pelvic floor health

All that junk!

Fergie working it with in the “My Humps” official video

Fergie working it with in the “My Humps” official video

So many songs have been written about the shape of a woman’s derriere we can be reminded fairly frequently that having some “junk in your trunk” is a good way to go.  Whether your butt is big or small the most important thing is that the muscles within work really well as those muscles are pretty central to everything else that happens in the body.  As a Mum the tendency is for our butt muscles to sag (let’s face it, everything else is!!) and “Mum Bum” becomes an actual reality, often accompanied by low back pain, pelvic floor weakness and posture changes through the rest of the body.  Now I don’t care what your butt or mine looks like, what I care about is that the flat look indicates underused muscles and when your buttocks are underused your whole system is not working cohesively - your buttocks are 3 set of gluteal muscles, plus a number of deep hip rotators in the pelvis most recognisably, collectively called your “glutes” and they attach in and across the pelvis and out to the hip joint, also connecting with the fascia (connective tissue) of the quad, hamstring and hip flexor muscles and upwards they connect with the fascia of the lower back, core system and large shoulder organising/moving muscles of the lats.  Plus very importantly when in comes to the movement Mums do and need to do on the daily, the glutes/deep hip rotators are completely connected with the pelvic floor - tight glutes = tight pelvic floor / weak glutes = weak pelvic floor.  In general terms we know that all muscles in the body are connected but the glutes/buttock muscles drive movement up into the trunk and upper body and down through the hip, knee and into your ankle.  So if you have a weak ankle that often rolls, look to strengthen the glutes, and if you have a clunky, hard to strengthen shoulder, look to work on exercises that strengthen both the glutes and shoulders together keeping in mind the fascial connection between the 2 areas.  

When it comes to the pelvic floor and the glutes connection, there are 3 things you can consider:

  1. How do you stand?  The standard playground posture for Mums is hips swayed forwards, knees locked back and ribcage dropped back and down - when you’re tired and this is your 4000th trip to the park that week you go into energy saving mode which means hanging off your hips.  The problem is to do this posture your glutes stay squeezed on all the time and they are not those sorts of muscles, they don’t like being switched on all the time so they get weakened by holding that position.  When we stand with hips pressed forwards it also means the pelvic floor is locked on and unable to relax or contract. 

  2. How you use your glutes.  As I’ve said above, the most important thing with the glutes is whether you are “switching them on and off”. Your glute muscles work best - and that means support your body and help it function well - when they go from some stretch to some contraction.  To really wake the glutes up we need to stretch them in all directions they can go: twist, lengthen and flex, and then contract them in all ways.  During strengthening exercises and movements we need to set the body up so that the pelvis is in a “neutral” position to be able to help the glutes lengthen and then work and we work the whole buttock muscle group in 3 dimensions as frequently as possible - think of the actions football and rugby players do around a pitch: side to side, sprinting fast, jogging slow, one leg standing, jumping and diving.  I’m not saying that’s the only way to get good working glutes, but if you only work your muscles by going forwards to stand/sit, walk, occasionally jog and also stand with poor posture, your glutes are not going to be working optimally.

  3. Glutes = pelvic floor. If you go to squat, sit on a chair or the toilet, walk up stairs, bend down to load the dishwasher, pick up toys from the floor, or go to pick your kids up you are using your glutes/pelvic floor over and over again.  As we now know from all the above, we want our glutes to work well when we do use them so that means going through the squat movement with a fairly “neutral” spine, hinging at the hip joint instead of tucking the pelvis under (which would be the pelvis moving rather than the hip joint) and then lengthening through the back of the legs and glutes while you bend down/squat/sit which gets the glutes/pelvic floor in the right place to work strongly as you stand up.  This is especially important if you are holding a load - a large, screaming toddler for example - as you don’t want your pelvic floor to be in a weak position causing leaking, or for it to tighten up too much as a reaction to poor patterning so while the pressure builds up in your abdominal cavity it presses down on your pelvic floor causing you to be susceptible to prolapse.

