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Finding Your Root:

Balancing Your
Foundational Core and the
Pelvic Floor Muscles

A Yoga U Online Course
with
Leslie Howard


Transcript, Session 2








Eva Norlyk Smith: Hello everyone. This is Eva Norlyk Smith with Yoga U Online.
Welcome to session two of our two-part online course with Leslie Howard on
Finding Your Root Balancing Your Foundational Core and the Pelvic Floor Muscles.
As we saw in our last session, Leslie is a long-term Iyengar-trained yoga teacher
with an impressive knowledge of the common pelvic floor issues many people
struggle with and how yoga can help. Leslies own story and her work helping
people with pelvic floor issues is a wonderful example of how learning about our
body and how it works, often can help us take greater charge of our own health.
And most encouraging of all, Leslies experiences working with people and
participating in a study on yoga for incontinence shows that the normal process of
aging may not be so normal after all, and that many problems can indeed be
prevented or even reversed, particularly when it comes to pelvic floor issues.

In our last session, Leslie looked at the almost epidemic of pelvic floor issues in both
men and women and discussed the basic anatomy of the pelvic floor as well as the
most common issues people struggle with. In this session, Leslie will review the
pelvic floor muscles and the core muscles and explain how they work together in
synchrony to form our foundational core. She will show how evaluating, stabilizing,
and connecting with this core is a key to preventing or improving conditions related
to the pelvic floor. I will turn the mic over to Leslie. Leslie, welcome.

Leslie Howard: Thank you, Eva. Thanks for having me back. Im very excited
about tonight. So I want to review a little bit of the pelvic floor muscles. I
inadvertently did not say the names of the first two layers of the pelvic floor last
week so I wanted to spell them out this week. The first layer is the
bulbospongiosus muscle. The second layer is the transverse perineal muscle. And
the third layer is the levator ani.

Today were going to review what is the core, where is the core, and how the core
and the pelvic floor relate to each other. So looking at this slide, again, I want to
review the muscles. So the first layer, remember, is the figure eight muscle. So if
youre looking at the slide straight on, its vertical from top to bottom and creates
the figure eight that goes around the vagina in the female body and around the
anus in the female and male body. In the male body, obviously instead of the
opening for the vagina, theres connective tissue and thats where the scrotum fits.
So the first layer looks like a figure eight both in the male and the female body.

The second layer sits directly on top of the first layer (so on top meaning going




towards the head), is that muscle that you see going left to right. And that is the
transverse perineal muscle. So those two muscles (layer one and layer two) connect
at the perineum. The perineum is considered the area behind the genitals and in
front of the anal sphincter. Thats the area that Ill talk a little bit more about in a
few minutes how to access that area. I just also want to review the third layer,
levator ani. So in this particular slide, you can only see the bottom part of the
levator ani. If you look to the left and the right of the anal sphincter, youll see the
beginnings of that. Well also have a better view of that.

So how do you find your perineum? I put a photograph of a rolled belt here, this is
a yoga belt. Its rolled up to be about a one inch diameter. And what I find is very
helpful is if youre sitting in a symmetrical position So that could be sitting in a
chair, Virasana is one of my favorites to access this in, and you put the rolled belt
on the rounded edge, not the flat edge, so that its pushing up a little bit into the
perineal area. This helps you distinguish between the anus, the genitals, and the
perineum. And this is really important. So I talked a little bit about Kegels and how
Kegels arent very well described out in the world. And often, theyre defined as
finding the muscles that cut off your urine flow which is not very accurate.

What Im teaching with the pelvic floor work is that the perineal area, that cross
between the first layer and the second layer, is really the strongest area to access
the pelvic floor muscles. So its not that you cant squeeze the genitals, its not that
you cant squeeze your anus, but those are different areas than the perineum. Im
hoping that if you put the belt on the perineum (again, thats the rolled belt), and
you can make it bigger or smaller depending on your sensitivity. It should not hurt,
it just might be mildly uncomfortable. But you want to put it at that center spot,
again behind the genitals, in front of the anus, in a symmetrical pose. And then,
what you might want to start with is just breathing, seeing if you feel a difference of
pressure on the perineum when youre inhaling and exhaling. The belt is just giving
you some sensory feedback.

And then what you should practice is lifting the area that the roll is touching. Its
actually better to lift on the exhale which I will explain more when we get to the
diaphragm muscle. So you want to try lifting on the exhalation away from the roll.
Its a very good exercise to find the perineal area.

Another thing you can do when the roll is touching the perineum is try moving just
the anal sphincter, or try moving just the genital area. And youll see, youll start to
get a little bit of the subtleness. Youll find theres a different sensation with your





intention. So let me just say that its not that those other areas dont move. Its
where are you initiating the action from. And to allow the pelvic floor to work most
efficiently, its better to put your brain on the perineal area. So sitting on the rolled
belt is not something I would recommend doing on a regular basis but it very much
helps you develop that neural pathway to find it. And as soon as you develop the
sensitivity, you wont need the rolled belt anymore.

Lets look at the levator ani again. This is my model that I teach with. Were now
looking into the pelvic floor from the top. And Im hoping that you can see that
some of striations on the levator that big red muscle in the center of the pelvis,
that whole thing is the levator ani. The purpose of the levator ani is to hold the
pelvic organs. So in the female body, its holding the bladder, the uterus, and the
rectum. And in the male body the bladder, prostate, and the rectum. So its a very
important muscle. Its actually made up of bands. And the bands are made up of
the puborectalis muscle, the pubococcygeus muscle, and the iliococcygeus muscle.
Now, you dont need to remember those names, because ideally, the levator ani
and all the bands should work together. The pelvic floor working in unison stabilizes
your abdominal and pelvic organs and should work with the abdominal muscles to
do that.

