Finding Your Root:

Balancing Your Foundational Core and the

Pelvic Floor Muscles

A Yoga U Online Course with

Leslie Howard

Transcript, Session 2

Eva Norlyk Smith: Hello everyone. This is Eva Norlyk Smith with Yoga U Online.

Welcome to session two of our two-part online course with Leslie Howard on

Finding Your Root – Balancing Your Foundational Core and the Pelvic Floor Muscles.

As we saw in our last session, Leslie is a long-term Iyengar-trained yoga teacher

with an impressive knowledge of the common pelvic floor issues many people

struggle with and how yoga can help. Leslie’s own story and her work helping

people with pelvic floor issues is a wonderful example of how learning about our

body and how it works, often can help us take greater charge of our own health.

And most encouraging of all, Leslie’s experiences working with people and

participating in a study on yoga for incontinence shows that the “normal process of

aging” may not be so normal after all, and that many problems can indeed be

prevented or even reversed, particularly when it comes to pelvic floor issues.

In our last session, Leslie looked at the almost epidemic of pelvic floor issues in both

men and women and discussed the basic anatomy of the pelvic floor as well as the

most common issues people struggle with. In this session, Leslie will review the

pelvic floor muscles and the core muscles and explain how they work together in

synchrony to form our foundational core. She will show how evaluating, stabilizing,

and connecting with this core is a key to preventing or improving conditions related

to the pelvic floor. I will turn the mic over to Leslie. Leslie, welcome.

Leslie Howard: Thank you, Eva. Thanks for having me back. I’m very excited

about tonight. So I want to review a little bit of the pelvic floor muscles. I

inadvertently did not say the names of the first two layers of the pelvic floor last

week so I wanted to spell them out this week. The first layer is the

bulbospongiosus muscle. The second layer is the transverse perineal muscle. And

the third layer is the levator ani.

Today we’re going to review what is the core, where is the core, and how the core

and the pelvic floor relate to each other. So looking at this slide, again, I want to

review the muscles. So the first layer, remember, is the figure eight muscle. So if

you’re looking at the slide straight on, it’s vertical from top to bottom and creates

the figure eight that goes around the vagina in the female body and around the

anus in the female and male body. In the male body, obviously instead of the

opening for the vagina, there’s connective tissue and that’s where the scrotum fits.

So the first layer looks like a figure eight both in the male and the female body.

The second layer sits directly on top of the first layer (so on top meaning going

towards the head), is that muscle that you see going left to right. And that is the

transverse perineal muscle. So those two muscles (layer one and layer two) connect

at the perineum. The perineum is considered the area behind the genitals and in

front of the anal sphincter. That’s the area that I’ll talk a little bit more about in a

few minutes how to access that area. I just also want to review the third layer,

levator ani. So in this particular slide, you can only see the bottom part of the

levator ani. If you look to the left and the right of the anal sphincter, you’ll see the

beginnings of that. We’ll also have a better view of that.

So how do you find your perineum? I put a photograph of a rolled belt here, this is

a yoga belt. It’s rolled up to be about a one inch diameter. And what I find is very

helpful is if you’re sitting in a symmetrical position… So that could be sitting in a

chair, Virasana is one of my favorites to access this in, and you put the rolled belt

on the rounded edge, not the flat edge, so that it’s pushing up a little bit into the

perineal area. This helps you distinguish between the anus, the genitals, and the

perineum. And this is really important. So I talked a little bit about Kegels and how

Kegels aren’t very well described out in the world. And often, they’re defined as

finding the muscles that cut off your urine flow which is not very accurate.

What I’m teaching with the pelvic floor work is that the perineal area, that cross

between the first layer and the second layer, is really the strongest area to access

the pelvic floor muscles. So it’s not that you can’t squeeze the genitals, it’s not that

you can’t squeeze your anus, but those are different areas than the perineum. I’m

hoping that if you put the belt on the perineum (again, that’s the rolled belt), and

you can make it bigger or smaller depending on your sensitivity. It should not hurt,

it just might be mildly uncomfortable. But you want to put it at that center spot,

again behind the genitals, in front of the anus, in a symmetrical pose. And then,

what you might want to start with is just breathing, seeing if you feel a difference of

pressure on the perineum when you’re inhaling and exhaling. The belt is just giving

you some sensory feedback.

And then what you should practice is lifting the area that the roll is touching. It’s

actually better to lift on the exhale which I will explain more when we get to the

diaphragm muscle. So you want to try lifting on the exhalation away from the roll.

It’s a very good exercise to find the perineal area.

Another thing you can do when the roll is touching the perineum is try moving just

the anal sphincter, or try moving just the genital area. And you’ll see, you’ll start to

get a little bit of the subtleness. You’ll find there’s a different sensation with your

intention. So let me just say that it’s not that those other areas don’t move. It’s

where are you initiating the action from. And to allow the pelvic floor to work most

efficiently, it’s better to put your brain on the perineal area. So sitting on the rolled

belt is not something I would recommend doing on a regular basis but it very much

helps you develop that neural pathway to find it. And as soon as you develop the

sensitivity, you won’t need the rolled belt anymore.

Let’s look at the levator ani again. This is my model that I teach with. We’re now

looking into the pelvic floor from the top. And I’m hoping that you can see that

some of striations on the levator – that big red muscle in the center of the pelvis,

that whole thing is the levator ani. The purpose of the levator ani is to hold the

pelvic organs. So in the female body, it’s holding the bladder, the uterus, and the

rectum. And in the male body – the bladder, prostate, and the rectum. So it’s a very

important muscle. It’s actually made up of bands. And the bands are made up of

the puborectalis muscle, the pubococcygeus muscle, and the iliococcygeus muscle.

