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Posture and the Perineum

 

 

Figure 1. With their pelvises tucked under, the therapistís bodies are compressed through their midlines. Because the shoulders are unsupported by the spines, the arms are working too hard. The necks are also unsupported and strained.

Figure 1. With their pelvises tucked under, the therapist’s bodies are compressed through their midlines. Because the shoulders are unsupported by the spines, the arms are working too hard. The necks are also unsupported and strained.

 

 

Figure 2. Release of the pelvic floor and hips results in better body alignment, better grounding through the legs, and greater efficiency of movement. Recipients reported that the quality of touch was much better as well.
Figure 2. Release of the pelvic floor and hips results in better body alignment, better grounding through the legs, and greater efficiency of movement. Recipients reported that the quality of touch was much better as well.

 

 

Figure 3. The diamond-shaped pelvic floor with its sling of perineal muscles. Illustration by Stephen P. Miller. Reprinted with permission from The New Rules of Posture , by Mary Bond (Rochester, VT: Healing Arts Press, 2007).

Figure 3. The diamond-shaped pelvic floor with its sling of perineal muscles. Illustration by Stephen P. Miller. Reprinted with permission from The New Rules of Posture , by Mary Bond (Rochester, VT: Healing Arts Press, 2007).

 

 

Figure 4. When the pelvic floor is spacious, the whole body easily finds good alignment. With the chest open, the neck and shoulders are supported by the spine. This provides the arms with proper leverage.
Figure 4. When the pelvic floor is spacious, the whole body easily finds good alignment. With the chest open, the neck and shoulders are supported by the spine. This provides the arms with proper leverage.

 

 

Posture and the Perineum

 

 

Figure 5. How you bend over in your daily activities pre-patterns your body usage when you perform massage. Illustration by Stephen P. Miller. Reprinted with permission from The New Rules of Posture , by Mary Bond (Rochester, VT: Healing Arts Press, 2007).

Figure 5. How you bend over in your daily activities pre-patterns your body usage when you perform massage. Illustration by Stephen P. Miller. Reprinted with permission from The New Rules of Posture , by Mary Bond (Rochester, VT: Healing Arts Press, 2007).

Figure 6. Your whole body can elongate when your pelvic floor is free. Illustration by Stephen P. Miller. Reprinted with permission from The New Rules of Posture , by Mary Bond (Rochester, VT: Healing Arts Press, 2007).
Figure 6. Your whole body can elongate when your pelvic floor is free. Illustration by Stephen P. Miller. Reprinted with permission from The New Rules of Posture , by Mary Bond (Rochester, VT: Healing Arts Press, 2007).

 

 

Posture and the Perineum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Posture and the Perineum

By Mary Bond

 

As bodyworkers, we embrace the demanding physicality of our occupations not only out of passion for helping others, but because we enjoy using our bodies to do our work. So it becomes demoralizing—even a bit shameful—to be delivering ease to others’ bodies while our own bodies ache from the endeavor. And while we suspect our pains are products of our body usage, we know our body usage is difficult to correct. This is because our body use is founded on our habitual postures. How we work is one with how we stand and move in all aspects of our lives. Shoulders bunched, chests caved, spines rounded, necks craning: try as we may, our bad habits persist despite good training and despite our sincere intentions to use our bodies well. Yet most postural mistakes and the pain they cause can be traced to a subtle error made in an area of the body rarely associated with body mechanics or posture.

In the thirty-five years since being trained by Ida Rolf, I’ve taught many people how to achieve ease and grace in their bodies. Among them are hundreds of massage therapy students whom I’ve trained in efficient body mechanics. I’ve watched most of these people struggle with a single postural error. I make this error myself when I’m tired, when I’ve seen one too many clients for the day, or when I’ve lost track of the yoga practice that helps keep me mindful of my body. The error consists of a subtle compression of the pelvic floor. As I hope to show you in the course of this article, correction of the pelvic floor affects every other aspect of posture. With that area established as the root of posture, many issues involving shoulders, hands, spine, and legs simply disappear.

