Category: Anatomy

Yes, Men can have pelvic pain too.

~ jesspreale ~ 4 Comments

Confession: I treat men. Lots of them. Seriously, I think my schedule is often about 30% men. This shouldn’t have to be a confession. You shouldn’t be surprised, or shocked by this, but you possibly are. I mean, my female patients are often surprised when they see a male walking out prior to their appointments. I’ve seen that same surprised look on a friend’s (or family member’s, or random person at the bar who happened to ask me what I do for a living’s) face. For some reason, pelvic floor problems are typically seen as a “woman’s problem,” and this is so so unfortunate. It’s unfortunate, because it means that many men feel embarrassed or awkward seeking help for a problem seen to be “unmanly.” It’s unfortunate, because SO many of the men I treat end up seeing close to 5-6 physicians, plus 2-3 physical therapists/chiropractors/acupuncturists, etc. before they actually end up in a place that offers them hope. And it’s unfortunate, because it means that many many men end up suffering with pain for way longer than they should. And this just has to stop. < Rant ended>

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So, today, we’re going to talk about Pelvic Pain in Men. First, you should know that pelvic pain in men is not that uncommon. In fact, this study estimates that close to 1 in 10 men experience chronic prostatitis/chronic pelvic pain syndrome. Often times, pelvic pain is first diagnosed as prostatitis, and I think this happens because of where the pain is located. Prostatitis means inflammation in the prostate… but not all men with the diagnosis actually have inflammation present in the prostate. In all seriousness, I encourage men who are having pelvic pain and receive this diagnosis to ask for a culture. Make sure your prostate is really the one who should be blamed. In some cases, it is (like with bacterial infections). But, often times, these cultures come back negative. So ultimately if the pelvic pain doesn’t go away after a few months, men will often get the diagnosis of chronic nonbacterial prostatitis (which is now categorized as Type 3 chronic prostatitis) or chronic pelvic pain syndrome.

Now, you may be thinking, “Jessica, where are you going with all of this?” Well, these men are the ones I generally end up treating. They’ve had pelvic pain for a long time. Haven’t really responded that well to many medications. And still have pretty significant pain levels. <<Side bar: Today, we’re going to talk about the musculoskeletal aspects involved in pelvic pain in men; however, we never want to downplay the role that other systems and structures can play in pain. So, make sure you are working with a multidisciplinary team and are thoroughly evaluated medically.>>

The symptoms of myofascial pelvic pain in men can include the following: 

  • Pain (which can be sharp, dull, achey, burning, pulling, etc) localized to the lower abdomen, hips, buttock, anus, perineal body, penis, scrotum and/or tailbone.
  • Changes in urination, including urinary urgency/frequency, pain with urination, difficulty starting a urine stream, intermittent or slow urine stream, dribbling after urination and/or urinary leakage.
  • Changes in bowel function including constipation, difficulty emptying bowel movements, pain during and/or after bowel movements.
  • Changes in sexual function including premature ejaculation or erectile dysfunction and/or pain related to sexual function.

So, what can a physical therapist do to help a man with pelvic pain? 

Well, a lot. First, you should know that pelvic pain is complicated (I would argue that all pain really is) and when someone has been in pain for a long time, their pain experience becomes multifactorial. We know now that when a person has had pain for a long time, his or her brain changes the way it processes the signals from the area, and many people develop what we call “central sensitization.” This study found that this happens commonly in men with chronic pelvic pain, which should come as no shock to those of you who read my blog regularly. How exactly is the brain involved in all this? I’m not going to repeat myself here…but I will tell you, to stop here if you don’t know it already, and read this, this and this.

