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THE PELVIC FLOOR

Article by Sylvia Lampe, President of the Callanetics Teachers Association of South Africa
Sylvia Lampe has been working in the health and fitness industry since 1981 and teaching Callanetics since 1991. She offers Callanetics teachers training courses and workshops in South Africa and teaches the SA Callanetics Programme at her studio in Randburg, Johannesburg.
Sylvia is also a registered therapeutic reflexologist.

The pelvic floor – a most important, but often misunderstood muscle group, has a host of benefits if well trained, and at the same time it can lead to many unnecessary health problems if neglected or exercised the wrong way.

Training the pelvic floor the correct way is an investment in your health with guaranteed returns for the rest of your life. The ability to hold the contents of the bladder in moments of straining, like coughing, sneezing, lifting, running etc. depends on the coordinated cooperation of selected muscles, nerves and ligaments that make up the pelvic floor.

The anatomy and function of the pelvic floor muscles is very similar in men and women. A pre-requisite for the lasting success of pelvic floor training is the consistent connecting of the pelvic floor muscles with the back, abdominal, hip and thigh muscles. The musculature has to be trained dynamically – a strong contracting of the muscles is as important as is their conscious relaxation.

The training has to be integrated into everyday life, until the pelvic floor muscles respond automatically in a correct way. Then the deep muscle layers practically exercise by themselves.

In the SA Callanetics programme clients learn to exercise the pelvic floor lying down, sitting, standing and whilst walking.  This training can then be integrated in any type of exercise or sport, therefore protecting joints and organs.

Muscles which are strengthened whilst maintaining optimum posture are the ideal protection from injuries and prevent wear and tear through wrong use. When the pelvic floor is well trained and activated, the torso does not hang heavily in the legs, but floats as if it were being carried by the pelvic floor. The shoulders feel lighter, the head is poised sublimely, the spine feels longer, lighter and stretched. The legs move as if of their own accord. The feet feel totally different. And as you walk it feels as if your buttocks are being lifted by invisible hands.

It is not gravity which causes us to become shorter. We ourselves are the cause of that, as we no longer know how to use our body correctly. Therefore pelvic floor training is also an anti-aging precaution. A trained pelvic floor fulfils its function without a problem.

An interesting study conducted in 2002 by the German urologist Frank Sommer, who compared the effects of Viagra with those of pelvic floor training in 120 men, showed that the group of men who trained the deep muscles of the pelvic floor achieved better results than the Viagra group*

 Benefits of pelvic floor training include:

  • Keeps the organs of the lower body young.
  • Prevents/improves/corrects prolapse of lower body organs, hernias, incontinence, and other problems in this area.
  • Protects men from prostate enlargements and erectile dysfunction (if due to physical causes).
  • Prevents/improves haemorrhoids
  • Intensifies orgasms – in men and women.
  • Improves posture.
  • Relieves hip and lower back pain.
  • Relieves the joints of the lower back, hips and legs during walking and running.
  • Improves cellulite, shapes the legs and lifts the buttocks, diminishes ‘saddle bags’.

Anatomy of the pelvic floor:

The pelvic floor is approximately the size and thickness of the palm of your hand and consists of seven muscles which are attached to the hip bones, the pubic bone and the coccyx. They are a muscle plate of criss-crossing muscles, and this muscle group is, as the name implies, the floor of the torso. It consists of three layers each with its specific function.

  1. The first (outer) layer of the Pelvic floor:

This layer winds itself like a net around the sphincter muscles (ureter, vagina and anus in the female; root of penis, ureter and anus in the male). In both male and female the muscles cross over in the perineum. Many women have a relatively well trained outer layer. If you can hold urine back midstream, you activate the sphincter muscles. This muscle layer does not need any specific training, on the contrary: if you concentrate on this layer only, it can lead to haemorrhoids or worsen existing ones. In females it can also lead to painful intercourse, if the muscles of the vagina are trained too much whilst the rest of the pelvic floor remains untrained.

