Pelvic Floor and Squats
It's imperative to write about the pelvic floor (PF) since so many women with endometriosis have issues in this area. These PF problems could have contributed to the endometriosis in the first place, or they could have been caused by it, but they’re usually the same issue: Overly tight and incredibly weak muscles, leading to terrible pain, incontinence, digestive issues, or even pelvic organ prolapse.
What is a pelvic floor? It's a layer of muscles that support the pelvic organs (your bowel and uterus) and span the bottom of your pelvis. They actually stretch like a muscular trampoline from the tailbone to the pubic bone and from one sitting bone to the other sitting bone (side to side). Imagine your favorite round mixing bowl in the kitchen. Now imagine it sitting under your pelvis. This, my friends, is your pelvic floor.
I myself am no PF specialist (obviously) nor did I ever have terrible issues in my personal PF journey. What I did have was have an experience that forced me to see I was on my way to having a PF issue: When I was getting bodywork (rolfing) my rolfer told me to release my PF as I hinged forward. “I am”. “No, you’re definitely gripping it”. We went on like this for a while until she truly helped me see I was tensing my PF without even realizing it. Once I finally relaxed it I felt a wave of tension leave my body... yet she had to convince me I was tensing it in the first place!
Have you had that before? Maybe with your shoulders? Someone tells you your shoulders look tense and you have no idea you were gripping them up to your ears? Oh, maybe that was me too, but maybe you catch what I’m throwing :)
The Problem with Kegals (as in, consider stopping them)
What compounds this problem so often is that when women have been diagnosed with “weak” PFs they’re told to do kegals. In yoga it’s mula banda. Some sex therapists call it vaginal weight lifting. Basically the consensus is: flex this muscle to strengthen it. The problem is that if the PF has been subconsciously “flexed” for so long that it's tight, brittle, and terribly underused. It often needs to be released instead of flexed.
Like your shoulders, your pelvic floor is incredibly hard wired to react to stress. It too will tense when stressed or under pressure — which can be anything from driving in traffic to rushing to finish your chores, from giving a presentation to a thousand people to being chronically annoyed with your spouse. Stress is stress, no matter what form, and your PF (and body) will respond.
It can also be chronically tight from a biomechanic viewpoint. If you're glutes and legs aren't strong enough to hold you upright you're body can think it's a perpetual state of almost falling over. This means to counterbalance the muscles that aren't there, your body tightens this muscle in the center of your body to help make sure you're balanced. This too will lead to PF disorders.
That's why there's a two pronged approach to help your pelvic floor. First, relax the iron grip. Next, work on strengthening it, as well as the muscles your body needs to keep you standing strong.
The best solution for relaxation I ever found was in the form of visualization. Like the psoas, it’s hard to release the PF unless you imagine it happening. Isa Harrera, author of Ending Female Pelvic Pain (she has a male book too if you know any men with PF issues) has a few awesome visualizations to try:
1) Red Roses Red Roses
Lay on your back with your knees bent, feet on the floor, and take some deep breaths. Now imagine your pua nani (flower, in Hawaiian ;) is a rose, plumeria, or anything else you like to imagine opening. With each breath imagine the rose opening, slowly coming into bloom with each petal that opens. Here's a video to help ;)
2) Dead Bug Release
Lay on your back in “dead bug” pose. As you breath, imagine your sits bones spreading wide. Feel your PV relax.
3) Stomach relax
Lie face down on your stomach and place your left hand on your left sit bone. As you breathe in, lightly "pull" the left sit bone away from the right. Feel and imagine your pelvic floor muscles dropping outward, relaxing and releasing. Hold this release for five seconds and repeat for five breaths. Now try it with the right hand on the right sit bone. Which side gives you the better pelvic floor muscle release?
As you get better at feeling this relax the tension in your PF, start to do it in other positions. While you stand. While you drive. Maybe even while you yell at your kids for spilling paint on the floor. See, with some practice you can learn to release this tension anywhere!
