Like so many of you, my new year’s resolutions include exercising more and eating healthy. As I embarked on my plan for doing both, I got to wondering where my pelvic floor health fell into the mix.
“Shouldn’t my exercise plan take my pelvic floor issues into consideration?” I wondered. I certainly didn’t want to start a fitness routine that would jeopardize all of the progress I’ve made in rehabbing my floor. “And was it possible to add some changes to my diet that would also benefit my pelvic floor health?”
To answer this questions, I decided to turn to, well, this blog! Turns out we’ve written posts on just these topics. In this blog post we’re going to rerun that advice. Because it’s advice worth repeating, and because reruns are awesome. I mean, there’s nothing better than catching one of your favorite episodes of Golden Girls as you’re drifting off to sleep after a long day, am I right?!
So here goes.
Pelvic Pain: Some General Exercise Tips
By Stephanie Prendergast
Exercising for fitness often poses a problem for those in the middle of the healing process for a pelvic pain issue. That’s because it can potentially cause their symptoms to flare. Often this occurs after patients have taken a break from their fitness routine because of their pelvic pain and/or fear of making themselves worse. After they return to exercise they oftentimes will start to become symptomatic again as a result.
Understandably this is very frustrating and people think they may never be able to exercise again.
It’s important for people to get daily exercise, so we work hard with patients to figure out the balance between staying fit and healthy and not exacerbating their symptoms. Therefore, exercise routines may need temporary modifications at first, with the goal being progression towards the patient’s desired activities.
So after years of conversations with my patients and a knowledge of exercise anatomy and physiology, we compiled a list of exercises that are reasonable starting places for people beginning to work out again as well as a list of activities that are often more provocative for pelvic pain patients.
The advice below is by no means and end-all be-all of “do’s and ‘don’ts”. I created it because I want people to know that they can exercise, and certain choices may be better than others when learning to manage pelvic pain.
A-List of Exercises for Pelvic Pain Patients
Slower, isometric, double-limb, lower impact exercises:
People that have been through any pain experience may have altered neuromuscular recruitment patterns. What this means is that they may use muscles other than the ones intended for the movement in question, which can result in injury and symptoms. Therefore, in general, slower, isometric, double-limb, lower impact exercises are a good place to start. With these types of exercises, the patient has a higher chance of performing the necessary motions with proper muscle recruitment as compared to faster moving, higher impact, and single-leg stance activities. Below is a list of examples of these types of exercises.
Shallow squats are better because the deeper the squat, the greater the chance that hypertonic (too tight) muscles will change the motion and that the external rotators and hamstring muscles instead of the gluteal muscles will get involved, which are the muscles you want to be working in this type of exercise.
Progression: shallow squats on a foam pad
This movement creates an unstable surface and co-contraction of muscles, and is a safe and effective way to strengthen the gluteus muscles, thighs, and hips.
Balancing on the Bosu ball or foam roller
If using the Bosu Ball, first use the flat side down, then progress to flat side up for 30 seconds to two minutes.
Abdominal Exercises that are appropriate for pelvic pain patients
Abdominal muscles are often associated with pelvic pain; therefore, some abdominal exercise can exacerbate symptoms. Below are the abdominal exercises that we recommend for patients with pelvic pain. For a variety of reasons, these exercises do not negatively impact the pelvic floor.
Plank: these are great because they are a good way to recruitment trunk muscles.
Standing Triceps Extensions: these create a way to recruit the core without over-activating the rectus abdominus muscles.
Supine leg-lifts on a physio ball: again, these create a way to recruit the core without over-activating the rectus abdominus muscles.
Walking backwards on a treadmill at 5% incline, 2.0 miles per hour.
This will help to strengthen the lower extremities while also providing an aerobic activity, but it will do so in a way that doesn’t engage those muscles that are a problem like the pelvic floor and the rectus abdominus muscles.
The StepMill cardiovascular machine that most gyms have.
This machine is great because at slower speeds (less than level five), people can get great gluteal muscle recruitment while also getting cardiovascular benefits.
Exercises that are more provocative and may flare symptoms:
Activities that involve impact, such as single leg or double leg jumping
Squatting in single leg stance
Hamstring and quadriceps machines: I recommend free weights over gym machines. Many of my female patients report that these machines simply feel uncomfortable and exacerbate their symptoms.