People make a number of assumptions about posture. It’s common to think that posture is something that takes place from the waist up. Voices surely echo through your own personal history: “Shoulders back! Sit up straight! Chest out! Stomach in!” But posture, as I’m sure my Rolfing structural integration colleague Thomas Myers will tell you, is a holistic affair (see “Acture,” page 42). Posture is not a matter of isolated offending parts like forward heads or protruding bellies. Posture involves the whole self—body, mind, and spirit—from head to toe.

Your posture is determined by how you orient yourself to gravity, and to the things, people, and events in the world around you. Your posture is affected by how you stand your ground and by how you take up your space as you move through each moment of your day. Your ten-thousand-plus daily steps, plus your gestures of love and frustration, your mundane household activities, your recreation, and your tapotement and effleurage mold your plastic body, year by year, into a form so distinctive that a long-lost friend can recognize you from a block away.

Most people are familiar with an image of good posture as the alignment of body parts along a vertical axis passing through ear, shoulder, hip, knee, and ankle. Although this static postural cliché correctly portrays human stance as a relationship with gravity, few people actually sense this relationship as embodied experience. It was Ida Rolf’s mission to “spread the gospel of gravity” so that the postural ideal could become lived human experience and could contribute to “a more human use of human beings.”1

The Problem of Posture
Human stance on two legs is a precarious business. Our tissues, primarily fluid in nature, are framed by an unstable system of struts and levers. Our bony joints, unlike the right-angled joints of buildings, are rounded, designed to move. We stand, not to remain stationary, but in preparation for movement. Our standing posture is not a static state, but an orienting activity that prepares the body for practical action.

The problem of posture is a problem of stabilization. Our fluid tissues and flexible frames must somehow acquire enough stability to provide leverage against the pull of gravity. Our neuromuscular systems accomplish this by redirecting gravity’s downward force. An aikido practitioner yields to his opponent’s assault and, by so doing, channels the attacking energy back to its source. Similarly, our bodies, in yielding to gravity, are able to redirect the force that would otherwise render them immobile.

At the same time, our senses—the tactile, visual, auditory, olfactory, and several “sixth” senses—extend our awareness beyond the confines of our bodies, making it possible to perceive our surroundings. Thus, our senses provide the impetus to push away from the earth and to reach out beyond ourselves. The diametric tendencies between our response to gravity and our response to our senses are the basic elements of postural activity. The ability to yield to gravity and the quest to reach beyond it make vertical alignment—and human stance—possible.

Postural activity is composed of the primary yielding into earth, from which we push and reach into our surroundings. These activities—yielding, pushing, and reaching—comprise the dynamic stabilizing activity that prepares the body for any movement. This activity occurs within the neuromuscular system and usually below the level of consciousness. Before taking an outward action, our bodies require this subtle orienting activity.

We can visualize the diametric “earthing” and “heavening” dynamics as a flow of energy through our bodies. The mostly vertical orientation of our voluntary musculature mirrors this flow. Muscles contract distally to proximally to draw our bodies upward; proximally to distally to bring us down. But there are numerous junctions throughout the body where horizontally-oriented muscular and fascial structures traverse the lengthwise structures. These horizontal structures act like valves in the flow of energy through the midline. The locations of these “valves” are the feet and hands, the interosseous membranes of both legs and forearms, the pelvic floor, the respiratory diaphragm, the thoracic outlet, the submandibular tissues and tongue, the hard palate, and tentorium.

Because of fascial relationships between the horizontal structures, constriction in any of these zones tends to affect distant horizontal structures, as well as to locally block the orienting dynamic. You experience this whenever you’ve accidentally worn tight shoes for a long day on your feet. The limitation of your ability to ground yourself makes your body grow tense all over. It also diminishes the ease with which you move. Try tensing the plantar surfaces of your feet right now. Most likely you’ll feel that tension play up through your interosseous membranes as if welding tibia and fibula together. Or you might feel an immediate referral into your pelvic floor. You may feel yourself breathing more shallowly, tensing your shoulders, or even tightening your tongue or jaw.

