I’m currently enjoying all the busy activities of the Xmas season with baking, friends dropping in, parties, cooking and one too many slices of fruit cake. I stopped in my tracks today when I read about the Xmas school holidays ahead for some young females in the UK undergoing ritual Female Genital Mutilation which is a deeply entrenched practice in many cultures. This article from Europe News tells of what lies ahead for many girls in the UK this Xmas.

Click here to read more

Mary will be presenting a short paper and a 90min workshop at the Queensland Branch State Conference of Sports Medicine Australia in February 2010.

‘I am very excited to have the opportunity to speak and work with the medical professionals caring for our athletes’, said Mary.  ‘The pelvic floor problems in the female athletic population are under identified and present unique challenges for management.  Teaching medical and training professionals to identify, refer and modify programs for their female athletes at risk will bring health and performance benefits and reduce a life long legacy of pelvic floor problems after a woman’s sporting career is over.’

Members of Sports Medicine Australia can register through the Queensland branch.  The conference is on the weekend of February 6/7, 2010 at the Novotel Twin Waters Resort on the Sunshine Coast north of Brisbane.

For information or registration click here for the organisation website.

I have just finished a successful series of workshops to Physiotherapists at St Thomas Hospital, London, arranged by the private practitioners group. Today was a full day of book signing at the WOW (Wellbeing of Women) Show at the Royal College of  Obstetricians and Gynaecologists. This fabulous show is where women can come and chat with experts in the women’s  health field. Check out the great work done by this association at www.wellbeingofwomen.org.uk

Felt so honoured to sign books and chat with the award winning journalist, Fiona Bruce and Sarah Brown, the wife of the British Prime Minister, (who is the patron of WOW).  There was great interest from journalists and women about various pelvic floor issues. Womens’ most common queries were about how to prevent incontinence and pelvic organ prolapse . Many were looking  for advice on how to perform pelvic floor exercises correctly.   I was able to give them general advice and introduce them to the Hold It Sister book and website as a starting point for them.  A great day with lots of likeminded women.  Might come again next year.

Continence Awareness Week 2009 (August 2-8) gained only a brief mention in The Australian this week. It’s one of those topics we should be talking about in great length, but……One savvy lady, Tania McCartney, who ranks in Australia’s top100 women bloggers, wrote a great article on Continence Week for Australian Women Online. Read about her adventures and ‘bladder bounce’ when she gleefully joined her kids on their new trampoline. Her hilarious hop has made her more determined to continue with pelvic floor exercises and spread advice from experts to other women.

Click here to read Tania’s article
To visit Tania’s brilliant blog click onto http://taniamccartney.blogspot.com/

Singing and the Pelvic Floor

Last night I enjoyed a fascinating dinner conversation with a tenor who performs with Andre Rieu. His interest in my pelvic floor work, lead him to about talk about his experiences both as a singer and teacher. He described how the strength of his resonance and projection comes from the base of his body, combined with perfect posture to gain maximum airflow into his lungs. As the muscles controlling the vocal cords are so small, he generates force from the base of his body (pelvic floor). Placido Domingo described how he sings from his sexual centre, generating a powerful force to project his mesmerizing voice, sparing strain on the vocal cords, allowing them to fine tune pitch and accurate tone.

My dinner companion teaches his students perfect posture, deep chest opening breathing plus techniques to connect with their pelvic muscle force, as part of learning advanced singing skills. Showing a deep knowledge of his body, and without using medical terms, he perfectly described the steps I use to teach pelvic floor awareness and exercise. Poor postural control, faulty breathing patterns and release of enforced abdominal tension all need to be addressed first to allow the pelvic floor muscles freedom to move , coordinate with other abdominal muscles and generate enough force to close pelvic sphincters, support internal organs and build up strong sexual sensation.

Researchers are finding differences in the pelvic floor and abdominal muscle activity between continent and incontinent women. (Smith et al 2007). When muscles around the abdominal cavity contract, (External Oblique and Rectus Abdominis) pressure is increased inside the abdomen. This downwards pressure requires Pelvic Floor Muscles (PFMs) to simultaneously contract to maintain continence eg when sneezing or dancing. Pelvic floor and abdominal muscles contract at the same time in continent women. This study shows women with incontinence have increased activity in their External Obliques, leading to greater PFM activity than in continent women. This finding challenges the belief that incontinent women have less PFM activity.