Ok, back to what we can do to help these men experiencing pelvic pain. Let’s break it down:

  • Identification of the musculoskeletal and neuromuscular structures involved: A skilled pelvic PT will perform a comprehensive examination to observe movement patterns and identify structures that could be a component of the pelvic pain experience (including neural, muscular and connective tissue)For many men with pelvic pain, the pelvic floor muscles can be some of those components. These muscles are actually fairly similar anatomically to the pelvic floor muscles in women (although different, of course!). These muscles can be evaluated externally via palpation or internally via the anal canal. Typically, assessing both ways is the best option as it gives us a comprehensive picture of what is happening from a muscular standpoint.

 

  • Nervous System (Brain) Training: I could really just stop here…because this is our primary and most important goal in physical therapy. This should (and will eventually) be a series of posts in itself.  Basically, we know that the brain protects a person against “threatening” areas, movements, etc. when a person is experiencing persistent pain. We want to slowly teach the brain that the areas it is protecting are no longer a threat. We want to widen the “safety net” of the brain to allow for more variability in movement, and we can do that through manual therapy, downtraining the nervous system(restoring breathing patterns, guided relaxations, stress management, etc), restorative exercise/movement, and lots of behavioral education.
  • Manual Therapy Techniques: Musculoskeletal structures are often significant components of chronic pelvic pain in men, like I mentioned above. This includes the pelvic floor muscles (both the external, superficial layer of muscles around the penis and perineum as well as the deeper layers of muscle) as well as the muscles around the pelvis (gluteal muscles, adductors, hip flexors, low back muscles, etc.). Many men will also have restrictions in connective tissue around the pelvis, as well as possibly decreased nerve mobility in some of the nerves around the pelvis. Manual therapy techniques performed both externally and internally help to restore tissue mobility, improve blood flow, and improve the movement of the spine and joints around the pelvis.
  • Improving Bowel, Bladder and Sexual Habits: As mentioned above, pelvic pain is often accompanied by bladder, bowel or sexual symptoms. Part of helping a client move toward better function means making sure that habits are supporting the best possible outcome. So, we look at everything from dietary habits, toilet positioning, sexual positioning/habits, as well as even sleeping habits to make sure we are addressing as many components of the “pain picture” that we can.
  • Restoring Movement Patterns:  As we have learned previously, movement patterns are often changed/adapted when a person is experiencing pain. Although this can be a helpful adaptation short-term, these adaptations can often contribute to problems as time goes on. So, our goal is to observe these patterns of movement and identify asymmetries or dominant patterns in order to add some variety to movement and improve the fluidity of movement patterns. Basically, we want to restore the large variety of movement that you used to have before you were dealing with pelvic pain.
  • Much, much more… I know, this is a catch-all subheading. But honestly, there is SO much more that we can do to help someone with pelvic pain depending on the specific case and it would be impossible to get it all in within one blog!

So, basically, what I’m trying to say is that if you’re a man who is having pelvic pain, it’s time to do something about it! I really do recommend seeking out a pelvic PT who is skilled in treating persistent pelvic pain, and comfortable in treating men (Come see me if you live in the metro Atlanta area!). And, if you’re a pelvic PT and don’t feel comfortable treating men? Then, I want you to read what I’m about to write with the kindest, gentlest undertones… It’s time to get comfortable. I’m serious, and I’m talking to you blog reader who only accepts female clients. I understand that some women feel awkward about this…but men need us! They’re hurting, and they need help, so I really think it’s time to get comfortable. Go to a course, seek out mentoring, or whatever you need to get comfortable…but I think we all need to take responsibility to start providing these men with the care they need!

Wanna read more? Check out these great posts by my colleagues on male pelvic floor problems:

As always, I love to hear from you! Please feel free to comment with any questions or thoughts about any of this! Let’s keep the conversation going!

Wishing you an early, happy Thanksgiving! 

~Jessica

 

 

 

Do we move differently in pain?

