Many people think that only women who have given birth vaginally have to deal with pelvic-floor issues. Not true. Everyone has a pelvic floor, and it’s much bigger, more complex, and way more important than most people think.
First of all, we’re not talking about just one muscle: there are twenty muscles that make up and/or support the pelvic floor. And you’d never guess who has the most pelvic-floor issues:
Long-distance runners
Smokers and chronic coughers
People who are chronically constipated
Weight lifters and CrossFitters
People who are overweight
Confused about where the pelvic floor is? Let me guide you.
• First, put your hands under your butt and sit on them. You’ll feel what are called “bony landmarks,” the two pointy bones that press down into your hands. Pull your hands away until only the tips of your fingers are touching these bones—these are your “sitz” bones. Try to imagine how much distance is between them—it might be 4 or 5 inches, or it might be 6 to 8.
• Now, place two fingers of one hand on your pubic bone and two fingers of the other on your coccyx (the tailbone). Your pubic bone is where your zipper ends, and the coccyx is where you’d have a tail, if you had one. If you measure underneath, from front to back, how many inches would it be, 6, 7, 8?
• Think of these two “lines” as intersecting lines that show you a span of space on your body—the size of a very small pizza! Aha! this is the size of your pelvic diaphragm. It’s almost the size of your thoracic diaphragm! Maybe they have something to do with each other? Actually they do, very much so, when you’re breathing right.
Well then, you might ask, where are all those twenty muscles we mentioned earlier? Your pelvic floor relies on muscles in your lower back, your abs, your hips, and all the ones that circle in and out and around your pelvis. And while it’s important to be able to locate and distinguish the specific ones that touch the “bicycle seat” (the small pelvic floor), working out the ones that connect to and help them are just as important. Be mindful that your pelvic-floor muscles are deep muscles and, accordingly, you won’t feel the burn as you would with more superficial muscles after a workout. You need to pay attention to them, regardless.
Trying to “find” those pelvic-floor muscles? Next time you’re urinating, stop in midstream. Those are definitely not all the muscles of your pelvic floor, but they can start giving you more awareness of your pelvic floor. Now don’t do this as your exercise; do this just to gain awareness.
At this point, you should be able to imagine, in your mind’s eye, how your pelvic diaphragm is the “bottom” of a container. Your belly and upper abs are the middle of the container, and the top is your thoracic diaphragm. Some people envision a poster tube, others a long water balloon.
There’s a muscle that connects the top and bottom of the container—the psoas—and a lot of important organs in between.47 Good breathing means that both diaphragms move in a rhythm, in synch, and everything between the two really appreciates the massage that occurs with every breath (and conversely, gets very unhappy and sick if it doesn’t).
So, here’s the rule: Stretch and strengthen. Stretching and lengthening the muscles and moving the joints in your pelvis are absolutely necessary in your daily routine. You need to do both. Many times, a weak pelvic floor is one that is tight and rigid, so doing more contractions (Kegels) isn’t going to help and might exacerbate any pain you have.
How do I include this in my breathing? Well, if you breathe with a Lower-body Breath, you already automatically are doing it. On the inhale, you should (as in Cat and Cow), relax your belly and hips. What else relaxes when you relax your belly and hips? All the pelvic-floor muscles. Be careful; I don’t mean bear down, I simply mean relax. Exhale, squeeze your abs, and rotate your hips. Now, each time you tip forward and back, these muscles will contract and expand a minuscule yet significant amount.
Want to take it up a notch? On the exhale (see figure 10), squeeze your lower abs, and then think about squeezing the ab muscles that continue down under your body into a pelvic-floor contraction (or Kegel). Make sure you give an equally important conscious release on the inhale (see figure 9). Now you’ll truly get the sensation of how breathing is something your whole body does, and from which your whole body benefits.
Figure 9
Inhale
Figure 10
Exhale
While sitting in a squat or squat variation, put one hand on your bicycle seat (or small pelvic floor). Inhale and feel a slight drop into your hand. Exhale and see if you can pull your pelvic floor off your hand slightly. The movement is small, so you’ll only feel a slight difference in pressure on your hand. Good job!
