How's Your Pelvic Floor?

Not everyone looks this good with a pelvis on her head:
Katy Bowman rocks the look and the pelvic floor advice.

It's been more than a year since I interviewed Katy Bowman, biomechanical scientist extraordinaire and founder of the Restorative Exercise Institute. In that post, "Pelvic Floor Party: Kegels are NOT Invited," you might remember, I asked her about Kegels, expecting to hear something insightful about alignment. Instead she informed me that too many Kegels can actually cause pelvic floor dysfunction, and she said that deep, regular squats were the answer to pelvic floor strength. From that day forward this blog (hello to any of the 70,000 visitors who discovered Mama Sweat by reading that post) and my pelvic floor hasn't been the same. To be clear, both are better for that discussion.

Katy and I wanted to check in with each other via our blogs (you can read her interview with me here). A lot has happened in a year. Katy's biggest news is that she became a mom herself. Her site should be required reading for anyone thinking about thinking about becoming pregnant. She is also gestating a few books. But I'll let her explain...

KARA: OK, smarty pants big-brain biomechanical scientist... Now that you've been pregnant and birthed a super-adorable human does the real-life experience change the text-book experience? That is to say, were there any surprises about pregnancy and postpartum? You have fantastic info for pregnancy and postpartum moms on your site, does it change at all now? (And how many different ways can I phrase that question?)

KATY: I'm glad you called me smarty pants big-brain as opposed to big-pants smarty brain. I DID have a wonderful birth, at home. (In fact, he's looking at me now, all nestled in his very own bean bag chair, wondering why I am typing on the computer instead of cooing at him all the time which is what I am usually doing.) I am also super-happy to say that I gave birth au naturel. Well, I wasn't super-happy at the time because MAN that was some intense sensations (WTF!) 

KARA: I know, huh? A little like hanging over the crater of a volcano and just when you think you might fall in you heave yourself back over the top. And while as unbearable as it could possibly be the exhilaration prevails. It's some kind of awesome. A reward in itself, along with the baby, of course. And from what I can tell, you got yourself a cute one. I hope he got your brains, too. But what I really want to know is what did that big-brain cutie pie baby do to your pelvic floor?

KATY: In regards to my pelvic floor (hey, thanks for asking about my perineum) I didn't have a tear or a rip or nada. So, no, I wouldn't change anything about my pregnancy prep, which, of course, includes alignment throughout my pregnancy and lots of correct pelvic floor use via my glutes.

KARA: And all that pregnancy pre-birth prep will soon be found in a great prenatal package through the Restorative Exercise Institute, and I might add is much more useful than knowing how the size of your embryo at different weeks compares to various types of fruit. Like a good scientist you tested all that great information out on yourself. Thanks for that scientific contribution. Any observations to share?

KATY: Well, I'll have to admit that, I WAS NOT PREPARED for how birthing felt afterward. I truly believed I would feel up to going to go hiking the next day. Turns out that a cough or a sneeze was causing panic--my body was that out of whack. It is amazing to think that, in a few hours, you can totally lose touch with a part of your body. I guess that's what happens to the pelvic floor and the core muscles after delivery. And I was glad that my pelvic floor wasn’t super-tight, fighting against me during deliver. That would have caused actual damage to the muscle, instead of just weakness due to stretching.

And, fun fact: It took me about four weeks to be able to Kegel and find these muscles.  Even then, it felt like my pelvic floor was in the other room. That’s a cool feeling...not.

So, professionally--while my pelvic floor info remains the same--everything else has changed. Like sleep. And my hair (chop). And other important things that I can't remember right now. Oh yah, memory. That's different, now isn't it.

KARA: What was the question again? I can't remember much anymore, either. I lose things all the time, too. But sometimes that's the kids' fault. Just wait till your adorable son starts taking off with your keys, cell phone and favorite lip gloss. But I'm getting ahead of myself. You're not chasing him around the house yet, but you ARE a Hot (Sweaty) Mama now and I'm quite certain you're finding ways to get your body moving. How have you been able to sneak in fitness so far?

KATY: Well, I made the mistake of opening my big hunter-gatherin' lovin' mouth and started quoting research about the peoples waaaay back and how women used to walk over 900 miles a year, carrying their babies, and that strollers were anti-alignment and natural strength (which is true, but...) 

So now in my quest to use my human body in the way it was designed to be used, I carry this kid all of the time. That is a huge workout. That, and I haven't driven my car in two months, which means you can find me walking 3-5 miles a day running my errands while working out my arms. Which are buff now. (Hunter-gatherin' Bonus!)

Because I am walking tons, my glutes and legs are super-strong. My arms and abs are super strong carrying the little man. The one piece of fitness that was totally lacking was the stretching part though. And I am a stretching freak (strength is all about those muscles being the right length, after all.) So, after reading your book I realized that I was not going to be given a magical Why-Don't-You-Go-Take-A-Yoga-Class while I sit here quietly sleeping, not pooping or crying or needing you (and that's just my husband) moment. And I started stretching in one or two minute increments. And doing my exercises when and where I could--a squat here and there, a pull up when I pass by the bars. I even stretch my chest and shoulders (great for that breastfeeding neck tension) when I'm done changing the little man, he coos on the table and I stretch like this: 

Or, I lay him on my mat and do downward dogs over him, taking breaks from one-minute holds to give him kisses. And, P.S. I mean the kid, not the hubby.