If you have low back pain, can feel tightness or weakness in your pelvic floor, or get aches and pains in your hips, knees and feet, making glute strengthening (with the right form) a priority will be a major part of your rehab, preferably under guidance.

Breathing for mind and body!


When it comes to breathing in running it would seem simple enough that you just breath and your breathing gets bigger as you need more oxygen through exertion.  However, how many times have you got a stitch, felt some weakness in your pelvic floor, or felt that you don’t have enough breath left in you to keep going?  These are all symptoms of a problematic breathing pattern and you can do something about it really easily.

Why is breathing correctly so important? 

  1. Full breath = more oxygen - pretty obvious but the more of your lungs you use the more oxygen you get in and so the more your muscles have available to use up.  Often I find runners will breath into the upper part of their lungs and use their shoulders to heave their upper ribs up and down which creates a shallow, short breath, this is fine if you’re sprinting shorter distances but not if you’re running a 10k or marathon.

  2. Diaphragm and Pelvic Floor (PF) need to work together.  Your diaphragm is a large sheet of muscle sitting and curving with the base of the ribcage and attaching into your spine, and your pelvic floor is a set of different muscles that all sling like a hammock between the bony parts of the base of the pelvis and spine.  The pelvic floor muscles and the diaphragm mirror each other and work most effectively and completely when they mirror each other exactly both in alignment (being over the top of each other on the same plane) and movement pattern.  When we breath out the diaphragm draws up and this is mirrored by the pelvic floor drawing up, and as we breath in and the diaphragm comes down opening the ribs out to the sides, the PF also draws down between the bony landmarks of the pelvis giving a feeling of expansion or release.  In this way the PF works in the most effective way, allowing for the management of pressure in the abdominal cavity - if your PF and diaphragm work in opposites to each other (with the PF pushing down on the breath out) then the pressure in your abdominal cavity is increasing and pressure going into the PF can be hard to manage possibly resulting in PF dysfunction, leaking or potential to prolapse.  

  3. Breathing from the base of the pelvis helps to connect with the lower abs as well as reducing pressure in the abdominal cavity.  Place one hand on your lower abs, and one hand on your upper abs and then breath heavy enough to be able to feel the movement of your belly while your breathing.  As mentioned above, it’s important for your PF to move down during the breath in and draw up on the breath out, you want to feel that the hand on your lower abs moves before your hand over your upper abs, drawing inwards.  The cue I use is “breathing out from the base of your pelvis”.  When you do this you are helping to manage the pressure in your abdomen again so that it doesn’t get pushed out to the wrong places (forwards or down) and helps your PF to connect with the lower part of the deep abdominal muscles below the belly button.  

  4. Reduce strain on the shoulders.  As mentioned in point 1, runners often breath by heaving their shoulders up and down, by the end of a run you may find you have neck and shoulder aches and strain which can be quite tiring and require you to do something to soothe your aching shoulders!

What’s the solution?

  1. Think of breathing 360 degrees all the way round the base of your ribcage imagining your ribs are like bucket handles lifting up and out to the sides, so you are not just breathing to the front but sides and back of your ribs as well.  You need to also think of feeling your ribs expanding out to the back of your body as well so mobility in this area is important - how do you get that?  More back body breathing of course!

  2. When you’re at rest get used to practicing the movement of your PF and diaphragm so that they move synchronously up together on the breath out and down together on the breath in.  When you feel you’ve got that well practised, use the same breath pattern in all strength exercises you do and then also when you are moving dynamically.  Running might be the last step in that progression particularly if you’re having difficulty with it.

  3. As in step 2 practice breathing from the base of your pelvis when at rest, then when doing strength exercises - supine lying, on hands and knees, sitting and then standing would normally be the progression for this as standing is the most complicated, but not always with all people.  Then progress to dynamic movement, always feeling the breath from the base of the spine.

  4. If you are doing all the above you will be focussing on breathing down and low which is great and will release the strain on your shoulders.  Think of your shoulders as an American Football players shoulder pad frame that sits on top of your ribcage, unconnected to your ribs and so you are able to breath underneath your shoulders without involving them.