FAQ: I’m having a hard time understanding the idea of “relaxing” my pelvic floor. Any suggestions? Think about when you run to the bathroom and have to pause to let the stream of urine start.
FAQ: How do I stretch my pelvic-floor muscles? Sit in a squat as often as possible (or a partial squat, if you have knee pain). Bear in mind that stretching a muscle is vital to blood flow and its ability to get stronger.
FAQ: I’ve done Kegels but never added the breath. Remind me how to add the breath. When you contract your pelvic floor, you should be exhaling, which makes sense anatomically. When you inhale, relax your pelvis and hips.
• Make sure you relax between squeezes and do a Reverse Kegel, which means softening these muscles. Don’t push down; just let them go.
• Many of your pelvic-floor muscles are connected to your lower back. Got lower-back pain? Go see a pelvic-floor physical therapist.
• Tightening your glutes or thighs is not doing a pelvic-floor contraction. Whereas your glutes are important to a healthy pelvic floor and hips, what we want is to focus on the muscles underneath.
Finally, one of the great benefits of all of this is that you align your body with your breathing: that is to say, you connect with your center of gravity by moving it down to where it should be, right under your belly button. The lowest, most balancing breath you can take includes your pelvic-floor muscles. When you breathe this “low,” you lower your center of gravity; consequently, you are indeed more stable.
FAQ: It’s hard for me to imagine both the top and the bottom working together. Can you explain it again? On the inhale, you let your thoracic diaphragm flatten and your pelvic diaphragm relax; then, when you exhale and squeeze, you contract your pelvic diaphragm. It’s complex, but the good news is that if you’re doing a Lower-body Breath and adding some hip movement, you’re already doing a gentle version of this.
Now pause a moment, and look to see how incredibly different this is from breathing with your shoulders. It’s like day and night!
Good morning!
At first, I was just bracing my middle when I was exhaling. I had to really retrain myself to exhale and narrow my middle. Lying on my back and exhaling until my belly felt concave helped a lot. It was really about using totally different muscles! Every once in a while during my breathing workout, I’d throw in some Cat and Cow, since that really had that “scooped-out” belly that meant a good exhale. The first week I had to go slow, since I’d get out of rhythm fast. If I didn’t pay attention, I’d end up doing a bunch of pulsations totally backward. It’s funny, with this whole process, how you have so many “aha!” moments. You just turn a corner and get it. Your body really does want to breathe this way. —Brinkley, age 34
I found I was moving my back a lot when I was doing Exhale Pulsations. When I would get tired, I’d start bouncing my shoulders to inhale and exhale. I had to be stern with myself: Slow down and do them right! This is an abs exhale exercise! It was funny, when doing them right, I felt my abs right away! The next day, I was actually sore all around my middle. But it was a good sore: work your muscles and get it right. It made me proud that I was making such a big change in something so important, this late in life. —Coco, age 55
Gavin didn’t really think changing his breathing would help, but he came to class to appease his wife, who was worried about his level of stress at work and how it was affecting him. A forty-one-year-old corporate professional, he was having trouble getting to sleep at night, due to the “chatter” in his head about his to-do list. Then, when he finally did fall asleep, he woke up too early—often in a panicky state—feeling tired but with no chance of going back to sleep. The sleep deprivation was making him irritable and short-tempered at work. It took him half the weekend to relax, only to get anxious on Sunday night because of the upcoming week. He stated animatedly that he was not the type to meditate and in the past had either fallen asleep or been restless and annoyed during traditional meditation. It was too “crunchy” and “woo-woo” for him. He wanted nothing to do with “the universe, chakras, chanting, or divine spirits.” Hopeful but somewhat skeptical, he learned how his “modern predatory state” at work, crouched over the computer, was burning him out. Not coincidentally, it was the same posture he had while driving and playing golf—shoulders internally rotated, hips tucked under, sunken-in chest. His posture was severely affecting his breathing. Altering his breathing helped ease his constant feeling of exhaustion and changed his ongoing fight or flight mode. He added five minutes of breathing exercises to his morning, midday, and evening routine. His sleep improved as well as his mood.
47 The best explanations and visuals for the complex psoas muscles are provided by the very erudite Tom Myers. See https://www.anatomytrains.com/news/2013/01/20/cobra/.