So the levator ani attaches behind the pubic symphysis. So theres a left and right
side to it and it attaches to the base of the sacrum on the left and right side. And
thats really important for you to remember, because we think of the pelvic floor as
a bowl or even a circle. And really it has a left and right side. And I want to make a
point of that because often, one side of our pelvic floor can be very constricted, or
one side can be very loose. So in the female body, we deal with a little more
instability. Were looking for balance. In the male body, its more common that
theres just general tightness in both sides of the levator. But its not uncommon for
one side to be tighter than the other. And remember, if thats attached to the inside
edge of the sacrum, that can pull on the sacrum unevenly and can create sacroiliac
pain. So this can be one of the reasons that you might have sacroiliac pain.

Here is a slide of the sacrum, tailbone area. The levator attaches to the bottom part
of that sacrum, at the very base of the spine. Layer one muscle attaches to the tip
of the tailbone and the levator is above that. So I want you to think about if both of
those muscles are tight (or either of those muscles are tight, I should say), that will
pull the base of your sacrum (your tailbone area) forward. So something I talked
about last week was how we dont sit very well in our culture, and that we tend to




sit with our pelvis forward. And what I mean by forward is in a posterior tilt, which
means that youre sitting really on your gluteus muscles and not your sitting bone.
So if your pelvis tends to be in more a posterior tilt or what I call tucked, that would
indicate that your pelvic floor muscles are short. Because if youre pushing the base
of the sacrum forward, those muscles will learn to live in a more tightened and
shortened state.

So I want to talk a few minutes about our gluteus muscles. If the levator ani
attaches to the front face of the sacrum, what attaches to the back face of the
sacrum is our gluteus maximus. So the origin for the gluteus maximus is the
posterior inferior sacrum and coccyx. I want you to think of our glute muscles as a
balancing muscle for the pelvic floor muscles. So if the pelvic floor muscles are short
and tight and the base of the sacrum is pulled forward, then what can pull it back
out is developing our gluteus muscles. Now if you sit a lot, that is going to make the
gluteus muscles weak. And that will again contribute to the pelvic floor either being
imbalanced or more on the tight side.

So lets look at the gluteus maximus. We have three gluteus muscles, but the most
superficial (meaning close to the surface), the one that we all know about, the one
we look at in pictures, is the gluteus maximus. You can see how big that muscle is.
I believe it is either the biggest or second largest muscle in the body. And if you can
see on the top of that slide, it attaches right on the sides of your sacrum. So again,
think of that muscle, if its well-developed, it pulls the sacrum back into that sacral
angle.

So lets go back for a moment and look at the sacral angle. This slide is showing
how the sacrum ideally should sit. If you look at the first vertebrae above the
sacrum, youll see that it has a slightly wedge-like shape to it. That wedge shape of
that vertebrae is to accommodate that sacral angle. So if you can imagine that the
tailbone and the base of the sacrum are constantly forward in the slide, you would
be squeezing the front part of that vertebrae, which is not what it was meant to do.
So if were constantly sitting eight/ten/twelve hours a day, that disc is constantly
getting pressure in the wrong direction. And its one of the most common discs to
bulge or herniate. And the reason is because of too much posterior tuck.

Again, think of the gluteus muscle as that balancer. It pulls it back out. What I find
in teaching is often one gluteus works much better than the other, and that can also
contribute to pelvic floor dysfunction. It can contribute to instability of the sacrum.






This is not Slumpasana but I want to talk about Slumpasana. This is a slide from
Primal Pictures of Tadasana, and I want to talk a little bit about Tadasana from the
pelvic floor standpoint. Often in classes, youre told to push your femurs back. When
you push your femurs back in Tadasana, that creates some space around your
tailbone. But often, the next instruction is to tuck your pelvis, tuck your butt, or pull
your tailbone forward theres a lot of different instructions on that. I believe that
the pelvis does need to be adjusted but I think that what were doing in a lot of
yoga classes and in Tadasana is over-tucking the pelvis, which tends to again
shorten the muscles of the pelvic floor. It brings the tailbone too much forward into
the body. And that doesnt help your gluteus muscles.

So if you are in a place right now where you can just practice this, you can stand,
and push your femurs back and feel how that actually lifts your buttocks slightly.
Create some lateral space for the tailbone. But if you overdo the tucking of the
pelvis, youll feel how that kind of compresses the pelvic floor area and the groin
area

You need to be careful when youre doing Tadasana. I want you to lengthen the top
of the buttocks away from the lumbar which is a very different idea than tucking the
whole pelvis. So I dont believe that the cue to tuck your tailbone is helpful because,
again, its too focused. Its too small of an area. It pulls your tailbone forward and
shortens the pelvic floor muscles and I find that a lot of pelvic floor muscles are
already too short. So try not to tuck too much, to stand on your bones, and to feel
your gluteus muscles engage. If you stand in Tadasana and youre doing it
correctly, the buttocks muscles shouldnt feel soft. They should feel like theyre
engaging.

