FROM THE FEET TO THE PELVIC FLOOR

Understanding the relationship between the feet and the core can improve any teachers ability to teach for the individual and while feet come in many shapes and sizes, there are some common structural presentations that can inform the teacher without intruding on the students intimate experiences.

My hope is that movement educators will use this article as a guide to making better choices and better understand the importance of appropriate exercise choices for individual needs.

It is estimated that up to 30% of people have pelvic floor dysfunction. Having worked for many years with women on all things movement I would say that while there is a general awareness of pelvic floor dysfunction when it comes to low tone or pelvic floor weakness when it is associated with ageing women, women who have had multiple children resulting in ‘weak pelvic floor’ and just general poor core strength but there is a resounding lack of awareness and education around hypertonic pelvic floor or pelvic floor tightness and how too much tension can also bring about issues including weakness.

Interestingly the feet and in particular the arch of the foot can give an insight into a persons pelvic floor health and Pilates may inherently be supporting good pelvic floor function simply by practicing the work using the Pilates repertioire in it’s entirety and making the most of all the specialised Pilates machines that naturally encourage dynamic pelvic floor strength and flexibility. Without even realising the benefits, Pilates can be a wonderful way to help women in particular release tension associated with hypertonic pelvic floor and encourage deeper, more dynamic connections.

STRUCTURAL CONNECTIONS

The feet and the pelvic floor are structurally connected through a chain of muscles, tendons, and fascia. This means that the way your clients use and position their feet can have an impact on the alignment and function of their pelvic floor.

The structural connection between the feet and pelvic floor involves a complex interplay of muscles, tendons, and fascia that link these two regions of the body. Understanding these structural components is essential for comprehending the functional relationship between the feet and the pelvic floor. Let’s explore them in detail:

Muscles:

  • Plantar Intrinsic Foot Muscles: These small muscles are located within the foot and are responsible for maintaining the arches and providing stability during weight-bearing activities. They include muscles like the abductor hallucis, flexor digitorum brevis, and quadratus plantae.
  • Lower Leg Muscles: The muscles in the lower leg, such as the gastrocnemius, soleus, and tibialis posterior, connect to the foot via tendons. These muscles play a role in foot and ankle movement, as well as providing support and control during walking, running, and other weight-bearing activities.

Tendons:

  • Achilles Tendon: The Achilles tendon is a strong and thick tendon that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It transfers the force generated by the calf muscles to the foot during activities such as walking, jumping, and running.
  • Plantar Fascia: The plantar fascia is a dense band of connective tissue that extends along the sole of the foot. It connects the heel bone to the toes and provides support to the arches of the foot. The plantar fascia helps maintain foot stability and absorbs shock during weight-bearing activities like walking and running.

Fascia:

  • Deep Fascial Connections: Deep fascia is a dense connective tissue that surrounds and supports muscles, providing structural integrity. In the lower limb, deep fascia such as the deep fascia of the leg (also known as the crural fascia) and the deep fascia of the thigh (fascia lata) connect the muscles of the leg and foot to the pelvis.
  • Superficial Fascial Connections: Superficial fascia, including the fascia of the lower extremities, covers the muscles and provides a pathway for blood vessels, nerves, and lymphatics. It helps with the transfer of tension and force between different parts of the body, including the feet and pelvic floor.

FUNCTIONAL RELATIONSHIP

The functional relationship between the feet and the pelvic floor involves a concept known as the “deep front line.” This myofascial chain, as described by Thomas Myers in his Anatomy Trains concept, highlights the interconnectedness of muscles and fascia from the feet to the pelvis and beyond. It suggests that tension and dysfunction in one area of this myofascial chain can influence other areas.

For example, when the feet are in a state of imbalance, such as with high arches or excessive pronation, it can affect the alignment and stability of the legs, hips, and pelvis. This, in turn, can impact the coordination and function of the pelvic floor muscles, potentially leading to issues such as pelvic floor tension, weakness, or dysfunction.

A high arch foot, also known as a cavus foot, can have implications for pelvic floor function. Here’s how it can affect the pelvic floor and some examples of what can be done to ease tension in both the foot and pelvic floor during movement practice:

  1. Muscular Imbalances: A high arch foot is characterised by an excessive arch height, which can lead to muscle imbalances and altered biomechanics. In the case of a high arch foot, the muscles on the bottom of the foot, such as the plantar fascia and intrinsic foot muscles, may become tight and overactive. This can create a pulling effect on the connective tissues and muscles of the pelvic floor, potentially leading to increased tension and compromised function.
  2. Impact on Alignment: The structural alignment of the foot influences the alignment of the entire body, including the pelvis. With a high arch foot, there may be a tendency to shift the weight towards the outer edge of the foot, potentially causing the pelvis to tilt or rotate. These misalignments can affect the optimal engagement and coordination of the pelvic floor muscles.

