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The art of down training, then retraining then up training

Our women's health team in the Shire (Woolooware), Bondi Junction and Cammeray are very experienced in the art of downtraining then uptraining pelvic floors!


You may have already heard about the pelvic floor being “tight” however if you are new to this concept we will break it down for you before delving into the art of down training. The pelvic floor, like any muscle within your body has the ability to create tension and become what we can feel as ‘tightness’. This can happen for many reasons which is beyond the scope of today’s blog but an example of why your pelvic floor muscle can recruit more tension may be following an injury to your ankle where the stability of the foot is compromised. Whilst you are recovering from this injury, the body cleverly makes sure other muscles further up the leg take on the extra work load, wallah.. it’s started recruiting more tension in your pelvic floor to create further stability in the pelvis which will in turn help the foot.  

If the pelvic floor muscle is in a state of tension or tightness, we first need to unwind this with the art of down training. Learning how to switch off your pelvic floor muscle is crucial to improving your symptoms and best guided by our women's health physios in the Shire (Woolooware), Bondi Junction and Cammeray.  As the phrase suggests, down training is an art – there is a subtlety to relaxing a muscle – it cannot be forced or stressed into a relaxed state. In this section of your rehabilitation there may be elements of manual release work, stretching & visualisation plus much more.  

Once we have mastered the art of letting go of the pelvic floor it is now that we can truly evaluate your muscle control & function. For some, allowing the pelvic floor to be relaxed gives access to automatic strength & control which means your rehabilitation is complete. However for others the pelvic floor can now be unsure how to respond to load through your body without just creating the previous static tension.  

Here we see the art of retraining; the pelvic floor should work in co-ordination with day to day movements of your body. The first movement the pelvic floor should be co-ordinated with is your diaphragm. If you breathe well, your diaphragm descends down on an inhale breath and lifts up on an exhale breath; the pelvic floor should work in sync with this muscle and this is where your retraining journey may start. At The Physiotherapy Clinic the Shire (Woolooware), Bondi Junction and Cammeray our women's health physios look at your body holistically and it is at this part of your rehabilitation that you may find we look elsewhere in your body (if we haven’t already) – remember that earlier ankle injury I mentioned! 

We know that the pelvic floor should move and contract automatically through movements such as squats, stair climbing etc. and sometimes because of the position of your body, stability or restriction in other joints the pelvic floor may not be able to work optimally. Part of your retraining phase may not look like pelvic floor rehabilitation at all – but it all matters to prevent the pelvic floor winding up! 

Once you have mastered the art of a co-ordinated pelvic floor contraction and relaxation through different tasks you unfortunately may still be symptomatic. This tells us your pelvic floor needs to be stronger – and here comes the work out! Up training the pelvic floor involves gaining strength, like you would if you were working on building bigger biceps in the gym.  

Up training – or strength training – involves time and patience. The changes made to a muscle at a structural level can take a minimum of 12 weeks. But it is here, with diligence in your exercises that you will see the difference and build confidence in your body. 

As you can see, if your pelvic floor requires all 3 phases of down training, retraining and up training your journey to becoming symptom free may take some time but the feeling of having no second guesses or hesitation with your pelvis is all worth the effort! 

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