So how do we develop the gluteus muscles in yoga? Salabhasana is one of the best
poses that we can do to help develop the glutes. In Salabhasana were lying down
on the belly. You can do this many different ways in the upper body. If youre kind
of new to this practice, you may want to have the head down or low to the ground
and just work the legs. What I like to teach in my classes is to put the hands
actually on the two buttocks, and you can often feel the disparity between the two
sides. Often, one buttock grips very easily. It engages very easily which you need to
do this pose. And then one buttock is not working so well. And that hamstring is
overworking. So I would recommend doing both legs, touching the buttock and
seeing if you feel like your buttocks engage equally.






Then if you find that one isnt working so well, what I would recommend is Ardha
Salabhasana. So thats doing one side at a time. If you have a weaker gluteus that
doesnt kick on so well, I would recommend doing this pose one side at a time and
on your weaker side, maybe doing more repetition on that side.

Right underneath the gluteus maximus is the gluteus medius. The gluteus medius,
you can see has a different attachment point. The gluteus medius is attached to the
outer side of the ilium, to the greater trochanter, which is the top edge of the femur
bone. So lets look at the slide again. You can see it attaches to your ilium on the
back side, underneath the gluteus maximus. And you can see on the bottom, if you
follow that red line down to the bone, that is attaching to the greater trochanter of
the femur bone. So this muscle engages when we do external rotation. It helps you
with external rotation. And I think the best poses to evaluate your gluteus medius is
Baddha Konasana.

Now lets talk about Baddha Konasana for a moment. So thats an external rotation
of the hip joint in Baddha Konasana. But a lot of people do this pose not at enough
height. So number one, you need enough height under your buttocks so that the
angle of the femur bone is down, so that your knee is lower than your hip crease.
This is really important.

The other thing that people do incorrectly is I see a lot of people tucking their pelvis
in this position. They again bring their tail and their sitting bone so far forward that
theyre either on the back of the sitting bones or theyre not even on the sitting
bones. Theyre more on the gluteus maximus. So you want to have enough height
that the angle of your femur bone is slanted downwards. And you want to make
sure that youre not tucking your pelvis in the beginning. I think its very helpful to
have enough height under you and then take the hands behind you. Because a lot
of times this pose is more classically taught with the hands forward, but a lot of
people have such tight hips that its hard to do it with the hands in front of you
without tucking the pelvis. So if you just do the pose with your hands behind you,
that can help push you on to your sitting bones so youre closer to what I call
anatomical neutral. Remember, if youre sitting on the sitting bones, that is better
for your spine, better for your pelvic floor. It accommodates the sacral angle.

Now, how do you find the glute medius in this pose? So once you take the outer
position, if you push the little toe side of the foot together particularly near the heel,
so the little toe side of the heel, if you push the heels together at the same time





that youre trying to stretch the inner thighs away from each other, you will feel
your glutes fire. Your glute medius will fire. But what happens is in this pose its
very obvious which glute medius is not engaging as much. So if you press the outer
heels together, pull the inner thighs away from each other, youll feel a connection
all the way up into your hip socket. And for most people, its very obvious which
side is kicking on and which side is not.

So Baddha Konasana, a symmetrical pose that youll feel when you do this pose
with your buttocks muscles and again specifically the glute medius is not working
symmetrically. So that can give you a clue to which glute medius needs some work.

So how do you get the glute medius to be stronger? The standing poses,
Virabhadrasana II (Warrior II) is one of the best poses to find your glute medius on
both legs. The legs are in external rotation. The back leg, I find for most people, is
not doing what its supposed to do. What I would suggest to find your glute medius
in Virabhadrasana II (it also works in Utthita Parsvakonasana which is a side angle
pose and also Trikonasana, Triangle Pose), is putting your left hand, your back
hand, on the buttock of the back leg. And if you turn the back leg out ever so
slightly, you should feel your glute medius kick on immediately. If the leg is not
working properly, the glute medius is not going to work properly. So you should
have a little more weight in the back leg. You should have the left hand on the left
buttock if its the back leg. And then if you turn that leg out more, you should feel a
difference of the glute medius kicking on.

Its important to be aware of the glute medius because sometimes what will happen
is the external rotators of the leg are very tight and its because the glute medius
isnt doing its job. I find often the external hip rotators are too tight. The TFL, the
tensor fascia latae, and the piriformis muscle is tight. And this is because the glute
medius isnt firing the way it should be. And so these other muscles are trying to
pick up the slack.

Lets talk a little bit about the core. I teach workshops all over the country and I ask
people if theyve heard the expression to work from your core. So this is very
much in the vernacular out there. Weve all heard it. And then my next question is,
What do they mean by that? What does the teacher mean when they say work
from your core? And most people point to the front of their belly. And they say,
Well, here. Working from here.






So a lot of people think that the core muscles are these muscles in the slide the
rectus abdominus muscle. Our rectus abdominus muscle also has the nickname of
the six pack and thats because body builders will often overdevelop these muscles
so that you have that little ribbed effect in the front. Now I dont know who decides
whats core and whats not. I dont know who the body of deciders that is, but in
the physical therapy world, in the medical world, the rectus abdominus is not
considered a core muscle. The rectus abdominus is considered extra to the core. So
Ill get into the core muscles, but I want to talk a little bit about the rectus.