Now, you don’t need to remember those names, because ideally, the levator ani

and all the bands should work together. The pelvic floor working in unison stabilizes

your abdominal and pelvic organs and should work with the abdominal muscles to

do that.

So the levator ani attaches behind the pubic symphysis. So there’s a left and right

side to it and it attaches to the base of the sacrum on the left and right side. And

that’s really important for you to remember, because we think of the pelvic floor as

a bowl or even a circle. And really it has a left and right side. And I want to make a

point of that because often, one side of our pelvic floor can be very constricted, or

one side can be very loose. So in the female body, we deal with a little more

instability. We’re looking for balance. In the male body, it’s more common that

there’s just general tightness in both sides of the levator. But it’s not uncommon for

one side to be tighter than the other. And remember, if that’s attached to the inside

edge of the sacrum, that can pull on the sacrum unevenly and can create sacroiliac

pain. So this can be one of the reasons that you might have sacroiliac pain.

Here is a slide of the sacrum, tailbone area. The levator attaches to the bottom part

of that sacrum, at the very base of the spine. Layer one muscle attaches to the tip

of the tailbone and the levator is above that. So I want you to think about if both of

those muscles are tight (or either of those muscles are tight, I should say), that will

pull the base of your sacrum (your tailbone area) forward. So something I talked

about last week was how we don’t sit very well in our culture, and that we tend to

sit with our pelvis forward. And what I mean by forward is in a posterior tilt, which

means that you’re sitting really on your gluteus muscles and not your sitting bone.

So if your pelvis tends to be in more a posterior tilt or what I call tucked, that would

indicate that your pelvic floor muscles are short. Because if you’re pushing the base

of the sacrum forward, those muscles will learn to live in a more tightened and

shortened state.

So I want to talk a few minutes about our gluteus muscles. If the levator ani

attaches to the front face of the sacrum, what attaches to the back face of the

sacrum is our gluteus maximus. So the origin for the gluteus maximus is the

posterior inferior sacrum and coccyx. I want you to think of our glute muscles as a

balancing muscle for the pelvic floor muscles. So if the pelvic floor muscles are short

and tight and the base of the sacrum is pulled forward, then what can pull it back

out is developing our gluteus muscles. Now if you sit a lot, that is going to make the

gluteus muscles weak. And that will again contribute to the pelvic floor either being

imbalanced or more on the tight side.

So let’s look at the gluteus maximus. We have three gluteus muscles, but the most

superficial (meaning close to the surface), the one that we all know about, the one

we look at in pictures, is the gluteus maximus. You can see how big that muscle is.

I believe it is either the biggest or second largest muscle in the body. And if you can

see on the top of that slide, it attaches right on the sides of your sacrum. So again,

think of that muscle, if it’s well-developed, it pulls the sacrum back into that sacral

angle.

So let’s go back for a moment and look at the sacral angle. This slide is showing

how the sacrum ideally should sit. If you look at the first vertebrae above the

sacrum, you’ll see that it has a slightly wedge-like shape to it. That wedge shape of

that vertebrae is to accommodate that sacral angle. So if you can imagine that the

tailbone and the base of the sacrum are constantly forward in the slide, you would

be squeezing the front part of that vertebrae, which is not what it was meant to do.

So if we’re constantly sitting eight/ten/twelve hours a day, that disc is constantly

getting pressure in the wrong direction. And it’s one of the most common discs to

bulge or herniate. And the reason is because of too much posterior tuck.

Again, think of the gluteus muscle as that balancer. It pulls it back out. What I find

in teaching is often one gluteus works much better than the other, and that can also

contribute to pelvic floor dysfunction. It can contribute to instability of the sacrum.

This is not Slumpasana but I want to talk about Slumpasana. This is a slide from

Primal Pictures of Tadasana, and I want to talk a little bit about Tadasana from the

pelvic floor standpoint. Often in classes, you’re told to push your femurs back. When

you push your femurs back in Tadasana, that creates some space around your

tailbone. But often, the next instruction is to tuck your pelvis, tuck your butt, or pull

your tailbone forward – there’s a lot of different instructions on that. I believe that

the pelvis does need to be adjusted but I think that what we’re doing in a lot of

yoga classes and in Tadasana is over-tucking the pelvis, which tends to again

shorten the muscles of the pelvic floor. It brings the tailbone too much forward into

the body. And that doesn’t help your gluteus muscles.

So if you are in a place right now where you can just practice this, you can stand,

and push your femurs back and feel how that actually lifts your buttocks slightly.

Create some lateral space for the tailbone. But if you overdo the tucking of the

pelvis, you’ll feel how that kind of compresses the pelvic floor area and the groin

area

You need to be careful when you’re doing Tadasana. I want you to lengthen the top

of the buttocks away from the lumbar which is a very different idea than tucking the

whole pelvis. So I don’t believe that the cue to tuck your tailbone is helpful because,

again, it’s too focused. It’s too small of an area. It pulls your tailbone forward and

shortens the pelvic floor muscles and I find that a lot of pelvic floor muscles are

already too short. So try not to tuck too much, to stand on your bones, and to feel

your gluteus muscles engage. If you stand in Tadasana and you’re doing it

correctly, the buttocks muscles shouldn’t feel soft. They should feel like they’re

engaging.