I hope all these points help you to breath with more control and more comfortably, able to run for longer and potentially faster!  

Let me know what you think, if you have any questions and if you have tried out these points and have any comments.

How not to hurt yourself when you run!

I hear from many women (myself included at one point), that they are worried about running because they don’t trust their pelvic floor, or they can’t run very much before it all going a bit pear shaped.  I get that, I wasn’t sure my pelvic floor would hold either, but now I know that you can start running whenever you like or whenever you need to without worry because if you set yourself up well you’ll be using your body efficiently so your pelvic floor will be in the right place. 

“But surely my pelvic floor is always in the same place, how can it be in the right or wrong place?” - ah well that’s the thing, the way we stand, walk, go up and down stairs, get out of a chair and run can all influence whether our pelvic floor is in a position where it can do it’s job well or in a position that there’s not a hope in hell it could hold on and so most likely it won’t!  So let’s set you up right and then off you go!

  • Ideally I would have you take a photo of yourself side on so you can see the curves of your spine - if not a photo, at least stand side on to a mirror and take a look.

  • Our spine has natural curves from the joint between our skull and neck curving slightly forward, the area around the back of our ribs curving slightly back and then a low curve behind our pelvis which curves forward again.  In some people these gentle curves can become exaggerated and a head forward posture leads to an increased upper back curve and increased lower back curve to balance all the way through.  In others the spine can be very flat through the upper half and with a steeper curve in the low back to compensate.  In others, and this is more common in post-natal women, the curve in the low back travels up to behind the belly button and either their butt sticks out or, more commonly they tuck their bottom under to compensate for the excessive curve higher up.

  • So when you look at your spine, what do your curves look like?

  • When you’re standing, walking, running and all the rest of your daily movements you want to think about keeping your ribs connected to the pelvis at the front.  In 99% of my clients we focus on ribs down - this is through expanding your back as well as connecting through your front.  So when you walk and go to start running keep your ribs dropped down so you have that connection and control set up right.

  • Then check in with where your pelvis is, if it’s stuck out you’re going to have problems with the impact of running on your low back, and if it’s tucked under - surprisingly common! - you’ll have problems with your pelvic floor struggling to hold strong enough with the weight of your trunk going down through your pelvis. Start from the ribs and then you may find the pelvis stacks correctly underneath.

  • What about your head?  Remember your head is pretty heavy, if you run with your head stuck out forwards that’s going to increase the slump down through your upper back and make it heavy to keep picking up each step - like holding a bowling ball in your arm all the time!  So keep your chin tucked slightly and back of your neck long so your head and ribs are all in a line.

  • As you start to run, make sure you drive your legs back out behind you each step instead of scooting your feet forwards.  It helps if you start from where your foot lands - make it mid or fore foot instead of heel which means you are best to strike the floor almost under your body rather than out in front.

  • Last thing - arms - do they swing across your body or do you use your arms forwards and back like pistons to help propel you.  If you are doing the cross body swinging thing you are potentially lacking mobility in your upper back to get enough counter rotation to your pelvis - ie. your pelvis and ribcage should rotate opposite to each other each step - but if you don’t get enough of this then your arms have to swing to get more momentum.

Having someone take a video of you running is a brilliant tool to help you learn.  You often find that what you think you’re doing and what you’re actually doing are a world apart from each other and seeing yourself can help you close that gap.

Don’t be afraid to run, here’s my top 3 tips for starting out:

  1. Go by feel not distance, speed or what your technology says

  2. Walk then run, walk, run, walk, run - slow to a walk when you feel your alignment (all those points above) is failing to hold.  There’s only any point in running while you’re doing good technique rather than ending up in a sloshy mess at the end.

  3. Breath into your ribs to the side and back under your shoulders - more of that in the next post - not by tightening your neck and dragging your shoulders up

Have fun, running is a brilliant way to get some headspace, take an easy amount of time out to do something for yourself and most importantly enjoy spending time in nature whatever the weather. I will post more soon about conditioning exercises for running so you can make sure you’re strong enough all over to keep going.

Happy Running!