So, uh, I’ve got a hypertonic pelvic floor and I want to tell you about it.
I am here to talk about my pelvic floor. My hypertonic pelvic floor to be precise. I would like to unload some of the information I have learned over the past few weeks of research and physical therapy for a variety of reasons – not least of all because I am convinced that more than a few of you are also living with a less than ideal pelvic floor. Heck, the superhuman Paul Buono has one (http://paulbuonochronicles.com/2013/07/06/hypertonic-pelvic-floor/)!
So, first, what is a hypertonic pelvic floor and how do I know that I have one?
According to the Institute for Sexual Medicine, the condition is when the muscles surrounding the vagina (in women – I am talking about me in this post, but YES men can and certainly do have hypertonic pelvic floors!), bladder, and anus are in spasm. A 10% increase in muscle tone of the pelvic floor muscles causes a 50% decrease in blood flow and oxygen. Holy moly! This leads to a build up of lactic acid in these muscles which cases the muscles to be sore.
Basically, a hypertonic pelvic floor is a constantly contracted pelvic floor. The pelvic floor is ideally elongated yet taut. It connects your sacrum to your pelvis and sits like a bowl shaped sling. It supports EVERYTHING I’ve got going on in there – uterus, bladder, bowel, etc. When it is constantly contracted, these organs are pushed up and under enormous amounts of pressure. It also means that I am pulling on my sacrum and my pelvis which, in my circumstance, has created a pretty noticeable anterior pelvic tilt. If you’ve ever watched my squat you will have definitely noticed this. If I had this issue in, let’s say, my traps, I would look like a hunchback. It would be MUCH more noticeable and probably wouldn’t have gotten to the point that I am at today as someone, somewhere, would’ve forced me to fix it. What we can’t see is often ignored – out of sight, out of mind. However, with natural movement and functional fitness, what we can’t see is perhaps the most important aspect of our movement.
I was diagnosed with a hypertonic pelvic floor by Dr. Susan Kellogg-Spadt at the Pelvic and Sexual Health Institute here in Philadelphia. How did she know? Well, first she applied pressure internally with her finger and OH MY GOD! I screamed. Literally, screamed. It was so painful. Dr. Susan then used a device to read my internal pressure. My resting score of 75 is what the average woman will achieve when tensing – my tensing score of 125 is what the average woman will achieve while delivering a child. Wait, what? Yes, you read that correctly – I am constantly feeling the same pressure of a contraction (admittedly significantly different in representation) every single time I tense my pelvic floor. Every squat I made, every time I tensed for a pull up, every time I rode a bike, every time I ran, my pelvic floor was receiving labor level pressure.
After visiting Dr. Susan, I was lucky enough to get an appointment with Dr. Perry of Stop Chasing Pain with two of my fellow CrossFit Center City buddies and our coach, Erin. Dr. Perry saw my issue immediately and also saw a very obvious expression of my hypertonic pelvic floor – I have an incredibly uneven squat. Without any weight whatsoever, I tend to the right when going down. Dr. Perry’s analysis is that I do this because my pelvic floor is turning off my right QL, right gluteus medius, and TVA which in turn makes my right side pretty much useless. If I can turn these muscles on I can be lifting SO MUCH MORE. Dr. Perry is an amazing man and I will probably get into more detail regarding my visit in another post. For now, just know that Dr. Perry and Dr. Susan both saw my hypertonic pelvic floor- one through a more traditional OB/Gyn exam and one through a much less traditional assessment focusing on movement.
I am currently attending Physical Therapy to help release my excessively intense pelvic floor. I am 3 weeks in to an 8 week series. I am seeing small gains and am MUCH more aware of my pelvic floor and when (and why!) I turn it on so frequently. More posts about PT will follow, I am sure!
So, other than a whacky squat, what else does a hypertonic pelvic floor do to you?
