Prenatal Series #2: 3 Things I Learned During Pelvic Floor PT ... As a Patient!

It's always fun to switch roles and put yourself in someone else's shoes. For the first time in a very long time, I got to walk a mile in my patients' shoes! I sought out a pelvic health physical therapist to help me better manage the physical changes that occur during pregnancy, to improve my voluntary control of my pelvic floor muscles, and to learn how to connect breathwork with my pelvic floor during exercise and at rest. And this just scratches the surface of what you can learn with pelvic PT!

    As a physical therapist, I'm well informed of the advantages of making these changes - in working with pelvic therapy, I know that I will be able to lessen my chances of bladder leaks, pelvic pain or discomfort, and even prevent conditions such as low back pain or sciatica. But, many people don't know what else pelvic floor PT can help with, which includes everything from bowel and bladder issues, pain during sexual activity, and even orthopedic pains in the low back, hips, and more. What's more, these services extend to pregnant, postpartum, NOT pregnant, female and MALE patients! Pelvic PTs undergo specialized training in the pelvic anatomy and physiology, evaluation and treatment, so on top of their physical therapy degree (entry level is now the Doctor of Physical Therapy, DPT degree) and their work experience, they have completed additional certification, continuing education and hours of experience in evaluation and treatment of pelvic floor conditions. 

    So what did I learn from my first visit as a patient of a pelvic PT? Again, though my goals and questions were related to my pregnancy, know that these lessons are widely applicable to non-pregnant individuals, too! 

1. The ABCs of Pelvic Health

    Alignment, Breathing, and Connection. My PT was amazing and relayed in importance of her ABCs - “Alignment” meaning the recognition of how your body is positioned in space when still and when on the move; “Breathing” meaning the ability to activate and coordinate the correct musculature for breathing to minimize tension, maximize range of motion, promote digestion and even nerve activation; and “Connection,” referring to the ability to engage the full core system, not just abdominals or the ability to perform a Kegel. Mastering each of these components requires consistent practice and patience, but in the end you need all 3 components to have a healthy, sustainable system.

2. “Spiraling” Muscular Tension

    In pregnancy, we think everything is “lax,” due to relaxin, right? Relaxin is a hormone that increases during pregnancy that allows are joints and ligaments to shift and create space for the growing passenger inside. However, you can still have muscular tension and joint stiffness, and actually need to manually release certain areas - in my case, we found that my right hip, left lumbar spine musculature (paraspinals, quadratus lumborum) and right scapular region all held greater tension in a pattern that moves up the spine. These “spiral” patterns of tension can occur without also having a pregnancy in the mix, so it can be well worth it to be evaluated  by an orthopedic PT (does not necessarily have to be pelvic specialist at first) to identify your patterns of tension so that you can get the best tools to independently manage tension and stiffness and prevent or treat pain!

3. Center of Gravity Matters

    Toward the end of the session, my PT had me stand in my “best posture," looking in a mirror. As a PT, I thought I was on point! Tuck the tailbone a little, squeeze the abs, even engage the glutes and quads. But in a blow to my ego, my PT let me know right away that I was clearly assuming the “pregnant person” stance: increased lumbar lordosis, lack of core control, and a misplaced center of gravity. Luckily, a very practical tip goes a long way: when told to recenter my body weight over the front of my heels, my body automatically realigned itself for the better, from the ground up. Since then, I have been training myself to stand in the best alignment while standing at my desk at work, cooking, and even during exercises, like squatting.

Bonus: Strength Externally, Confused Internally

I was so used to engaging my abdominals/core muscles, glutes, and biggest external muscles (muscle groups I train daily in my own patients) that it was actually a challenge for me to engage smaller pelvic muscles with more control and greater finesse. Through watching videos of my breathing and other visual, verbal and tactile cues, I was able to engage the right internal muscles and perform controlled movements of my sacrum, which will help me combat low back pain and even serve me during labor and delivery. Lesson learned - it's not just about the big guns! We have to have some finesse to probably utilize our innermost muscles.

Have questions about pelvic PT, finding a therapist or want to share your pelvic PT experiences with us? Leave a comment, question or suggestion below!