Posts Tagged ‘stability’

Pilates and Male Pelvic Fitness: Part 2

April 12, 2014

 

Blog #149

Pilates is a discipline that has a strong foundation in core strength and pelvic floor conditioning. This blog is the second part of an interview of Catherine Byron, Pilates trainer and owner of CB Performance Pilates (www.CBPerformancePilates.com). This material is excerpted from my forthcoming book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health. (now available in ebook format on Amazon; soon to be available on iBooks, Nook, and paperback)

Dr. Siegel: Can you elaborate on the mind-body connection?

Catherine Byron: Integrating “awareness” and the “mind-body” connection are key components to reaching your potential. The art of being in the moment, of involving the intellect with movement is the key to reaching one’s goals. Often, we are not living in the moment but are simply going through the motions, a condition known as “mindlessness.” Pilates is rooted in “mindfulness”—staying alert and aware in the present moment. Not only does Pilates educate a person about his anatomy, but also how to use it more efficiently.

Dr. Siegel: But doesn’t too much thinking interfere with our ability to do a physical task in a natural and fluid fashion?

Catherine Byron: During the rehabilitative/reconditioning phase of training, mindfulness is key. Over time, these patterns become natural and intuitive and the need to “think” about it will diminish. Initial “heightened” focus is part of the overall process 

Dr. Siegel: In your opinion, what constitutes fitness in general and pelvic fitness in specific?

Catherine Byron: Being physically fit has its roots in the foundations of stability, flexibility, strength and aerobic conditioning. Pilates adds spinal alignment, muscle balance and core strength. Throughout your book, you have emphasized the importance of blood flow to the pelvis, linking it to cardiovascular and penile health and function. Cardiovascular fitness is a foundational pillar of good health and should be a lifestyle habit that is incorporated into one’s existence. In terms of pelvic fitness, a simple formula is improve blood flow, improve function.

Dr. Siegel: What differences have you observed in working with men vs. women?

Catherine Byron: One of the main differences between men and women is range of motion. Most males do not have the degree of joint flexibility as do females, particularly around the hip region. Movement is directly related to this range of motion or flexibility. The more flexible a person is, the more they can “articulate,” meaning move the body with greater detail. For example, think of a ballerina in terms of how she moves. She has the ability to move her ribs and hips with petite, incremental articulations and singular, ratcheted movements as opposed to the chunky, massive movements of many men. The good news is that through stretching and Pilates, men can greatly improve their range of motion and muscle function and begin to perform pelvic movements with greater articulation. The resulting improved range of motion ultimately translates into awareness and improved control of your core, pelvic floor and all-importantorgan, the penis.

Dr. Siegel: How will your 10-step Pilates program improve male pelvic health?

Catherine Byron: The Pilates exercises will develop the deep stabilizers of the spine and improve pelvic movement. These muscle groups work to “hold” or “stabilize” the hips and spine in place. They greatly contribute to the strength and endurance requirements of pelvic movements. There are two types of muscles—movers and stabilizers. For example, your biceps muscle allows you to move your arm but does not work to stabilize any part of your body. Stabilizer muscles are located throughout the body and, in essence, hold you together so that you don’t collapse. In terms of pelvic fitness, Pilates focuses on the pelvic stabilizers. The pelvic floor muscles lift, support and stabilize our pelvic organs. Without the pelvic stabilizer muscles, we would all be wearing diapers. Unfortunately, over time, these lose elasticity and tend to collapse to some extent, which is why strengthening them is so vital.

Dr. Siegel: How does pelvic stabilization help sexual function?

Catherine Byron: Pelvic stabilization builds endurance of the pelvic floor muscles and surrounding core region. This directly equates to improved function, stamina and the length of time that the pelvic muscles can contract before they fatigue. An improved pelvic floor coupled with active pelvic floor muscle contractions will enhance sexual function by allowing a man greater control over his erections.

Dr. Siegel: What about breathing?