So we’ve begun to relax the iron grip, but how to strengthen without doing another kegal? Squats.
A few years ago, biomechanist Katy Bowman blew up the pelvic floor world when gave a warning to the kegal zealots who advocate kegals create a strong PF:
A Kegel attempts to strengthen the pelvic floor, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to pelvic floor disorder (PFD). Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the pelvic floor is beginning to weaken. An easier way to say this is: Weak glutes + too many Kegels = PFD.
Think of it by going back to the shoulders. Think of what the shoulders are capable of when they’re supple and strong. They can do shoulder circles, move forward and back, paddle you into waves, push you into a headstand. They’re dynamic is what I’m saying. And so is your pelvic floor. (if you want to read the article that started this discussion click here)
That’s why a squat done correctly will strengthen and tone your PF into one supple beast, using your PF to its best capability, allowing it to move through it’s full range of motion while supporting your upper body.
But it’s not that simple to do a correct squat (you knew there was a but), since a correctly done squat is really-freaking-hard for the average Westernized person, male and female alike. So now’s the time to start prepping - let’s get squat-ready.
How do you do them correctly? Here are a few tips from Katy:
Keep your shins vertical:
“Because the squat we are after is really a gluteal-using one, whole-body joint positioning is essential. To get a squat to move from the front of the body (think all quads) to the back (think all glutes) is by using SHIN position. The more vertical the shin (that’s the knee joint stacked over the ankle joint) and the more untucked the pelvis, the more glutes you’ll use. The more the knees are in front of the ankle and the more tucked the pelvis, the less glutes you’ll use.”
When you rise from your squat use your butt, not your quads: if you’re rear is under-developed, it’ll be easier to rock forward on your toes and push with the front of the legs rather than squuuueeeeeze up with your glutes. But don’t do it. Only go as far as you can while you still feel your butt engaging.
Don’t go deeper than you’re capable of:
“How far you go down will be based on how well you can keep the shin and the pelvis where you want them. Most people who have not squatted to use the bathroom throughout a lifetime will find the range of motion of their 'glute squat' to be fairly small. Which is fine. It will improve over time, especially if you’re working on changing the habits of where you hold your pelvis throughout the day.”
What's too deep? If your pelvis tucks or your shins are no longer vertical. Now practice going only this deep, and squeezing up with your butt. If you need to, use a wall to help you from falling over as you allow your glutes to stretch further and push you back up higher.
The main take away: it's more important to maintain the squat integrity than get low to the ground.
Do Frog Pose
Basically the same position as a squat but without the challenge of gravity, which allows your joints and muscles to gain flexibility without the strength needed to hold you. On your hands and knees, spread your legs apart so they're a little wider than your hips, then push your upper body back towards until your tail starts to tuck. This is as far as you can go, so stay here WITHOUT any tucking of your tail. It's good to do this in front of a mirror if you can so you can stop before your pelvis tucks, just like a standing squat.
Spend some time in the squat throughout the day, let your body relax into it:
“The amount of time you spend in a squat also depends. The glute action is primarily used on the way up - however lingering in a squat, especially if you can kind of relax, helps the muscles and involved joints change their tension patterns. Seriously. Doing a potty-squat gives you a more natural, real-world relationship with your squat.” To spend time squatting comfortably it may be appropriate to grab something to prop your heels up (remember your calves are probably really short from a lifetime of shoe wearing). I here use a yoga matt but you can use anything, even a pair of high heels if you need!
Practice the Half squat:
Half the work, most all the benefit. The half squat allows half your body at a time to fit into the squat movement. This is really great to help tight hips start to open up.
Build this base before you attempt a Squat Challenge
You probably see lots of "Squat Challenges" online. The humble squat is obviously super in fashion at the moment. That's why this last bit of advice is to urge you to refrain until you're ready. Squats are really, really challenging for the general population, and you should be cautious, ensuring that you have the strength and mobility before you start an intense squat routine that might end up doing more harm than good.
Sorry, done nagging, happy squatting!