While tension in any of the posture zones prevents optimal vertical alignment and ease of motion, the lesson my clients and students need most is education about the pelvic floor. I’ve learned what I know about the relationship between posture and the perineum by observing a monthly procession of massage students over the course of fifteen years. For so many of them, orienting activity—the interior movement they make before moving—involves a very subtle compression of the pelvic floor, which dramatically affects how the rest of the body can be used.

The Pelvic Floor Jewel
If you’ve read Thomas Myers’ excellent anatomy columns in this magazine, you know your pelvic floor is the diamond-shaped area defined by your pubic symphysis, your ischial tuberocities, and coccyx. Within the pelvic floor is a muscular hammock, or diaphragm, consisting of the levator ani and coccygeus muscles and their fascias. The inferior surface of this diaphragm is known as the perineum. The transverse perineal muscles divide the area into two triangles: the anterior, or urogenital, triangle, and the posterior, or anal, triangle (see Figure 3, left). Penetrated by the urethra, vagina, and anus, the perineal sling is an area of our bodies that we must be able to open and yet protect. Its location in our bodies is both out of the way and accessible. Because our culture has taught us to feel shame about this region of ourselves, it is not surprising that it would be the last place to look for the source of ease and grace in our bodies.

Ida Rolf was so emphatic about the importance of the pelvic floor to the balancing of structure that when I studied with her in 1969, she invited Arnold Kegel, MD, to speak to our class. Kegel was the obstetrician who first suggested that perineal exercise could repair injury to the vagina after childbirth. Women who complained of postpartum urinary incontinence were taught to contract the levator ani repeatedly to strengthen it. Because women subsequently reported that the exercise stimulated the capacity for orgasm, the “Kegel” quickly became a household word (see Accessing Core Support Through the Perineum, page 24).

The effect of the pelvic floor on posture can occur through tension in the perineum per se, or through tension in the neighboring hip, spine, and abdominal structures that change the inclination of the pelvis as a whole.

Bending and Straightening
The performance of massage and bodywork primarily involves movements of bending over and straightening up. It is therefore useful to examine the manner in which we habitually perform these actions.

To begin, perch yourself on your massage table with your sit bones just over the table edge. Adjust the table high enough that your hip joints are considerably higher than your knees, but low enough that your feet can be flat on the floor. This position, halfway between sitting and standing, allows your pelvic floor diaphragm to be optimally spacious. It also supports appropriate lumbar lordosis for most people. (Later on you’ll learn why lordosis is essential to healthy posture.)

For now, though, I’ll ask you to purposely reduce your lumbar curve. Sit a bit back on your pelvis, with your weight falling on your buttocks, behind your sit bones. For many readers, this instruction will result in a familiar slouching posture, with the pelvis tilted posteriorly. If you mentally gaze down within your body to your pelvic floor, you’ll see that the urogenital triangle—the one in front—has become more spacious than the anal triangle. You are sitting on the anal triangle and compressing it.

Now reach your hand forward as if to retrieve something from a low table in front of you. As you do this, you’ll probably notice that you’re bending forward from your waist, and that reaching your arm requires considerable protraction of your scapula. Then be aware of what you do to straighten up again. If you’re like most people, you’ll feel some strain through your lower back. Next, stand up and pantomime the position in which you brush your teeth. Imagine yourself standing at the sink. Most likely, you’ll bend over in a similar way—with your pelvis slightly posterior, your coccyx tucked under, and your upper body folded over your belly at the waist. In both cases, your actions of bending and straightening make little or no use of your hip joints.

If those movements felt familiar, you’re among a majority of people. Your habitual way of bending over predisposes your patterns of movement while you work and increases or decreases the likelihood of pain and discomfort. Both you and your client will find the massage more pleasurable if you are using your body efficiently. Ease in your body translates directly into the quality of your touch.

Pay attention to your movement the next time you give a session. If your bending and straightening actions take place mostly at your waist, this occurs because your hip joints are too stable. The inclination of your pelvic floor prevents your hip joints from participating in your movement.