Deep squats and lunges
When folks who have pelvic pain do squats or lunges, their hamstrings oftentimes fire instead of their gluteal muscles, which can be detrimental to a tight pelvic floor. Also, pelvic pain patients often have hip rotators that are too tight to be able to do the exercise properly.
Biking or spinning
Most people with pelvic pain have problems and pain in the muscles that are compressed on a bike seat, i.e. nearly the entire pelvic floor. So the pressure will aggravate the pelvic floor. In fact, some of our patients’ pain started as a result of biking in the first place. I’m not saying that if you’re a passionate cyclist and develop pelvic pain that you’ll never be able to ride again, but for those who are in treatment these exercises are not the best choices.
Sitting abduction/adduction machine (inner/outer thigh)
The sitting adduction and abduction machine is not a functional exercise, meaning that we do not use these muscles in our daily lives in the positions required on these machines, so unless you’re a competitive weightlifter, there really is no functional reason to do these exercises. On top of that, these machines can actually cause pelvic pain and, therefore, should be avoided.
Unless you are a professional body builder, most people do not need to strengthen their calf muscles. The general population tends to have tight calf muscles, which can change how a person walks and the muscles that they use daily. These muscles should be stretched versus strengthened, and daily.
Situps or crunches
Sit-ups directly involve the rectus abdominus muscles, one of the abdominal muscles, which have a high correlation with pelvic pain or a high tone pelvic floor as well as urinary urgency and frequency. In addition, this muscle is not a trunk stabilizer and does not need to be individually strengthened for musculoskeletal health.
Deep squats with heavy weights
Deep squats with heavy resistance are not a good choice due to a higher risk of injury and incorrect muscle recruitment. This position also causes a lengthening of the pudendal nerve and a tightening of the pelvic floor muscles. This combination can cause pudendal neuralgia.
May or May not be Appropriate for Pelvic Pain Patients
Patients who have trigger points in their hips or if their gluteal muscles aren’t strong enough, running is going to bother their pelvic floor symptoms, but if they are clear in those areas they can usually slowly start to get back into running.
Swimming is a great form of exercise. Certain strokes may be problematic for patients with trigger points. For example, the breaststroke activates the obturator internus muscle, patients with trigger points here should choose a different stroke, such as freestyle. Conversely, patients with psoas or hip flexor trigger points may get aggravated by the freestyle motion, but feel comfortable using the breaststroke.
But walking in water can be a fantastic cardiovascular exercise because it gets your heart rate up but because we’re practically weightless in water, muscles and joints are free of pressure.
Pilates and yoga
These exercises have a range of motions that can be therapeutic for pelvic pain, good for general fitness, and occasionally problematic. Therefore, pilates or yoga programs really need to be individualized per patient. To read more about yoga and pelvic pain, check out our blog on the topic here.
When it comes to exercise and pelvic pain it’s important for me as a PT to help my patients find that happy medium between continuing to exercise and stay fit and not exacerbating their pelvic pain symptoms. Not only because it adds to their quality of life and overall health, but because any exercise, and especially cardiovascular exercise will encourage blood flow and release endorphins, which is beneficial for patients in pain.
Eating to Manage your Pelvic Pain
By Melinda Fontaine
Can we eat to relieve our pain?
Actually, the answer is a resounding “Yes!” More and more research is finding a connection between what we eat and how our bodies experience pain.
That’s why I was so thrilled to attend a lecture on how nutrition can help us manage our pain at the IPPS Conference in Chicago last month. The lecture titled “Nutritional Considerations in Treating Patients with Pain,” was delivered by the brilliant Dr. Geeta Maker-Clark.
The nutrition advice that Dr. Maker-Clark gave focused mainly on tackling the body’s inflammatory responses. For many chronic pain patients, inflammation plays a major role in their pain.
Inflammation is the body’s natural response to acute injury, and chronic inflammation significantly contributes to persistent pain. At the cellular level, pro-inflammatory cytokines produced at the site of injury increase the sensitivity to pain. (“Cytokines” are proteins that interact with cells of the immune system to regulate the body’s response to disease and infection.)
