Julie Wiebe’s Diaphragm/Pelvic Floor Piston for Adult Populations Online – Part 2
In Part 1 of this series, I spoke about Julie Wiebe’s Piston Science course and introduced the need to explore the function of the diaphragm first when looking at regaining core function. This is particularly important when treating any pelvic health concerns, but also applicable when looking at the contribution of the core in any other musculoskeletal concerns.
As a practitioner, you may find that some patients have immense difficulty in performing a diaphragmatic breath. Initially we may chalk it up to poor motor patterning or discoordination. Julie Wiebe has challenged this thought by asking the question: which postural faults are contributing to the patient’s lack of ability to utilize the diaphragm, and the rest of the core? She effectively outlines the research which shows us that in order to optimize core function including the coordination of the pelvic floor, transversus abdominus, multifidus and diaphragmatic contractions we have to look more closely at the contributing postural elements.
As Wiebe introduces this concept she breaks posture down into two categories: looking at the lumbopelvic region and exploring the thorax.
As a practitioner, how often have you seen a post-partum female with urinary incontinence or a post-menopausal woman with a pelvic organ prolapse present with the classic posture of the sacrum being tucked under and the thorax fixed in a hyper-kyphosis? I find it so often in fact, that I will tell patients, ‘show me someone with a complaint of a pelvic organ prolapse, and I will show you a stiff thoracic spine’.
We see several variations of this pelvic-thoracic interplay as it pertains to pelvic dysfunction and posture, but sometimes we forget how important it is to address these issues early on in both assessment and treatment to really provide our patients with the best opportunity for success.
Wiebe does an excellent job of breaking down in a step-wise fashion how we should be successfully assessing these postures, allowing our pre-conceived notions of what we think we should be finding not cloud our judgement. Looking at the lumbo-pelvic region we can often see two compensatory patterns: An increased anterior tilt of the sacrum or the counter-posture, an increase in the posterior tilt of the sacrum. Wiebe reinforces that there is not one correct pelvic position, but rather alignment occurs along a spectrum with the ultimate goal of obtaining a neutral pelvis.
So what is a neutral pelvis then?
A neutral pelvis could be described as the midpoint between maximum posterior and anterior pelvic tilt, or a position of optimal nutation on the L5 vertebrae.
The research shows that the position of the lumbo-pelvic structures has a direct effect on the ability to successfully perform a pelvic floor contraction. Wiebe describes the research in her course, showing the positions that best enabled participants to contract both their pelvic floor and transversus abdominus. The research was unanimous that the least effective positioning for a pelvic floor contraction was a posterior pelvic tilt.
How frequently do we see patients presenting to our clinic hanging out in a posterior pelvic tilt? Clinically, I see it all the time.
If we explore the thorax further we can see a variety of compensations here as well. Wiebe does an excellent job of categorizing the thorax as being either A) Bell Rung Up or B) Belly Rung Down, which essentially equates to identifying the postural dysfunction in the thorax. The ultimate goal of her teachings in this region is to optimize the position of the thorax to enhance the performance of the diaphragm, which in turn improves the overall function of the core working as that beautiful integrated piston system.
The alignment of the rib cage is a key determinant of what is happening in our posture lower in the spine, our ability to utilize the diaphragm and our availability for muscular contractions through the pelvic floor and transversus abdominus.
If your patient is unable to contract their pelvic floor properly due to postural compensations at rest, it is very likely that they are under-utilizing their core system during dynamic movement throughout the day.
Over time global compensation strategies will ensue and we will begin to see chronic postural dysfunction. Core muscle and postural stabilizers will remain under-utilized, and compensatory musculature may become over worked and under paid, so to speak. There is endless variation in how this can present, but the key is to recognize how the postural presentation is affecting core utilization, and the movement of the diaphragm as a driver of the core.
One of the wonderful things about Wiebe’s course is that despite being online, she has incorporated a way of applying a lab component to enhance the sound research evidence and easy to understand lecture material she provides. This enables one to explore their own posture while moving through the modules, which I think you will find, is rather surprising.
Stay tuned for the second last blog in this series!
Julie Wiebe and Pelvic Health Solutions have joined together to offer 20% off Piston Science Bundles A and B, Sports Medicine Bundles A and B, and Piston Science Module One. Click here to receive a 20% discount on any of these courses and use code NewYear20. Offer is valid until 02/28/2018.
Written by Michelle Vanderpol