Doctor of Physical Therapy
Take a deep breath
We as humans know how to do a lot of things automatically, and breathing is probably the first one that comes to mind. However, not all of us do it properly.
That’s right! Some common things we do that aren’t great habits are constantly breathing through our mouths, not using our diaphragm properly, and holding our breath while lifting heavy things or exercising. Let’s talk about the mechanics of our breathing and how it can affect our pelvic floor, especially while lifting heavy things.
The diaphragm is a muscle that sits right below your ribcage and looks somewhat like an upside-down bowl or parachute. When we breathe air in, our diaphragm muscle moves downward to allow for lung expansion. When we exhale air out, the diaphragm moves back up and the lungs return to their resting position. The diaphragm is very important in maintaining overall pressure throughout the abdominal cavity and works very closely with the pelvic floor and core muscles to do this. With inhalation and exhalation, our pelvic floor moves downward and upward just like the diaphragm does, maintaining a balanced pressure system. So, what happens when this pressure system is disturbed?
Whether you’re lifting weights at the gym, doing low-intensity exercise at home, or lifting your kids every day, there is a good chance that you are influencing that abdominal pressure system. What most people tend to do is, as they go to lift something, they strain and hold their breath, contracting their core muscles. This can place excessive pressure and strain through the pelvic floor. This core contraction with heavy lifting is called the Valsalva maneuver. It is when our body uses built-up pressure to help stabilize our core while doing hard things. But this is not the proper way to perform the Valsalva maneuver. First off, here is something you can do to test your breathing mechanics and how you perform Valsalva: Find something moderately heavy to lift, like a chair or box. As you lift, take note of your breathing and the pressure in your abdomen. Are you holding your breath? Are you breathing normally? Do you feel lots of pressure in your pelvic area? Are you totally unsure of what is even going on? That’s all okay! There are things you can do to learn how to properly contract your core and your pelvic floor all while using your diaphragm to breathe correctly.
Let’s say you’re going to squat down to pick up a heavy box. As you squat down, take a deep breath in through your nose, letting your belly and diaphragm expand. Once you grab the box, you’re going to squeeze your pelvic floor (also known as a Kegel), suck your belly button in toward your spine to contract your stabilizing core muscles, and exhale as you stand back up. This is proper Valsalva! You are contracting your core and exhaling at the same time, maintaining a stable pressure system while also maintaining a strong core. The key is to exhale while you are doing the “hardest part” of the activity, all while maintaining the contraction of your abdominal muscles. And this takes practice! The same goes if you are lifting something above your head: do a Kegel, brace your core, and exhale as you move the object above you. If you feel that you are straining or holding your breath, maybe try all these movements without weight to practice the proper technique. Also, if you do not have pelvic floor dysfunction, it is not always necessary to do a Kegel before doing heavy lifting. If your pelvic muscles are strong, your body will naturally perform a Kegel while you contract your core muscles. However, if you are dealing with weak pelvic muscles, this Kegel helps to make that pelvic floor contraction more automatic when you are maintaining a stable core.
A very important muscle we want to strengthen while doing abdominal work and to help with overall core stabilization is called the Transversus abdominis (TA). This muscle acts as a corset, surrounding our entire torso. This muscle is key in stabilizing the core as well as the spine and pelvis. It helps to properly align us when we are doing difficult exercises, like deadlifts or planks. It also helps with functions such as bowel movements, posture, and childbirth by bracing the abdomen (as we talked about before, the Valsalva maneuver). When this muscle is strong, it helps to prevent low back pain, pelvic pain, and assist with pelvic floor function. A good way to think of contracting this muscle is to lay on your back with your knees bent up. As you inhale, think of a string pulling your belly button down toward your spine. This is your TA. Now, while you maintain that TA contraction, make sure to breathe comfortably through your nose. This can be difficult to do, so try to hold the muscle for 5 seconds and work your way up to 20 or 30 seconds! Practice makes perfect, and this is a muscle that is hard to isolate if you never knew it existed in the first place!
As you can see, breathing isn’t as simple as “inhale, exhale.” There are many other muscles at play when we breath, especially with activities we might not even consider strenuous. Don’t feel bad if this doesn’t come naturally to you when you first try it. It’s hard to rewire your brain and body to change something that comes so naturally. If you feel that you have trouble with pelvic floor weakness, core weakness, poor breathing and lifting mechanics, or all the above, the pelvic floor physical therapists at Apex Physical Therapy and Wellness can help you! We can watch you lift, observe your breathing, and teach you how to do everything properly so that your core and pelvic floor can function at their very best.