PRACTICE MAKES PROGRESS

To help ease tension in the foot and pelvic floor during movement practice, consider the following strategies:

  1. Foot Mobility and Stretching: Incorporate exercises to improve foot mobility and flexibility. This can include rolling a tennis ball or using a massage ball to release tension in the arches and fascia. Stretching exercises, such as toe curls and toe extensions, can also help alleviate tightness in the foot.
  2. Strengthening Intrinsic Foot Muscles: Focus on strengthening the intrinsic foot muscles to improve their strength and stability. Toe spreading exercises, picking up small objects with the toes, or performing exercises with resistance bands around the forefoot can be beneficial. Footwork and feet in straps using the Pilates machines are great choices to build strength and mobility in the feet while supporting the arches. Be sure to cue students to spread their toes on the bar and have all the digits connected to the foot bar.
  3. Pelvic Floor Awareness and Activation: Include exercises that promote awareness and activation of the pelvic floor muscles. Deep breathing exercises combined with gentle pelvic floor contractions can help individuals establish a mind-body connection and release tension in the pelvic floor. Encouraging deep squat positions and bringing awareness to the pelvic bones can help release tension and build dynamic strength.
  4. Integrated Movement Patterns: Incorporate movement patterns that encourage optimal foot and pelvic floor coordination. Examples include functional exercises like squats, lunges, and single-leg balance exercises, emphasising proper foot alignment and pelvic stability.

The knock off effect

When high arches in the feet and pelvic floor tightness are present, it can lead to a knock-off effect on various muscles in the pelvis, back, glutes, and legs. Let’s explore how this interconnected relationship can manifest:

  1. Pelvic Floor Muscles: High arches and pelvic floor tightness can disrupt the coordination and function of the pelvic floor muscles. Increased tension in the pelvic floor can affect its ability to contract and relax properly, potentially leading to symptoms such as pelvic pain, urinary dysfunction, or sexual discomfort.
  2. Hip Muscles: The muscles around the hips, including the hip flexors, glutes, and deep rotators, are closely linked to the pelvis and foot mechanics. With high arches and pelvic floor tightness, imbalances in these hip muscles may occur. For example, the hip flexors can become overly tight, potentially pulling the pelvis forward and causing increased stress on the lower back.
  3. Lower Back Muscles: The muscles of the lower back, particularly the erector spinae and multifidus, work in conjunction with the pelvic floor and hip muscles to stabilize the spine. When there are imbalances in the pelvis and foot, the lower back muscles may compensate and become overactive or strained, leading to discomfort or pain.
  4. Gluteal Muscles: The gluteal muscles play a crucial role in hip stability and movement. With high arches and pelvic floor tightness, the glutes may not function optimally. The gluteus maximus, medius, and minimus can become weak or inhibited, impacting overall hip and pelvic stability.
  5. Leg Muscles: The alignment and function of the feet and pelvis can affect the muscles of the legs. High arches and pelvic floor tightness can create imbalances in leg muscles, such as the quadriceps, hamstrings, and calves. These imbalances may contribute to altered movement patterns, decreased performance, or increased risk of injuries in the lower limbs.

IN CONCLUSION

Combining exercises to improve foot alignment, release tension in the pelvic floor, strengthen weak muscles, and restore balance throughout the entire kinetic chain.

In the Pilates studio, functional exercises that incorporate stability, balance, pelvic lumbar stability and breath are most beneficial for people with high arches and hypertonic pelvic floor.

As movement educators we have the advantage of using observational skills, having time to discuss intricacies and delve deeper into the relationship between good movement practice and functional strength. And while it is satisfying to apply our skills and explore possibilities, we must never assume and should always recognise that the body is individual in every way and that not everyone will respond the same to the movement we prescribe.

Pelvic floor dysfunction is a broad term encompassing various conditions, such as pelvic organ prolapse, urinary incontinence, fecal incontinence, pelvic pain, and sexual dysfunction. The prevalence of specific conditions within the spectrum of pelvic floor dysfunction may vary.

Remember to always work within your own understanding of movement prescription and dysfunction and when in doubt seek help out.

If you have learned something valuable from this article and you are ready to take a deep dive into exercise prescription for pelvic floor release, dynamic strength and pelvic function simply email me with the words PELVIC POWER and I will send you a link to information on my virtual and in person workshops.