KARA: Quick though--can I make an appeal here for the best way to carry your baby? I didn't figure out till the fourth kid that I needed a baby-carrying device that distributed the weight on my hips as well as back. There are certain carriers (like Ergo and Moby) that are so much more comfortable and functional. The carriers that just drape over your shoulder seem to cause more problems, at least they did for me. I'm sure you're right about the stroller, but there is a time, there is a place (says the woman who once had three children under 2). So, how can a stroller-pushing-mum save her spine/strength?

KATY: Well for starters, use the stroller to push the kids and not as a crutch. Remember when people used to hang themselves over the stairmaster? That’s what I see a lot of. Running with the torso leaning forward of the legs...really bad for the back and, funny enough, is minimizing caloric expenditure cuz you’re using gravity to help you fall instead of your muscles to push you forward. And there’s no BUTT muscles working in a woman fallin’ forward. You catch my drift?

KARA: You got into with a lot of Kegel lovers last year. Bottom line, what's your Kegel policy? 

KATY: My kegel policy is unchanged from last year as referenced in your post because it wasn’t my "opinion" as in "Hey! I like orange cats because they're pretty..." as it is a theory based on, you, know, the physics and physiology of muscle.  


KARA: Readers can learn all about that policy, by the way, in Katy's online course, "No. More. Kegels." 

KATY: In order for the pelvic floor muscles to function properly, long term, you have to (HAVE TO) have strong and supple gluteals and deep hip rotators (like your piriformis). When you are having a pelvic floor issue, yes, the pelvic floor muscles are weak, but most likely due to the fact that the opposing muscle group is affecting their ability to contract correctly, i.e. shorten and release.

So, I don't have a Kegel policy as much as I have a butt policy. It's called, Get One for optimal pelvic floor function. Now contracting your pelvic floor is something you need to be able to do. If you can't "find it", then you need to increase this motor skill, but any good physical therapist will be able to tell you that the research shows that people who can't contract their pelvic floor (a Kegel) is more often associated with OVER TENSE muscles, not under used ones. Unfortunately we've got people getting their health information from fitness magazines or reading the abstracts of research articles they don't thoroughly understand.

KARA: I think a lot of people (and I used to be one of them) believe the Kegel is something as easy as swallowing. We oversimplified it, and in doing so took some short cuts (the relaxing/stretching part) that rendered the exercise useless or even in some cases problematic. It's our sound bite culture. I also think a lot of women kinda resented being told to do them all the time. When the Pelvic Party Post happened last year, we (all females, everywhere) were in the process of a collective eye roll over being told to keep Kegeling when we intuitively knew that something wasn't right. Now we (all females, everywhere) are thumping our heads with the heel of our hand and saying, "of course!"

KATY: I agree--pelvic floor function has been oversimplified to “do your kegels” and really, you are talking about an area of the human body that you can study at the university level for YEARS. I was actually surprised by the number of people saying stuff like they didn’t believe that kegels could cause Pelvic Floor Disorder or that needing to squat was not research-proven. I don’t think people really understand what gets researched, what that research means, and how things not yet researched are not false. But, if your kegels work for you, then keep doing them. For those who are doing their kegels and still having problems, being open to new science-based theories are a good idea. And from the volumes of positive feedback, I am so glad you ran the post Kara.

KARA: Those Kegel posts got the attention of a lot of people for sure and I hear a book deal for you. How did that come about?

KATY: Well, the phone rang and a publishing fairy said "can I pay you to write down a bunch of stuff you love to write about?" It was amazing. And then the fairy gave me one million dollars, which was exciting, because I got into pelvic floor science to make money and not because women's health was my passion.

Just kidding.

I actually just finished writing "Every Woman's Guide to Foot Pain Relief: The NEW Science of Healthy Feet," in which I allude to the fact that your Pelvis is attached to your thighs and your thighs to your knees and feet, so you should start down at the bottom. The next book on Pelvic Health via da Butt and correct gait patterns (not via Kegels) will actually be a self-publish on Amazon. 

The publishers I talked to said that they thought people weren’t really interested in the pelvis. And then I said, “you mean the 80 percent of the population who will eventually have a pelvic floor disorder aren’t interested?” and then they hung up the phone. No, really, I just decided that women need this info NOW and not in a couple of years by the time a book gets published. Soon you can just download it. Bam. Isn't technology amazing?

And, by the way, if any of you readers would like to submit "your story" of how your switch from Kegels to squats, or doing the "Down There" exercises from my DVD helped you with PF or hip issues, I would love to include it in the book. And, if I use your story, you get a free copy! Does that motivate you? How about if I sign it. How about if Kara signs it too?

KARA: You're getting my squat story. Where should we submit them and what's our deadline?

KATY: You can share your story on the "Pelvic Floor Party Anniversary Special" post on my blog and I will be taking your stories through the end of August.

KARA: While there has been a lot of pelvic floor talk on my blog this last year, Katy has been super busy answering questions and addressing issues. Here are links to a few of the follow up posts she did:

The Hunting and Gathering Mama

You Don't Know Squat

1234 We Like Our Pelvic Floor

And the conversation continues between Kara and Katy over at Katy Says! How have those squats worked for you?

Everything I know about pelvic floor health is posted on my website, www.lifeasafitmom.com.