Youve got two rectus muscles. At the top, it attaches to either side of the sternum
at the cartilage of the fifth, sixth, and seventh ribs. They narrow as they descend
almost directly down the front of the belly and attach to the front of the pelvis at
the pubic bone. So again, it attaches left and right sides of the pubic bone. If you
then can call into your mind a body builders body, sometimes theyre very curled
forward, meaning the front of the ribcage is pulling towards their pelvis and the
front of their pelvis is pulling up towards the front of the ribcage. So if you
overdevelop this muscle, what it can do is really shorten the front of the body and it
can shorten your breathing. Technically, core muscles are considered stabilizers.
This is not considered a stabilizing muscle, because its such a smaller muscle in
comparison to the bigger abdominal muscles which well see.

So I want to just say that the rectus abdominus is not considered a core muscle.
And for most people, its too tight. So even if youre not a body builder, lets say you
sit for work and you have a postural habit of kind of slumping remember
Slumpasana? That muscle gets short. So again, the front of the ribcage gets pulled
towards the pubic bone and the pubic bone gets pulled up towards the ribcage. And
again, this very much can shorten your breathing.

The definition of the core is your pelvic floor on the bottom, your diaphragm (your
breathing muscle at the top), your transverse abdominus, which is your deepest
abdominal muscle, your internal and external obliques which are your side
abdominal muscles (so those stabilize the side of the body), and then your spinal
muscles (your erector spinae muscles and the multifidus0. This slide shows the
rectus, but underneath the rectus, what youre looking at there you can see is a
nice view of the transverse abdominus. Below the ribcage, around, youll see the
transverse abdominus, which in comparison to the rectus muscle, you can see is a
much larger muscle.






The diaphragm is considered the top of our core. The core being, again, the
contents, our abdominal organs Those constantly need to be stabilized when
were doing things out in the world. The diaphragm, if you think of that as the cap
that caps our core. It has a dome-like shape. Its a thin and supple muscle that is
situated between the thorax and the abdomen. It attaches to the inside frame of
the ribcage. The diaphragm is basically the principal muscle of inhalation. When it
contracts, it descends. So if you can imagine the lungs sitting above the diaphragm
as you take air into the lungs, it pushes down on that muscle, and that muscle
flattens out a little bit and pushes the organs down. This is really important to pelvic
health because as I mentioned earlier when I was explaining how to sit on the
rolled belt, I was asking you to contract the pelvic floor, the perineal area, on the
exhalation. So if you again think of air coming into the lungs, pushing the
diaphragm down on the inhale, theres actually more pressure into your pelvis when
you inhale. Theres less pressure into the pelvis as you exhale.

This is a really important thing to think about because a lot of us dont breathe very
deeply. A lot of us are breathing fairly shallow, and this can affect your pelvic floor
health. Because if you think about deep whats called abdominal breathing or belly
breathing, when you breathe more deeply, youre getting movement and blood flow
into the pelvic floor. I want to try to start calling abdominal breathing pelvic
breathing, because I feel like why stop at the abdomen, just keep going.

So heres another view of the diaphragm. This is looking at it from below, so youre
looking up into it. Its almost like the wingspan of a bird. Its so beautiful. So you
can see again, it attaches to the inner frame of the ribcage. And then youll see two
attachment points at the bottom of the slides. The diaphragm actually attaches to
the lumbar spine. Again, everything affects everything else. If you are not sitting or
youre not standing in anatomical neutral, if you tend to round and slump, what can
happen is the back of the diaphragm is somewhat constricted. So I cant stress this
enough, how important posture is to breathing, and how important breathing is to
the pelvic floor. So again, the diaphragm is the top of the core. This is with the side
view with the ribs on.

This is a male pelvic floor. But again, I want you to think of looking at the
diaphragm as a dome. You look at the pelvic floor as a bowl. So ideally, when were
breathing, the diaphragm pushing down, pushes towards the pelvic floor. So the
pelvic floor receives the inhalation. And as we exhale, the pelvic floor contracts
slightly and goes upward towards the diaphragm as the diaphragm exhales out.





Think of the pelvic floor as the bottom of the core. So youve got the top of the
core, bottom of the core. And if you think of the shape of a capsule, you want to
think of those moving together. So thinking of this nice, pulsating movement up
and down with the breath. This is a great opportunity for the pelvic floor to get
more oxygen and blood flow. And if youre not sitting well, standing well, the breath
is short.

So here is looking down into the pelvic floor. The slide before was looking from the
bottom. So again, think of your inhale getting received into that muscle there and
that muscle gets a little stretch on the inhale, gets a little contraction on the exhale.
Its not something that youre consciously doing its happening. Engaging your
pelvic floor is going to encourage that action. But again, deep breathing should help
the health of the pelvic floor.

The deepest abdominal muscle we have is the transverse abdominus. There are two
transverse abdominus muscles, one on each side of the body. Its so deep its
practically up against the organ and its separated only by one little later of fascia.
So your transverse abdominus sits really close to the organs and affect the organs.

I want to talk about how the transverse abdominus works. One way to find the
transverse abdominus is to lie down on the floor and do a strong exhale through
your mouth. If you have your fingers on your lower belly, you will feel the
transverse abdominus kick in. Thats one of the best ways to find it. A cue thats out
there about the transverse abdominus is to pull your navel to your spine.