Awareness exercise for the outer layer of the pelvic floor:

Sit on a soft surface like an exercise ball or a cushioned chair. Place one hand under the perineum and cough strongly. The centre of the pelvic floor – the perineum – is where you feel the air pushing the body outwards, against your hand.

Now pull the air back into the body. You should feel a small movement in the palm of your hand.

2. The second (middle) layer of the pelvic floor:

This layer is stretched like a trampoline between the joints of the upper thighs and the pubic bone. This muscle plate consists of a criss-cross of fibres. Through strengthening this level, the legs become toned and slim, the inner thigh muscles lift, and the upper thigh muscles become ‘suspended’. Top athletes use this level automatically, like the batting of an eye lid.

Awareness exercise for the middle layer:

Pull the sitting bones towards the perineum and pull the perineum up a little, expanding this feeling like a star. When you place your finger tips very lightly against the hip joints, you should feel a slight pulling.

3. The third (inner) layer of the pelvic floor:

This is the largest level of the pelvic floor. It braces the coccyx with the femurs. It opens up like a fan consisting of six parts. When activating this level, you can see it. The hamstring muscles are tightened through this level and even stubborn cellulite improves with some patience and regular training.

Awareness exercise for the inner layer:

First sit with your fingertips under your sitting bones and contract your pelvic floor to the deepest level, until you can feel the sitting bones moving towards each other – do this several times  Then stand in front of a long mirror and tighten the pelvic floor  to the deepest level again until the sitting bones move closer together. Your hips will narrow noticeably. This innermost level, which is the actual pelvic floor, pulls the hip joints and sitting bones together and tightens the base of the buttocks muscles, lifting the buttocks. This little exercise alone can already cause an intensive tingling around the testicles in men. Some men report that the testicles pull tight against the body without sexual arousal.

The pelvic floor and a healthy back

Without the anchoring of the pelvic floor muscles one cannot maintain a healthy back in the long term. The pelvic floor muscles make the stability and flexibility of the pelvic bones possible.  In many cases back pain soon disappears with the help of correct pelvic floor training. The reason is that the innermost layer of the pelvic floor pulls the whole lower pelvic opening together and therefore opening the upper rim of the pelvis. The pelvis becomes wider, like a funnel. This creates more room for the sacrum, and the lumbar vertebrae and coccyx can now lengthen and stretch vertically.  At the same time the hip joints are being pulled together, enlarging the gap in the joints to the head of the femur and the joint sockets. This is quite comforting for people suffering from arthritis.

It is important to keep the pelvis in an upright, straight position, neither tilted forward nor back, or the pelvic floor cannot be activated correctly.

Some simple exercises to get you started:

  1. To make sure that it is the pelvic floor muscles you work and you are not merely clenching the buttocks:

Stand in front of a long mirror with your feet hip wide apart, bend your knees slightly and lean your upper body forward until your torso is parallel to the floor. Do not tilt the pelvis forward. There should be a straight line between your coccyx and the crown of your head– like a table top. Place your fingertips on your sitting bones (you will always find them in the middle of the horizontal folds at the base of the buttocks).  Dig into your buttocks until you can clearly feel the sitting bones (which are the protruding ends of the pelvic bones). Pull the sitting bones strongly towards each other. What you feel between these two bones is the collective pelvic floor. Alternately pull the sitting bones together and release them a few times, until you feel a distinct movement.

  1. To integrate pelvic floor training into everyday life:

Do this contracting exercise standing up, while sitting and lying down, as often as possible throughout the day. Use periods of waiting in queues, talking on the phone, brushing teeth, driving the car etc. to contract and release the pelvic floor muscles as often as possible. Once you feel the pelvic floor strengthening, you can add one of the following variations:

  • Tighten the pelvic floor as deep as possible and pulse the sitting bones towards each other – up to a hundred times.
  • From a completely relaxed pelvic floor, tighten it in three stages – you should feel three distinct movements. Then release the pelvic floor in three stages, until it is completely relaxed again – do this at least three times.
  • Tighten one side of the pelvic floor, then the other side, ie: you pull the left sitting bone towards the perineum, release it again, then do the same with the right sitting bone – as often as you want, up to a hundred times.

