Four Amigas Part 2: Reclaiming the Friendship
Did you read my last blog HERE and scream, “Holy moly Batman, I need help!”? No worries, help has indeed arrived, let’s get to the bottom of your Four Amigas issue.
If you need a reminder, the "4 Amigas" is a phrase I invented to describe the relationship between 4 very important parts of your core. They're the pieces of your abdomen that rely on each other to move properly, and without one working correctly can lead to a cascade of body issues. They include the
Diaphragm at the top
Pelvic Floor at the bottom
Transverse Abdominus in between
Multifidus up the back
Now that you remember, my first piece of advice is to GO TO A PELVIC FLOOR PHYSIO! Yes, I screen yelled that. That’s because if you have health insurance and endometriosis, you should have no problem in getting a referral, which is basically free if you have insurance. If you don’t have insurance, call around as ask for the cash price for an appointment: now start saving.
Just because you had never heard of a pelvic floor physical therapist before doesn’t mean there’s not some really good ones right in your area. Or, just because you used to think they were for broken vaginas doesn’t mean they’re not for you. Think of this is a big investment in your healing, whether it be time, effort, or money.
Ok, already found one, called, and made an appointment? Good! Now you can read this blog post which is good info, but simply not even close to enough info to actually fix your Amiga issue without a bonafide specialist (which, to be very clear, I am not). Here's some helpful activities in the meantime :)
A few tips to help your amigas be friends again
1) Don’t ever think you can outsmart them
Your amigas are all smart, smarter than you actually. They should work without your brain interfering at all, so trying to control them would be akin to controlling how many breaths you take in a day. Think of your Amigas like a litter of puppies: you want to nourish and train them so they behave well on their own, rather than stick them all on puppet strings and force them to do what you want. Sounds damaging on everyone, right? Right.
This is why you need to make the mental note now that while you will do some activation exercises, you vow to never squeeze your pelvic floor to death. This would be someone who holds a kegal, like, forever, thinking it will make her pelvic floor stronger but unfortunately shattering her Amiga friendship (I did this once, tried to hold a kegal for an entire walk! Bad Katie). I also want you vow to stop sucking your tummy in all the time, which ruins proper breathing patterns and thumps your uterus with pressure. Train your amigas, then let them be - like growing puppies. :)
2) Realize when you’re loafing, and stop
Check your belly when you’re getting out of bed, sitting up from the couch, or getting off of a chair and see if you're loafing. If you can’t physically see the loaf, try to feel for it. Clues might be a flacid or unengaged lower belly (feel by your hip bones for muscle engagement), if you *grunt* while getting up (akin to bearing down), or if you notice you’re holding your breath, which is often more than we realize. These are signs of downward pressure in the abdomen, and downward pressure = uterus punch.
Here is a list of normal daily activities that might have you loafing so pay attention:
getting out of bed with ab “strength”,
getting off a couch,
getting out of a chair or car,
walking up stairs,
getting up off the floor,
pulling your tight pants up every time you get dressed or go pee,
lifting a heavy box,
maybe lifting anything,
Wow, that's a lot of activities! Maybe, like, everything you do. Want more? Here's a list of workout activities that might have you loafing: everything. Yes, even yoga, also planks, crunches (do these never again, btw), tabletop, squats, and everything else you can imagine. If you hold your breath while squatting, jumping, lunging, that's a big signal. And remember that grunt, usually an indicator your organs are moving south.
If you don’t have the strength or correct engagement to get up without loafing, use your arms to help push you up. Roll to the side, now push up with your arms. Voila!
3) Remind them how friends are supposed to behave once a day
Your amigas may be so lost and resentful that they need a few reminders of how to work together, so once a day (I like morning to set the day up for success) consider these awakenings. *notice how none of these are "do a bunch of kegals". That's for a reason, so please don't "do a bunch of kegals". Or any kegals, for that matter.
Activate your TVA whilst remembering to breathe:
This allows your stomach to be strong (different than sucking in, ladies!) while you're still able to breath at the same time. To do, get on the floor and put your knees in table top while avoiding the loaf at all costs! You may not be able to do this easily - I certainly can't at 5 months postpartum - in which case you can walk your knees to bent, then lightly lift one foot off the floor, then the other, while avoiding the loaf. Hold for 30 sec - or as long as you can without loafing. This might mean 10 seconds, 5, or even less if that's all you can do.