There was a study done by the Womens Health Foundation in Chicago that hooked
up the transverse abdominus to sensors. They took some people through the cue,
navel to spine or they also had the instruction draw the sides of the navel back.
What they found was really interesting. The cue navel to spine actually was
almost too aggressive. It put too much pressure into the organ. Whereas drawing
the sides of the navel was just as efficient in engaging the transverse abdominus,
but didnt squeeze the organs like that. So just something to keep in mind for those
of you that teach, that drawing the sides of the navel back might be a better cue
than pulling the navel to the spine.

So again, transverse abdominus think of it as a container. You can see the fibers
of the transverse abdominus, the red part of the slide, those fibers are lateral,
meaning they are sideways. And then the white that you see is connective tissue.





Right above the transverse abdominus (so now were moving from the deepest
coming outwards towards the skin), is your internal obliques. Again, theres an
internal oblique muscle on each side of the abdomen. Of the three big muscles
found on the sides of the waist, the internal obliques form the middle layer. So
youve got transverse abdominus, internal obliques, and the external obliques. The
internal obliques are situated under the external obliques and on top of the
transverse abdominus. So think about the internal obliques as middle abdominal
muscles.

At the top, the internal oblique muscle attaches to the edge of the thoracic ribcage
and at the bottom, it attaches to the iliac crest of the pelvis, which is the spot where
you would put your hands on your hips. And then it extends along the inguinal
ligament of the groin.

At the lower level, the internal obliques have the longest and most significant fibers
of all of the abdominal muscles. The internal obliques help us side bend. So it pulls
the pelvis laterally when were side bending. It can rotate the pelvis forward and it
can inhibit its rotation in the opposite direction. So thats the internal obliques.

And then again, were coming outwards the external obliques. Theres an external
oblique on each side of the abdomen. These are the most superficial of the three.
Theyre found just under the skin and the internal obliques and the transverse
abdominus lie beneath them.

At their upper end, the external obliques attach primarily to the side and the front
of the ribcage. At their lower end, they attach to the iliac crest of the pelvis. They
extend by way of tendinous fibers along the inguinal ligament of the groin. So
again, side bending is where we get to our obliques. And we dont do a lot of side
bending outside of yoga, so side bending is a really important thing to be doing in
yoga.

And then in the back, youve got your erector spinae muscles. And the erector
spinae muscles travel the length of your spine. So youve got them in that groove
thats on the side of your vertebrae. Those are all considered your core muscles.

How do the transverse abdominus and the pelvic floor work together? This is
important. We saw on the slide of the transverse abdominus that the fibers of the
transverse are lateral. So if you think about the old-fashioned corset where you





would pull the strings of the corset to cinch the waist in, thats how the transverse
abdominus works. Ideally, when the transverse abdominus is called upon, the pelvic
floor should lift from the bottom. So lets say Im standing somewhere and I need to
pick something heavy up, what should happen is my transverse abdominus, as soon
as I lift something heavy, my transverse abdominus should kick in like a corset and
my pelvic floor should lift up to hold the organs, to stabilize the organs. Transverse
abdominus and pelvic floor are considered synergistic muscles. They should kick on
at the same moment. The problem is if theres any pelvic floor disorder (meaning
too loose, too tight, one sides too tight, one sides too loose, any combination of
any problem), you are going to not have the support from the bottom when youre
called upon to have your stabilizer core muscles kick on.

So this is really important because a lot of people are focused on the transverse
abdominus and they may not know about the pelvic floor. Ive had some women
come to my workshops that were weight lifters. Maybe they werent so aware of the
pelvic floor and they went to lift a heavy weight and they felt their uterus fall. They
felt one of their organs prolapsing in result of the pelvic floor wasnt doing its job.
The person wasnt aware of it. They went to lift something heavy. The transverse
abdominus squeezed in like a corset. And if you think of squeezing a tube of
toothpaste, everything just pushes down So if theres any weakness in that area
And again, for some women, the uterus may not be in their most stable position,
that can cause a prolapse. So this is a really important thing to remember, that
ideally the pelvic floor and transverse abdominus are kicking on together. And I
talked about the navel to spine cue.

How do we know if our levator is working? Its very simple to look at, but actually
fairly complex to feel. You want to lie down on the floor. I have my arms above my
head just so you can see my lower back but ideally, your arms will be at your sides.
If you have any lower back issues, I would recommend lifting one leg at a time
rather than both together. What I teach in my classes is to put your fingertips on
your lower abdomen with your feet on the floor and then lift your feet up like Im
showing in this photograph. And you will feel your abdomen kick on. Now, whether
your pelvic floor is working remains to be seen.

I recommend doing this Lift the feet up, see how much movement is in your
abdomen. See how much movement is in your lower back. Ideally, your lower back
should not overarch. It should stay in neutral. So its not tucked. Its in neutral.






After you test that is I would do it again. But the second time, what you should try
to do is try lifting your feet as youre exhaling, and as youre exhaling, lift the
perineal area, and hopefully, you have cultivated more awareness because of that
yoga belt you were working on earlier. Youll feel that when you lift the perineal
area as you exhale and then lift your feet, there will be a very different quality in
your abdomen to what happened. That would show you the difference of the pelvic
floor helping you out and stabilizing you as your feet lift off the floor.

And this is a pretty safe position to do it in, because youre lying down, so the pelvic
floor doesnt have a lot of weight on it. And again, remember, if theres any lower
back issues, you should lift one leg and then the other rather than both together.

