What is a Biotensegrity focused approach to pelvic floor rehabilitation?

 

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Traditionally it is considered that our pelvic floor muscles give us the stability and support for our internal pelvic organs.  The main focus of pelvic floor rehabilitation has been on strengthening exercises to improve muscle strength that will provide more support to pelvic organs from below.

 

We believed:

  • That the support came from the continuous compression of tight pelvic floor muscles and tight vaginas.
  • Pelvic organ prolapse was because of a weakness within the floor, or ligament strains.
  • A weakness in the pelvic floor muscles leads to pelvic floor dysfunction.
  • Exercises are Key to providing pelvic organ stability.

Our pelvic connective tissue, fascia and organs are highly mobile and dynamic; the Biotensegrity concept looks at the interaction of all the structures of the pelvis and their interconnectedness as a complete functional unit. We now understand that it is all the structures of our pelvis that provide the stability and support for optimal function. Any tension, adhesion, or scar tissue can cause pulling and dragging tension on core structures to reduce function and manifest into dysfunctional pelvic symptoms and/or pain. To be fully functional all structures rely on their dynamism, their ability to lengthen and recoil, to stretch and be flexible and quality interactions with each other.

Healthy pelvic function plays key role as part of our core mobility and flexibility.

 

Healthy pelvic floor structures need to soften to enable –

•             Our bladders to fill.

•             Relax to defecate.

•             Unfold and unfurl for movement.

•             Uncurl and lengthen for child birth, walking and squatting.

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“A tight pelvic floor and vagina is not what holds our pelvic floor up from below”.

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The area that lies between our sit bones (between our bum cheeks,) has layers and layers of connective tissue, multiple folds of fascia that lengthen in walking and unfolds in child birth. This area needs to be flexible in sitting, soften while walking, and lengthen in squatting.

In child birth the perineum can lengthen up to three times its normal resting length to accommodate crowning of the baby’s head in child birth.

                    

Biotensegrity, the ability of the surrounding tissue and the structure of the vagina, vulva and the perineum to reposition, expand and then contract with changes of tensegrity to accommodate the various stages of childbirth is amazing.

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In child birth our pelvic floor muscles need to soften, dilate, and open to accommodate the passage of the baby through the vagina. Then amazingly within minutes they recoil back, and we are able to stand up and walk around.

Prolonged sitting, obesity, menopause, hormones, injury, surgery, childbirth and inactivity are elements that affect function and elasticity to our perineum, pelvic floor, pelvis and hip movements.

One of many reasons that Pelvic floor dysfunction can occur is when your muscles and perineum don’t contract and relax the way they functional should do.   Other potential symptoms of pelvic floor dysfunction include but are not limited to: perineum pain, frequently feeling like you need to have a bowel movement, feeling like you can’t have a complete bowel movement, constipation, frequent urination, chronic pain in your pelvic area, genitals, or rectum, pain in your lower back, painful urination and vagina pain during sex.

 

“DO NOT ignore any symptoms get help and advice from our Healthcare professionals”

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Perineal massage relaxes the perineal tissues ready for birth. Check with your midwife when you are ready to massage at approximately 35 weeks.

Perineal massage can help in reducing the chances of perineal trauma!

 

Even after a normal uncomplicated vaginal birth there are a high proportion of women that will be left with scar tissue postpartum. This is common at the rim of the vagina where it meet the perineum, in approximately ninety percent of women. Even more scar tissue can be found amongst women who experience trauma and obstetric interventions at birth. This scar tissue leaves the pelvic floor muscles and the perineum prone to load dysfunction.

Scar tissue will also increase tension within the structures of the pelvic floor and in between the pelvic organs and can cause; dragging, pulling, bulging and a sensation of heaviness within the pelvis. These symptoms are all consistent with, pelvic organ prolapse and other pelvic floor dysfunctions. This reduced inter-structural flexibility and increased tension within the tissue will alter tissue loading, reduce tissue hydration and oxygenation, and in turn decrease pelvic floor function and movement.