~ jesspreale ~ 12 Comments

For the past few years, my studies in pelvic health have taken me further and further outside of the pelvis.  I have learned and continue to learn how amazingly interconnected our bodies actually are. The pelvis can be influenced by the ankle, the knees—and even the neck! It is amazing and awe-inspiring. This past weekend, my studies took me to the Level 1 Selective Functional Movement Assessment (SFMA), where I spent 2 days learning a systematic way to evaluate movement and identify where dysfunctional patterns exist—head to toe! (How awesome is that?!) There are many different systems and programs out there for evaluating someone’s movement, and honestly, I don’t necessarily think one is superior to the other. I liked this one though, as it made sense to me and the initial screen could be completed in 2 minutes :).

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So, why is it important to look globally at human movement when a person is experiencing pain anywhere in the body? For lots of reasons, like I said above—but for the purpose of today’s post—because we now know that movement patterns do really change when a person is experiencing pain—and this is helpful initially and important—remember, your brain wants to protect you from experiencing harm! However, dysfunctional movement patterns, although helpful to the body in that moment, can persist and lead to further problems down the road.

Paul Hodges (a favorite researcher of mine!) and Kylie Tucker examined the current theories regarding movement adaptations to pain in a 2011 review published in the International Association for the Study of Pain. They looked at the current research regarding movement variations in pain, and frankly poked holes in the theories where holes needed poking.  They then presented a new theory on the motor adaptations to pain, and that’s what I would like to share with you today.

The theory they presented is based on the premise that movement adaptations occur to reduce pain and protect the painful part. The way in which a person does that actually varies and is flexible. Here are the basics of their theory, simplified, of course. I do encourage you to read the paper if you’re interested—it’s great!

  • Adaptation to pain involves redistribution of activity within and between muscles. Basically, the brain varies which pools of motoneurons fire in a muscle based on the individual and the task requirement. The common goal still is to protect the painful part from pain or injury, but the way the body does this can vary greatly. Interestingly, we know that the motoneurons active before and during pain tend to reduce activity, and the production of force actually seems to be maintained by a new population of units who were previously inactive. Normally, motoneuron units are recruited from smaller to larger pools to allow for a gradual increase in force—but in pain, a person often will have earlier recruitment of larger pools to basically allow for a faster development of force to get away from pain (think fight or flight response!). Also, the new population of active units may be altered to change the direction of the force generated by the muscle (again, aiming to help protect the painful structure). We also can see in some areas, like the trunk, that one muscle may become inhibited (like the transverse abdominis) while other larger muscles become more activated. This again, makes sense with the body’s goal of protection. Quick activation of larger motor units allows for a quick activation of a muscle to help protect and escape pain.
  • Adaptation to pain changes mechanical behavior. Basically, like we just discussed, the redistribution of activity within and between muscles changes the force and output of the muscle. Hodges & Tucker give us a few examples of this. First, they’ve found that when someone has knee pain, the quadriceps muscles fire differently to change the direction of knee extension by a few degrees. They also explain that the changes in muscle firing in the trunk muscles in someone with back pain leads to more stiffness and less control of movements and less anticipatory action. Basically, in each of these cases, the big picture motion stays the same, but there are small changes within how the body accomplishes those tasks.
  • Adaptation to pain leads to protection from pain or injury, or threatened pain or injury. Basically, this redistribution of muscle firing is done to protect against pain—or even the threat of pain. When a person experiences pain, the brain choses a new pattern to move to either splint the injured area, reduce the movement of the area, or alter the force on the area. The interesting piece here is that the body responds this way even when there is a perceived threat of pain! The key with all of this is that the adaptation varies significantly—not one pattern is seen for all types of pain, but the nervous system has a variety of options for protection!
  • Adaptation to pain involves changes at multiple levels of the motor system. So, although we know that the activation of motoneuron pools can change during pain, that alone does not describe the variability we see. We know now that the way the body changes movement can be influenced by structures in the brain, spinal cord or at the local level of the motoneuron. All of this is going to be influenced by the task at hand and the individual (thoughts about the pain, emotions, stressors, and previous experiences)
  • Adaptation to pain has short-term benefit, but with potential long-term consequences. Although the short-term benefit is protection of the painful area and prevention of further pain, this may lead to consequences down the road if the adaptation persists. Of course, we assume in this case that movement in a non-pain state is likely the most efficient and optimal way to move. So, changes over time could produce decreased movement variability, modified joint loading, modifications in walking patterns, joint load and ligamentous stress. Hodges and Tucker state that in order for these long-term consequences to occur, there would likely need to be a gradual maintaining of the compensation, thus that the nervous system did not recognize it being problematic. Basically, the brain slowly adapts to the new pattern and does not recognize the problems it could cause down the road.