Well, a hypertonic pelvic floor can affect a LOT of your life from an inability to reach orgasm (your clitoris goes through your pelvic floor – an orgasm is a spasm of you pelvic floor. Boom.), your ability to hold your pee (double unders, anyone?), your ability to have correct, natural posture (anteriorly and posteriorly tilted pelves are a direct result), hip mobility/stability, weak core stability, weak overhead/upper body strength (pullups!), as well as “Pain upon penetration, soreness, “pressure in the vagina,” pain upon sitting, tightness, throbbing, aching, stabbing, “spasm, ” urinary frequency, hesitancy, incomplete emptying, constipation, rectal fissures, generalized vulvar burning.” UGH. http://www.sexualmed.org/index.cfm/sexual-health-issues/for-women/hypertonic-pelvic-floor-muscle-dysfunction/symptoms/
In general, a hypertonic pelvic floor means that something else is turned off. If your pelvic floor, like mine, is always facilitated (read: “turned on”) then something somewhere else will be inhibited (read: “turned off”). For many of us, this means our transverse abdominals (TVA) are not active and doing their job. They are not in sync with the pelvic floor and are therefore misfiring. Without an active and facilitated TVA, we have no stability, minimal strength, and (probably) poor posture and low back pain. When contracted, TVA will lift the abdominal wall up and back toward the spine. This will give natural space between lumbar vertebrae (expressed as a natural lumbar curve) as well as put my glutes in a position to turn on. For me though, my TVA has an incredibly difficult time turning on because my pelvic floor is taking all that energy. When I think about turning on my TVA, I usually wind up “sucking in” as do most people. Sucking in though, generally causes a flat lumbar area and a posterior pelvic tilt (tucked in) which is the total opposite of the ideal position when the TVA is on.
One of the biggest questions that I had for Dr. Susan, Dr. Perry, and Erica (my PT) was WHY. Why me? What did I do? How did this happen? There are myriad ways for one to develop a hypertonic pelvic floor. Below are some of the most common and researched reasons along with my take on my personal experience with each.
· Chronic stress: Tension patterns in the pelvic floor used to be unequivocally linked to sexual (or other types) of abuse. However researchers are finding that the vagina automatically fires (tenses up) in almost any type of stressful situation. The vagina does this to protect the incredibly precious goods inside and this is a direct reflection of the fight or flight response. A fight of flight situation used to be rare for us humans but now, any stress will cause us to enter this mode. Watching a scary movie? VAGINA SPASM. Nervous about delivering a report? VAGINA SPASM. Trying to get a back squat PR? VAGINA SPASM. Weirdo guy walking a little too closely behind you? VAGINA SPASM. Chronic stinkin’ stress. Everywhere. All of the time. This is an easy one. I KNOW that I have chronic stress. How do I know? I am an American, that’s how.
· Physical trauma: Our pelvic floor is constantly used and takes a beating and in response tightens to protect the insides. Constant physical stress (load bearing), repetitive pressures (running , cycling, jumping – you know, like doing double unders) and blunt trauma can all cause a hypertonic pelvic floor.
· Excessive tension in the core: Tension is NOT strength. We know this – or at least we should. Sucking in your tummy is not the same as having turned on and engaged abdominals. Right? Right. So having excessive tension in your core from habitual tummy sucking (ahem, ladies), pilates (with its focus on core strengthening with minimal attention paid to pelvic floor release and stabilization), ab crunching, etc will lead to a messed up pelvic floor. Movement and health professionals know that the pelvic floor and core fire together. It is important that the timing and force production are synced up and when you do these sorts of activities, you are messing with the timing and force production. “Most people have replaced deep, abdominal activity with “sucking their stomach in”, and think they are constantly using their muscles. In actuality, the sucking in motion is a pressure (like creating a vacuum) that pulls the abdomen’s contents up (not in), displacing the guts up against the diaphragm (hiatal hernia, anyone??). You get a flat stomach that looks fantastic by the pool, but you also get a tucked pelvis (do we need to talk more about where pelvic floor disorder comes from?), no butt muscles used when walking, no real work done in the abdomen, and excessive friction in the lumbar spine, hips and knees. That friction is called Osteoarthritis.” - See more at: http://www.alignedandwell.com/katysays/what-a-waist/#sthash.k5pcbvGe.dpuf GA-ROSS. I have been an expert tummy-sucker-inner since 13 or so. Never a skinny girl and rarely a fit one, I turned to sucking in to feel good about myself. Learning to un-suck and let my tum just BE is one of the hardest parts about this rehab. Ladies and gents, let your tummy go and be kind to your pelvic floor, please.
· Unhealthy surrounding tissue: Trigger points, points of extreme tenderness or out of place “lumpiness” in the specific parts of the body are common in those with hypertonicity of the pelvic floor. That is, if you have extreme tenderness in your lower back, IT band, ab-and adductors, then it is probably worth investigating your pelvic floor. The picture below highlights some of the more common areas that can tip you off to a hypertonic pelvic floor. I was having pretty terrible IT band issues and also some pretty acute lower back tenderness. I originally thought this was because I was running and therefore took it as a sign that I was not “meant to run” which is not true. I am just meant to run CORRECTLY and having a fully functioning, taut-yet-relaxed pelvic floor will allow me to do just that. Pain is a sign that something else is wrong. Listen to that pain – it might just tell you something really really useful!
I fully intend on updating this blog with more things that I learn along the way and trying my best to bring some useful and relevant information to you!