The good news is that these pro-inflammatory cytokines can be reduced by proper diet. In fact, Dr. Maker-Clark is adamant that proper nutrition must be a part of our treatment for pain and is also an important part of the healing process.
So what sort of diet can help us manage our pain?
Well, the guidelines and rules of eating to help manage pain and promote healing or what I like to call an “anti-inflammatory diet” are not all complicated. In fact, there are only two basic rules of thumb to follow.
The first rule has to do with how quickly our bodies process sugar. You see, the slower your body processes sugar, the better it can tackle inflammation.
In fact, one important study found that inflammation markers were higher in women who ate foods with a high glycemic index. (The glycemic index is a measurement of how quickly your body can process the glucose or sugars in a food.) The study showed that pain tends to follow the glycemic index, meaning that foods that are higher on the index are associated with more inflammation and more pain.
Examples of foods that are high on the glycemic index include: white bread, potatoes, beer, cereal, and rice, white flour, and processed foods.
So foods that are lower on the glycemic index are a better choice for folks dealing with pain. And conversely, foods that are higher on the index are not a good choice for pain management.
A little tip: foods that are higher in fiber are going to be lower on the glycemic index, so better for anti-inflammatory purposes.
Rule number two focuses on essential fatty acids–specifically how we balance our intake of omega-3 fatty acids and omega-6 fatty acids.
Essential fatty acids are called “essential” because we can’t make them on our own, but must get them from our diet. It turns out that when it comes to essential fatty acids, it’s not a matter of more is better, but a matter of balance is the key.
Let me explain: Nutritionists believe that in the past, humans ate just as much omega-3s as omega-6s, but since the advent of the modern diet, there has been a huge shift in the ratio. And for optimal health, it’s important for us to get a balanced amount of omega-3s to omega-6s.
In our modern diet there are actually not many sources of omega-3s. The main source is the fat of cold-water fish, other sources include walnuts and flaxseeds, olive oil, avocado, and enriched eggs.
On the flip side, our modern diet is full to overflowing with omega-6s. Omega-6s are found in seeds and nuts as well as the oils extracted from them. Most processed foods contain refined oils. On top of that, the majority of the protein we eat–even farmed fish–are fed grains. And not only are you what you eat, you are what you eat eats.
So because omega-3s are so hard to come by and omega-6s are all too easy to come by on the modern menu, there’s a huge imbalance between the omega-3s and omega-6s we eat.
Many researchers believe that it is this dietary imbalance that is behind the rise of such diseases as asthma, coronary heart disease, many forms of cancer, and the slew of autoimmunity and neurodegenerative diseases, all of which are believed to stem from inflammation in the body.
For our purposes, it is this imbalance that can cause problems when it comes to inflammation. That’s because, in general when it comes to inflammation, omega-6s and omega-3 have different effects. Omega-6s tend to increase inflammation (which isn’t necessarily a bad thing because inflammation plays an important role in the body’s immune response), while omega-3s decrease inflammation.
For the purposes of following an anti-inflammatory diet, what you’re striving to do is to get a healthy ratio of omega-3s and omega-6s. The best way to do that in today’s Western diet is to make it a point to eat more foods with omega-3 fatty acids and less with omega-6 fatty acids. One tip that Dr. Maker-Clark gave for upping your intake of omega-3s is to buy eggs that are fortified with omega-3.
In addition to the two hard and fast rules Dr. Maker-Clark gave she also listed a handful of specific foods that, according to research, have anti-inflammatory properties.
Here are a few:
Tart Cherry juice:
So to summarize, a solid anti-inflammatory diet consists of:
Low glycemic index foods
Limited amount of processed foods
A reduction of hydrogenated fats
Plenty of omega 3-rich foods
Other tips include:
Less meat and dairy
More fresh fruits and vegetables
Fewer chemical additives
Not only will I be recommending Dr. Maker-Clark’s dietary tips to my patients, I’m going to be implementing a few of them into my own diet. If you would like more info on Dr. Maker-Clark’s pain management diet advice, just click here.
Do you have any pelvic floor-related new year’s resolutions? If so, share in the comments section below!
All our best,
Molly, Stephanie, and Melinda