Interesting stuff right? The tricky thing is, we don’t really know for certain how these long-term changes can impact the body—but we do know that one of the biggest risks for injury is previous injury. I can’t help but think that movement changes could possibly contribute. But how do we change this in a positive way?  I think the first step is understanding pain, learning what pain is and what pain is, and developing a healthy mindset toward pain—this alone goes a long way! We also have to look closely at our own emotions, our psychological state, our previous experiences, and understand how all of these things can influence how are brain chooses to respond to pain. But then, we need to identify which movements the body has changed, understand how the brain is varying movements to protect against pain, and then slowly provide variability with good force modulation in those movements to help the brain learn optimal, safe and pain-free ways to move again.

What do you think? I’d love to hear from you in the comments below!

Cheers!

Jessica

What’s new in pelvic health? Reading homework included.

~ jesspreale ~ 2 Comments

I love reading blogs about pelvic health, the human body, chronic pain, movement, neuroscience–and especially get excited if these things get combined together. Periodically, I’d love to simply do a blog on blogs, so that is what you get today. Basically, it is a quick list of blogs, journal articles, random articles, and possibly books that I am reading right now. There are SO many great things out there. I hope you enjoy, and have a great friday! 🙂

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1. The Pudendal Neuralgia Wrecking Ball. Of the different diagnoses in the chronic pelvic pain world, pudendal neuralgia is often a scary one for a patient to hear. Not because it’s untreatable–it IS treatable. But simply, because , and unfortunately, many patients with this type of problem (like SO many other problems related to pelvic pain) are often misdiagnosed many times before receiving help and assurance, and often find scary and less than assuring things when researching online (leading to high levels of worry and fear).  So, this article on US News and Reports came out recently. As pelvic PTs, we always love to have big news websites post information to bring awareness to pelvic pain problems. But we took some issue with exactly how that was done and some of the information which was provided…which lead to this excellent response by Stephanie Prendergast, PT of the Pelvic Health and Rehabilitation Center in California (If you don’t follow their blog, you really should! They consistently put out fantastic, high quality information.) And then, led to this response by Sara Sauder, PT, who writes her own blog, focusing all on pelvic pain (it’s great too!). Read these posts–they have great information in them!

2. Can’t Get Enough of the Diaphragm. March was really the month of the diaphragm. Not only did you get my post on the 6 reasons why the diaphragm is the coolest muscle ever, but Ginger Garner (who also has a great blog with a big emphasis on women’s health) went into great detail on this post, expanding on how important the breath really is. I’ve written a lot recently on the importance of breathing with movement and coordinating the breath with other muscle activation, but is holding the breath ever a good strategy? Julie Wiebe gave great insight into that in this post here. (And you know Julie posts awesome stuff!).

3. Movement Variability. As humans, we are designed for movement. Typically when people have pain, their movement patterns become more rigid, and they can often develop alterations where their bodies are guarding movements by pain. Retraining slow, controlled motions with a lot of variations is an important component of treatment! For those without pain, movement variety is key to keeping healthy bodies! That’s why I loved this post by Katy Bowman (my favorite biomechanist) on sitting variations while playing with her child.