Our pelvis and the structures within rely on a healthy three dimensional flexibly interaction and optimal position to function. Perineal and vaginal massaging will help reduce the tension within and will help to release the pull of the organs, and the tissue will realign and move more freely.

Massaging both externally and internally to release myofascial tension and scar tissue can have immediate and profound results. It will increase pelvic flexibility, function and movement and also release tension to other structure around the hips, sacrum and lower back that are all connected.

The myofascial structures are similar for both men and women, we recommend you try to release and not just squeeze to return to normal equilibrium. We must remember that everything is connected, a tensional pull can have knock on effect to so many other structure.

 

Massaging can-

  • Reduce the sensation of pulling, heaviness and organs prolapsing.
  • Reduce tissue tension that maybe the cause of your pain.
  • Reduce abdominal distension.
  • More Effective empting and bowel function.
  • Happy healthier pelvis.

 

Did you know there are vaginal moisturizers!

Well we moisturise our faces so why not our vaginas, remember to use an organic vaginal moisturiser.

 

Why Perineum Massage is important

The perineum is part of our body needs looking after to keep its’ elasticity, function and mobility. Over time, or from lack of movement and poor posture, or childbirth the perineum loses the ability to unfold, unwind. We spend a long time sitting on it and it is an important structure of our pelvis that forms a structural part of our core stability.

Perineum & Vulva Massage is an effective modality that reduces tension, adhesions and scar tissue that causes pulling and tension on core structures to reduce function and dysfunctional pelvic symptoms. It is possible for self-massage techniques to help reduce symptoms of; Pelvic floor dysfunction, coccyx, sacroiliac joint, back and hip pain.

 

Advantages of Perineum Massage

  • Maintain tissue oxygenation, flexibility and hydration.
  • Improves localised biochemical responses.
  • Enables the perineum to stretch more and less painfully during child birth to reduce the risk of needing an episiotomy.
  • Reduce symptoms of pelvic floor dysfunction.
  • Reduce pelvic diaphragm tension.
  • Increase whole body relaxation.

 

‘Sitting is the new smoking’

Massaging your perineum can be very relaxing, and is especially good when you have discomfort or pain in your hip or pelvis.

You can do this by yourself, or get your partner to help.

The Perineum

Urogenital Triangle

 

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Anal Triangle


Perineum- you may be asking where that is, well it’s the area between your sit bones. It’s this triangle here, if fact it’s two triangles. The Urogenital triangle and the Anal triangle.

 

How to Massage your Perineum

You can also massage around our anus, buttocks and upper thighs for a more Biotensegrity focused approach to our pelvic floor rehabilitation which would be very useful technique to reduce a variety of pelvic and hip pain.

 

Remove the bullet and use either end of MyKori™. Try both ends and use which ever end you find more comfortable.


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First Step: Lubricate your perineum, around your sit bones and upper inner thigh with a water based lubricant for internal massage. For external massage only use natural mineral oils such as grapeseed, mineral massage oils are best used for areas away from you anus and genitalia.

(It is important that your Internal lubricants must not contain harsh ingredients please check the labels before using them, I can recommend using organics products).

Fact: Our vaginas have a different pH values to our anus, so both need their own specialised lubricants.  

 

“Perineum & Vulva Massage supports core stability, pelvis and hip function And rehabilitation”

 

Second Step: Lay in a semi-reclined position with your feet on the floor or bed and your knees bent. Reach down and place MyKORI™ length ways at the entrance to your vagina.        

                    

Get comfortable, either lay on your back with your knees bent and your head supported by pillows.

Or try lying on your side with one knee and hip bent.

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Third Step: Massage your perineum with gentle stroking and circular movements.

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Try self-mapping to locate local areas of tension and discomfort. Slowly and gently, pressing very slightly, move MyKORI™ both up and down then sideways in a U shape, then hold a gentle pressure in one spot then release and repeat on another. Do this for several minutes. Stay within your limits, this should not be painful; it might possibly be slightly uncomfortable at first but not painful.