Catherine Byron: Breathing is literally the “lifeline” of the entire body. Inhalation brings a surge of oxygen to every cell of the body, fueling and providing energy. Exhalation is a necessary release not only of waste gases but also of physical tension. Holding one’s breath or a lack of coordinated and full breathing diminishes this fuel connection and can result in tense and rigid movements. Breathing is part of that mind-body connection and can help to maximize the integration of body, mind and spirit.

Dr. Siegel: What is the relationship between stability and flexibility?

Catherine Byron: Stability and flexibility can be likened to a tree’s roots and branches. The roots represent stability and the branches, flexibility. If either function is in greater measure than the other, an imbalance occurs. Pilates creates a body that is stable and flexible in equal measure. Over-development or under-development of one or both of these can lead to injury and dysfunction. Pilates exercises produce both length (flexibility) and strength in the muscles, creating a harmonious balance.

Dr. Siegel: What is a Pilates ring?

Catherine Byron: The Pilates ring, also called a Pilates “circle,” is a device used to activate the inner and outer muscles of the pelvis and pelvic floor. The ring is excellent at directly targeting and allowing one to develop the core muscles addressed in this book. For this reason, the 10-step program will require one. The ring is positioned inside or outside the hips, activating hard-to-reach stabilizers required for spinal, urinary and sexual health. Using this device will ignite the “hidden” muscle groups, rarely targeted in traditional gym style exercises.

In addition to strengthening the pelvic stabilizers, the 10-step program involves movement patterns so that muscle development will occur not only statically, but also dynamically during motion. While using the ring, movement in several planes of motion will function to develop the pelvic region in a balanced fashion. Creating balance in this region results in greater performance. Strengthening the front, back and sides of the hips is of vital importance because all are connected. Mastering movement withstabilization is our primary goal in order to enhance core strength and pelvic floor function to the maximum!

Dr. Siegel: What does Pilates offer men if they already know how to exercise their pelvic floor muscles including the bulbocavernosus, ischiocavernosus, and pubococcygeus muscles?

Catherine Byron: The 10-step Pilates exercises will maximize the strength and endurance of the pelvic floor muscles. This program will target and ignite the pelvic floor and will allow one to work the pelvic floor more deeply, effectively and efficiently.

Dr. Siegel: How is the 10-step exercise program geared towards men?

Catherine Byron: To reiterate, one of the main differences between men and women is the way in which they move. Women move with greater and more focused detail. It is easier for a woman to move her pelvis and tilt it one vertebra at a time as compared to a man whose pelvis is typically “thicker” and moves more in “chunks.” In addition, men tend to choose sports, exercises and hobbies that further exacerbate this bulky, heavy movement style. The result is a serious restriction of motion that can lead to diminished performance and potential injury.  For the 10-step program, along with step-by-step photos of the technique, please refer to Dr. Siegel’s book.

 

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and now available in e-book on Amazon:

http://www.amazon.com/Male-Pelvic-Fitness-Optimizing-Urinary-ebook/dp/B00JIJDGXC/ref=sr_1_1?ie=UTF8&qid=1397295413&sr=8-1&keywords=andrew+siegel+male+pelvic+fitnesswww.MalePelvicFitness.com

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity (free electronic download) www.findyourfountainofyouth.com

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Pelvic Floor Muscle Exercises: Becoming the Master of Your Pelvic Domain

May 18, 2012


Andrew Siegel, M.D.  Blog # 59

The pelvic floor muscles (PFM)—first described by Dr. Arnold Kegel—are key muscles that are essential to the health and well being of both women and men.  These muscles do not get a great deal of respect, as do the glamour muscles of the body including the pectorals, biceps and triceps. The PFM should garner such respect because, although hidden from view, they are responsible for some very powerful and beneficial functions, particularly when trained.