So how do we develop the gluteus muscles in yoga? Salabhasana is one of the best

poses that we can do to help develop the glutes. In Salabhasana we’re lying down

on the belly. You can do this many different ways in the upper body. If you’re kind

of new to this practice, you may want to have the head down or low to the ground

and just work the legs. What I like to teach in my classes is to put the hands

actually on the two buttocks, and you can often feel the disparity between the two

sides. Often, one buttock grips very easily. It engages very easily which you need to

do this pose. And then one buttock is not working so well. And that hamstring is

overworking. So I would recommend doing both legs, touching the buttock and

seeing if you feel like your buttocks engage equally.

Then if you find that one isn’t working so well, what I would recommend is Ardha

Salabhasana. So that’s doing one side at a time. If you have a weaker gluteus that

doesn’t kick on so well, I would recommend doing this pose one side at a time and

on your weaker side, maybe doing more repetition on that side.

Right underneath the gluteus maximus is the gluteus medius. The gluteus medius,

you can see has a different attachment point. The gluteus medius is attached to the

outer side of the ilium, to the greater trochanter, which is the top edge of the femur

bone. So let’s look at the slide again. You can see it attaches to your ilium on the

back side, underneath the gluteus maximus. And you can see on the bottom, if you

follow that red line down to the bone, that is attaching to the greater trochanter of

the femur bone. So this muscle engages when we do external rotation. It helps you

with external rotation. And I think the best poses to evaluate your gluteus medius is

Baddha Konasana.

Now let’s talk about Baddha Konasana for a moment. So that’s an external rotation

of the hip joint in Baddha Konasana. But a lot of people do this pose not at enough

height. So number one, you need enough height under your buttocks so that the

angle of the femur bone is down, so that your knee is lower than your hip crease.

This is really important.

The other thing that people do incorrectly is I see a lot of people tucking their pelvis

in this position. They again bring their tail and their sitting bone so far forward that

they’re either on the back of the sitting bones or they’re not even on the sitting

bones. They’re more on the gluteus maximus. So you want to have enough height

that the angle of your femur bone is slanted downwards. And you want to make

sure that you’re not tucking your pelvis in the beginning. I think it’s very helpful to

have enough height under you and then take the hands behind you. Because a lot

of times this pose is more classically taught with the hands forward, but a lot of

people have such tight hips that it’s hard to do it with the hands in front of you

without tucking the pelvis. So if you just do the pose with your hands behind you,

that can help push you on to your sitting bones so you’re closer to what I call

anatomical neutral. Remember, if you’re sitting on the sitting bones, that is better

for your spine, better for your pelvic floor. It accommodates the sacral angle.

Now, how do you find the glute medius in this pose? So once you take the outer

position, if you push the little toe side of the foot together particularly near the heel,

so the little toe side of the heel, if you push the heels together at the same time

that you’re trying to stretch the inner thighs away from each other, you will feel

your glutes fire. Your glute medius will fire. But what happens is in this pose it’s

very obvious which glute medius is not engaging as much. So if you press the outer

heels together, pull the inner thighs away from each other, you’ll feel a connection

all the way up into your hip socket. And for most people, it’s very obvious which

side is kicking on and which side is not.

So Baddha Konasana, a symmetrical pose that you’ll feel when you do this pose

with your buttocks muscles and again specifically the glute medius is not working

symmetrically. So that can give you a clue to which glute medius needs some work.

So how do you get the glute medius to be stronger? The standing poses,

Virabhadrasana II (Warrior II) is one of the best poses to find your glute medius on

both legs. The legs are in external rotation. The back leg, I find for most people, is

not doing what it’s supposed to do. What I would suggest to find your glute medius

in Virabhadrasana II (it also works in Utthita Parsvakonasana which is a side angle

pose and also Trikonasana, Triangle Pose), is putting your left hand, your back

hand, on the buttock of the back leg. And if you turn the back leg out ever so

slightly, you should feel your glute medius kick on immediately. If the leg is not

working properly, the glute medius is not going to work properly. So you should

have a little more weight in the back leg. You should have the left hand on the left

buttock if it’s the back leg. And then if you turn that leg out more, you should feel a

difference of the glute medius kicking on.

It’s important to be aware of the glute medius because sometimes what will happen

is the external rotators of the leg are very tight and it’s because the glute medius

isn’t doing its job. I find often the external hip rotators are too tight. The TFL, the

tensor fascia latae, and the piriformis muscle is tight. And this is because the glute

medius isn’t firing the way it should be. And so these other muscles are trying to

pick up the slack.

Let’s talk a little bit about the core. I teach workshops all over the country and I ask

people if they’ve heard the expression to “work from your core.” So this is very

much in the vernacular out there. We’ve all heard it. And then my next question is,

“What do they mean by that? What does the teacher mean when they say ‘work

from your core’”? And most people point to the front of their belly. And they say,

“Well, here. Working from here.”

So a lot of people think that the core muscles are these muscles in the slide – the

rectus abdominus muscle. Our rectus abdominus muscle also has the nickname of

the six pack and that’s because body builders will often overdevelop these muscles

so that you have that little ribbed effect in the front. Now I don’t know who decides

what’s core and what’s not. I don’t know who the body of deciders that is, but in

the physical therapy world, in the medical world, the rectus abdominus is not

considered a core muscle. The rectus abdominus is considered extra to the core. So

I’ll get into the core muscles, but I want to talk a little bit about the rectus.