Another really great pose for the core is Plank Position or also being on your hands
and knees, which Ill describe. Again, think about Plank Position. You dont have all
of the weight of the organs sitting on your pelvic floor. In Plank Position, your pelvic
floor organs are sitting more forward towards the lower abdomen so theres a little
less weight on the pelvic floor in Plank Position.

This is also the beginning position for Chaturanga Dandasana which is done a lot in
yoga classes. And what I see more with women than men, but both men and
women do it, is when you go to lower from Plank Position, a lot of us over lift the
tail to try to make it easier. Again, the cue out there might be to tuck your tailbone.
Ill say that Plank Position should be done in anatomical neutral. So what youre
trying to do is not flatten the lumbar. Youre not trying to over tuck your pelvis. It
should be like youre standing on the floor. Youre in neutral. Youre holding your
weight on your arm. Your stabilizers should all kick on. Stabilizers, again
transverse abdominus, pelvic floor They should kick on, immediately work
together. Your obliques are working to stabilize you. The spinal muscles and the
diaphragm are all working to stabilize you.

If Plank Position is challenging for you or Chaturanga Dandasana is challenging for
you, you can also do this on hands and knees. Think of the classic Cat Cow that
weve all been taught. If you find that position halfway through Cat and halfway
through Cow, so neutral again would be not all the way tucked and not all the way
untucked in the pelvis, not all the way retroverted or anteverted Youre looking for
neutral on hands and knees. And if you engage the perineal area in that position,
you should feel (you probably will feel) your transverse abdominus kick in. Thats






one of the best positions for beginners to find the pelvic floor, because theres no
weight of the organs sitting on the pelvic floor. So those are a couple things to try
to find your levator ani and the perineal area.

This is taught a lot in not so much yoga classes, maybe classes for the abs, is
crossing elbow to knee. What I see a lot is that what people do is they bring their
knee to their elbow. So go back to this one. You can see my femur bones, my thigh
bones, are pretty much perpendicular to the floor. So if you want to work your
obliques correctly (your side abdominals, the side of your core), what you want to
do is keep the femur in that perpendicular position to the floor and try to bring your
elbow to your knee. If you bring your knee to your elbow, as soon as the leg goes
past perpendicular, then your obliques turn off and your hip flexors turn on. So all
youre doing in this photograph that Im showing, is working your hip flexors which,
again, most of us dont need as much as we do oblique work.

Just to recap, its just as important to stretch your pelvic floor as it is to strengthen
it. I talked quite a bit about strengthening it and finding it. So I wanted to do a
couple of things to think about stretching your pelvic floor and relaxing it. Again, I
cant stress enough deep abdominal breathing or if you want to call it pelvic floor
breathing can help tremendously if you have hypertonicity, if you have pelvic pain, if
you have any of the conditions that I talked about for hypertonic pelvic floor. But
dont think that if you dont have a hypertonic pelvic floor that abdominal breathing
isnt as important. Its important for everyone its just even a little more important
for people with hypertone.

One of the best positions to stretch your pelvic floor is squatting. Please note in this
photograph that my heels are up on a blanket. And even if you can squat with your
heels down, I recommend for pelvic floor stretching, that you put your heels up.
Because a lot of us can squat with the heels down but then our pelvis is extremely
tucked under which again is not helping you. Youre getting two benefits here. You
have your heels up. Your pelvis can be more neutral, which is helping to open the
pelvic floor. And because youre squatting, all the weight of the organs is getting
pushed into the pelvic floor. So this is a pose that I recommend doing passively for
pelvic floor stretching. The only contraindication with this pose would be prolapsed
organs. If you have prolapsed organs, you shouldnt do this pose until things have
improved a little bit.







Forward bends generally stretch the pelvic floor, but the exception to that rule is
that our hamstrings are usually so tight that it doesnt stretch the pelvic floor. So for
pelvic floor stretching, Im a big advocate of bending the knees in poses like
Downward Dog or this pose, Prasarita Padottanasana to get into the pelvic floor. So
Im not saying do these poses with bent legs all the time, but to get into the pelvic
floor a little more deeply, these poses done with bent legs and then thinking about
keeping the legs bent, you think about lifting your buttocks and your tail up. And
this should feel really good, and youll feel the difference. Its not stretching the
backs of your legs so much, but its really getting deeply into the pelvic floor
muscles.

And then a last shout out for the pelvic floor is relaxing it. This is a photograph of
Supta Baddha Konasana. Whats lovely about Supta Baddha Konasana is if you
support the femur bones with blankets (you can see that my thigh bones are resting
on blankets there.) Its not so easy to see that I have sandbags on my thighs. Let
me just say you should never, ever, ever put weight on thighs that arent supported
by a blanket. You should never put weights on unsupported joints. However, if you
have a blanket under the femur bone, put a sandbag on each thigh bone, this will
very much help you breathe more into the pelvic floor. This is a great pose to
cultivate that deep pelvic floor inhale awareness. So again, if youre lying in this
pose, a nice thing to think about is when you inhale, the pelvic floor is receiving the
breath. And as you exhale, the pelvic floor is rising in reaction to the exhale leaving.
So again, its not something that youre doing, its something that youre allowing.
And thats how you should think of it.

So your homework: Breathe into your pelvic floor whenever you think about it. Be
vigilant about your posture. You cant breathe into your pelvic floor if youre in a
bad pose, meaning if you slump in your chair or if you slump when youre standing,
you cannot breathe deeply. Try it out if you dont believe me. If you stand or you sit
in a slump and try to take a deep breath, youll very much be aware the breath does
not go down into the pelvic floor. So you must be on your sitting bones if youre
sitting, or you must be on your heels, a little bit on your heels, femurs back, to get
your breath to go down.

