Often, just a small change can have a large and lasting impact.  Watch (or read) how activating a little-used muscle group can impact more than just Low Back Pain. 

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Hi, I’m Dr. Cathy Kim, and I’m a Body Function Specialist.

In my Functional Medicine practice, I help you understand how chronic inflammation and structural imbalances are sabotaging your health, and I teach you how to make the most meaningful changes to restore your wellbeing. 

Today, I want to share a tip that I have been teaching for years, especially to my pregnant patients.  

What are two of the most common problems plaguing women at the end of pregnancy? My vote is for low back pain and leaking urine, otherwise known as stress urinary incontinence.

Well, It turns out that one functional solution can help both of these conditions.  

Before we can understand what we should do about them, let us first understand why they happen.

Let’s imagine that this bowl is our pelvis. The orange tape on the side helps us see it’s orientation — when it’s horizontal, it is balanced, otherwise known as neutral. When it’s tipped forward, it’s called anteriorly rotated, and if backward — posteriorly rotated.  

These pink straps represent the pair of muscles alongside the spine where many people experience back pain. 

Our bony pelvis is actually completely open at the bottom, and a group of muscles cross this space, making a sling called the pelvic floor –If we use this yellow tape to represent the force of these muscles, we can see how it helps support the bottom of the pelvis, and with this lift, it helps to unload the back muscles as well.  

By the end of pregnancy, there’s a heavy large uterus filling the pelvis, and the back muscles are straining to keep the torso upright. At the same time, the load of the uterus is pushing on the pelvic floor and this hammock of muscles is having a difficult time supporting the bladder and the uterus.

Doctors commonly recommend Kegel exercises to combat Stress Incontinence. To do them, you basically have to contract the same muscles that you do when you really have to go pee and can’t go, like at the end of a car ride, or to start and stop a urine stream when you have to provide a sample to the lab. Medically, the standard instruction is to do these kegel exercises as many times as you can remember, whenever you’re sitting at a stop light, a stop sign, watching TV, etc. The improvement, however, is very slow, because it takes hundreds of repetitions to get any benefit.

In yoga, practitioners have been activating their pelvic floor muscles to aid them in alignment and strength during postures for centuries. It is called engaging your Mula Bandha, which means root lock. Those old yogis figured out that if they engaged their Mula Bandha during movement, this would help to lift the pelvic, stabilize the pelvis,  and also unloads some of the work for the back. 

When we bend over for a diaper change with a slack pelvic floor, our back muscles automatically go into overdrive to keep the torso lifted, usually exacerbating a deep curve known as lordosis or swayback.  

But, if I kegel just before or during bending over, my pelvis doesn’t have to hang like a dead weight, and my back can finally get some relief. Not only that, but our hammock of pelvic floor muscles develops strength much faster because they are lifting against the real weight of the contents of the pelvis as opposed to just air.

Note: Not all people tip their pelvis anteriorly. Some tip their pelvis posteriorly and show a straightened low back — without any curve. Even in these cases, engaging the Mula Bandha is still helpful because of how it decreases the load on the back.

Of course, other muscle groups, such as the thigh muscles, contribute significantly to low back pain as well, but this is a topic for another video.  

Until then, pregnant or not, please try to incorporate this tiny-but-mighty movement before any kind of bending activity — for the car seat time, crib, pack-n-play, laundry, dishwasher, even to get in and out of the car.
Let me know what you think of this tip and if you have suggestions for future topics addressed from a Functional Medicine perspective. You can also go to my website, drcathykim.com, to learn more about me and my Integrative Body Method™ approach.