4. Share MayFlowers: Women’s Health Awareness. My list would not be complete without a shout-out to Jessica McKinney’s excellent work with Share MayFlowers. SMF is a public health initiative aimed at improving awareness in Women’s Health, and Jessica has been posting excellent information all month long! She highlights women who are doing fantastic things to support WH initiatives, and links to great blogs, articles, etc. out there! A few of my faves from this month are this New York Times article which discussed an innovative form of sex education for adolescents, and this post, bringing awareness of obstetric fisulas.

Hope you enjoy! Now it’s your turn– what are you reading? I’d love to hear in the comments below!

Do men have pelvic floors too? The truth about 10 common pelvic myths

~ jesspreale ~ 4 Comments

Earlier this week, I asked the Twitter and Facebook PT world a simple question:

What are the common misconceptions you hear about the body?

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My initial goal was a fun blog post on common misconceptions about anatomy, etc…but I was not prepared for the huge response I received—over 40 responses with SO many different things that people often misunderstand! Some pelvic, some general—and it made me realize there is SO much bad information out there!! So, what once was one post will become two. Today, we’ll hit on 10 common myths related to the pelvis (you knew I’d start there!). Then stay tuned for a future post hitting other misconceptions related to…well… the rest of the body, fitness, wellness, pain etc.  So, here we go:

1. Men don’t have pelvic floor muscles: They do, I promise. And guess what? The anatomy is not quite as different as you would think! The same muscles that contribute to urinary, bowel and sexual function as well as lumbopelvic stability in women do that in men too. Pelvic PTs treat men with incontinence, pelvic pain, constipation, painful sexual intercourse and much more.

 2. Vaginas need a lot of work to keep clean. No, they don’t. The Vulva (vagina really just refers to the canal itself) is actually self-cleaning. It does not need to be scrubbed with soap. You can totally just shower and run water over it, and it will be just fine. In fact, scrubbing the vulva can irritate it and even kill the good bacteria that prevent infections! I could say so much more, but you really should just read this article on Pelvic Guru by Sara Sauder, PT and this one by Dr. Jen Gunter.

 3. Abdominal pain is always caused by organ problems. Not necessarily. Now, don’t get me wrong, abdominal pain can definitely happen with ovarian cysts, appendicitis, constipation, and much more—but abdominal pain can also happen when the organ is not to blame. This is so common in men and women with chronic pelvic pain. These people often will have very sensitive nervous systems, tender muscles around the pelvis and in the pelvic floor, as well as even neural irritation (lots of nerves run through the abdominal wall!). So, if the organ has been ruled out as a source of pain and the pain persists- it may be worth considering something different.

4. Not having enough sex OR having too much sex OR masturbating too frequently causes pelvic pain. I cannot tell you how many times I have had a patient timidly ask me if there sexual habits or frequency are to blame for their pain. No. Just no. You should be able to have sex as little or as frequently as you want without any problems or pain. Now, being forced to have sex—that may cause a strong protective response of the pelvic floor muscles. But, consensual sexual activity is normal and should be enjoyed by all without worrying about pain. And if you are having pain? Don’t ignore it– go talk with your physician or physical therapist!

 5. Tight pelvic floor muscles are healthy pelvic floor muscles. Guess what? Tight ≠ strong. Flexible ≠ weak. Strong ≠ Well-timed. Functional pelvic floor muscles are non-tender, flexible muscles that are able to activate when they should activate (well-timed). We want the pelvic floor to stretch to allow you to poop and have sex, and we want the muscle to activate at the right time with enough strength to help you not leak urine when you cough.

6. If the doctor says “all looks good” 6 weeks after having a baby, it means your body is completely back to normal. Newsflash here, you’re body isn’t really going to go back to being exactly what it was like before the baby. It’s not meant to, and that is ok! It can still be an awesome, strong and well-functioning body– but you do need to take care of it. Remember that urinary or bowel leakage, constipation, persistent low back/pelvic pain, vulvar pain, and pain with sexual activity are NOT normal. If “all looks good” at 6 weeks, but you are having these problems, find a skilled pelvic PT near you to get evaluated and get some help! And even if you are not having these issues—your body has been through a lot! Take time and care in slowly getting your body back into good movements. Also, check out this article by Ann Wendel, PT on 5 myths surrounding the pelvic floor after pregnancy.