You’ve got two rectus muscles. At the top, it attaches to either side of the sternum

– at the cartilage of the fifth, sixth, and seventh ribs. They narrow as they descend

almost directly down the front of the belly and attach to the front of the pelvis at

the pubic bone. So again, it attaches left and right sides of the pubic bone. If you

then can call into your mind a body builder’s body, sometimes they’re very curled

forward, meaning the front of the ribcage is pulling towards their pelvis and the

front of their pelvis is pulling up towards the front of the ribcage. So if you

overdevelop this muscle, what it can do is really shorten the front of the body and it

can shorten your breathing. Technically, core muscles are considered stabilizers.

This is not considered a stabilizing muscle, because it’s such a smaller muscle in

comparison to the bigger abdominal muscles which we’ll see.

So I want to just say that the rectus abdominus is not considered a core muscle.

And for most people, it’s too tight. So even if you’re not a body builder, let’s say you

sit for work and you have a postural habit of kind of slumping – remember

Slumpasana? That muscle gets short. So again, the front of the ribcage gets pulled

towards the pubic bone and the pubic bone gets pulled up towards the ribcage. And

again, this very much can shorten your breathing.

The definition of the core is your pelvic floor on the bottom, your diaphragm (your

breathing muscle at the top), your transverse abdominus, which is your deepest

abdominal muscle, your internal and external obliques which are your side

abdominal muscles (so those stabilize the side of the body), and then your spinal

muscles (your erector spinae muscles and the multifidus0. This slide shows the

rectus, but underneath the rectus, what you’re looking at there you can see is a

nice view of the transverse abdominus. Below the ribcage, around, you’ll see the

transverse abdominus, which in comparison to the rectus muscle, you can see is a

much larger muscle.

The diaphragm is considered the top of our core. The core being, again, the

contents, our abdominal organs… Those constantly need to be stabilized when

we’re doing things out in the world. The diaphragm, if you think of that as the cap

that caps our core. It has a dome-like shape. It’s a thin and supple muscle that is

situated between the thorax and the abdomen. It attaches to the inside frame of

the ribcage. The diaphragm is basically the principal muscle of inhalation. When it

contracts, it descends. So if you can imagine the lungs sitting above the diaphragm

as you take air into the lungs, it pushes down on that muscle, and that muscle

flattens out a little bit and pushes the organs down. This is really important to pelvic

health because as I mentioned earlier when I was explaining how to sit on the

rolled belt, I was asking you to contract the pelvic floor, the perineal area, on the

exhalation. So if you again think of air coming into the lungs, pushing the

diaphragm down on the inhale, there’s actually more pressure into your pelvis when

you inhale. There’s less pressure into the pelvis as you exhale.

This is a really important thing to think about because a lot of us don’t breathe very

deeply. A lot of us are breathing fairly shallow, and this can affect your pelvic floor

health. Because if you think about deep what’s called abdominal breathing or belly

breathing, when you breathe more deeply, you’re getting movement and blood flow

into the pelvic floor. I want to try to start calling abdominal breathing pelvic

breathing, because I feel like why stop at the abdomen, just keep going.

So here’s another view of the diaphragm. This is looking at it from below, so you’re

looking up into it. It’s almost like the wingspan of a bird. It’s so beautiful. So you

can see again, it attaches to the inner frame of the ribcage. And then you’ll see two

attachment points at the bottom of the slides. The diaphragm actually attaches to

the lumbar spine. Again, everything affects everything else. If you are not sitting or

you’re not standing in anatomical neutral, if you tend to round and slump, what can

happen is the back of the diaphragm is somewhat constricted. So I can’t stress this

enough, how important posture is to breathing, and how important breathing is to

the pelvic floor. So again, the diaphragm is the top of the core. This is with the side

view with the ribs on.

This is a male pelvic floor. But again, I want you to think of looking at the

diaphragm as a dome. You look at the pelvic floor as a bowl. So ideally, when we’re

breathing, the diaphragm pushing down, pushes towards the pelvic floor. So the

pelvic floor receives the inhalation. And as we exhale, the pelvic floor contracts

slightly and goes upward towards the diaphragm as the diaphragm exhales out.

Think of the pelvic floor as the bottom of the core. So you’ve got the top of the

core, bottom of the core. And if you think of the shape of a capsule, you want to

think of those moving together. So thinking of this nice, pulsating movement – up

and down with the breath. This is a great opportunity for the pelvic floor to get

more oxygen and blood flow. And if you’re not sitting well, standing well, the breath

is short.

So here is looking down into the pelvic floor. The slide before was looking from the

bottom. So again, think of your inhale getting received into that muscle there and

that muscle gets a little stretch on the inhale, gets a little contraction on the exhale.

It’s not something that you’re consciously doing – it’s happening. Engaging your

pelvic floor is going to encourage that action. But again, deep breathing should help

the health of the pelvic floor.

The deepest abdominal muscle we have is the transverse abdominus. There are two

transverse abdominus muscles, one on each side of the body. It’s so deep it’s

practically up against the organ and it’s separated only by one little later of fascia.

So your transverse abdominus sits really close to the organs and affect the organs.

I want to talk about how the transverse abdominus works. One way to find the

transverse abdominus is to lie down on the floor and do a strong exhale through

your mouth. If you have your fingers on your lower belly, you will feel the

transverse abdominus kick in. That’s one of the best ways to find it. A cue that’s out

there about the transverse abdominus is to pull your navel to your spine.

There was a study done by the Women’s Health Foundation in Chicago that hooked

up the transverse abdominus to sensors. They took some people through the cue,

“navel to spine” or they also had the instruction “draw the sides of the navel back.”

