Physiotherapy

In order to release the pelvic floor muscles you need to master three things: SNIFF, FLOP and DROP.

But before you start you must be aware of any tension in the abdominal muscles (rectus abdomins or the obliques) that may be a barrier to you. You become aware of this tension through PALPATION.

Once you have mastered PALPATION and – separately – SNIFF, FLOP and DROP you can move on to the next level of SNIFF & FLOP and FLOP & DROP.

Once you have mastered the release exercises (SNIFF, FLOP & DROP) you can move on to the STRENGTHENING EXERCISES

THE STEPS

START WITH

PALPATION

MASTER THESE SEPARATELY

SNIFF
FLOP
DROP

THEN THE NEXT LEVEL

SNIFF + FLOP
FLOP + DROP

FINALLY

SNIFF + FLOP + DROP

THE EXERCISES


PALPATION

Palpation is the process of identifying & monitoring muscle tension.
It is important as it allows us to monitor the abdominal muscles as we exercise.

GET READY

Palpate_Wide

Lie on your back with your knees out straight.
If this is uncomfortable then put a pillow under your knees.
Let your whole body go.
Then place your hands on the upper part of your stomach between your rib cage and your umbilicus.
THE EXERCISE

Palpating involves pressing your fingers deeply into your muscle to identify tension points.
As you press in the muscles it should be completely soft.
If they are not, there is a tension point.

You have to palpate 3 areas:

UPPER TRIANGLE

Palpate_Triangle

The triangular area formed by the lower part of the ribs
MIDDLE STOMACH AREA

Palpate_Wide

The mid part in line with the umbilicus where there is often a flexion or holding line
UPPER & LOWER ABDOMEN

Palpate_UpperLower

The lower part, below the umbilicus, inserting into the pubic bones of the pelvis shown here with the lower hand on the left

The images show superficial palpation but deeper palpation may reveal tension where superficial palpation does not.
The fingers should be placed more perpendicular to the skin surface pressing down harder to locate the tension

At rest the stomach should be soft on deep palpation.
If not then pressing in to the areas of tension throughout the stomach for a total of five minutes can help with becoming aware of the tension and softening it


SNIFF (IN BREATH)

Correct breathing plays a vital role in pelvic floor control. We will always be using inhalation to let the pelvic floor go.

The principles are that we inhale directly into the abdomen rather than into the chest. The chest must not rise at all. The stomach must be completely soft in order to allow this to happen. The pelvic floor muscles must also be relaxed.

When the pelvic floor is out of balance, typically the abdomen and the pelvic floor will be tense so this is difficult to achieve. You will not necessarily be aware of this tension. We cannot over emphasize the importance of taking your time with this exercise. It requires concentration and a mindful attitude when performing it in order to picture the abdomen and pelvic floor letting go.

GET READY

lay-back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)

Palpate_Wide

Gently palpate at rest before we start the exercise. Focus on your tension points when palpating.
THE EXERCISE

To start, softly sniff in through the nose and direct the air into the abdomen.

The diaphragm descends:

SNIFF-IN

Fulcrum-lineDo not inhale into your upper chest, the chest must stay down making sure that the breath goes into your abdomen.
flop-outAs you sniff in the abdomen should remain soft and flop out. If you compare the two diagrams you will see how the breast bone is static and the abdomen flops out past the fulcrum line.
The fulcrum line is placed here to demonstrate the differences between the two images

THE TIP

The exercise is counterintuitive for two reasons:

– Normally when we breath in deeply we think of inhaling by pulling in our stomach and lifting the chest
– Breathing in and softening the stomach upwards with the in breath is against gravity so there is a temptation to push up

You can think of filling it out like a balloon or filling out the flexion line (the line running across the middle of your stomach) to make it disappear
The abdomen must stay completely soft

When you breath out, exhale a soft ‘hah’ out through the mouth.The diaphragm lifts again passively, not forced

SNIFF-OUT

.. and the last of the air comes out with the ‘hah’ sound. It will sound as if there is less air coming out than went in and as if some of the air has disappeared. This is correct as the out-breath is reflective of how well everything has let go on the in-breath.The ‘hah’ should sound as if you are cleaning a pair of glasses i.e. the warm air from your abdomen. Make sure it is passive. Don’t force your stomach muscles. The exercise is essentially over at the end of the in-breath so don’t put much emphasis on this part.
REPEAT