 7. If a woman had a c-section, her pelvic floor was not impacted, and she doesn’t need to think about it. Guess what the biggest risk factor for urinary incontinence is? PREGNANCY. Although mode of delivery is important, simply being pregnant and carrying a baby puts significant pressure on the pelvic floor. Both vaginal deliveries and c-sections impact the body—remember, a c-section cuts through the abdominal wall! Remember that team of muscles that work together for lumbopelvic stability? The abdominal wall is a KEY member. Regardless of your mode of delivery, seeing a skilled physical therapist after having a baby is crucial to help your musculoskeletal system function optimally, manage unwanted pain or leakage, and get back to the fitness activities you enjoy. And guess what? It’s standard care for all ladies postpartum in many countries around the world.

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8. Urinary incontinence is always due to a weak pelvic floor muscle group. I wrote a whole blog on this one, so I recommend you read it here. The short answer is, No. No problem is due to solely one muscle. Our body is a system, and we have to always treat it like that.

 9. Hips and sacrums dislocate regularly in some people. This is such a common one too—I’ll have patients come in and say, “My hip keeps ‘going out’ and I have to do this <does weird hip movement> to put it back in.” OR “My SI joint keeps ‘popping out of place.’” Let’s all be honest about this- dislocations of joints do happen, but it tends to be pretty painful, likely traumatic, and if your hip dislocates, you bet you are going to the ER. That “pop” you hear? It’s likely just a joint cavitation- basically a decrease in pressure causes dissolved gasses in the joint fluid to be released into the joint. Same thing happens when you pop your knuckles. If it happens frequently and is associated with pain, talk with a physical therapist.

10. Sucking in the stomach constantly creates a strong “core” and a flat abdomen. You know what creates a flat abdomen? Eating healthy and exercising regularly. Contracting any muscle constantly is not functional, nor does it really do what we want it to do. Sucking in the stomach actually tends to make it more difficult for your diaphragm to move well when you breathe and also can cause the pelvic floor muscles to over contract and become tender/uncomfortable. It can also inhibit movement, and we know moving well with variety is SO key to a happy body. So, relax your stomach and allow yourself to breathe (remember how important that diaphragm is!)

I hope you gained a little insight with this list—it was fun to write! This is by no means an exhaustive list (over 40 responses, remember?), and I’d love to keep the conversation going! Special thanks to my world-wide pelvic health team! It’s so fun collaborating with such a great group!

Have you heard anything else about the body that does not seem to be right? Ask here and we’ll do our best to answer! Physical therapists out there—what are your other favorite myths to de-bunk? Let’s all work to spread accurate knowledge—knowledge really is power! Have a great Wednesday!

~ Jessica

6 Reasons Why the Diaphragm may be the Coolest Muscle in the Body

~ jesspreale ~ 25 Comments

I have a small confession to make– I love the study of human anatomy. Always have. It was studying human anatomy and physiology that made me shift my undergraduate degree at Gordon College away from “Biology” and into “Movement Science” (which has now become “Kinesiology”… Who would have known that years later, “Movement Science” would have been the coolest name for a major ever? Am I right fellow PTs?). The human body is fascinating and incredible. So, it should come as no shock to you that I have favorite muscles. In PT school, my favorite muscles were the ones with the most fun names… like the Gemelli brothers (who are small hip external rotators) or Sartorius (a thigh muscle…best, if sung to the tune of “Notorious“). Of course, you know that now the pelvic floor muscle group ranks pretty high on that list…but the diaphragm, well… it just takes the cake. Here are some of the reasons why the diaphragm really is so cool.