Remember, relaxing the pelvic floor is just as important as engaging it. Remember,
the buttocks is not considered part of your core but think of your buttocks as the
muscle that balances the pelvic floor muscle, so it pulls the sacrum back outwards,
especially if you tend to have a posterior tilt to your pelvis. And I totally think that






we should all work from our core when were working hard, but dont think the core
is just your rectus abdominus. The core is all of it diaphragm, pelvic floor,
transverse abdominus, your obliques, your spinal muscles.

Ill stop it here because I know there are some questions. Lastly I want to thank
Primal Pictures for letting me use their wonderful images. For those of you that
teach, I think its a great resource. Okay, so I think there are some questions, yes?

Eva Norlyk Smith: Yes, we got a lot of questions. I thought (first of all, just a
comment) that it was wonderful just to have that look of the cylinder of the core
and how the top and the bottom, the diaphragm and the pelvic floor muscle, kind of
have to dance together, the diaphragm and the breath.

Leslie Howard: Thats a great way to say it.

Eva Norlyk Smith: And I wondered, we know that the movement of the
diaphragm massages internal organs, but it makes a lot of common sense. And you
talked about how the movement of the diaphragm on the pelvic floor helps bring
blood flow to the pelvic floor muscles by stimulating just that soft movement up and
down. Are you aware of any studies that show any kind of correlation between
people who are diaphragmatic breathers and the rate they have pelvic floor issues
or is that too complicated?

Leslie Howard: You know, Eva, that is a great study to have, but Im pretty sure it
hasnt been done. I have to say pelvic floor research is really just at its infancy. I
mean, theres a fair amount of pelvic floor research for incontinence, cystitis, things
like that. But as far as it operating optimally, its so hard to fund some of these
studies and I think that would be a great yoga study for someone to do. I would do
it if someone asked me. Id be part of that study. It would be very fascinating.

Eva Norlyk Smith: Now, you gave this wonderful overview of the cylindrical core
with the top and the bottom and the sides and Joanne is asking why you didnt
include the psoas and the iliacus and also the quadratus lumborum because the
psoas is connecting diaphragm to spine and pelvis to the femur. So she wondered
why they were not included.







Leslie Howard: They are not technically considered core muscles. So again, I dont
know who the body that says what muscles are what. Im going to guess its the
American Medical Association. I dont know. I should find that out. But those are
considered hip flexors, specifically the psoas. Theyre not considered core stabilizers.
So thats why.

Eva Norlyk Smith: There seems to be different schools of thought on those
different groupings.

Leslie Howard: Right.

Eva Norlyk Smith: Laura in Milwaukee is saying, I have a bladder prolapse. Are
there any of these poses that I should not do while Im attempting to recover? And
that question came in while you were doing the strengthening poses.

Leslie Howard: Squatting. Thats the only one she needs to avoid squatting.

Eva Norlyk Smith: And Plank Pose would be considered okay?

Leslie Howard: Plank Pose would be okay.

Eva Norlyk Smith: Okay, good. Here is a question from June. She says, I have
had a spinal fusion at L5 and S1 and a hysterectomy. I am so unstable that Ive
developed many other problems. What can I do to become more stable? And you
might want to say what that means to be stable..

Leslie Howard: Thats a great question. So remember, Im talking generally, men
tend towards hypertonicity in general. Women dont tend towards hypertonicity as
much as they tend towards instability. And instability can mean tight on one side
and loose on the other, or very unevenness in the pelvic area. Because our pelvises
are less stable, more open for childbearing, we kind of open the opportunity for the
two sides to be really different. So for this person, theyve had a hysterectomy
which destabilizes the integrity of the pelvis a little bit, and then the spinal fusion is
kind of locking that in place. So I guess because of what shes gone through that
theres definitely some hypertonicity. And the rule is that if theres any hypertonicity
(and remember, thats too much tightness), if theres any hypertonicity, you have to
address that part of the equation before you can do strengthening exercises. So for






this person, I would recommend internal massage, maybe even seeing a physical
therapist that does internal work to guide her a little bit better than I can in a
webinar. But Im pretty sure shes probably got some tension in there just because
her pelvis has been traumatized by the hysterectomy, by the fusion, these are all
considered traumas to the pelvis. And how does our body react to trauma? It grips.
Our muscles grip when we are in pain or something happens to us that shouldnt
happen. So this person, she needs to address her hypertonicity first. Im sure that
shes probably got some. And then she should embark on the stabilizing,
strengthening exercises which I talked about in the first half of todays webinar.

Eva Norlyk Smith: Good. Laura from Milwaukee is asking how often someone with
a prolapse should do the workouts.

Leslie Howard: You know, every day Whats important for everybody, but
particularly for prolapse, is you want to change your orientation to gravity. So with
prolapsed students, what I usually do is work with them on the floor. So theyre
lying down, or theyre on hands and knees, or their pelvis is elevated. So think
about Supported Bridge Pose or Viparita Karani where you put your legs against the
wall and put a bolster under your pelvis. Those really help with prolapsing because
what that will do is let the organs slide back to where it should be. Its more
supported by the abdomen. And then the pelvic floor has less weight on it so you
probably get a little more sensation and feeling of movement in that area when it
doesnt have this heavy weight sitting on it. So for prolapse, I would start lying
down, hands and knees, or pelvis inverted.

