasize the controlled exhalation and pelvic floor contraction that is at the heart of strengthening the pelvic floor.  The diaphragm and the pelvic floor are synchronistic muscles, meaning they work in unison. When you breathe in, your diaphragm descends down into your abdominal cavity, creating abdominal pressure that provides a gentle stretch to your pelvic floor at the base of this cavity. And when you breathe out, your diaphragm ascends into your thoracic cavity, creating an opening of space for your pelvic floor to activate. The best yogis use this connection of diaphragm and pelvic floor to improve their practice.

Ashtanga yoga, which I was trained in as a highschool student, includes the practice of mula bandha. Sometimes this is called “root lock.” It is synonymous with pelvic floor contraction. The pelvic floor and deep abdominals co-activate, which is why for folks who enjoy Pilates, weight-lifting, Cross-Fit, and other disciplines, this action is simply called “activating your core.” The transversus abdominus is the abdominal muscle beneath the rectus abdominus (“six-pack muscle”) and intercostals (look for swimmers to exhibit these in prime form—they are the muscles that connect the ribs and pelvic girdle). Postpartum and pregnant women do well to strengthen this muscle to prevent diastasis recti. But really all people need this deep core muscle to perform the functional activities of lifting, pulling, pushing, and carrying (and dare I say: pooping) that we do in our daily lives without risk of strain, herniation, or pain. Ashtanga yoga and other yoga and strength and conditioning practices that emphasize this deep abdominal contraction of the TA (transversus abdominus), are providing the “uptraining” for the pelvic floor that those with underactive pelvic floor need.

Meanwhile, restorative and relaxation focused yoga practices including Yin Yoga, Hatha Yoga, and Pralaya emphasize the deep belly breathing that permits the pelvic floor lengthening needed for those with overactive pelvic floor muscles. What I love about yoga, is that it does this in a holistic way that links whole body, mind, and spirit. The best restorative yoga provides a connection between our body and our mind, our thoughts, even our lifestyle (the choices we make every day as we get things done.) Yoga has a special spirit to it, that can connect us to our deepest selves. It drives home those lofty “mind-body” connections we are all striving for.

A few practical points to offer as I close this post. Yoga emphasizes the deep breathing, and the abdominopelvic contraction, that can help those with both overactive and underactive pelvic floor concerns. This is why I am starting a pelvic floor physical therapy practice inside of a yoga studio. Before I was a PT, I saw some PTs who were like, “OK, maybe you can do yoga but just definitely don’t do headstands.” I somewhat agree with them. Only do headstands when you are ready. But please—even if you have never done yoga, consider the benefits it has to offer. We at Pelvic Care Physical Therapy believe in the mind-body connection. We also believe in YOU. We are ready to listen to your concerns, to focus on your goals, and to help you link breath-and-movement in focus to achieve those goals.