Stay with the exercise for five minutes at least and continue for up to 10 minutes if it is difficult. When it becomes easier you will be able to move on more quickly. You will usually be doing this as combined Sniff, Flop & Drop for the 5-10 minutes and not Sniff on its own. Your goal will be to feel that the in-breath softens the stomach and connects with the pelvic floor releasing the muscles. The SNIFF becomes more effortless with practice.

COMMON MISTAKES

1. The most important thing during this exercise is to palpate the upper abdomen especially the upper triangle formed by the ribs with your finger tips. The most common mistake is to force the abdomen out while trying to get the air into the abdomen – it must be completely soft both at rest and during the in breath, you must keep palpating all the time
2. Often the chest will keep lifting before the air gets to the abdomen as the diaphragm is not used to descending so much. If this happens keep one hand on your chest so that you can stop the inspiration as soon as it rises and start again
3. If the ribs do not move at all you might begin to force the air past the ribs, this can be seen as a narrowing below the ribs in the space where the ribs should expand, this should be corrected by flattening the palm of the hands over the side of the lower ribs and expanding out into the hands on the in breath
4. When the abdomen is overactive and in a holding pattern it can be difficult for it to fill out completely. You can put a hand on the lowest part of the abdomen nearly over the pubic bone and imagine that you are flopping your tummy as if like a muffin over the muffin case as you release the lower tummy over the pubic bone. The abdomen here is very close to the pelvic floor so it can help to connect with the pelvic floor
5. If the out breath at the end is very long it means that you did not let go completely on the in breath and you now need to breathe out the CO2. Your aim is to make this out breath shorter and shorter. Watch your chest as some of it was probably held there


FLOP

The abdominal and pelvic floor muscles will typically hold tension and you may not be aware of it. You should press deep into the muscles to feel for any tension before you start this exercise. You will not be able to breathe into the stomach successfully unless the abdominal muscles are soft.

Once you SNIFF in through the nose the stomach muscles should further soften allowing the abdomen to FLOP out.

If the stomach does not soften and flop out with the in breath, the pelvic floor muscles will not release as we want. Please spend time on this exercise, don’t force it – wait for the muscles to let go. It can take time.

GET READY

lay-back

Lie on your back with your knees bent up.

Palpate_Wide

Place your hands on your upper stomach and feel for any tension under the finger tips. Wait for the in breath to soften the muscles filling up into your finger tips.
THE EXERCISE
FLOP-img1Flop out your stomach into your finger tips
FLOP-second-handThe second hand can be placed beside the
top hand to feel for the upper abdominal tension and soft in breath
chest-downDon’t force the stomach as it will tighten.

THE TIP

Don’t be tempted to force your stomach out. Just let it FLOP, soften or fill out.

Keep palpating at intervals and you will become more familiar with where you hold your tension.

REPEAT

Stay with the exercise for five minutes at least and continue for up to 10 minutes if it is difficult. When it becomes easier you will be able to move on more quickly.

You will usually be doing this as combined SNIFF+FLOP+DROP for the 5-10 minutes and not Flop on its own.

Your goal will be to feel that the in-breath softens the stomach and connects with the pelvic floor releasing the muscles. The stomach becomes softer with practice.


DROP

Your pelvic floor muscles may be held in a constant state of tension even though you don’t feel it. You will need to learn how to release them completely in order to restore normal range of movement. The bulk of pelvic floor muscle is centered around the back of the pelvic floor and the back passage. It will help to think of this area when trying to let the whole of the pelvic floor go.

GET READY

lay-back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)
THE EXERCISE

Identify where your deep pelvic floor muscles are by trying to stop yourself from passing wind.

PF-Contraction

Now release the pelvic floor – DROP your back passage by trying to imagine you are opening the back passage. This is a release backwards towards the base of your spine.