Eva Norlyk Smith: And because its so gentle, that will probably be every day. Is
that a correct assumption?

Leslie Howard: Yes. Thank you. Yes, every day try to work up to three sets of ten
holding, releasing, holding, releasing, holding, releasing. See how long you can
hold. You know, it might be one second. It might be three seconds. You could work
up to holding for eight seconds, but you want to be careful that youre definitely
releasing between, just like they tell you to do when youre lifting weight. Its just as
important in the pelvic floor that you have to give your pelvic floor time to relax
before you engage again. So not forgetting that What we tend to do is grip, grip,
grip and not do the relaxing part.

Eva Norlyk Smith: Would you do that in conjunction with the inversion?




Leslie Howard: Yes, thats what Im saying. Yes, do the contractions of the pelvic
floor with the pelvis elevated, or lying down ,or on hands and knees.

Eva Norlyk Smith: Very interesting. Great. Jennifer from Portland, Oregon is
asking if you see a connection between TMJ or neck tension and a hypertonic pelvic
floor.

Leslie Howard: Absolutely. Absolutely. Yes. I want you to think of the pelvic floor
and the jaw-throat area as mirrors to each other. Theres a huge connection.

Eva Norlyk Smith: Can you give an example? Have you worked with someone
where

Leslie Howard: I can give you an example on my own body when I first found out
that I was hypertonic when I went to my physical therapist that was doing internal
work. My right side was way, way, way tighter than my left side. She massaged me
internally for about forty minutes and I left her office, it took me about five minutes
to realize that a constant pain that I have on the right side of my neck was gone. So
that, to me, speaks to the connective tissue, the fascia. Theres just a chain there.
So if one side is gripped up, its pulling on the other side of the chain. That will be a
perfect example.

Eva Norlyk Smith: Alright, heres a question, Im wondering how male
incontinence and impotence may be related to pelvic floor tonicity.

Leslie Howard: Great question. Okay, a lot of men (particularly older men) start
having problems with incontinence, or an indication of a coming problem in the
pelvic floor could be the arc of a mans pee. So most men have been peeing long
enough that they know the arc of their urine stream. If that starts to lessen, that is
probably denoting hypertonicity in the pelvic floor. A lot of men that think they have
prostate problems, often its a pelvic floor problem, not a prostate problem. So Im
not saying that if you are having some incontinence or the arc of your pee is going
down that it might not be a prostate problem. So always check with your doctor.
Im just saying that it can also be not a prostate problem, it can be pelvic floor-
related. So the hypertonicity of the pelvic floor for men can lessen their pee stream,
the strength of their pee stream, and it can also create some erectile dysfunction.
So again, this is why were all out there wanting to make things stronger, and
sometimes, what we need to do is actually let go and stretch and relax the muscles.
And thats a perfect example of it.





Eva Norlyk Smith: Interesting. And heres a question from Tatiana in Canada. She
says, My husband had an inguinal hernia operation two months ago. Now, its time
to resume our yoga practice. But we would like to know if you have any suggestion
on sequences of stretching this area to prevent formation of inner scars.

Leslie Howard: I would just tell him to really take it easy and, as he gets back into
his yoga practice, to not go to what his full extent of the stretch is. But what I
would suggest more than that is to get the okay from the doctor (I believe its two
months to three months but definitely check with the doctor), and then you can do
a scar massage and you definitely want to do that. Because when you dont
massage scar tissue, what youre doing is youre creating an internal adherence of
the skin to the muscle to the viscera. Ive done a number of cadaver labs where you
see scar tissue and its like a staple gun has been put in that place. Its like
everything from the skin to the organs is glued together. When I saw that, it really
impressed upon me how important it is to, as soon as its okay, to mobilize the scar
tissue again (make sure to check with the doctor). He should be doing it or you can
have a physical therapist do it, but I would suggest learning it from a physical
therapist maybe and then doing it himself as much as possible to mobilize that area.

Eva Norlyk Smith: Very interesting. Now, we have had a couple of people asking
for more information on how to distinguish between hyper- and hypotonicity and we
talked about that earlier. Were working on a handout for that, is that correct?

Leslie Howard: Yes. And also, remember that theres two videos attached to this
webinar, and I talk about it there. But basically I talk about massaging around the
sitting bones and if you wanted to brave doing internal massage. If you massage
that area and you have any sensitivity, hardness, if theres any sense of ouchiness
or oh, my God, thats so tight, that is probably the number one indication that
theres some hypertonicity.

Eva Norlyk Smith: The thing that was fascinating to me last time, you said it can
vary very much even from the left to the right side of the pelvic floor.

Leslie Howard: Right, thats right. So if you massage sitting bones, the two sitting
bones separately around that area, youll often feel a huge difference. Or again, if
you go internally and you push a little bit more on the left or the right, sometimes
one side can be way more tight than the other.






Eva Norlyk Smith: As you said people will have access to more information about
that in the video and a summary of some of the key points for that.

Leslie Howard: May your pelvis be happy and healthy, everybody.

Eva Norlyk Smith: Well, everyone, thank you so much for joining us. And Leslie,
thanks again for sharing all this very, very interesting information.

Leslie Howard: Thank you so much for hosting it and just being a great resource
to find out about it. Thank you, Eva. I really appreciate it.