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avoiding overuse injury

Pelvic Floor Health in Hypermobility

Pelvic floor function in hypermobility is a big topic. Leave me a comment below if you have ever had issues with your pelvic floor tissues. It comes up a great deal with my clients. Many hypermobile people experience a hypertonic pelvic floor with often debilitating symptoms. Both women and men. The pelvic floor can often try to act as a trunk stabiliser all the time. This leads to tightness not just in the pelvic floor but with all it’s close relations like the hip, low back and abs. In turn this presents as tightness and pain. Recent research from Australia has shown a tight pelvic floor can lead to SI joint issues, which makes perfect sense due to its intimate connection.

If you follow me on social media, you will know I’m not a fan of ‘core’ training in the ‘traditional’ sense of pulling belly button in and pelvic floor up to exercise. The last thing someone with a hypertonic pelvic floor needs to do is more gripping and sucking in. We are so often diagnosed with pelvic floor weakness. We are instructed we need to strengthen and tighten the pelvic floor muscles. And yet we actually need the opposite so that all the surrounding structures can learn to glide happily together. We need to unwind the pelvis and teach it that it is safe to move. This takes time, as you are dealing with some of the deepest muscles – be patient and gentle.

Here’s my personal story of my pelvic floor issues. After the birth of my second son, things started to change. Let’s just say running and jumping was out of the question. I felt weak, out of control and extremely upset. My GP sent me for women’s health physio. I was given pelvic floor exercises that involved squeezing and holding in the pelvic floor. I did these religiously three times a day for weeks.

At each appointment, I would be strapped up to a machine and pelvic floor strength assessed. Every week I got worse. Every week I got more upset. I was discharged because the physios didn’t know how to help me.

Thankfully I found a pelvic floor expert a three-hour drive away. She diagnosed a hypertonic pelvic floor. No wonder I was getting weaker. The more I squeezed and pulled up my pelvic floor, the more fatigued the muscles became. They couldn’t support me. The muscles gave up.

But at last, I had an answer. Pelvic floor exercises that contract may not be the right strategy. I didn’t know I had EDS then, but I now see this pattern a lot in my EDS clients too. Many people with hypermobility and EDS end up with imbalances and pain caused by a hypertonic pelvic floor.

The strategy to a healthy pelvic floor (and now I can run – see my very proud photo) was 1) unwinding the pelvis, 2) treating all the muscles around the pelvis with mobility and stability and 3) breathwork. Breathing was a game changer. For a hypermobile body, bracing or guarding is a common occurrence in daily life. This inhibits the breath. I call this guarding false stability because either we think it’s helping, or we are not even aware we do it. To be told to brace or guard more before doing an exercise is going to lead to more tension and pain. That’s why I never tell my clients to pull in their abs or ‘activate their core’.

Learning the intimate relationship between the diaphragm and the pelvic floor, learning not to guard or brace my abs or glutes, re-learning correct belly breathing. To belly breathe, we must learn to expand the thoracic spine first.

I have several videos on breathing over on my YouTube channel if you’d like to explore the power of your breath too.

8 Comments
  • Bonnie Southgate
    Posted at 11:18h, 15 March Reply

    HI Jeannie,
    It would be great if we could meet and have a good chat one day. I definitely agree that a number of hypermobiles have very held and have hypertonic over active pelvic floors. I also find this in the normal population. I can see it now when I look at my clients. I was taught to assess this in Nuero kinetic training a number of years ago. I think it partly goes with the sympathetic overdrive, and poor breathing patterns as you have said.
    I however am the opposite. I have had three children , was told by my Pilates trainer Susanne Scott not to ever cue pelvic floor. I tried not to due pelvic floor exercises when doing Pilates, but ended up with multiple hernias and a prolapse. I knew I felt way better when I did recruit my pelvic floor but it took some time to really work out how to do it correctly. It was a game changer for me. My proudest moment was going on a pelvic course with Diane Lee in New York. I was the only non gynaecological physio in the room and we used ultra sound to look at one another. She declared I was the only one in the room who had a proper functioning pelvic floor and TVA which let me know what felt right and what I had been doing was correct.I do not suffer with many of the commorbidites, but I suffered more with dislocations and was seriously unstable. I don’t think I have found anyone bender than myself yet. It just goes to show how individual Zebras are and how important it is to treat each one individually.

    • Jeannie Di Bon
      Posted at 08:59h, 17 March Reply

      Thank you for taking the time to reply and sharing your personal experience. Always happy to chat and discuss.

      Yes I agree, every zebra is different – I see around 20 different people a week in my clinic with EDS, HSD or symptomatic hypermobility. And everyone needs different things and every session is different.

      There are some common themes however and seeing this many people a week, I do see a tendency towards the hypertonic pelvic floor. This is what has informed my work and research. We of course want the pelvic floor to function, but in a natural way in response to the load being put through the tissue, rather than mechanically contracting it prior to movement. This is what I teach my clients and it has proven to be very important for them.

      Lederman’s paper on the contraction of so called core muscles is also a useful read. I also discuss this more in my book Hypermobility Without Tears if you’d like a read too.

  • Maria
    Posted at 09:45h, 17 March Reply

    Thank you for an interesting post! Does it mean that the use of Kegel balls can lead to unwanted results if one doesn’t have any specific pelvic floor issues?

    • Jeannie Di Bon
      Posted at 16:45h, 23 March Reply

      Not necessarily. I think Kegals are sometimes required – especially after pregnancy or pelvic operations – but they are a short term solution. Ideally we want the pelvic floor to begin working naturally in response to its demands. I’m not sure why we would do them if we had not been told we definitely had a weak pelvic floor.

  • Kathleen Van de Velde
    Posted at 21:27h, 08 May Reply

    Hello, I also have EDS and i found you on YouTube and so i learned to relax my PF. Over 2 years ago i had to start with PFT and Kegel excercises. After a few times i developped Pudendus Neuralgia. Verry painfull. After a few months i stopped going to PFT. But PN didn’t go away. Thanks to you i now know how to try to relalx my pf.

    • Jeannie Di Bon
      Posted at 10:40h, 10 May Reply

      Thank you – I am glad you found the article useful.

  • Taylor
    Posted at 05:23h, 25 May Reply

    Thank you for posting this. I am a former ballet dancer and was diagnosed with hypertonic pelvic floor 8 years before my EDS diagnosis. I had been suffering with severe pelvic pain for at least 6 years before that, and though I’ve had EDS symptoms my whole life, my pelvic pain was one of my first really debilitating issues. It has been really confusing and difficult for me to know how to exercise or strengthen my body, knowing I have to work to convince my core to settle down. My hypertonia never really goes away, maybe because I went so long without being properly diagnosed. I think it is my body’s coping mechanism, and sometimes I think my whole body tenses up to hold me together. I’d be interested to know eventually if certain hypermobile subtypes are genetically prone to this, as this is common in my family. Thank you so much for posting about it.

    • Jeannie Di Bon
      Posted at 11:12h, 25 May Reply

      Thank you for your comment. I’m so glad the post was useful.

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