PF-Releasing

THE TIP

Release of the pelvic floor is always soft and directed towards the base of the spine, any downward pressure or tension is incorrect, you should never have a feeling of pressure or descent of the organs

REMEMBER

1. This exercise requires concentration

2. Even though you started this exercise from a non-contracted position, you should still be able to feel a release

3. The object is to widen the range of movement of the pelvic floor. The more you can release the better

4. Although you may feel you are releasing all the way, you may not be

REPEAT

Stay with the exercise for five minutes at least and continue for up to 10 minutes if it is difficult. When it becomes easier you will be able to move on more quickly.

You will usually be doing this as combined Sniff, Flop & Drop for the 5-10 minutes and not Flop on its own.

Your goal will be to feel that the in-breath softens the stomach and connects with the pelvic floor releasing the muscles. The stomach becomes softer with practice.


SNIFF + FLOP

Now we work further on the Flop exercise to include correct breathing. We are working towards the Sniff in becoming a trigger for a Flop of the stomach. In doing this we are building on the link between correct breathing and a relaxed pelvic floor.

We are aiming to let the stomach FLOP out as we breath in. This can be counter intuitive as we sometimes think of a breath in as drawing the stomach in.

By learning this exercise you are moving away from previous tense breathing.

GET READY

lay-back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side).

Palpate_Wide

Palpate as described in Palpation section
THE EXERCISE

SNIFF in through the nose as if you are sniffing in when you have a cold, it must be loud but not so loud that it creates tension in your chest or abdomen.
At the same time as you are sniffing in, FLOP out or fill up your soft abdomen, it must be completely soft.

Flop_Out
REMEMBER

1.The abdomen must remain completely soft throughout

2. Don’t try too hard! The more relaxed you are as you perform the technique the more effective it is

3. If the Sniff becomes too dominant then it can take away from the feeling of anything else happening

4. The louder your Sniff the bigger the volume of air that goes in and the more that the diaphragm goes down. Also your tummy will flop more. These are all good signs

REPEAT

Practice this repeatedly on a daily basis until you feel you have mastered the technique. Take your time and do not rush.


FLOP & DROP

The aim here is to train your pelvic floor and abdominal muscles to work in unison. This is similar to how we trained the SNIFF IN and FLOP to work in unison.

By learning this exercise you are moving ever closer to releasing the pelvic floor

GET READY
lay-back
Lie on your back with your knees bent up. (You can also do this exercise lying on your side).

Palpate_Wide

Palpate as described in Palpation section
THE EXERCISE

Without contracting, become aware of the stomach muscles and the pelvic floor muscles as described previously in sections on Flop and Drop

woman-pf
Now release the tummy out in a FLOP and release the pelvic floor down in a DROP at exactly the same time.
Flop_OutPF-Releasing

THE TIP

Even though you didn’t actively contract your tummy or pelvic floor, you should try and flop out as much as you can when you are letting go.

When you co-ordinate both movements at exactly the same time, one action helps the other.

REPEAT

Practice this repeatedly on a daily basis until you feel you have mastered the technique. Take your time and do not rush.

Because there is so little movement this exercise requires a lot of concentration. This will become automatic and easy with a little practice.


SNIFF + FLOP + DROP

It brings together SNIFF(breathing), FLOP(stomach) and DROP(pelvic floor). This is the actual Release Exercise.

At this stage you will have practiced these techniques individually and 2 at a time ( SNIFF & FLOP, FLOP & DROP). If not, please do repeat them until you feel ready.

GET READY

lay-back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side).

Palpate_Wide

Palpate as described in Palpation section
THE EXERCISE
In one motion, SNIFF IN, FLOP OUT your stomach and DROP the pelvic floor
Flop_OutPF-Releasing
REMEMBER

Success is when you feel on each in breath that the Sniff in connected with the pelvic floor to make it release as if there is a line of connection between the nose and the back passage.

The abdomen must remain completely soft and the chest must not rise.

If the SNIFF becomes too dominant then it can take away from the feeling of anything else happening, in this case soften it and try leading with the stomach by releasing or swelling it out into the finger pads and let the in breath follow

REPEAT

Practice this repeatedly on a daily basis until you feel you have mastered the technique. Take your time and do not rush.