Remember: it is important to have a ‘floor like’ feeling and not a ‘tube like’ feeling. If you get a ‘tube like’ feeling, you are only working the outer layer of the pelvic floor with the muscles surrounding the vagina. In that case, relax completely, then start again, concentrating that you feel the sitting bones, as described above.

It takes about five to seven weeks of conscious, daily  training until the pelvic floor begins to take over its natural function automatically once again – the results will be well worth the effort!

If you would like to learn more about the pelvic floor, how to integrate the pelvic floor into exercises and specific movement patterns and how to get an ‘advanced’ pelvic floor, please contact the Callanetics Teachers Association of South Africa for classes, workshops, teachers training and DVDs on: info@ctasa.org.za or go to www.ctasa.org.za

References:

  1. Spiraldynamik®: intelligent movement (Dr med. Christian Larsen), Switzerland www.spiraldynamik.com (Vitales Becken – schmerzfrei und beweglich, Trias publishers)
  2. ‘Tiger Feeling’ by Benita Cantieni (www.cantienica.com)
  3. *www.maennergesundheit.info/pdf/Vigorrobic-viagra-placebo-English.pdf (Dr Frank Sommer)

 

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The SA Callanetics Programme : HEALTHY FEET

Our feet carry us through life – on average 40 000 km or once around the earth.

They have to withstand up to a tone in weight, and need to be flexible and stable. They must be able to adapt to various surfaces. Each step is an impact which travels up the body like a wave.

A coordinated foot provides each step with bounce. It rolls off the floor and develops dynamic force and energetic bounce – step after step.

How does the foot work?

Bone – a living tissue which adapts according to its needs and uses – is the framework of the foot. There are 26 bones, 33 joints, 107 ligaments and 19 muscles in a foot. These form the element of the heel, the middle foot and the forefoot.

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The ankle is not a load bearing joint and needs to be protected. Therefore one has to place  weight on the heel evenly and straight. The weight gets transferred from above over the ankle to the heel bone, which carries the weight.

Looking at the foot from the front, we can see wedge like bones, which make long term weight bearing possible. Further forward are the bones of the toes. They form a transverse arch which creates an effective suspension for the foot.

The Arch principle

An arch distributes the forces weighing on it in an even manner. It becomes more stable under load.

When several arches run in different directions, they form a three-dimensional dome.

There should be enough space under the transverse forefoot arch, that a small ball (eg: a big marble) can be totally hidden under it, ie: we should have a hollow underneath the foot.

A correctly aligned foot forms a spiral rotation which mirrors the basic principles of the skeleton of the foot, and this enables the joint of the big toe to reach the floor whilst the heel remains upright.

In a coordinated foot the heel carries the weight on the outside (not on the edge of the foot, but towards the outside from the middle of the heel), whilst the big toe and its joint keep stable contact with the floor. The other toes remain relaxed and stretched out, lying lightly on the floor.

 

What happens when the spiral rotation is reversed and the forefoot arch collapses?

Looking at the foot from behind: due to the change of weight distribution the heel bone kinks towards the inside of the foot – one becomes knock-kneed. The foot gets overloaded on the inside, and the arches drop, which results in a so-called flat foot. This causes the bones of the forefoot to touch the floor, where there should – by nature – be an arch.

This causes the transverse arch in the forefoot to collapse and the small bones of the middle foot get pressed into the floor – we get a so-called splay foot. At the same time the foot experiences a deviation of its axis towards the side, which – over time – results in the formation of a bunion or halux valgus.

The straightening and lifting of the heel bone re-establishes the arch and therefore a coordinated foot: you can hear, see and feel it.

 

What is the purpose of the toes?

They enable the foot to strongly push off, which is needed for walking, running, jumping or crawling.

