The pelvic floor muscles are ones we use every day without realizing it— they’re essential to our wellbeing and sense of dignity— yet they’re not ones we actively think about ‘exercising’ or engaging.
The pelvic floor muscles help support the pelvic organs, along with other connective tissue, and can sometimes be the source of common issues such as pelvic pain, poor bladder control, constipation and sexual dysfunction, to name just a few. These issues may arise as the result of pregnancy and delivery, urinary tract infections, erectile dysfunction, hysterectomies, prostatectomies, lower back and tailbone pain, and the list goes on.
At Lakeview Physiotherapy, a physiotherapy clinic and movement studio in Calgary, Canada, pelvic health treatment has become a mainstay of the business over the last 13 years, with about 55% of its staff trained in this area.
The growth has come through word-of-mouth referrals and increased awareness of pelvic health issues, which can affect men, women and children. But it also has to do with the clinic’s holistic approach to care, which includes clinical Pilates.
“The gold standard in our profession for a physiotherapist to call themselves a pelvic floor/pelvic health physiotherapist is that they are trained and routinely perform internal vaginal and/or rectal examination, so they can fully understand the function of the muscles, nerves and organs that are causing problems,” says Gayle Hulme, a physiotherapist and co-founder of Lakeview Physiotherapy.
These clinicians may also have additional skills to draw on, such as acupuncture, dry needling, pain science education and Pilates training, to help them assess and treat patients, she says.
One of those Pilates-trained physiotherapists is Leah Milne, who hosts private, semi-private and three-person Pilates sessions tailored to her pelvic health patients.
She sees Pilates as a way of bridging the gap between pelvic health dysfunction and a return to one’s desired activity.
For example, if a runner comes in with stress urinary incontinence, it could be that they’re lacking strength and stability in the pelvic floor; or it could be that the pelvic floor is too tight and is unable to relax. Running is a complex physical task that requires pelvic floor contraction, pelvic girdle stability, the ability to balance on one leg and coordinate the movements with the breath.
Pilates allows us to break down the parts of running into smaller pieces so that the patient can integrate the pelvic floor strategies and postural biomechanics learned in the clinic more easily.
In the example of the runner, Leah will break down each element of running into simplified exercises, making it easier for the patient to focus on their pelvic floor needs, breathing and posture.
This type of Pilates program might focus on establishing imprint and neutral to engage the pelvic floor muscles, breathing and balancing exercises, torso rotation, gluteal strength and hip extension. One prop she uses often is the Mini Stability Ball™ in between the thighs to encourage pelvic floor engagement while working on lower body strengthening exercises.
The V2 Max™ Reformer is another useful piece of equipment for many patients, including those who suffer with prolapse and generally experience worsened symptoms while standing. By being able to lie down on the Reformer, they’re able to strengthen their entire body without increasing the pressure on their pelvic floor or feeling symptoms of heaviness there, she says.
“Each patient is unique in their needs from pelvic health physiotherapy which is why our initial assessment is so essential,” Leah says. “It is our assessment that helps us to ‘target’ the right areas, and Pilates allows us to work on each of the problem areas to help the patient achieve their functional goal.”
Pelvic health and Pilates for post-natal women
As part of Lakeview’s “from physio to fitness” model of care, it also offers group classes for overall fitness and wellness, which are often taught by the clinic’s on-staff Pilates instructors.
One of its most popular and more specialized pelvic health Pilates group classes for post-natal women is taught by Megan Jenkinson, a physiotherapist and STOTT PILATES® Rehab Certified Instructor, for one hour a week over six weeks.
Patients are first assessed by a physiotherapist and then, based on clinical findings and their goals, may be referred to the class, where they can choose from two levels. The exercises progress in difficulty in Level 2 as the women advance in their post-partum journey.
“Our post- partum clients learn a lot about their core and pelvic floor in our six-week workshops. There is a lot of pressure on these women to get back to activity quickly, which often has unfavorable results. Pilates helps these clients re-learn how to engage their core and pelvic floor post- partum, and allows a more gradual and progressive return to exercise and activity.
“In this way, we work with the body’s natural healing process, making sure that the client’s body is really ready if they decide to return to more intense or high impact exercise post-partum,” Leah says.
More clients are also coming to the clinic for preventative purposes, such as pre-natal women who want to strengthen their pelvic girdle to maintain healthy function throughout their pregnancy and delivery. With these clients, Leah likes to use the Split-Pedal Stability Chair™ which is often more comfortable and easier for them to transition on than the Reformer.
“The chair is easy to get on and off, does not put any pressure on the sacrum and allows them to perform a variety of strengthening exercises in a seated position,” she says.
Pilates has become such an integral part of Lakeview’s offering that it’s actually expanding its movement studio in February 2020.
“The studio expansion is really exciting for us; it means we have listened to our clients’ needs and with some careful planning— and amazing professionals to back us— we’ve been able to deliver,” Gayle says.
“The Pilates growth over the past few years has been tremendous, which keeps us not only relevant, but also innovative as our business continues to evolve and grow.”
Find out more about the STOTT PILATES Rehab Program.