To feel what I mean, re-seat yourself on the edge of your table. This time roll your pelvis forward so you are resting just in front of your sit bones. When you do this, you’ll sense more of your weight being born by your legs. Mentally gaze down into your pelvic floor and notice that the perineal diamond is now more spacious. Urogenital and anal triangles should both feel open. To achieve this, it helps some people to let the pubic bone sink so that it seems to rest on a slightly lower plane than the coccyx. Other people find it helpful to visualize the tiny ligament between anus and coccyx—the anococcygeal ligament—and to imagine it growing longer.

Now reach forward again. Most likely, you’ll automatically use your hip joints as you bend over. To straighten up, you’ll use your feet for leverage. Next, push and pull your hands forward and back as if you’re effleuraging the air. Be aware of the activity in your hip joints. You should feel similar sensations of hip activity when you’re working with your clients.

One more experiment will help you notice a few more effects of pelvic floor orientation. Sit once more with your pelvis rolled back. See whether you notice any of the following phenomena. With your pelvis in this orientation, your feet probably feel lightly placed on the floor. This indicates that when the pelvic floor is withdrawn, you lose your capacity to ground your feet. Most people also notice that breathing is shallow and located in the upper chest. This is because the posterior inclination of the pelvis and resulting flexion of the lumbar spine compresses the abdomen in a way that blocks the full descent of the diaphragm. It should also be obvious that the compressed midriff encourages the shoulders to protract and the head and neck to jut forward. The moment you restore the spaciousness of your pelvic diamond—by rolling forward over your sit bones—your feet feel more grounded, your breathing feels more complete, and your spine finds an erect configuration.

On Your Feet
Once you can clearly recognize the sensations of an open pelvic floor, you’re ready to put this principle of posture into action. To stand up from your chair, simply tip your torso forward enough to feel your body’s weight over your feet. Stay mindful of the openness of your diamond. Then push your feet down into the floor and rise, straightening your knees. Try this several times. Take time to register both the physical sensations and the state of mind you experience as you achieve your new stance. Because a spacious pelvic floor supports more openness through the whole body, many people report that a more open mental outlook seems to accompany the more open stance.

Now let’s challenge the new pelvic inclination by practicing a forward and back glide; by this I mean the movement you make (or should be making) as you shift your weight from foot to foot as you deliver effleurage strokes. Place your left foot well ahead of your right, and glide your weight forward and back. Notice what happens to your pelvic floor as you do this. If you’re like most of my students, you’ll find it’s easy to let the diamond remain open as you move forward onto your left foot. But when you shift your weight back into your right foot, there’s a tendency to close the posterior triangle. You’re likely to tuck your coccyx under, even if only a very little.

Try the movement again, reversing your legs so the right one is forward. This time, try to let your posterior triangle remain spacious. All of this will be easier to do if you turn your back leg out a little as you glide backward. To avoid knee strain, be sure to align your back knee directly over your foot. This will result in a slight rotary motion of your trunk as you glide forward and back. It’s a natural curving motion, like the windup of a tennis serve or baseball pitch. You’re winding up for effleurage.

My students’ responses about how it feels to move with the pelvic floor released run a gamut from “Wow, this is so much easier, so much more stable and balanced” to “You mean I’m supposed to stick my butt out?” If hip muscles have become excessively tight through chronic suppression of the pelvic floor, the movement will feel awkward. But for most people, it feels like some reins have been let out so the legs and buttocks can move with greater ease.

For some people, freedom in the hips evokes a hint of fear or shame. We are so accustomed to protecting and hiding the pelvic floor, that releasing it can feel like exposure. This can be a problem of body image, a sense of shame about size or shape. But tucking the pelvis under does nothing to diminish the size of the buttocks. In fact, tone in the gluteal muscles is more readily developed when the pelvic floor and hips are free. For those who have suffered physical injury or abuse to this area of the body, a drive to protect it is natural. But whenever we guard our bodies with tension, such tension does more harm than good by cutting down on our capacity to move out of harm’s way.

