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The Last Fitness Issue

Dr. Bruce S. Crawford MD, FACOG


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It really deserves our attention. The pelvic floor does so much for us, so much that we take for granted and indeed so much that we wouldn’t want to live without. And yet we do so little for it. Our relationship with the pelvic floor is clearly out of balance. Consider how much attention we give to the more “traditional” aspects of fitness. Our quads and glutes, our abs and arms are all more likely to be the focus of training; after all this is what makes us (and our clients) look good. Looking good gives us the confidence, and sense of security, that makes it all worthwhile; at least in retrospect.

Consider how generous the pelvic floor is with us. How deserving it is of our gratitude and support (pun intended). The muscles of the pelvic floor, the pubococcygeus, iliococcygeus, and coccygeus, are the repurposed vestiges of tail wagging muscles in the quadraped. In the biped mammal (us) these muscles have quite a different purpose that makes this system especially relevant when it comes to fitness training.

Purpose 1: Bladder Control (is a Fitness Issue)
Purpose 2: Sexual Response (is a Fitness Issue)
Purpose 3: Pelvic Organ Prolapse (is a Fitness Issue)
Purpose 4: Bowel Control (is a Fitness Issue)

The state of the art for pelvic floor fitness training, since Arnold Kegel described the importance of therapeutic exercise for these muscles in 1945, has been a series of quick and slow isometric contractions. We cannot overestimate the importance if his contribution but we can, and should, still try to improve. It is time.

I wonder what might have been born from a relationship between Dr. Kegel and Joseph Pilates. A program of pelvic floor rehabilitation that involves movement originating from the core may have evolved seven decades ago. Imagine if this method had been introduced as the product of a collaborative effort between mainstream medicine and the fitness industry. How much further would we be today in our cultural understanding of the pelvic floor as a fitness consideration essential for our health and wellbeing, indeed for our confidence and security. This opportunity was missed in the 1940’s and 50’s but still the opportunity exists. The Pilates community is a very sophisticated community fully capable to moving the art forward toward its rightful place in healthcare. It is my observation that Pilate’s spirit is alive and well in this highly educated, body conscious, and determined community of fitness professionals.

Likewise the Urogynecological community seems ready for collaboration. The medical literature has taught us that the causes of urinary incontinence are much more a function of neuromuscular integrity of the pelvic floor that was once believed. The medical-legal system has taught us that we had better be discussing, offering, and hopefully encouraging, conservative non-surgical alternatives to our patients with incontinence.

No one disputes the value of therapeutic exercise of the pelvic floor as first line treatment of bladder control problems. What we need to be focused on is how to improve this type of exercise and make it more practicable. Pfilates™ is a program of movement, inspired by Pilates movements, that I created in 2009. To date we have over 600 instructors in North America, and over 100 in Japan. This method was created by identifying movements that effectively engage the pelvic floor using electromyography (EMG) synchronized to study subject video recordings. The technique of Video –EMG Synchronization (VESy™) is now available to Physical Therapists, Fitness Professionals, and Physicians as tool for optimizing each client’s Pfilates™ program by selecting out only those movements that provide the greatest degree of pelvic floor engagement. The data indicates that by doing this we can increase motor unit recruitment of the pelvic floor by 75% (relative to the traditional Kegel exercise). Our clinical data shows that after 4 weeks of using their “custom” program clients improve pelvic floor strength by 33%, and improve bladder symptoms by 75%.

The Pfilates™ Method will be presented to UK instructors for the first time on September 28th and again on September 29th 2013 in London. The VESy Lab will be demonstrated at this certification course which will be led jointly by myself Sarah Pilates and Claire Mockridge.
Email Sara at sarahpilates@sarahpilates.com to register for this one day event
www.pfilates.com
www.vesylab.com