The arches of the foot are not rigid, but flexible and supple, made possible by the help of muscles, tendons and bones. This is necessary so the foot can adapt to uneven terrain.

The interaction between bones, muscles and tendons make the foot into an efficient tool for moving.

 

Which muscles co-ordinate the foot?

The muscle running from the outer part of the knee down the shin and crossing over the foot, ending in a ligament inside and under the foot (tibialis anterior muscle) is of central significance for the formation of the longitudinal arch of the foot. The long calf muscle (peroneus longus muscle) ends in a ligament underneath the outside of the foot. Together these two muscles form a muscle loop which holds the arches forming the dome under the foot. In a coordinated foot these two muscles work evenly together.

If the tibialis anterior is too strong, it is difficult to keep the big toe on the floor – you tend to stand and walk on the outer edge of the foot.

If it is too weak, knock knees result – you tend to stand and walk with flat feet (ie: fallen arches).

In these cases one of the two muscles is stronger than the other. This in turn pulls on the knee ligaments, which – over the years – can pull the cartilage out of alignment, as the knee ligaments are attached directly to the cartilage, leading to uncomfortable knee problems.

With a straight heel both muscles work together, keeping the balance.

A healthy foot starts moving by rolling from the heel over the outside of the foot to a strong pushing off of the toes.

Incorrect foot positioning often starts very young in childhood already. However it must be pointed out, that the heel is only becoming upright around the age of about 5 or 6 years; before that the muscles are not sufficiently developed to keep the heel upright. If the heel has not straightened by the time the child starts school, an orthopaedic specialist should be consulted and specific foot exercises should be incorporated into daily life (in a playful way), to avoid later problems.

As we get older, feet get fixed in a deformation to a greater or lesser degree, which causes all sorts of problems, affecting not only the feet but also other parts of the body. In the end an operation is often necessary.

But even in old age it is possible to reverse foot problems to a certain degree.

Here we can see two pictures of the feet of a 60 year old woman.
The 1st picture shows the feet with bunions.
The 2nd picture was taken a year later after regular and frequent
exercising and awareness training of the feet, and incorporating
the correct foot alignment into every day life.

 

With regular, frequent and correct exercise, structural changes are possible, even in old age. A coordinated training is best started with slow and simple exercises, which can then be integrated into every-day life.

Due to the lack of movement and the ‘sitting culture’ of our time the development of a healthy foot cannot be taken for granted any more. The long hours of sitting start already in childhood, during watching TV, playing video games, in school, in the car etc.

Walking barefoot over uneven terrain is very important. Lack of exercise, walking on hard surfaces and unsuitable shoes are all causes of foot problems.

The deciding element of healthy feet is the coordinated use of the feet and taking own responsibility for this (no doctor or therapist can do it for you).

 

 

 

 

 

 

 

 

 

Does the shoe fit?

Draw the outline of your foot on a sheet of paper and place all your shoes, one after the other, on top of this outline. What can you see? Are the shoes too narrow for your feet? Are they too wide?

Furthermore, a sole which is too hard, will cause problems.

High heels transfer the weight too far forward. Instead of through the heel, the impact goes through the forefoot. The transverse arch in the forefoot cannot withstand these demands and collapses.

Shoes do not have the purpose of forming, supporting or adorning the feet! They should prevent injuries and protect us from cold.

Besides specific foot strengthening and awareness exercises and the wearing of good, well fitting shoes (for more on shoes and correct walking go to http://www.swissmasai.com), foot reflexology and foot mobilisation treatments may also be helpful in preventing and correcting foot problems. If you look after your feet, your whole body will greatly benefit.

Walking on heels 5 cm or higher tightens and weakens the calf muscles, making you susceptible to Achilles tendonitis. If you must wear high heels, take your shoes off as much as possible during the day and stretch your calf muscles. Source: Benjamin Gelfand, physiotherapist.

