Herman & Wallace instructors Bill Gallagher PT, CMT, CYT and Richard Sabel MA, MPH, OTR, GCFP are currently leading a four-session workshop for men who recently underwent prostate surgery. They recently completed the first two sessions and shared their story and experience with Pelvic Rehab Report:
For the past few weeks, we’ve had a unique experience: leading a four-session workshop for 22 men recovering from prostate surgery. This experience was unique in that it's rare to get a group of men together to discuss health issues- it happens...about as often as congress reaches a bipartisan agreement!
So far it's been an amazing journey. At the first session we did a quick go round, well, actually not so quickly, as each participant had a story to tell. Things picked up when one participant mentioned he was using a penile clamp. Sex, sports, politics couldn't compete in that moment for the groups attention. (Perhaps the details will be shared in another blog.) For now, the key point we'd like to make is that groups work well for this type of practice. Obviously, individual treatment is imperative, but groups help foster the "new habits" learned in therapy and, perhaps more importantly, from other group members. The mutual support and sharing of information can't be beat.
Given there are only four one-hour-and-fifteen minute sessions, choosing the "lessons," took a little thought. Ultimately we selected four from the Integrative Techniques for the Pelvic Floor & Core Function: Weaving Yoga, Qigong, Feldenkrais & Conventional Therapies live course and online course series that aims to reintegrate of the pelvic floor with the core and full body movement. Below is an overview of each lesson:
Lesson 1 - The Pelvic Breath: The pelvic breath serves as the foundation for the program. In this lesson, participants begin to develop an awareness of the pelvic floor; sense how it moves in relation to the respiratory diaphragm; gently contract and release the pelvic floor as a whole and in sections: right, left, front and back. This focus helps participants develop a keener awareness of the pelvic region and notice differences such as the right side is tighter than the left, how one side can be sensed more clearly, or noticing that while doing Kegel exercises how the back, anal portion, was contracting, not the front.
The pelvic floor is also referred to as the pelvic diaphragm. Given we breathe in and out over 20, 000 times per day, reeducating the pelvic floor to dance with the respiratory diaphragm, is key to maintaining the pelvic floor’s suppleness. By focusing on the breath, this lesson also promotes the relaxation response.
Lesson 2 – Standing Stake: Standing Stake, which goes by a variety of names, is practiced within Tai Chi Quan and Qigong and is an important part of internal martial arts training. In Standing Stake, the participant stands with their feet shoulder width apart, toes straightforward. The hips and knees are slightly bent. The tailbone is released down as if it a weight was attached to the coccyx. The chin is slightly tucked while imaging the head floats upward. The arms are protracted, as if hugging a wide tree, while keeping the shoulders relaxed down and out. There are a few more adjustments, but this gives you an idea, which might have you asking…and how does this relate to the pelvic floor? First, after developing an awareness of the pelvic breath in the first lesson, is it possible for the participant to allow the pelvic diaphragm to move in concert with the respiratory diaphragm, while the upper and lower extremities are engaged? Can the rest of the body maintain a relatively relaxed state in this form? If not, can the holding or tension be identified and released? Standing Stake ups the ante, helping the nervous system relearn that the pelvic breath can be available even when other parts of the body are actively engaged.
Participants are also guided through a short experiential comparing how locked versus slightly bent knees impacts their breath, lower back/pelvic comfort and stability. Participants typically report that when the knees are slightly bent, the breath is deeper, the pelvis and back feel more comfortable and easy to move, the feet are more grounded and…they “feel” their quadriceps. Many people experiencing pelvic discomfort tend to lock their knees and this is an effective strategy to foster the “new Habit”…of keeping the knees slightly bent when doing everyday activities such as microwaving food or waiting on a line at the store. Not bad for one activity.
Lesson 3 - Coordination of the Pelvic Floor with the Obturator Internus and Adductor Muscles: This lesson builds on the integration of the pelvic floor with the core, obturator internus and adductor muscles. The participant first learns to coordinate the pelvic breath while contracting the obturator internus and adductor muscles and then adds pursed lip breathing or Ujjayi breath to activate the abdominals. On the first go round; it can feel like juggling three or more balls, but by having participants work gently and easily, the coordination begins to emerge.
Lesson 4 - Integrating the Pelvic Floor into Everyday Movements: How many people adhere to their home exercise program? Not enough. In this final lesson, the participants learn to engage the pelvic floor into everyday movements such as sit-stand, lifting objects, bridging and going up stairs. After all that’s the goal…to help the nervous system relearn how to use the pelvic floor muscles in everyday activities, which will help maintain their strength and suppleness.
Broadly speaking this work can also be seen within the context of energy conservation and joint protection, as the powerful muscles of the pelvic floor “reassume” their role in everyday movements, thereby contributing to the health, function and well-being of our clients.
So far, two weeks into the program, we’ve covered the first 2 lessons and all is going well. Our next blog will highlight the participants’ reaction and comments, along with any other interesting anecdotes that arise.
If you would like to contact Bill or Richard, you can do so through their website, EastWestRehab.com