1) We can contract our diaphragm voluntarily–but it also will contract without us consciously telling it to. How cool is that? You can activate your diaphragm by taking a long, slow, breath expanding your ribcage 360 degrees and allowing your belly to relax. But, before I brought your attention to your breath, you were using the diaphragm without even thinking about it!

2) The diaphragm helps to mobilize the ribs, lumbar spine and thoracic spine. The diaphragm attaches to the 1st, 2nd, and 3rd lumbar vertebrae, the inner part of the lower 6 ribs as well as the back of the sternum at the xiphoid process. The central tendon of the diaphragm then attaches to the 3rd lumbar vertebrae. During inhalation as the diaphragm flattens to allow the lungs to fill with air, the diaphragm will “pull” slightly on each of those attachments, effectively giving you a gentle mobilization. The ribs will also move during inhalation and exhalation to allow space for the lungs to fill.

3) The diaphragm is a key member of a team of muscles which help to create dynamic postural stability. You knew that would be one of my bullets, right? I think I mention this in almost every post…but… the diaphragm works together with the pelvic floor muscles, abdominal muscles (transverse abdominis) and low back muscles (multifidus) to pre-activate and provide support to the body during movement. Together, these muscles make up our “anticipatory core” and are important muscles for healthy pain-free movement patterns. Now, no post on the diaphragm would be complete without an excellent video explanation by Julie Wiebe, PT, who is amazing and has done so much to help advance the understanding of dynamic stability in PT practice.

4)Retraining proper firing of the diaphragm can help to reduce urinary incontinence AND low back pain.  Now, that is pretty cool, right? Excellent research by Paul Hodges and colleagues has shown altered firing patterns of the diaphragm in people with low back pain or urinary incontinence.  Amazingly, when people re-established proper firing of the diaphragm leading to full excursion, both low back pain and bladder problems reduced   This is likely due to the relationship between the pelvic floor and diaphragm in controlling intraabdominal pressure within the abdomen and the pelvis.  Proper breathing helps to restore the optimal pressures needed to control movements and support the pelvic organs. This relationship is so huge that problems with breathing and continence are more correlated with low back pain than obesity and physical activity. 

5) Slow breathing with the diaphragm can calm down the nervous system.  The breath is so connected to the autonomic nervous system. When a person is fearful or anxious, the sympathetic nervous system (fight or flight response) is activated, and a person will take quick shallow breaths to bring oxygen to the muscles as quickly as possible (think: being chased by a bear)  the parasympathetic nervous system (rest and digest) is activated when in a more calm or relaxed state (yes, I am oversimplifying all of this… I know). In that state, a person will take slow calm breaths (think: sipping a cup of tea after a great massage).  The cool thing is that we can use our breath to help us move toward a more relaxed state. Slow breathing will help calm stress, anxiety and promote a person being in a more parasympathetic state. And guess what? There’s an app for that! The Breathe2Relax app for iphone/android allows a person to program in his or her breath and then takes you through a guided breathing exercise.

6) Slow breathing with the diaphragm can reduce pelvic pain. As we discussed previously, the pelvic floor and diaphragm are coordinated and work together to control pressures through the pelvis. As the diaphragm is activated during inhalation, the pelvic floor relaxes to accept the contents of the abdomen/pelvis. As we exhale, the diaphragm returns to its rested position and the pelvic floor activates slightly. Long slow breaths then encourage complete relaxation of the pelvic floor and thus can help decrease pain for people with tender pelvic floor muscles.

So, there you have it! I bet the diaphragm just moved up a few notches on your favorite muscles list (you know you want one!). If you need more reasons, and enjoy “nerding-out” with Anatomy, check out these studies:

What’s YOUR favorite muscle? Did I miss any reasons why the diaphragm is amazing? Let’s chat together in the comments below!

~ Jessica