Many people that want to continue exercise without the implications of impact, joint stress, post exercise muscle soreness and overheating issues will prefer to exercise in water. This clientele group is usually also the population group that experience pelvic floor issues. It is well known that mature adults and certainly menopausal or post-menopausal women would also prefer to exercise in water because of the issues with ‘wetting themselves’ during land based exercise. Pregnant women and obese clients would also prefer to exercise in water for the obvious reduced impact benefit, but also because the pelvic floor is more protected in water. Lower back pain is also strongly linked with pelvic floor weakness and there is certainly awareness that water exercise provides a safer choice of fitness program for these participants.
It is clear, then, that water exercise has not only massive appeal for these population groups for the benefits of exercising in water, but also because of the potential pelvic floor issues that they will face with land based exercise. This provides water exercise instructors with a huge opportunity to provide much needed education, information and instruction on what is the pelvic floor and how to use it during the workout.
Teaching correct pelvic floor technique
A lifting up and holding action is desired when activating the pelvic floor inside the pelvis, and the muscles will work more effectively when the lumbar spine is in neutral.
In aqua classes, pelvic floor muscle exercises can be included in standing, cool down, stretching or postural awareness components.
Consider the following mental reminders:
- “Focus on lifting up your pelvic floor on the inside”
- “Drawing up inside, tightening around your front and back passages”
- “Imagine you are holding onto a full bladder and wind at the same time” (in whatever way you feel most comfortable saying this)
- “Breathe, don’t suck in the ribs and upper abdominal area (under the ribcage)”
- “Between contractions, it is okay to feel your lower abdominals tighten, but you shouldn’t feel tightening under your ribs or in your upper abdominal area”
- Guide them through relaxing their pelvic floor after each contraction: It is also important to relax your pelvic floor and you should feel your pelvic floor muscles release completely. If you don’t feel a relaxation, your pelvic floor muscles have fatigued and they have relaxed already. Alternatively, you may still be holding them tightly and you should focus on relaxing between the contractions. To check if the muscles are fatiguing, you can do a shorter contraction (e.g. 2-3 seconds). If you then feel the muscles relax, you will gain the awareness of your own pelvic floor muscle hold time, and be able to work on building that hold time up as your pelvic floor strength improves.
Land verses Water
Buoyancy
The effect of buoyancy decreases the gravitational forces acting through the pelvis and therefore a decrease in pressure on the pelvic floor with exercise compared with similar exercise on land. In fact, buoyancy does not simply affect the force of the internal organs on the pelvic floor, but also ‘floats’ the internal organs. Therefore, jumping and jogging exercises that would normally not be recommended for land based activities are still appropriate in the water. This is of particular benefit for people who are pregnant or obese. There is a precaution here – this depends on how jogging is performed.
Fast verses slow
When performing either a fast or slow jog, there are marked differences between the two activities. Similar responses were also found with other exercises, for example, cross country ski, jumping jacks and kicks. What was discovered with these classic aqua moves was that when they were performed with speed and consequently more turbulence, the pelvic floor responded by lifting and engaging with the transverse abdominals to create a stable torso. Slower rebounding actions created more force on the pelvic floor and thus causes more pelvic floor stress. This can be problematic for those whose pelvic floor is weakened.
Buoyancy equipment
Dumbbells, noodles, kickboards and buoyancy belts
There are benefits of using buoyancy equipment like dumbbells and noodles. When pushing equipment down into the water, this is an ideal time to focus on the pelvic floor and lift in correspondence to the resistance being felt in the upper body.
Any exercise that uses the equipment to float the body in the water has no negative effects on the pelvic floor and is recommended as pelvic floor appropriate activity. These exercises can help increase both muscular strength and endurance and can also be used for cardiovascular conditioning, making them ideal for anyone with pelvic floor issues.
The only item of buoyancy equipment that has potential issues is the buoyancy belt. This wraps firmly around the waist to help support the body in the water to do suspended exercises. Like most corset-like garments and weight training tools such as weight belts, this has other implications for the pelvic floor.
Buoyancy belts are required to be worn tight against the mid-section, otherwise they float off the body. This tightening through the mid-section, coupled with the decreased lung capacity which can encourage smaller sips of breath and breath holding, will create downward pressure on the pelvic floor. Most programs will have the belt in place for up to 60 minutes, so the length of time will also create fatigue in the pelvic floor.
To be able to continue participating in deep water programs, ankle cuffs or using a noodle under the body or arms is recommended.
Depth of water
The depth of water that an individual exercises in can greatly impact the force placed on the pelvic floor. This relates to water exercise programs where the feet are required to stay in contact with the bottom of the pool. Exercising in hip to waist depth creates the most amount of impact on the body as well as creating the greatest amount of downward force on the pelvic floor.
Chest depth is the ideal depth for effective cardiovascular and resistance training in the pool, though moving to shoulder depth will provide the greatest protection for the pelvic floor. It should be noted that at this depth, the cardiovascular effects may decrease slightly but the focus is on maintaining exercise whilst providing appropriate support and protection to the pelvic floor until strength and endurance is regained.
Written by Marietta Mehanni., fitness leader and Pelvic Floor First ambassador.
References:
Bump, R C; Hurt, G; Famtl, A and Wyman, J (1991). ‘Assessment of kegel pelvic floor muscle exercise performance after brief verbal instruction’. American Journal of Obstetrics and Gynaecology. pp 322 – 329.
Sapsford, R R, Hodges, P W, Richardson C A, Cooper, D H, Markwell, S J and Jull, G A (2001). Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourology & Urodynamics, 20, 31-42.
Thompson, J.A., O’Sullivan, P.; Briffa, K.; and Neumann, P. Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. International Urogynecology Journal 2005; 16: 285-292.
Thompson, J.A., O’Sullivan, P.; Briffa, K.; and Neumann, P (2006). Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva manouevre. Neurourology & Urodynamics, 25, 148-155.