What they found was really interesting. The cue “navel to spine” actually was

almost too aggressive. It put too much pressure into the organ. Whereas “drawing

the sides of the navel” was just as efficient in engaging the transverse abdominus,

but didn’t squeeze the organs like that. So just something to keep in mind for those

of you that teach, that “drawing the sides of the navel back” might be a better cue

than “pulling the navel to the spine.”

So again, transverse abdominus – think of it as a container. You can see the fibers

of the transverse abdominus, the red part of the slide, those fibers are lateral,

meaning they are sideways. And then the white that you see is connective tissue.

Right above the transverse abdominus (so now we’re moving from the deepest

coming outwards towards the skin), is your internal obliques. Again, there’s an

internal oblique muscle on each side of the abdomen. Of the three big muscles

found on the sides of the waist, the internal obliques form the middle layer. So

you’ve got transverse abdominus, internal obliques, and the external obliques. The

internal obliques are situated under the external obliques and on top of the

transverse abdominus. So think about the internal obliques as middle abdominal

muscles.

At the top, the internal oblique muscle attaches to the edge of the thoracic ribcage

and at the bottom, it attaches to the iliac crest of the pelvis, which is the spot where

you would put your hands on your hips. And then it extends along the inguinal

ligament of the groin.

At the lower level, the internal obliques have the longest and most significant fibers

of all of the abdominal muscles. The internal obliques help us side bend. So it pulls

the pelvis laterally when we’re side bending. It can rotate the pelvis forward and it

can inhibit its rotation in the opposite direction. So that’s the internal obliques.

And then again, we’re coming outwards – the external obliques. There’s an external

oblique on each side of the abdomen. These are the most superficial of the three.

They’re found just under the skin and the internal obliques and the transverse

abdominus lie beneath them.

At their upper end, the external obliques attach primarily to the side and the front

of the ribcage. At their lower end, they attach to the iliac crest of the pelvis. They

extend by way of tendinous fibers along the inguinal ligament of the groin. So

again, side bending is where we get to our obliques. And we don’t do a lot of side

bending outside of yoga, so side bending is a really important thing to be doing in

yoga.

And then in the back, you’ve got your erector spinae muscles. And the erector

spinae muscles travel the length of your spine. So you’ve got them in that groove

that’s on the side of your vertebrae. Those are all considered your core muscles.

How do the transverse abdominus and the pelvic floor work together? This is

important. We saw on the slide of the transverse abdominus that the fibers of the

transverse are lateral. So if you think about the old-fashioned corset where you

would pull the strings of the corset to cinch the waist in, that’s how the transverse

abdominus works. Ideally, when the transverse abdominus is called upon, the pelvic

floor should lift from the bottom. So let’s say I’m standing somewhere and I need to

pick something heavy up, what should happen is my transverse abdominus, as soon

as I lift something heavy, my transverse abdominus should kick in like a corset and

my pelvic floor should lift up to hold the organs, to stabilize the organs. Transverse

abdominus and pelvic floor are considered synergistic muscles. They should kick on

at the same moment. The problem is if there’s any pelvic floor disorder (meaning

too loose, too tight, one side’s too tight, one side’s too loose, any combination of

any problem), you are going to not have the support from the bottom when you’re

called upon to have your stabilizer core muscles kick on.

So this is really important because a lot of people are focused on the transverse

abdominus and they may not know about the pelvic floor. I’ve had some women

come to my workshops that were weight lifters. Maybe they weren’t so aware of the

pelvic floor and they went to lift a heavy weight and they felt their uterus fall. They

felt one of their organs prolapsing in result of the pelvic floor wasn’t doing its job.

The person wasn’t aware of it. They went to lift something heavy. The transverse

abdominus squeezed in like a corset. And if you think of squeezing a tube of

toothpaste, everything just pushes down… So if there’s any weakness in that area…

And again, for some women, the uterus may not be in their most stable position,

that can cause a prolapse. So this is a really important thing to remember, that

ideally the pelvic floor and transverse abdominus are kicking on together. And I

talked about the navel to spine cue.

How do we know if our levator is working? It’s very simple to look at, but actually

fairly complex to feel. You want to lie down on the floor. I have my arms above my

head just so you can see my lower back but ideally, your arms will be at your sides.

If you have any lower back issues, I would recommend lifting one leg at a time

rather than both together. What I teach in my classes is to put your fingertips on

your lower abdomen with your feet on the floor and then lift your feet up like I’m

showing in this photograph. And you will feel your abdomen kick on. Now, whether

your pelvic floor is working remains to be seen.

I recommend doing this – Lift the feet up, see how much movement is in your

abdomen. See how much movement is in your lower back. Ideally, your lower back

should not overarch. It should stay in neutral. So it’s not tucked. It’s in neutral.

After you test that is I would do it again. But the second time, what you should try

to do is try lifting your feet as you’re exhaling, and as you’re exhaling, lift the

perineal area, and hopefully, you have cultivated more awareness because of that

yoga belt you were working on earlier. You’ll feel that when you lift the perineal

area as you exhale and then lift your feet, there will be a very different quality in

your abdomen to what happened. That would show you the difference of the pelvic

floor helping you out and stabilizing you as your feet lift off the floor.

And this is a pretty safe position to do it in, because you’re lying down, so the pelvic

floor doesn’t have a lot of weight on it. And again, remember, if there’s any lower

back issues, you should lift one leg and then the other rather than both together.