While you do this, make sure you’re breathing through the relaxation and opening of your ribcage. Breath is the superpower that connect all amigas, so you want to foster breath in every activity you do. If your ribcage is clenched shut you will know because it should be moving (i.e. flowing open and closed) with your breath. Put your hands on your ribcage just to verify she's moving.
The further away from your body you can hold your legs without “loafing”, the stronger your TVA is becoming, but do not do not do not force anything until you can both engage your TVA and breathe without loafing. If you can’t do this without loafing, don’t do it at all. AT ALL. (for some reason I feel like I need to repeat myself a lot in this post to get my point across, apologies, but sticking with it). And pat yourself on the back that you made that appointment with the pelvic floor physical therapist.
While you’re laying down relaxed your pelvic floor shouldn’t be workin’. So help her relax now: feet wide but knees together, breathing through all cavities. Notice if you're holding any tension at all in your tummy and let it goooOOOoOOOoooo. It’s only when you’re up against gravity that your pelvic floor should be activating (to hold your organs up) like a good muscle does. For now, with no gravity, let her sigh with relief.
Sit or stand tall, not fake straight
This is a lot harder than it seems because we sit on chairs for decades, which substitute in for our core holding us up, then we flop over with kyphosis and forget how to truly be straight. Then, whenever we’re told to sit "straight”, most of us arch our back and shove our ribcage in front of us instead. Why do we do this? To lift our heads up to the top of our body... it’s as if our heads and chests are fused together! They're not, btw.
In case you have absolutely no idea what I mean, I brought Angel the snow-woman on board to demonstrate:
That’s right, to start counteracting chair culture without shoving your body into more weird angles like Angel, you may have to imagine leaving your head totally out of the equation. It's also helpful to sit or stand against a wall, allowing your lower ribcage and butt to touch the wall at the same time. This should help stop you from shoving your chest out in a “pretend” straight sit, and for most people this feels weird and totally slumped because of your kyphosis. Hang in there :)
If you can only sit tall for a minute or two, that’s great! Feel how it engages your TVA naturally. Keeping your “snowballs” aligned properly like this will allow you to move through your day without low back pain. Oh, and remember to keep breathing.
I don’t know why it’s called this, maybe because there’s a knack to learning how to cough or sneeze appropriately when your amigas aren't working correctly. Here’s what you do: Close your eyes and imagine you’re doing the ultimate kegal in the world, zipping yourself up tightly from anus, to vagina, to urethra. Now do a little cough. Good! Now release that kegal fullllllly. Is it relaxed? Ok, now do it again, and cough a little harder. Stop. Relax. Done for the day. Seriously, that was it.
Don’t do this too much, even just a few times per week is good enough to start to train your body to engage the TVA/pelvic floor while you cough or sneeze. Eventually, this should happen naturally but for now remember, we're training the puppies to behave correctly.
4) Now stop
Don’t let that A+ student inside force you into a pattern of holding everything at all times. Holding anything for long periods does not equal happy amigas. Simply do these wake up activities as strength allows, observe your loafing as necessary, and then let your body be without holding your breath.
Remember, fixing the four amigas is about both strength and release in equal parts - which is why a chronic kegal or tummy sucker-in-er gets women into trouble, it’s all tension and no release. So start to engage your TVA, wake up your awareness of how pressure affects your pain, but then go about your day without actively trying to engage it all.
I hope this post helps you to see if your dealing with an exploding soda can all day long, how that can make your endo pain flair, and why pelvic floor dysfyuction doesn’t just mean something obtuse like having a “broken vagina”. Your four amigas are a complex and delicate system that keep you strong, stable, breathing, and pain free. So if any of them are tense, weak, or dysfucional, your abdomen as a whole will suffer.
This is also why I urge everyone to get thee to a pelvic floor physio with endo experience!! Learning to retrain and recruit these mucles properly can be a sink or swim for many a’lady with endo.