How Pelvic Floor Physical Therapy Unlocked My Movement Patterns
By Dominika Borovansky Gaines
I have been engaged in practicing and studying movement most of my life and have been a conscious and mindful movement practitioner for over 30 years. I’ve studied classical and contemporary dance and dance pedagogy, Pilates as a student and trainer, Ideokinesis and Mindful Movement™, Alexander Technique, dabbled in Hanna Somatics and Feldenkrais, studied Whole Body Alignment through Nutritious Movement®, am a GYROKINESIS® Pre-Trainer and GYROTONIC® Master Trainer, and a Z-Health® Practitioner. I’ve worked with massage therapists, energy healers, myofascial therapists, had Rolfing sessions, and had numerous very talented movement coaches. Each and everyone these modalities and experiences have helped me to have a deeper awareness of anatomy and biomechanics, bone rhythms, breathing, myofascial tension patterns, gait and neurology and unravel some part of my scoliotic posture and movement tendencies.
I intuitively and intellectually know that the body is an own ecosystem and that every part is connected to every other part. However, my recent experience with Pelvic Floor Physical Therapy (PFPT) has been a game changer. I’ve understood for many years that the pelvic floor is an important player in breathing mechanics, abdominal function, hip health, lower back pain, foot issues, and chronic neck issues. What I didn’t realize it just how much the chronic holding “up” of my own pelvic floor is the reason for many of my movement patterns.
My Pelvic Floor PT journey began earlier this year when I visited a PFPT to assess why I was experiencing chronic discomfort, including new sensitivity of an old scar, itching and micro-tears of my tissues which could bleed and burn. She noted my tendency to hypertonicity, diagnosed me with possible Lichen Sclerosis and noted the extreme tension on the left side of my perineum and intervaginal spaces. After visits to a gynecologist who specializes in dis-eases of the pelvic floor and subsequent surgery to remove pre-cancerous cells, I am healing well. (To read more about this experience, go here.) However, I now have a sizeable mid-line pelvic floor scar that was rather unyielding and irritated by the multiplanar movement I spend a lot of my time teaching and practicing.
In late June I began to work with a Pelvic Floor PT regularly. To say that I have had my “mind blown” is an understatement. Our first session was a physical exam checking for tonicity of the PF muscles, endurance of musculature while holding a Kegel, differentiating PF from gluteal muscles and then some manual scar stretching. I’ve always known that I am a bit of a “tight-ass” but this session revealed just how much I engage my glutes as part of breathing and movement. Having external pressure against the tissues and being able to relax them was my first AHA. Following the manual work, my PT had me do supine foot work on the Pilates Reformer; I have honestly never felt my lower abdominals, especially the transverse abdominus, so well engaged! As I walked out of the clinic, I felt the tightness at my right sacroiliac joint from my overworked back muscles, yet my jaw felt freer. I was experiencing a re-balancing of my entire system from this work directly at my most central mid-line.
Each subsequent session with my PT has led to more and more discovery. My therapist has given me stretches for the pudendal nerves to alleviate itching sensations, squatting while doing Kegels to experience the coordinated rhythm of the breath and pelvic floor, and dynamic lunge sequences to create awareness in motion. However, it is in the manual work where I continue to experience the most connection.
I have had a chronic back of left knee pain that was possibly a Baker’s cyst; it felt like a tendon was trapped and inhibited my ability to flex my knee fully. During our second session, as my therapist worked on my left PF, I felt the connection from my there to my knee. This was most likely a pudendal nerve entrapment issue. I now have full range of motion in my left knee without pain and my squat has gotten deeper and more easeful.
Child Pose has been a challenge for me most of my life. I always thought it was the tightness of my hip flexors and quads that prevented me from relaxing into this position. Now I understand how much of an issue my pelvic floor tension has been in accomplishing “rest” in this pose.
I no longer have urinary urgency. Prior to this experience, I would need to empty my bladder almost every hour in the first half of the day. I know that this is a stress response. As my PF has relaxed, so has this need and I now visit the restroom about every 3-4 hours.
When we hold the pelvic floor in chronic tension, we are in a “startle” threat response. I have been “ready to run” from (perceived) threat for most of my life. I have also found myself in “freeze” and unable to move away, bearing the threat. (Interestingly, it is my right side that wants to “flee” and my left side holds ground.) As the tension in my PF has lessened, so has my emotional reactivity. I am more able to respond to meet the needs of my close family without being defensive.
Stretching on either side of my PF releases my jaw tightness. I’ve had TMJ and wear a night guard to help with bruxism. This has improved and I have less clicking on the tighter side.
My eyes are more relaxed. My peripheral vision has improved scope and I wear my readers less frequently.
I am breathing more fully and deeply. I am able now to talk while teaching and moving aerobically without as much hyperventilation and the accompanying neck and shoulder pain.
I am becoming increasingly aware of my postural habits, such as clenching my lower glutes while bending over the sink, tightening one side or both sides for stability in standing, clenching when angry or frustrated, holding tension when anxious. None of these things are inherently bad; rather it is the accumulation of the pattern—the chronic tension-- and that I rarely take the time to fully release them.
We had a couple appointments where the work has been around the muscles of the coccyx and ischia. Even more than the earlier scar work where I became aware of how habitually I activate my glutes, having work done in the posterior pelvic floor has been profound. This particular series of sessions has helped me to release some long-held physical and emotional trauma, a benefit of which is that I am not so reactive to stressors as they occur—which might have sent me in to a “tailspin” in the past. (There is always a reason why our body has the posture and tone that it does!) My plan is to continue to see the therapist on a monthly basis to assist me in maintaining my newfound ease.
In my most recent session, which was following a several week break, my (new) PT did a pelvic exam and then began working on stretching my “tight” spots. Once again, the application of pressure allowed my tissues to unwind and release. As the tension let go, I felt other areas of my body respond: my lower back released and sacrum felt wider, the back of my neck softened and occiput felt more broad, my diaphragm expanded. After the session while I was driving home, I was aware that my upper palate was more arched and wider too and I felt my tongue differently. Yet, again, I am awed at the interconnectedness of our ecosystem.
As someone who thrives on embodiment and lives for the joy of movement, I am truly relishing this experience. I am inspired by what I am learning personally, which always fuels my work with my clients. As a movement practitioner and coach who sees so many chronic pain and postural issues, I now realize what a critical role this too-often-ignored part of the body plays in integrated, functional movement.
I cannot recommend pelvic floor PT highly enough—for everybody, and for any reason!