Fourth Step: Enjoy also gently massaging externally over your vulva, labia, buttocks and pubic region.

Perineal massage is an excellent way to relax (it can also be stimulating). It may also be challenging to do on your own, so get your partner to assist. If they are not willing to massage for you, you will find that practice makes perfect!!!

 

Core stability

Have you ever thought about how many muscles attach to your pelvic and hip, and how important this area is between your sit bones and your hips is for core stability.

We usually think of our core as abdominal muscles, but our pelvic and hip muscles also provide stability and balance our trunk in walking, running, jumping, squatting and sitting. As we move our pelvis twists and our thighs rotate to keep our feet straight and our pelvic level.

 

We also need to massage around the hip, buttocks and inner thigh

Pelvic dysfunction can contribute to other musculoskeletal pain such as Sacroiliac, back and hip pain.

 

The pelvis is emotionally loaded so remember to be gentle on yourself!

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There are over 20 muscles that attach to our sit bone and hip

 

Some may find it easier to massage the edge of their perineum and over their sit bones and around their hips whilst lying on their side.

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How often should I massage my perineum and/or my Vagina?

Once or twice a week should be plenty to soften, relax and hydrate the internal and external structures. The massage shouldn’t hurt, although it may feel like you are stretching and a little pressure.

Please remember to be gentle with yourself; use gentle stroking and circular movements to relax your perineum, vagina, vulva and pelvic muscles.

Let the ‘MyKORI™’ effect of the nodules gentle massage the various tissue structures to either relax or stimulate you by increasing localised tissue hydration, oxygenation and other biochemical responses.

 

Instructions for Internal Vaginal Massage

Make sure you feel comfortable, perhaps prop yourself up with pillows on a bed, knees bent up and legs open wide so that you can reach your perineum easily.

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  • Insert MyKORI™ into your vagina with a small amount of lube or vaginal moisturiser. Work gently and be mindful of how you are feeling, start ‘mapping’ where you are tight or experience mild pain or discomfort. If it’s too tight, STOP and then try some relaxed breathing exercises.
  • Place the flat end of MyKORI™ an inch (2.5cms) into vaginal opening.
  • Sweep, stroke or rotate gently from side to side from 3-5 o’clock and 7 to 9 O’clock.

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  • Stay relaxed and breathe calmly though the whole massage.
  • Start with gentle stroking and sweeping movements, then slowly apply just a little more pressure. Stroke back to front and rotate from side to side in a sweeping motion.
  • Work more over the areas that are tight or painful, this might cause a deep aching sensation

 

Work over an area more than once if it is tight or painful. Massage the areas between,

1:00 - 5:00 O’clock and 11:00 – 7:00 O’clock

Remember between 11:00 - 1:00 & 5:00 – 7:00 are to be avoided.

  • You can safely try squeezing and relaxing techniques during your massage.
  • While massaging the pain/tension/ache should not be more than a level 3/10, (0=no pain. 10=worse pain). Massage the area again later and progress steadily, you can even return to it another day, and over serval days.
  • Finish with breathing and relaxation exercises.

 

Try to do this one to two times or three times per week. It won’t harm to do it more often, listen to your body and be gentle with yourself. Make time for massage into your weekly routine, for example before or after a bath or shower. After is a good time because blood vessels in the area are already dilated, making the perineum softer and more comfortable to massage.

 

The bullet vibration settings are there to help improve your pelvic floor proprioception, to stimulate your perineum and for quality pelvic floor muscles performance.

 

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Massage without using the bullet but replace the bullet into the handle when you are ready to exercise, or use your imagination.

The bullet has 3 programmes of electrical vibrations, all with a combination of quick and longer holding vibrations.

Press and hold for 2 seconds to turn on

Press again to selects your programme.

Press and hold for 2 seconds to turn off.