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Dynamics of the forefoot: during walking and running the forefoot has the important function of a shock absorber. During the coordinated touch-down of the foot (pic 1 & 2 on top) all the toes point towards the floor, and not up into the air. The same is valid for the pushing off. The forefoot ‘grasps the floor’ (Pic 3 & 4)

Awareness exercise to help straighten the heel:

Sit on the edge of a chair with feet hip wide open, without shoes, on your sitting bones with an upright spine. Ankle, knee and hip should be in line. Have a look at your heel from behind and check whether the heels are straight, or whether they are kinking inwards or outwards.

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Then adjust them by shifting the weight onto the outer heels, whilst keeping the joints of the big toes in good contact with the floor.

Now lift one heel up and bring it back down to the floor in as straight a position as possible.

Start very slowly, then after a few times, do this a bit faster, but slow down, if you notice that the heel is not touching down straight any more. 6 x slow, 10 x fast.

Repeat this with the other foot, then alternate the feet and then lift both heels at the same time.

 

Awareness exercise practicing standing up from a sitting position without allowing heels to kink in:

7Sit as shown and lengthen the crown towards the ceiling, letting the coccyx ‘flow’ into the chair.

Now concentrate on your feet and make sure that they stand on the floor with the heels upright, ie: weight on outer heels and big toes in good floor contact. Activate the pelvic floor and with a straight back, upright neck and the shoulders back, down and out stand up with a smooth movement. The weight remains on outer heels and big toes, the heels upright.

A common mistake: uncoordinated sitting down, the feet collapse inwards, knees turn towards each other or even touch. Stand up and sit down slowly 5 – 7 times, and during the day stand up like this as often as you can remember, whenever you have to get up off a chair.

 

Strengthening exercise for the forefoot arch: sucking up the floor – or a coin for advanced people.

Place the foot flat on the floor. Without lifting toes or heel off, pull the toes towards the foot, lifting the transverse arch in the forefoot – as if you were trying to suck up the floor into this arch (a little niche should form behind the middle toe. With a bit of training you will be able to create this niche also when the foot is not on the floor, eg: during lifting the foot and looking at it in a mirror. 8

Do not curl your toes under, keep them quite flat on the floor. It is as if you were trying to shorten the toes or retract them into the foot. You will feel the muscles across the transverse forefoot arch quite strongly. Hold this position for a split second, then release and start again.

30 – 100 x with each foot.

Once you can do this exercise well, you can do both feet together or alternate them.

Be aware which of your feet is weaker and do extra repetitions with the weaker foot.

 

When you get very good at this, you can try and pick a coin up with the transverse forefoot arch.

Make sure to use the area behind your toes for this, and not the toes themselves.

It is difficult, but occasionally people manage with a five Rand coin.

 

For a complete foot workshop and exercise programme contact the Callanetics Teachers Assoc. of SA, info@ctasa.org.za, 011 795 3311. Foot workshops are held in Johannesburg and Cape Town at least once a year, but can also be organised in other parts of South Africa, depending on numbers of participants.

 

Sources:

DVD: Fuss Schule (Foot School)

Book: Spiraldynamik© – die 12 Grade der Freiheit: Kunst und Wissenshaft menschlicher Bewegungskoordination

(the 12 degrees of Freedom: Art and Science of human movement coordination)

Book & DVD from the series:  Spiraldynamik© – das Erfolgsrezept fuer die 10 wichtigsten Koerperregionen (the recipe for success for the 10 most important body regions)

‘Gesunde Fuesse – schmerzfrei und beweglich’

(Healthy Feet – pain free and flexible)

All by

Dr med. Christian Larsen, Doctor and co-founder of the Spiraldynamik© Medical Centre, Zuerich  (where he devotes his time to patients, research and training; his books are bestsellers and have all the same theme:

‘Art and Science of Human Movement’). Translated by permission from Dr Larsen by Sylvia Lampe, SA Callanetics Instructor and Trainer; president of the Callanetics Teachers Assoc. of SA other sources: author’s own.