Another really great pose for the core is Plank Position or also being on your hands

and knees, which I’ll describe. Again, think about Plank Position. You don’t have all

of the weight of the organs sitting on your pelvic floor. In Plank Position, your pelvic

floor organs are sitting more forward towards the lower abdomen so there’s a little

less weight on the pelvic floor in Plank Position.

This is also the beginning position for Chaturanga Dandasana which is done a lot in

yoga classes. And what I see more with women than men, but both men and

women do it, is when you go to lower from Plank Position, a lot of us over lift the

tail to try to make it easier. Again, the cue out there might be to tuck your tailbone.

I’ll say that Plank Position should be done in anatomical neutral. So what you’re

trying to do is not flatten the lumbar. You’re not trying to over tuck your pelvis. It

should be like you’re standing on the floor. You’re in neutral. You’re holding your

weight on your arm. Your stabilizers should all kick on. Stabilizers, again –

transverse abdominus, pelvic floor… They should kick on, immediately work

together. Your obliques are working to stabilize you. The spinal muscles and the

diaphragm are all working to stabilize you.

If Plank Position is challenging for you or Chaturanga Dandasana is challenging for

you, you can also do this on hands and knees. Think of the classic Cat Cow that

we’ve all been taught. If you find that position halfway through Cat and halfway

through Cow, so neutral again would be not all the way tucked and not all the way

untucked in the pelvis, not all the way retroverted or anteverted… You’re looking for

neutral on hands and knees. And if you engage the perineal area in that position,

you should feel (you probably will feel) your transverse abdominus kick in. That’s

one of the best positions for beginners to find the pelvic floor, because there’s no

weight of the organs sitting on the pelvic floor. So those are a couple things to try

to find your levator ani and the perineal area.

This is taught a lot in not so much yoga classes, maybe classes for the abs, is

crossing elbow to knee. What I see a lot is that what people do is they bring their

knee to their elbow. So go back to this one. You can see my femur bones, my thigh

bones, are pretty much perpendicular to the floor. So if you want to work your

obliques correctly (your side abdominals, the side of your core), what you want to

do is keep the femur in that perpendicular position to the floor and try to bring your

elbow to your knee. If you bring your knee to your elbow, as soon as the leg goes

past perpendicular, then your obliques turn off and your hip flexors turn on. So all

you’re doing in this photograph that I’m showing, is working your hip flexors which,

again, most of us don’t need as much as we do oblique work.

Just to recap, it’s just as important to stretch your pelvic floor as it is to strengthen

it. I talked quite a bit about strengthening it and finding it. So I wanted to do a

couple of things to think about stretching your pelvic floor and relaxing it. Again, I

can’t stress enough deep abdominal breathing or if you want to call it pelvic floor

breathing can help tremendously if you have hypertonicity, if you have pelvic pain, if

you have any of the conditions that I talked about for hypertonic pelvic floor. But

don’t think that if you don’t have a hypertonic pelvic floor that abdominal breathing

isn’t as important. It’s important for everyone it’s just even a little more important

for people with hypertone.

One of the best positions to stretch your pelvic floor is squatting. Please note in this

photograph that my heels are up on a blanket. And even if you can squat with your

heels down, I recommend for pelvic floor stretching, that you put your heels up.

Because a lot of us can squat with the heels down but then our pelvis is extremely

tucked under which again is not helping you. You’re getting two benefits here. You

have your heels up. Your pelvis can be more neutral, which is helping to open the

pelvic floor. And because you’re squatting, all the weight of the organs is getting

pushed into the pelvic floor. So this is a pose that I recommend doing passively for

pelvic floor stretching. The only contraindication with this pose would be prolapsed

organs. If you have prolapsed organs, you shouldn’t do this pose until things have

improved a little bit.

Forward bends generally stretch the pelvic floor, but the exception to that rule is

that our hamstrings are usually so tight that it doesn’t stretch the pelvic floor. So for

pelvic floor stretching, I’m a big advocate of bending the knees in poses like

Downward Dog or this pose, Prasarita Padottanasana to get into the pelvic floor. So

I’m not saying do these poses with bent legs all the time, but to get into the pelvic

floor a little more deeply, these poses done with bent legs and then thinking about

keeping the legs bent, you think about lifting your buttocks and your tail up. And

this should feel really good, and you’ll feel the difference. It’s not stretching the

backs of your legs so much, but it’s really getting deeply into the pelvic floor

muscles.

And then a last shout out for the pelvic floor is relaxing it. This is a photograph of

Supta Baddha Konasana. What’s lovely about Supta Baddha Konasana is if you

support the femur bones with blankets (you can see that my thigh bones are resting

on blankets there.) It’s not so easy to see that I have sandbags on my thighs. Let

me just say you should never, ever, ever put weight on thighs that aren’t supported

by a blanket. You should never put weights on unsupported joints. However, if you

have a blanket under the femur bone, put a sandbag on each thigh bone, this will

very much help you breathe more into the pelvic floor. This is a great pose to

cultivate that deep pelvic floor inhale awareness. So again, if you’re lying in this

pose, a nice thing to think about is when you inhale, the pelvic floor is receiving the

breath. And as you exhale, the pelvic floor is rising in reaction to the exhale leaving.

So again, it’s not something that you’re “doing,” it’s something that you’re allowing.

And that’s how you should think of it.

So your homework: Breathe into your pelvic floor whenever you think about it. Be

vigilant about your posture. You can’t breathe into your pelvic floor if you’re in a

bad pose, meaning if you slump in your chair or if you slump when you’re standing,

you cannot breathe deeply. Try it out if you don’t believe me. If you stand or you sit

in a slump and try to take a deep breath, you’ll very much be aware the breath does

not go down into the pelvic floor. So you must be on your sitting bones if you’re

sitting, or you must be on your heels, a little bit on your heels, femurs back, to get

your breath to go down.

