Your Pelvic Floor Health and Your Feet

Lily Hoog-Fry DC & John Baker of Swell Movement and Longevity 

What is the Pelvic Floor?

The Pelvic Floor is a group of muscles, ligaments and connective tissue that provide a sling for our internal organs like our bladder, uterus/ prostate and gut. Hung from our pelvic bones, these muscles play a vital role in pelvic pain, core strength, the flow of urine (the fancy doctor word for this is 'urinary incontinence'), deep hip pain, chronic back pain, hip internal rotation, sexual function, posture, and being able to take efficient breaths (Hodges et al, 2007). We think that posture and breathing efficiency are quite noteworthy -- have you realized that having healthy tone in your pelvic floor can help you sit up straighter and breathe easier? 

It isn't a topic of common conversation, but somewhere around 13 million Americans suffer from urine leakage, often during the movements they love like running, jumping, lifting or stretching (Poll, 2018). Additionally, over 50% of women have some degree of pelvic organ prolapse in their lifetime (yes this is literally where your muscles can't hold your organs inside your body) (Glass, 2019). 

Read on for 3 Easy Changes to Care for your pelvic floor from the ground up, whether you're dealing with pelvic disorders or just never want to... and why we don't recommend Kegel's! 

How is Your Pelvic Floor Connected to your Feet?

Now that you know how important pelvic floor health is to your overall health and good posture, what does it have to do with your feet? 

The alignment of your feet provides the literal groundwork for your pelvis and pelvic floor issues. The position of your feet change the orientation of all your other leg bones and muscles to each other, and therefore how these parts connect into your pelvis. And guess what, that change in orientation of the bones affects more than just the orientation of your pelvic floor, it affects the health of your pelvic floor muscles too. This is why great therapists will look at the feet when a patient presents with pelvic pain, or the pelvis when a patient presents with foot pain (Mhamis & Yjzhar, 2007). 

The easiest example to visualize this chain reaction is when someone has flat feet. This means their feet are overly pronated or falling in toward each other, and the medial longitudinal arch has collapsed. When this happens there is an uneven foot surface for the shin bone to sit on (the fallen arch causes the talus to tilt), which causes the tibia (shin) and the femur (thigh bone) to internally rotate. Now this can cause bunions like we've talked about previously, as well as increase your likelihood for low back pain, plantar fasciitis and knee tracking disorders. 

But this no-arch foot deformity also makes it harder to stabilize our hips because the deep hip rotators (external rotators) are stretched long and weak which means your tiny pelvic floor muscles are not only trying to keep your organs in your body but now also attempting to stabilize the heaviest part of you (think obturator internus) (Smith et al, 2007). And this is only one example of a foot alignment issue causing issues above it. 

3 Changes to Improve your Pelvic Floor & Foot Health

Now that you know how related our feet and pelvic area really are, here are 3 science backed tips to improve your pelvis-to-foot wellness:

1. Wear shoes that let your toes help to balance you: Shoes that have a wide toe box 

It's basic physics. A bigger base of support means a more stable structure. Imagine this exaggerated example- how stable would you feel balancing of ice skates? Not very, right? Although less extreme, squishing our feet into narrow toe boxes takes the ability to balance and stabilize away from our feet and forces our pelvic muscles to compensate instead (Smith et al, 2015). By wearing barefoot shoes that allow your feet to move naturally (think let that big toe be free to move!), you can strengthen the feets' many muscles with every step. Throw out those narrow shoes except for the occasional celebration. (side note: especially those traditional athletic shoes which have found to decrease static and dynamic balance (Smith et al, 2015)). 

2. Wear barefoot shoes that allow your hips to actually be over your feet: Wear shoes that are zero drop 

Many of us live with our hips pushed out in front of us while we stand. And this makes sense only because we almost exclusively wear shoes with heels, even most men wear small heels everyday! This tilts your entire leg forward because even a small degree of heel lift gets amplified over the length of the entire leg to create a large pelvis orientation change. Anytime you chronically change the orientation of the pelvis you will change the function of the muscles attached to it, exerting the external pelvis and hip muscles more, creating imbalances that can lead to pain in your soft tissues and pelvic health issues (side note: many hip thrusters also have low back pain because of the shearing forces this puts there!). 

3. Do your 360 degree breathing with perineal emphasis

This is a game changing, simple breathing exercises start to heal your poor posture, while strengthening your core muscles, doing pelvic floor therapy and calming your nervous system all at once! They used to think that pelvic floor issues like incontinence and pain were primarily causes by tight pelvic floor muscles, but we now understand that often these issues come with increased abdominal and pelvic muscle activity, and the issue is more in coordination and control of these muscles than a pure weakness deficit (Smith et al, 2007). Because these muscles are already overly tight muscles, Kegel exercises (in which you tighten the muscles repetitively) is not the best way to start. 

But by learning how to breathe into your entire abdominal cavity, even down into your pelvic floor, you can gain awareness, control and proper muscular tone for the health of your pelvic floor. The easiest way to do this is to breathe without letting your chest rise, allowing your breath to move down to push out 360 degrees around your abdominal muscles, sides, back and pelvic floor. You can even reach a hand down to your perineum if you can't tell, and feel the change in your pelvic floor with your breath (watch this video for more details https://www.youtube.com/watch?v=NMqwTBv_nt4&t=4s). 

These changes and movements are not a full pelvic floor program but a good starting place. They need to be done on a daily basis over long periods of time to affect change (you wouldn't go to the gym and ask one day later why your bicep wasn't bigger yet, would you?). Find a health professional that is a pelvic floor specialist near you to continue working on your pelvic floor health. 

The good news is, although your shoes have created weakness in your deep core and muscles of your feet, choosing new kicks and spending time teaching yourself how to breathe properly can have a huge impact on not only foot and pelvis pain but whole body health. When you can move, pee and be pleased better, who isn't better?  

References:

1.   Hodges, P. W., Sapsford, R., & Pengel, L. H. (2007). Postural and respiratory functions of the pelvic floor muscles. Neurourology and urodynamics, 26(3), 362–371. https://doi.org/10.1002/nau.20232

2.   Preidt R. Poll (2018). Women Don't tell their Doctors about Urinary Incontinence. WebMD. https://www.webmd.com/urinary-incontinence-oab/features/incontinence-womans-little-secret

3.   Khamis, S., & Yizhar, Z. (2007). Effect of feet hyperpronation on pelvic alignment in a standing position. Gait & posture, 25(1), 127–134. https://doi.org/10.1016/j.gaitpost.2006.02.005

4.   Dianne Glass MD, PhD (2019). Demistyifying Pelvic Organ Prolapses. UChiacago Medicine. https://www.uchicagomedicine.org/forefront/womens-health-articles/demystifying-pelvic-organ-prolapses

5.   Smith, M. D., Coppieters, M. W., & Hodges, P. W. (2007). Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourology and urodynamics, 26(3), 377–385. https://doi.org/10.1002/nau.20336

6.   Smith, B. S., Burton, B., Johnson, D., Kendrick, S., Meyer, E., & Yuan, W. (2015). Effects of wearing athletic shoes, five-toed shoes, and standing barefoot on balance performance in young adults. International journal of sports physical therapy, 10(1), 69–74.