 

Using the ‘Bullet’ for electrical vibration stimulation after the massage

After massaging replace the bullet into the handle of MyKORI™.

Using the bullet setting on vibration is another way to help relax your pelvic floor muscles and perineum. Relaxing with the vibrations will help you to engage with your pelvic floor; increase your proprioception which will help you to obtain both stronger and more relaxed muscles.

 

Start with relaxation techniques then progress onto squeezing exercises for your pelvic floor muscles when using the bullet settings.

Now you are relaxed a focus on the task in hand either insert MyKORI™ as per instructions or just sit or lay comfortably with MyKORI™ between your legs along your perineum.

Press and hold the top of the bullet for 2 seconds, then press again to engage with the first set of vibrations. Instead of contracting your pelvic floor when you feel the vibrations, let go of them and gently bear down and relax the muscles.

NB For those of you that have had babies it will feel like you are opening up to give birth to your baby, and if you haven’t it is the same motion for defecation (having a poo).

Try and completely relax!

Repeat this for a few minutes until you feel your pelvic floor relax and you feeling engaged with your pelvic floors.

If you do this before you start your strengthening exercises you will more likely achieve stronger pelvic floor contractions. It’s also a great way to practice your technique.

 

For strengthening exercises select the resistance training programme you wish to squeeze along to:

Again be mindful and focussed on the task head, when you are relaxed either insert MyKORI™ as per instructions or just sit or lay comfortably with MyKORI™ between your legs along your perineum.

  • Press and hold the button for 3 seconds. When the bullet vibrates briefly, it is now in standby mode.
  • Once in the standby mode you must press the button again quickly to select the range of hold vibrations and release pauses for the training programme you wish to perform.
  • You can change the pattern mid-cycle by pressing the button again to choose the cycle you require. Please note, if you select a new pattern during a cycle it will not start until the cycle has finished.
  • Press and hold for 3 seconds to turn off.

Start with the 3 second hold cycle and build up to the 9 second holds, build your pelvic floor strength up gradually until you reach your goal. It will take you between 12-23 minutes to complete the exercises depending on the programme you have chosen.

 

The Massage Mitts

You can also use the Mitts to massage you perineum, hips, buttocks and thighs. Using your hands, gentle massage some oil onto the area to be massage. Rub the residual oil on your hands then put the Mitts on and begin massaging the areas where you have applied the oil.

Gently massage the area, you might find some tighter areas and painful spots. The pain should be manageable and you will find the sensation will reduce and ease off after just a few minutes of gentle massage. If it the tension or pain doesn’t reduce after about 20 seconds move to another area, then come back and repeat.

The Mitts can be used with variation of pressure, speed, duration and direction to stimulate the skin and the tissue below. You can put extra pressure on using the thumb, the top of the Mitts or the whole surface of the hand.

Slow gentle strokes or fast stokes with stimulate numerous biochemical responses within the tissue matrix to reduce, pain and tension in the tissue to improving the tissue hydration, oxygenation and flexibility.  

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How to mobilise the area between your sit bones

Sitting on a soft cushion or exercise ball under your buttocks, then simple rock backwards and forward, circular movements, and side to side will help to massage/ mobilise the area between your sit bones.

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Contra-indications

Before you begin you must check for any contra-indications or symptoms that have not been looked at by a healthcare professional. Do not massage if you have vaginal bleeding, an active infection, vaginal herpes, thrush, or any other vaginal infection, a ruptured membrane, or if you have had vaginal surgery ask if it is safe to do so first.

Please check with your Doctor, Midwife, Women’s Health Physiotherapist or Specialist Nurse first. As always if in doubt ask professional advice!

N.B. DO NOT LEAVE ANY SYMPTOMS or CHANGES TO YOU VULVA, VAGINA or PERINEUM UNCHECKED.

 

Please click on this link for our artical on perineum Massage

https://www.mykori.co.uk/perineal-massage/

 

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