Remember, relaxing the pelvic floor is just as important as engaging it. Remember,

the buttocks is not considered part of your core but think of your buttocks as the

muscle that balances the pelvic floor muscle, so it pulls the sacrum back outwards,

especially if you tend to have a posterior tilt to your pelvis. And I totally think that

we should all work from our core when we’re working hard, but don’t think the core

is just your rectus abdominus. The core is all of it – diaphragm, pelvic floor,

transverse abdominus, your obliques, your spinal muscles.

I’ll stop it here because I know there are some questions. Lastly I want to thank

Primal Pictures for letting me use their wonderful images. For those of you that

teach, I think it’s a great resource. Okay, so I think there are some questions, yes?

Eva Norlyk Smith: Yes, we got a lot of questions. I thought (first of all, just a

comment) that it was wonderful just to have that look of the cylinder of the core

and how the top and the bottom, the diaphragm and the pelvic floor muscle, kind of

have to dance together, the diaphragm and the breath….

Leslie Howard: That’s a great way to say it.

Eva Norlyk Smith: And I wondered, we know that the movement of the

diaphragm massages internal organs, but it makes a lot of common sense. And you

talked about how the movement of the diaphragm on the pelvic floor helps bring

blood flow to the pelvic floor muscles by stimulating just that soft movement up and

down. Are you aware of any studies that show any kind of correlation between

people who are diaphragmatic breathers and the rate they have pelvic floor issues

or is that too complicated?

Leslie Howard: You know, Eva, that is a great study to have, but I’m pretty sure it

hasn’t been done. I have to say pelvic floor research is really just at its infancy. I

mean, there’s a fair amount of pelvic floor research for incontinence, cystitis, things

like that. But as far as it operating optimally, it’s so hard to fund some of these

studies and I think that would be a great yoga study for someone to do. I would do

it if someone asked me. I’d be part of that study. It would be very fascinating.

Eva Norlyk Smith: Now, you gave this wonderful overview of the cylindrical core

with the top and the bottom and the sides and Joanne is asking why you didn’t

include the psoas and the iliacus and also the quadratus lumborum because the

psoas is connecting diaphragm to spine and pelvis to the femur. So she wondered

why they were not included.

Leslie Howard: They are not technically considered core muscles. So again, I don’t

know who the body that says what muscles are what. I’m going to guess it’s the

American Medical Association. I don’t know. I should find that out. But those are

considered hip flexors, specifically the psoas. They’re not considered core stabilizers.

So that’s why.

Eva Norlyk Smith: There seems to be different schools of thought on those

different groupings.

Leslie Howard: Right.

Eva Norlyk Smith: Laura in Milwaukee is saying, “I have a bladder prolapse. Are

there any of these poses that I should not do while I’m attempting to recover?” And

that question came in while you were doing the strengthening poses.

Leslie Howard: Squatting. That’s the only one she needs to avoid – squatting.

Eva Norlyk Smith: And Plank Pose would be considered okay?

Leslie Howard: Plank Pose would be okay.

Eva Norlyk Smith: Okay, good. Here is a question from June. She says, “I have

had a spinal fusion at L5 and S1 and a hysterectomy. I am so unstable that I’ve

developed many other problems. What can I do to become more stable?” And you

might want to say what that means to be stable…..

Leslie Howard: That’s a great question. So remember, I’m talking generally, men

tend towards hypertonicity in general. Women don’t tend towards hypertonicity as

much as they tend towards instability. And instability can mean tight on one side

and loose on the other, or very unevenness in the pelvic area. Because our pelvises

are less stable, more open for childbearing, we kind of open the opportunity for the

two sides to be really different. So for this person, they’ve had a hysterectomy

which destabilizes the integrity of the pelvis a little bit, and then the spinal fusion is

kind of locking that in place. So I guess because of what she’s gone through that

there’s definitely some hypertonicity. And the rule is that if there’s any hypertonicity

(and remember, that’s too much tightness), if there’s any hypertonicity, you have to

address that part of the equation before you can do strengthening exercises. So for

this person, I would recommend internal massage, maybe even seeing a physical

therapist that does internal work to guide her a little bit better than I can in a

webinar. But I’m pretty sure she’s probably got some tension in there just because

her pelvis has been traumatized by the hysterectomy, by the fusion, these are all

considered traumas to the pelvis. And how does our body react to trauma? It grips.

Our muscles grip when we are in pain or something happens to us that shouldn’t

happen. So this person, she needs to address her hypertonicity first. I’m sure that

she’s probably got some. And then she should embark on the stabilizing,

strengthening exercises which I talked about in the first half of today’s webinar.

Eva Norlyk Smith: Good. Laura from Milwaukee is asking how often someone with

a prolapse should do the workouts.

Leslie Howard: You know, every day… What’s important for everybody, but

particularly for prolapse, is you want to change your orientation to gravity. So with

prolapsed students, what I usually do is work with them on the floor. So they’re

lying down, or they’re on hands and knees, or their pelvis is elevated. So think

about Supported Bridge Pose or Viparita Karani where you put your legs against the

wall and put a bolster under your pelvis. Those really help with prolapsing because

what that will do is let the organs slide back to where it should be. It’s more

supported by the abdomen. And then the pelvic floor has less weight on it so you

probably get a little more sensation and feeling of movement in that area when it

doesn’t have this heavy weight sitting on it. So for prolapse, I would start lying

down, hands and knees, or pelvis inverted.