Whenever we feel a need to center our bodies, it is common to tuck and tighten the pelvic floor area. The muscular activity of a weight lifter illustrates this. Strong contraction of the muscles that draw the pelvis posteriorly—the hamstrings, obturators, and quadratus femoris—secure the pelvis against its natural instability over the heads of the femurs. Such contraction is appropriate for a weight lifter whose femoral heads must be drawn into their sockets and held with enough muscular tension to buttress the body against an inordinate load. But for bodyworkers who need to move, excess tension around the hips and buttocks becomes a harness that inhibits freedom of movement throughout the body.

Many massage therapists have found it useful to practice tai chi ch’uan as a model for the movements of massage. While the smooth flowing movements of tai chi are desirable for Swedish massage, some proponents of this discipline train students to stabilize their trunks by tucking the pelvis and coccyx under, exactly the opposite of what I’ve been suggesting. I believe the discrepancy may be due to confusion between the functions of grounding and centering. These physical functions are not identical, but because both contribute to stability and balance, they are often substituted one for the other. Many people over-center the body because they do not fully sense the earth through their feet.

While it’s true that releasing the pelvic floor results in a slight anterior tilt and accompanying lumbar lordosis, the goal is not to assume an exaggerated lumbar curve. Mild lordosis is normal, despite many people’s outdated beliefs that the spine should be straight. Proper lordosis aligns the vertebral segments in the best configuration for safe rotary actions. Lordosis and kyphosis make possible the contralateral motion of graceful walking. The spinal curves also protect the spinal discs from the impact of walking.

It is possible, however, to have too much lordosis in the lumbar spine. About one in twenty of my massage students has an extreme lumbar curve. Most physical trainers try to help these people by instructing them to tuck their tails down to flatten the curve. Such a strategy only immobilizes the pelvis and creates more strain on the back. Many people with strong lumbar curvatures are lacking sufficient abdominal tone to secure the lumbar area (see Accessing Core Support Through the Perineum, page 24). Interestingly, pelvic floor tension may be present even when the pelvis is anteriorly tilted. Chronic tension of emotional or physical origin can cause narrowing of the posterior triangle independently of the position of the pelvis.

My emphasis on the pelvic floor should not be taken to imply that other considerations of body usage are of no value in the performance of massage. Certainly we need to be mindful of abdominal stabilization, shoulder girdle support, correct breathing, and many other factors. But it is the mobility between legs and pelvis that makes possible the transmission of energy from the feet through the spine and scapulas to the ulnas and hands. It is this transmission—the embodiment of dynamic orientation between gravity and surroundings—that renders the movements of bodywork smooth, effortless, and pleasurable. When the pelvic floor is restricted, the legs and feet are denied relationship with the ground. In such a case, the upper body must supply both support and power. Our bodies then overwork at centering because we fail to sense our foundation in Mother Earth.

***

In this article, I’ve used effleurage as a common denominator for touch in general. The principle of posture and movement is the same whether you’re doing cranialsacral therapy, deep-tissue interventions, trigger-point work, or energy healing. In a nutshell, the principle is to maintain a spacious pelvic floor diamond. If you notice your shoulders hunching forward, attend to your pelvic floor before adjusting your shoulders. If your back hurts, check what you’re doing in your pelvic floor. If you find yourself holding your breath, release your pelvic floor along with restoring steady breathing. Your pelvic floor diamond is a jewel of inestimable value.

Accessing Core Support Through the Perineum

With the popularization of Pilates workouts in recent years, the concept of abdominal or “core” support has gained increasing public awareness. Although it has long been commonly understood that abdominal tone supports the spine, new research has made it clear that there is an important difference in function between the superficial and deep layers of abdominal musculature.

The deepest layer of abdominal support is created by the transversus abdominus, along with its partner, the spinal multifidi group. The multifidi are small muscles underlying the erector spinae that connect vertebral transverse processes with neighboring spinous processes. The multifidi secure the transversus to the lumbar and sacral segments, like the lacing of a Victorian corset. So long as this deep corset is active, we will not encounter low-back pain in the course of our work. Research has shown that people who suffer from low-back pain have weak transversus and multifidi muscles. This is true even if their superficial abdominals, the rectus, and obliques, are strong. The same research indicates that a 10–25
percent contraction of the deep core (sometimes referred to as the local muscles ) is all that is necessary
to prevent or alleviate low-back pain.2

To protect ourselves from low-back strain in the course of our work, and during any other activity of life, we need to be sure that the transversus abdominus is mildly but constantly engaged. For those whose inner corset has a case of amnesia, this is a matter of learning to recognize new sensations of tone in the lower belly and low-back regions.