The authors believe the increased activity of External Obliques of incontinent women may contribute to incontinence and these women may perceive an abdominal contraction (or Valsalva manoeuvre) as a pelvic floor contraction. They suggest decreasing abdominal muscle activity or retraining coordination of both groups, to help reduce incontinence.

This diagram helps explain the different abdominal muscle action observed between continent and incontinent women. I find my clients with incontinence benefit from initially isolating and learning the gentle action of their Pubococcygeus (PC) muscle without External Oblique activity, before learning to control and strengthen the entire pelvic floor group.  The next step involves training the PFMs to work in coordination with trunk and other body muscles.

So when doing PFM exercises, ensure you know the correct action first before going for strength. Some Incontinent women will benefit from learning to relax their waist and chest wall muscles initially while learning to recognize the action of their PC. Aim to contract this muscle first instead of stronger abdominals and avoid strengthening an incorrect action.

Last week I was the guest of Gina Cloud who featured ‘Hold It Sister’ on her Redefining W.O.M.A.N Radio Show. This insightful lady embraces, honors and celebrates the rhythms of the feminine, the female cycles and most importantly, that fabulous temple known as a woman’s body. We spoke about the pelvic floor, what causes damage and why pelvic floor exercises or Kegels are difficult for many women. If you would like to hear more about the latest research on incontinence and prolapse and how some of our daily habits can contribute to incontinence, listen to the interview on http://www.contacttalkradio.com/hosts/ginacloud.html and click on the June 23 – Download

Remember how your mum nagged you about sitting up straight? She was right on the ball as researchers tell us our posture muscles shut down when we slump. So when your chest drops your posture muscles are switched off. This is a problem in the long term as when we sit, stand and walk, these muscles are meant to be continuously switched on. In the long term, chronically poor posture will weaken their ability to hold you upright.

The core muscles switch on and hold us upright for long periods of time when we grow tall through the crown of our heads and teach our brain this is the ‘normal’ posture. Our inner cylinder of core muscles is made up of the domed diaphragm above, the transversus abdominis around, spinal multifidus at the back and the pelvic floor underneath. The pelvic floor is the Queen of the core muscles as researchers tell us it’s the FIRST muscle in the body to tension when we move (milliseconds before our movement muscles). The other core muscles should automatically tension along with the pelvic floor so they work as an effective inner cylinder of protective muscle for the pelvic floor and spine.

These core muscles coordinate smoothly in a body without any dysfunction. In the clinic, I find my clients with pelvic floor  and lumbar dysfunction have delayed core muscle activation, or it’s uncoordinated with outer abdominal muscles which are too dominant. Clinically we find different types of pelvic floor muscle problem and I will write about the different types of pelvic floors next time.

The most important life time exercise for your pelvic floor is to continually grow tall through the crown of your head when ever you are upright against gravity. Notice how your pelvic floor muscles draw up more effectively when you are  ’Crowning’.

This workshop has been peer-reviewed by the Fitness Australia panel and approved!  This means fitness professionals will gain Continuing Education Credits (CEC) when they complete this workshop.
Details of upcoming workshops in Rockhampton, Brisbane, Gold Coast and Sunshine Coast are being finalised.  Stay tuned…

Course Program

THE CONFIDENT PHYSIO’S GUIDE TO CORE & FLOOR TRAINING

9.00 – 10.30 
Research
Core/Pelvic Floor Overview/Different Types of Pelvic Floor Muscle Dysfunctions
Causes of Pelvic Floor/Core Dysfunction
At Risk Populations of Women
Strength v Postural Muscles

11.00 – 12.30 – Practical
FIND IT- IDENTIFYING A NEW ACTION
Identifying Core Dysfunction
Barriers to Learning Pelvic Floor/Core Co-ordination
Retraining Core Dysfunction

1.30 – 2.45 – Practical
CONTROL IT- DEVELOPING NEUROMUSCULAR CONTROL
Controlling Pelvic Floor/Core for different functions
Protective Bracing Pattern – Functional Strength Pattern
Bracing v Hollowing

3.00-4.15 Practical
TRAIN IT – FUNCTIONAL INTEGRATION
Progressing core strength and endurance with functional training to gain full body integration