The Integrated Core: Harnessing the Diaphragm / Pelvic Floor Piston

This weekend, I had the pleasure of attending a CE course in MY OWN BACKYARD! Those of you who've visited this blog before will know that I probably spend 150% of my income on flights for continuing education so this was a welcome change.

The course I attended was "The Integrated Core: Harnessing the Diaphragm / Pelvic Floor Piston" with physical therapist, Julie Wiebe. While I admit that I'm a diaphragm guy, I have always recognized the importance of the pelvic floor but have really ignored it. Perhaps it's because I'm male and perhaps it's because people with urinary incontinence (i.e. post-partum women) rarely knock on my door for treatment. And while both this topic and course were definitely out of my comfort zone, I was really glad I attended this course.

Both feet were definitely out this weekend!Here are some takeaways to illustrate why:

• Julie views the muscles of the "core" as analogous to the gears of a system with each muscle interacting with each other for an end purpose. It's negligent to only polish one gear (i.e. Transversus Abdominis) and ignore the others.
• The core is a dynamic system. We don't want to statically hold one gear because it will stop the entire system. So stop hollowing, holding your kegels and holding your breath.
• Like the diaphragm, the pelvic floor also plays a role in postural stability since its activity becomes synchronous with the abdominals during movement.
• Speaking of the diaphragm, we all know that it plays a huge role for creating intraabdominal pressure. But remember, it needs to pelvic floor to create IAP against.
• The diaphragm and pelvic floor sets up IAP for inspiratory stability and creates elastic loading of the pelvic floor / transversus for expiratory stability.
• The breathing strategy Julie espouses is the "umbrella breath". I think this is a great strategy to facilitate lateral rib cage expansion. I'll admit that I may have swung too far on the belly breath pendulum and will probably be cueing the umbrella breath a little more.
• The vestibular system contributes to the sensory information that the diaphragm receives for the facilitation of postural stability (note: can someone share some Z-health info with me?)
• To optimize pelvic floor contractility in rehabilitation, it is important to send your patients to the bathroom prior to exercise.
• The male pelvic floor is shaped more like a cone resulting in a greater actin/myosin relationship
• The female pelvic floor is more broad shaped resulting in less ability to generate force. Note that this differentiation in shape begins at puberty and therefore, may likely play a role in core deficiencies (young females lack a neuromuscular spurt) related to ACL disruption.
• Post-partum females return to neurodevelopmental low-tone states
• Optimal diaphragmatic activity improves lower thoracic and upper lumbar mobility
• The pelvic floor is comprised mostly of slow twitch fibers. Therefore this may fall in line with Janda's work relating to inhibition.
• The pelvic floor is innervated by S2-5. So are the intrinsic muscles of the feet!
• A neutral spine increases the resting tone of the pelvic floor
• Anterior weight shift facilitates anterior pelvic floor activation (which is more prone to dysfunction)
• Adductor activity facilitates neural overflow into the pelvic floor (note: you can get more information about this from the Postural Restoration Institute)
• Cue a "lift" to facilitate the pelvic floor. Cue a "close" to facilitate the urogenital diaphragm (which is more fast twitch)
• Re: Rehabilitative Exercise of the generic variety - "supporting (facilitating) their weaknesses is feeding into their compensations" (read: each program must be individualized)

Overall, while I did enjoy this course, I have to admit that I still have to study this topic further and let it simmer. Clearly, the pelvic floor has a tremendous role to play in the "core", as all other muscles do, however integrating my learning from this weekend into daily practice will probably take some time.