One route to acquiring these sensations is through the perineal exercises devised by Arnold Kegel, MD. The exercise is simple to do: interrupt your flow of urine a spoonful at a time. Once you have the knack of doing this, you can practice activating your perineum with or without a full bladder.

Because there is a direct fascial relationship between the transversus abdominus and the pelvic floor diaphragm, activation of the perineal muscles stimulates contraction of the transversus. To feel this, sit on the edge of your table in the “perch” position suggested in this article. Be aware of the openness of your pelvic floor, and in particular, of spaciousness in the posterior triangle. Also notice your lower rib cage widening and settling as you breathe. Now, at the end of your next exhalation, slowly draw in and up through the anterior triangle of the perineum as if trying not to urinate. Make this contraction very gradually, and only to 25 percent of what you feel to be your maximum. Maintain the contraction while you restore steady, moderate breathing.

If your perineal muscles and transversus are underactive, you may not be able to hold the contraction for more than a few breaths. Persist. It may take several months of consistent daily practice to restore tone in this part of your body.

In time, the perineal contraction should be accompanied by a shrinking or drawing sensation in your lower belly, between your navel and pubis. It is also desirable to feel a subtle swelling sensation in your lower back. This indicates that your multifidi muscles are being activated. You can place your hands lightly on your lower abdomen and lower back to feel this happening.

You must teach yourself to distinguish the sensations of deep abdominal support from those of the superficial support provided by your rectus abdominus and external oblique muscles. While these muscles do help support the abdomen, they have no direct attachments to the spine. They flex the lumbar area and rotate the trunk in a global way. This fact can be used to ascertain whether you are engaging the transversus: if you sense any degree of lumbar flexion when you contract your perineum, this indicates that you’ve used the superficial abdominal muscles instead of isolating the transversus. This is why it’s so important to sit in a way that establishes your lumbar lordosis before you begin to practice the perineal contraction. Being able to breathe freely while you hold the contraction also lets you know that you’ve isolated the transversus. You can’t breathe comfortably if your lower rib cage is immobilized by the rectus or obliques.

This does not mean that tone in your superficial abs is unnecessary. The outer abs need to be strong to help you rotate and flex your trunk. But it is only the deep abdominal muscles that can protect the lower back. Many exercise regimes overwork the superficial abdominals and by overriding the deeper muscles, weaken them.

If you sense your body settling back down onto the table when you release your perineal contraction, you’ll know that you have not isolated the pelvic floor muscles. Instead, you’ve probably contracted your hamstrings and gluteals, the muscles that contribute to posterior pelvic tilt and to compression of the anal triangle. Restore your spacious pelvic floor and try again. Focus on slowly drawing up through your front triangle, leaving the posterior triangle free. When you contract your perineum, draw the sling of muscles upward without disturbing the spaciousness of the pelvic floor diamond.

If your deep core musculature is underactive, it may take months of patient practice to develop the tone you need to support your spine during the practice of bodywork. Remember, a 25 percent contraction is plenty. But keep at it. You’ll appreciate good spinal support in all the activities of your life.

Mary Bond teaches at National Holistic Institute in Los Angeles and is on the Movement Faculty of the Rolf Institute. She is the author of Balancing Your Body . Her new book, The New Rules of Posture: How to Sit. Stand, and Move in the Modern World , is to be published by Healing Arts Press in February 2007. Visit her website at www.marybond.net.

Notes
1. Ida Rolf, “Structural Integration,” The Journal of the Institute for the Comparative Study of History, Philosophy and the Sciences , 1963.
2. Carolyn Richardson et al., Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain (Edinburgh: Churchill Livingstone, 1999), 61–3.

 

 

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