The PFM compose the floor of our “core” muscles.  Our core is a cylinder of muscles of our torso that function as an internal corset.  They surround the inner surface of the abdomen, providing stability.  These muscles are referred to in Pilates as the “powerhouse”; Tony Horton, guru of the P90x exercises series, uses the term “cage.”  The major muscle groups in this core are the following: in the front the transversus abdominis and rectus abdominis; on the sides the obliques; in the back the erector spinae; the roof is the diaphragm; the base are the PFM.  These muscles stabilize the torso during dynamic movements and provide the wherewithal for body functions including childbirth; coughing; blowing our noses; equalizing the pressure in our ears when we are exposed to a change in air pressure as when we travel on airplanes; passing gas; moving our bowels; etc.  If you want to be able to expectorate like Gaston in Beauty and the Beast, you need a good core!

 

Core strength provides us with good posture, balance, support of the back and stabilization and alignment of the spine, ribs and pelvis. The core muscles are a “missing link” when it comes to fitness, often neglected at the expense of the limb muscles.   Tremendous core strength is evident in dancers, swimmers, and practitioners of yoga, Pilates and martial arts.  The core stabilizes the trunk while the limbs are active, enabling us to put great effort into limb movements—it is impossible to use the arms and legs effectively in any athletic endeavor without a solid core to act as a platform to push off.   An example of static core function is standing upright in gale force winds—the core helps stabilize the body so that the winds do not cause a loss of balance or posture. An example of dynamic core function is running up flight of stairs, resisting gravity while maintaining balance and posture.

POP QUIZ (answer below): CAN YOU NAME AN ANIMAL THAT HAS TREMENDOUS CORE STRENGTH?

The PFM form the base of the pelvis and represent the floor of the core muscles.  They provide support to the urinary, genital and intestinal tracts.  There are openings within the PFM that allow the urethra, vagina, and rectum to pass through the pelvis to their external openings.  There are two layers of muscles: the deep layer is the levator ani (literally, “lift the anus”) and coccygeus muscle.   The levator ani consists of the iliococcygeus, pubococcygeus, and puborectalis.  The superficial layer is the perineal muscles. These consist of the transverse perineal muscles, the bulbocavernosus and ischiocavernous muscles, and anal sphincter muscle.

 

The PFM have a resting muscle tone and can be voluntarily and involuntarily contracted and relaxed.  A voluntary contraction of the PFM will enable interruption of the urinary stream and tightening of the vagina and anus.  An involuntary (reflex) contraction of the PFM occurs, for example, at the time of a cough to help prevent urinary leakage.  Voluntary relaxation of the PFM occurs during childbirth when a female voluntarily increases the abdominal pressure at the same time the PFM are relaxed.

The PFM have three main functions: supportive, sphincter, and sexual. Supportive refers to their important role in securing our pelvic organs in proper position. Sphincter function allows us to interrupt our urinary stream, tense the vagina, and pucker the anus and rectum upon contraction of the PFM.  In terms of female sexual function, the PFM tightens the vagina, helps maintain and support engorgement and erection of the clitoris, and contracts rhythmically at the time of orgasm.  With respect to male sexual function, the PFM helps maintain penile erection and contracts rhythmically at the time of orgasm, facilitating ejaculation by propelling semen through urethra.

In men, the bulbocavernosus muscle surrounds the inner urethra. During urination, contraction of this muscle expels the last drops of urine; at the time of ejaculation, this muscle is responsible for expelling semen by strong rhythmic contractions.  In women, the bulbocavernosus muscle is divided into halves that extend from the clitoris to the perineum and covers the erectile tissue that is part of the clitoris.  The ischiocavernosus muscle stabilizes the erect penis or clitoris, retarding return of blood to help maintain engorgement.

The PFM can get weakened with aging, obesity, pregnancy, chronic increases in abdominal pressure (due to straining with bowel movements, chronic cough, etc.), and a sedentary lifestyle.

In women suffering with urinary incontinence or pelvic relaxation, the strength of the PFM can be assessed by inserting an examining finger in the vagina, after which the patient is asked to contract her PFM tightly.  (A similar assessment can be performed by placing a finger in the rectum, after which the patient is asked to contract the PFM.)

