Pelvic pain & beer guts - opposing ends of the spectrum with a common solution (part 2)
Part 2 - WHAT DOES BREATHING HAVE TO DO WITH PELVIC PAIN AND BLOKES WITH GUTS?
If we dont breathe well, we won’t use our abdominal muscles well, simple as that.
The graphic below gives an effective understanding as to how your diaphragm and pelvic floor (and the rest of your abdomen) interact.
When (and if) we effectively inhale, our diaphragm moves down and our abdominal muscles soften and stretch out. This includes our pelvic floor and all the deep abdominal muscles and is particularly applicable at rest.
Furthermore, a muscle called your psoas, which originates on your spine and attaches to the top inside of your femur (lesser trochanter), is affected by our respiratory strategies and has an acute effect on our hip and spine mechanics. There is evidence to suggest that the psoas has an acute relationship with your diaphragm and ultimately, your respiratory function. A chicken or the egg scenario.
What’s important for you to consider is the entire system of your diaphragm, psoas, pelvic floor, rectus abdominis and the movement of your trunk in general.
This is where the ends of the spectrum, when it comes to pelvic pain & blokes with guts, meet.
First and foremost, it has to do with a concept called “tone”.
Not the tone you read about in magazines or use to define lean individuals.
Conceptually, tone involves the neural impulse from your brain to muscles. If you tense your bicep, your bicep will have higher “tone”, if you relax, lower tone.
When your muscles feel tight, they will generally be holding tone.
Often it can be/feel problematic, for example, the tight neck and shoulders we feel may be caused by them sitting in an overly lengthened position as well as over use by poor respiratory strategy, as discussed above (breathing upward rather than downward).
As we consider the tone of the muscles described in the system above, the relationship between women's health and blokes with guts emerges.
Large guts & abdominal cavity tone.
The image below gives you an understanding of what a protruding stomach does to your superficial abdominals & your psoas major.
These muscles, now pulled in to length through postural positioning and excessive non-functional mass (subcutaneous & visceral), will now generally hold increased tone to resist further lengthening. Along with this, the superficial muscles of the abdomen will hold tension to resist “unnecessary” lengthening/instability.
If you’ve ever wondered why “beer guts” tend to be so hard, it's generally related to this theory, increased tone consistently (so we don't completely lack integrity/stability at the spine and pelvis).
Not only do we have an increased abdominal tension/tone, we now have a “bracing” strategy everytime generate force or require stability or movement from the trunk.
The classic stiffening & breath hold of someone with a large “gut” getting up from a chair comes to mind.
This is a reinforcing pattern of increased stiffness and bracing leading to the evils of some of the symptoms described above (haemorrhoids, herniations, rectus diastases specifically).
Moreover, when thinking about the relationship between diaphragm, abdominal & pelvic floor, these individuals are typically stuck at the bottom of their “inhale”.
Their diaphragm hardly moves up and down when they respire leading to faster and more shallow respiration strategies (and we know how ineffective that is from a use of lungs perspective).
Additionally, their ability to voluntarily recruit their pelvic floor muscles is generally poor leading to a cascading effect on movement strategies including compromised transverse abdominals recruitment, poor stability & control of lumbopelvic spine, erectile dysfunction and so on.
As you keep following the path of compromise from a movement perspective, typically these individuals would then present a poor ability to generate force from the hip (it's very hard to arch your lower back and squeeze your glutes) leading to an tightness/overuse of of lumbar extensors, hamstrings, calf and groin muscles.
Associated soft tissue injuries include osteitis pubis, hamstring tears & tendinopathy, calf strains & achilles tendinopathy. I won't even go into the potential effect it has on joint stress of the hip, knee, ankle and foot.
Cast your eye to the upper body and you’ll notice a slightly hunched/rounded upper back from potential lifestyle exposure (sitting, driving, mobile phones) but more concerningly from a breathing strategy perspective - the lack of movement of the diaphragm and lower part of the rib cage sees these individuals revert to the “upward” breathing strategy described above.
As a reminder, shorter shallow breathing is related to increased stress states. Increased exposure to “stress” is one of the leading causes of CVD & cancer and may happen as a result of our movement mechanics (not just lifestyle).
It is this breathing strategy in which we see the similarities between the pelvic pain/women's health related issues & “blokes with guts”.
What about pelvic pain?
And so now, let's dive into the mechanical details of our typically younger female counterparts that have to deal with pelvic related pain and other potential women's health issues on the other end of the mechanical spectrum.
Firstly, when we consider the typical traditional posture of females, the societal norm involves a tight stomach and “crossed legs” for many reasons including clothing (think leggings & tights on the muscle of the abdomen and skirts/dress on the crossed leg internal rotated femoral & hip positioning) and general societal dialog passed down through generations (“pull your tummy in, sit up straight, cross your legs etc.”).
I encourage you to consider the mechanical wash up chronic exposure to such postures has on the body and movement in general.
If we consider the fascial system, the deep front fascial line plays host to the adductor group, the psoas and deep hip flexors ultimately influencing the diaphragm, pelvic floor and entire deep abdominal system, as discussed above.
If our femur is chronically internally rotated & adducted (think crossed legged or inner thighs squeezed together), we’ll see an increased tone in the entire adductor group with limited movement capacity in the hip as a result.
Add on a narrow waist (because it's unladylike to let your belly push out) and you have this incredibly high tone, tight system with a limited movement and recruitment capacity at the abdomen and hip muscles (as a start).
Irrespective of typical pelvic & lumbar spine positions (anteriorly or posteriorly tilted) or movement exposure, this increased tone at a base level puts us in a compromised position from the outset. This is before we put training, neurological or psychological related stress on the system which only increases neural tone (tightness) of the muscles in this region.
So what does this have to do with pelvic pain?
During menstruation, your uterus contracts to help expel its lining, prostaglandins trigger the contraction of the uterus and higher levels of prostaglandins are associated with more-severe menstrual cramp symptoms (pelvic pain). This contraction of the uterus, with the accumulated high tone/stress in all the surrounding muscles as discussed above, is where the relationship of pelvic pain and postural and musculoskeletal tension becomes apparent.
Furthermore, as identified in our “blokes with guts” counterparts, this narrow high tone, tight waist and poor moving abdominal cavity leads to compromised breathing strategies in which the diaphragm doesn’t “move down” on inhale, the lower rib cage lacks expansion driving short shallow respiration strategies.
As we know the wash up effect is less efficient gaseous exchange, reinforcing stressed neurological/psychological states resulting in a potential spiralling effect on the entire system with potentially catastrophic outcomes.
Where it becomes psychologically complex, is the issue at hand is closely related to body image and female perception of their body and their bodies position in space.
The commonalities between the two are compromised respiratory strategies.
Part three of this series will go into potential solutions to the mechanical problems presented.