Pelvic Floor Dilemmas

…..client who was diagnosed with pelvic floor prolapse……..seeing a specialist in pelvic floor conditioning. Movements like prone planking, dead bugs, bird dogs, squats and lunges I read were not advised due to the downward pressure on the pelvic floor…….client has said, her info is also contradictory — “You can do any Nautilus machine work but only seated, light loaded weight movements…”

It's the Pelvic Floor.

It’s the Pelvic Floor. Giggle. Giggle.

Well, there just seems like some swirling information in what is written above.  There’s some truth, some middle ground that has rationale, and some probably nonsense.

1) First of all, if the pelvic floor is legitimately prolapsed, that’s some serious stuff.  Like really serious.
Rather than get into some things that are really out of the scope of most people reading this including myself to a degree, any time you lose your pee or have a wild diastasis, it is immediate grounds to work with other professionals.
And this is because if contraction of the pelvic floor is so relegated by hypotonia, even the mildest of loading is going to be provocative.  This is the kind of problem where you feel great, training like a stud, and then you get rolled into a microdisectomy in a matter or 2-3 days.

2) The list above is interesting because in my mind, it is very eclectic, and some of the moves can be coached differently in favor of being useful for someone recovering from a prolapse or advanced hypotonia.
Prone Plank done correctly = can’t imagine how they can do that with such low level pelvic floor skills
Dead Bug = typically useless beyond a warmup or cooldown, but this situation, it is a premiere option for developing motor skills of the pelvic floor and has a huge radius of Regressions
Bird Dogs = just getting into quadruped or quadruped differentiated would be excellent choices; hardstyle tensioned execution would not be
Squats = I think a lot of positions should precede it, but this is on the table; squatting with different types of upper body assistance really fit into this; squatting for fitness is out of the question
Lunges = Same as squats
Really all of the visions of these exercises come out of DNS.  For this client above, this is where the active exercise of DNS is the proper stimulus for this type of adaptation.  This is when DNS-based exercise excites me and can be magical.

Good for very low level core work.  Fraudulent for anything beyond that.  But you already knew that.

Good for very low level core work. Fraudulent for anything beyond that. But you already knew that.

3) The training with machines statement is just nonsense.  The seated position negates the need to relearn inner unit tension.  One can not acquire a new motor skill unless the system is in an environment where it has to.  If the learning environment is compensatory, there is no need to learn.  Nothing happens.
So then maybe this is the right person to use machines for some fitness effect?  Yet, the advice is to just use light weight can’t yield you any fitness.  You can get some low level arthogenic health in theory, but this is real reach.
If you use machines and go heavy without the skills of the inner unit to stabilize, you probably have to clean some stuff up right after 1 rep.

4) My overwhelming thought here is that this type of training should be guided by a PT.  And it looks like where this question came from is at least part of a triangle here.
But overall I find it strange that someone would be motivated to work and help these kinds of clients and choose to get into personal training.  I think the outlier would be the trainer or aide that has worked with a PT for many years and has basically become an apprentice.
And while it’s not an intelligence thing that leads me to ask trainers to stay away from this type of condition, it’s the mere fact that someone else can do it better.  There’s so many things that others can do better than any one person.  They should be the ones that steer the ship.
So then how do you get better if you don’t practice and get reps?  You do what is necessary to work in an environment where this is all you do all day.  And part of that is going to PT or Chiro or Medical school.  You can’t get good at things when you just get info off a blog like this.  Info from anywhere becomes powerful when you have years of repetitions to make mistakes.  That doesn’t happen in a fitness setting with many facets of painful or aberrant motoric conditions.

Yeah, this probably isn't fitness-related.

Yeah, this probably isn’t fitness-related.

  • January 11, 2015

Leave a Reply 6 comments

Don Reply

Agreed; maybe a peel-back of the levels of difficulty would be in order.

Charlie Reply

The order of difficulty may be the neurodevelopmental sequence — Dead Bug, Quadruped, Squat, Lunge, Plank could go after quadruped depending how coached or executed.

Don Reply

Most likely just firing/activating firing in T. abdominus would be a challenge for pt.

John D'Amico Reply

Thank you for this blog piece.

Dan Swinscoe Reply

I particularly appreciate your comment about exercising in the seated position. It connected with me RE teaching diaphragmatic breathing through developmental sequence. People tell me how much they’ve practiced but yet I reassess and they’re no better. Then they admit they only practiced in the car while commuting. Despite sometimes hours of practice between visits with me no improvement when it’s performed in sitting

Rachel Rolston Reply

Hi Charlie,
Thanks for writing about this topic. As someone who has had a uterine prolapse it’s encouraging to see it being addressed in the main stream.I also got some great suggestions and answers on the Strength Coach advanced forum a few months ago.

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