Eva Norlyk Smith: And because it’s so gentle, that will probably be every day. Is

that a correct assumption?

Leslie Howard: Yes. Thank you. Yes, every day try to work up to three sets of ten

– holding, releasing, holding, releasing, holding, releasing. See how long you can

hold. You know, it might be one second. It might be three seconds. You could work

up to holding for eight seconds, but you want to be careful that you’re definitely

releasing between, just like they tell you to do when you’re lifting weight. It’s just as

important in the pelvic floor that you have to give your pelvic floor time to relax

before you engage again. So not forgetting that… What we tend to do is grip, grip,

grip and not do the relaxing part.

Eva Norlyk Smith: Would you do that in conjunction with the inversion?

Leslie Howard: Yes, that’s what I’m saying. Yes, do the contractions of the pelvic

floor with the pelvis elevated, or lying down ,or on hands and knees.

Eva Norlyk Smith: Very interesting. Great. Jennifer from Portland, Oregon is

asking if you see a connection between TMJ or neck tension and a hypertonic pelvic

floor.

Leslie Howard: Absolutely. Absolutely. Yes. I want you to think of the pelvic floor

and the jaw-throat area as mirrors to each other. There’s a huge connection.

Eva Norlyk Smith: Can you give an example? Have you worked with someone

where…

Leslie Howard: I can give you an example on my own body when I first found out

that I was hypertonic when I went to my physical therapist that was doing internal

work. My right side was way, way, way tighter than my left side. She massaged me

internally for about forty minutes and I left her office, it took me about five minutes

to realize that a constant pain that I have on the right side of my neck was gone. So

that, to me, speaks to the connective tissue, the fascia. There’s just a chain there.

So if one side is gripped up, it’s pulling on the other side of the chain. That will be a

perfect example.

Eva Norlyk Smith: Alright, here’s a question, “I’m wondering how male

incontinence and impotence may be related to pelvic floor tonicity.”

Leslie Howard: Great question. Okay, a lot of men (particularly older men) start

having problems with incontinence, or an indication of a coming problem in the

pelvic floor could be the arc of a man’s pee. So most men have been peeing long

enough that they know the arc of their urine stream. If that starts to lessen, that is

probably denoting hypertonicity in the pelvic floor. A lot of men that think they have

prostate problems, often it’s a pelvic floor problem, not a prostate problem. So I’m

not saying that if you are having some incontinence or the arc of your pee is going

down that it might not be a prostate problem. So always check with your doctor.

I’m just saying that it can also be not a prostate problem, it can be pelvic floor-

related. So the hypertonicity of the pelvic floor for men can lessen their pee stream,

the strength of their pee stream, and it can also create some erectile dysfunction.

So again, this is why we’re all out there wanting to make things “stronger,” and

sometimes, what we need to do is actually let go and stretch and relax the muscles.

And that’s a perfect example of it.

Eva Norlyk Smith: Interesting. And here’s a question from Tatiana in Canada. She

says, “My husband had an inguinal hernia operation two months ago. Now, it’s time

to resume our yoga practice. But we would like to know if you have any suggestion

on sequences of stretching this area to prevent formation of inner scars.”

Leslie Howard: I would just tell him to really take it easy and, as he gets back into

his yoga practice, to not go to what his full extent of the stretch is. But what I

would suggest more than that is to get the okay from the doctor (I believe it’s two

months to three months but definitely check with the doctor), and then you can do

a scar massage and you definitely want to do that. Because when you don’t

massage scar tissue, what you’re doing is you’re creating an internal adherence of

the skin to the muscle to the viscera. I’ve done a number of cadaver labs where you

see scar tissue and it’s like a staple gun has been put in that place. It’s like

everything from the skin to the organs is glued together. When I saw that, it really

impressed upon me how important it is to, as soon as it’s okay, to mobilize the scar

tissue again (make sure to check with the doctor). He should be doing it or you can

have a physical therapist do it, but I would suggest learning it from a physical

therapist maybe and then doing it himself as much as possible to mobilize that area.

Eva Norlyk Smith: Very interesting. Now, we have had a couple of people asking

for more information on how to distinguish between hyper- and hypotonicity and we

talked about that earlier. We’re working on a handout for that, is that correct?

Leslie Howard: Yes. And also, remember that there’s two videos attached to this

webinar, and I talk about it there. But basically I talk about massaging around the

sitting bones and if you wanted to brave doing internal massage. If you massage

that area and you have any sensitivity, hardness, if there’s any sense of ouchiness

or “oh, my God, that’s so tight,” that is probably the number one indication that

there’s some hypertonicity.

Eva Norlyk Smith: The thing that was fascinating to me last time, you said it can

vary very much even from the left to the right side of the pelvic floor.

Leslie Howard: Right, that’s right. So if you massage sitting bones, the two sitting

bones separately around that area, you’ll often feel a huge difference. Or again, if

you go internally and you push a little bit more on the left or the right, sometimes

one side can be way more tight than the other.

Eva Norlyk Smith: As you said people will have access to more information about

that in the video and a summary of some of the key points for that.

Leslie Howard: May your pelvis be happy and healthy, everybody.

Eva Norlyk Smith: Well, everyone, thank you so much for joining us. And Leslie,

thanks again for sharing all this very, very interesting information.

Leslie Howard: Thank you so much for hosting it and just being a great resource

to find out about it. Thank you, Eva. I really appreciate it.