By Melissa Patrick, PT, DPT and Jennifer Keesee, DPT
In part I of this blog post, we covered the basics of proper breathing mechanics and how important they can be for your pelvic health. We introduced pranayama, yoga based breathing exercises, and discussed the benefits of regular breath practice. We also talked about diaphragmatic breathing, its impact on the nervous system, and the fact that it is the foundation of other breath practices. If you are not familiar with diaphragmatic breathing, I encourage you to check out Part I first before proceeding with practicing the following techniques.
Additionally, check out part I to see practice tips to set yourself up for success and learn more about how breathing exercises can help trauma survivors improve their coping mechanisms.
See below for a variety of techniques that you can try right now by following along with the videos. Don’t forget: trust your breath, then pause after practice to observe and see if you can listen to what your body may be telling you.
Breath Retention
- Inhale deeply, allowing the abdomen to fill, for a count of 3 or 4 (seconds).
- At the top of your inhale hold for a count of 5 or 6 (seconds).
- Release your breath slowly and completely, making your exhale last 7 or 8 seconds.
- Choose a pace that works for you and try not to worry about the number of seconds.
- Practice for 3-5 minutes.
Lengthened Exhale
*(If breath retention is too challenging or makes you feel lightheaded, this may be a better option for you.)
- Inhale deeply, allowing the abdomen to fill, for a count of 3 or 4 seconds.
- Release your breath slowly and completely, making your exhale last 7 or 8 seconds. You can start with 4 seconds and gradually progress to 8 seconds. Try not to worry about the counting, just make sure your exhale is longer than your inhale.
- Perform for 3-5 minutes.
Lion’s Breath (Simha Pranayama)
- Find a comfortable seated position in a space where you can feel comfortable making noise.
- Inhale through your nose.
- Open your mouth, stick out your tongue, extending it down toward your chin. Then forcefully exhale out your mouth, making a “ha” sound.
- Relax your face between rounds and take a few normal breaths.
- Practice for 5 rounds.
Bee Breath (Brahmari Pranayama)
- Find a comfortable seated position in a place where you feel comfortable making noise.
- Close your eyes or have the gaze downcast. You may want to close your ears, too to eliminate distraction and focus your attention on the sound of vibration.
- Keeping your mouth closed, inhale fully through your nose.
- As you exhale, hum the sound of “M” in the back of your throat. Keep making this sound until you need to inhale again.
- For shorter exhales, practice ten rounds. For longer exhales, practice five rounds.
Alternate Nostril Breathing (Nadi Shodhana Pranayama)
*Tip: You may want to clear your nose with a tissue before beginning this practice.
- Rest your left hand in your lap or on your knee, palm facing up.
- Place the index and middle fingers of your right hand in between your eyebrows. Rest your thumb on your right nostril and your ring finger on your left nostril.
- Inhale deeply and exhale fully through your nose.
- Close the right nostril with your thumb and inhale through your left nostril. Close the left nostril with your ring finger, open the right nostril (removing your thumb), and exhale through the right side.
- Pause briefly at the end of the exhale before inhaling through the right nostril. Close the right side with your thumb, open the left nostril (removing your ring finger), and exhale through the left side. You have now completed one full cycle.
- Perform for 2-5 minutes.
Victory Breath (Ujjayi Pranayama)
- Take a comfortable seat. Practice constricting the back of your throat at your vocal cords, as if you were going to fog a mirror. Now, with a closed mouth, try to keep this constriction as you breathe.
- Inhale through your nose. Notice the slight rasping sound as your breath passes through your throat and fills your lungs, allowing your belly to rise.
- Keep this gentle constriction as you exhale, noticing the breath passing back through your throat and exiting your nostrils.
- Practice for 3-5 minutes
Be patient with yourself as you practice and get comfortable with these techniques. Choose the one(s) that feel the best for you and try to be consistent in your daily practice to get the most benefit. Discuss them with your physical therapist as part of your treatment plan, too.
If you are interested in working one on one with Melissa Patrick, our physical therapist who offers virtual therapeutic yoga, please visit our website to learn more and sign up! She can assist you with practicing these techniques and help you to incorporate them into your existing stretching routine or yoga practice to optimize your pelvic health.
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Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.