Pelvic Health Blog

Mindfulness meditation

4/16/2018

Written by Karen Bruno, PT

Mindfulness is like that—it is the miracle which we can call back in a flash our dispersed mind and restore it to wholeness so that we can live each minute of life.
― Thich Nhat Hanh, The Miracle of Mindfulness: An Introduction to the Practice of Meditation

Mindfulness meditation is a practice to focus your attention on your moment to moment experience and to accept the present moment without judgment.

This technique draws you back to your center by bringing into the present moment the fragmented aspects of your mind-those thoughts that drift into the past and/or thoughts, fears and worries about the future. With non-judgemental awareness, these thoughts are free to come and go without gripping you and further dragging you down, resulting in a more alert, attentive and relaxed state of being.

Mindfulness meditation in physical therapy

You can practice mindfulness in variety of different ways. Here are some things upon which you can choose to focus:

Your breath
A word or mantra that you silently repeat.
Sensations such as sight, touch, sounds, smells and tastes.
Any activity, such as walking, doing the dishes, performing daily chores.
Noticing and naming your emotions-such as anger, grief, sadness or joy-accepting that they are part of your experience and allowing them to be present without judgement or commentary. Then, let them go.

The benefits of Mindfulness Meditation are bountiful. Mindfulness meditation is not considered a relaxation practice, however, you may have the experience of relaxation as a beneficial side effect. Please refer to the January 2018 e-newsletter for the list of benefits of meditation.

Some Basics of Mindfulness Meditation
To be done 20-30 minutes once or twice daily.

Sit in a comfortable position with your spine supported, head erect and feet flat on the floor.

Become aware of your inbreath and outbreath.
Become aware of any sensation in particular regions of your body. Naming them can help you let them go, e.g., the sensation of your shirt sleeve against your wrist, the tightness in your back, tension in the belly.
Become aware of your body as a whole.
Become aware of hearing silence and sounds. Again-naming them is helpful, e.g., the sound of the clock, the whirl of the fan.
Observe thoughts, emotions and feelings, e.g., joy, frustration, anger, as they move in and out of the mind moment by moment-not getting involved in the content of them but observing them as thoughts and feelings. Allow them to be present without judgement and let them move on.
When you have observed that the mind has drifted, gently bring it back to attention in the present moment.

Breaking it down
If you only have a few minutes, after focusing your attention on your breath to quiet your mind, you can choose one category, such as focusing on body sensations, or thoughts or sounds. Remember to be patient, loving, kind, forgiving and gentle with yourself. Even a few minutes of practice is a step in the right direction.

Meditation begins with the non-judgmental observation of life from moment to moment. When you find that the mind is being judgmental, for example, pushing away things it doesn’t like, simply observe that this is occurring. Meditation is an effortless and choiceless awareness of the totality of life expressing itself with and around you in every and any moment. It is a state of being, not an activity. So it is not something to do, rather it is allowing yourself to just be. THIS IS NOT A TUNING OUT PROCESS. Rather it is being fully present with a larger perspective grounded in a sense of being.
― Jon Kabat-Zinn

Can I do a crunch?

4/3/2018

Written by Bryn Zolty, PT

If I just had a baby can I return to running? I’m leaking - can I do exercise that involves jumping? My doctor says I have a prolapse - can I lift weights at the gym? As pelvic physical therapists, we hear these questions every day. It is very common to wonder if after having a baby, a surgery, or if you have pain in the pelvis, if it is okay to engage in activities that can push pressure down into the pelvis.

While more research is needed to better answer these questions, there are a couple of studies available that have measured the pressure in the vagina with functional tasks, yoga poses, and other exercises in attempts to answer these questions. Here is a little of what they found with a group of women ranging in age from 20-51:

Crunch AVG pressure: 23.8, range 19-76, with an exhale AVG 12.4 range 8-75
Downward facing dog AVG pressure: 39.1 range 26-72
Exercise machines AVG 37 range 20.3-182.3
Jumping AVG 171 range 43-252
Coughing AVG 98 range 49-130
Bearing down with breath hold AVG 101.7 range 45-131

*Units of pressure used in the study are in cm of water. This is the height in cm of water displaced by pressure. (O’Dell et al.2007) (Cobb et al. 2005)

These numbers can surprise people. How can a crunch be so bad if the average pressure is 23.8 and a normal daily occurrence like coughing is 98? As a therapist, my focus is drawn to the large ranges within each activity. What is the woman doing differently to crunch at a pressure of 8 compared to the woman at a 75?

As therapists we evaluate how you move and conduct each of these activities. As pelvic physical therapists we look closer at your movement, alignment, breathing, coordination, and muscle tone in relation to the pelvis. All these factors play a role in the pressure your body places on the pelvic floor. This pressure is known as the intra-abdominal pressure. This is how one woman can have very low pressure on her pelvic floor while another woman has high pressure during the same activity. The key is how they complete the task.

Back to the question, can I do a crunch? Can I return to strenuous exercise? Our goal is to teach you how to do movements or activities properly while minimizing the negative impact on the pelvic muscles. A pelvic physical therapist’s job is to evaluate the movement or activity that gives you pain or makes you leak and improve it.

How do we do this? Let’s take a squat for example. If a patient comes in because she leaks urine while squatting, we would explore all the possibilities.

If a weak pelvic floor is causing your leaking, we would teach you techniques to strengthen/engage your pelvic floor and prevent leaking. This could be done by performing a pelvic contraction, a breathing pattern to encourage activation, or even using a high tone phonation!
Conversely, leaking can also be caused by a tight/tense pelvic floor. In this situation, we could trial lengthening/releasing the pelvic floor during the squat.
Alternatively, leaking could be caused by too much pressure on the pelvic floor and not necessarily lack of strength. It is possible that a change in alignment of the head/neck, ribs, or pelvis could increase pressure higher than the pelvic floor can support. According to the study holding your breath and bearing down causes an average pressure of 101.7. It may be your breathing pattern might need to be adjusted!

After having babies, surgeries, or injuries our bodies change. Some of these changes can lead to incontinence or pain. A pelvic physical therapist is a great clinician to discuss these changes along with your goals for fitness or everyday activities. Whether it’s cueing on alignment or movement strategies, breathing, releasing or strengthening, it is our goal to help you reach yours.

References/Citations

From the Glottis to the Pelvic Floor: Making Clinical Connections. Julie Wiebe, PT, MPT,BSc, and Susan Clinton, PT,DScPT,OCS,WCS,FAAOMPT.

Cobb WS, Burns JM,Kercher KW, Matthews BD, Norton HJ,Heniford BT. Normal Intra-abdominal Pressure in Healthy Adults. 2005; Journal of Surgical Research 2005; (129):231-235.

O’Dell KK, Morse AN,Crawford SL, Howard A. Vaginal Pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. International Urogyneocology Journal, 2007;18: 1481-1489.

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