The Oxford grading scale is used, with a scale ranging from 0-5:

0—complete lack of response

1—minor fluttering

2—weak muscle activity without a circular contraction or inward and upward     movement

3—a moderate contraction with inner and upward movement

4/5—a strong contraction and significant inner and upward movement

PFM exercises are used to improve urinary urgency, urinary incontinence, pelvic relaxation, and sexual function. The initial course of action is to achieve awareness of the presence, location, and nature of these muscles.  The PFMs are not the muscles of the abdomen, thighs or buttocks, but are the saddle of muscles that run from the pubic bone in front to the tailbone in back. To gain awareness of the PFM, interrupt your urinary stream and be cognizant of the muscles that allow you to do so.  Alternatively, a female can place a finger inside the vagina and try to tighten the muscles so that they cinch down around the finger. When contracting the PFMs, the feeling will be of your “seat” moving in an inner and upward direction, the very opposite feeling of bearing down to move your bowels.  A helpful image is movement of the pubic bone and tailbone towards each other. Another helpful mental picture is thinking of the PFMs as an elevator—when PFMs are engaged, the elevator rises to the first floor from the ground floor; with continuing training, you can get to the second floor.

Once full awareness of the PFM is attained, they can be exercised to increase their strength and tone.  The good news is that you do not need to go to a gym, wear any special athletic clothing, or dedicate a great deal of time to this.  As a test, perform as many contractions of your PFM as possible, with the objective of a few second contraction followed by a few second relaxation, doing as many repetitions until fatigue occurs.  The goal is to gradually increase the length of time of contraction of the PFMs and the number of repetitions performed. Working your way up to 3 sets of up to 25 repetitions, 5 seconds duration of contraction/5 seconds relaxation, is ideal.  These exercises can be done anywhere, at any time, and in any position—lying down, sitting, or standing.  Down time—traffic lights, standing in check-out lines, during commercials while watching television, etc.—are all good times to integrate the PFM exercises.  Expect some soreness as the target muscles will be overloaded at first, as in any strength-training regimen.  It may take 6-12 weeks to notice a meaningful difference, and the exercises must be maintained because a “use it or lose it” phenomenon will occur if the muscles are not exercised consistently, just as it will for any exercise.

With respect to incontinence and urgency, recognize what the specific triggers are that induce the symptoms.   Once there is a clear understanding of what brings on the urgency or incontinence, immediately prior to or at the time of exposure to the trigger, rhythmically and powerfully contract the PFM—“snapping” or “pulsing” the pelvic floor muscles repeatedly—this can often be a means of pre-empting or terminating both urgency and leakage.   This benefit capitalizes on a reflex that involves the PFMs and the bladder muscle—when the bladder muscle contracts, the PFM relaxes and when the PFM contracts, the bladder muscle relaxes. So, in order to relax a contracting bladder (overactive bladder), snap the PFM a few times and the bladder contraction dissipates.  Stress incontinence can improve as well, because of increased resistance to the outflow of urine that occurs as a result of increased PFM tone and strength.

By improving the strength and conditioning of the PFM, one may expect to reap numerous benefits. Urinary control will improve, whether the problem is stress incontinence, urgency, or urgency incontinence. Post-void dribbling (leaking small amounts of urine after completing the act of voiding) will also be aided. Furthermore, improvement or prevention of bowel control issues will accrue.  Some improvement in pelvic organ prolapse may result, and PFM exercises can certainly help stabilize the situation to help prevent worsening.  PFM toning can also improve sexual performance in both genders.  When a female masters her pelvic floor, she acquires the ability to “snap” the vagina like a shutter of a camera, potentially improving sexual function for herself and her partner.  Similarly, when a man becomes adept at PFM exercises, erectile rigidity and durability as well as ejaculatory control and function can improve. For both sexes, PFM mastery can improve the intensity and quality of orgasms. In terms of quality of life, PFM exercises are really as important—if not more so—than the typical resistance exercises that one does in a gym.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Available on Amazon Kindle

ANSWER TO QUESTION: Can you name an animal that has tremendous core strength?

Dolphins—essentially all core with rudimentary limbs.

To access my video on PFM exercises:  http://www.youtube.com/watch?v=5IbliBiRzOw