Our Core – It’s Really Just Piston Science, Part 1

Julie Wiebe’s Diaphragm/Pelvic Floor Piston for Adult Populations Online


As a pelvic floor physiotherapist, I continue to advocate for a greater understanding of the mechanical faults in the body which compound to ultimately cause pelvic floor dysfunctions (load transfer failure). We see these compounding faults among individuals who present with a variety of pelvic health concerns including, but not limited to, urinary incontinence, pelvic organ prolapse, pelvic pain, low back pain and more. We also see failure of the core muscle system creating compensations more peripherally, and ultimately leading to injuries down the chain. These dysfunctions are commonly found in pregnant, post-partum and post-menopausal women, but we also see these faults in athletes, recreational exercisers, and nulliparous women, young and old. Men are not exempt either! Treatment of the pelvic floor and core muscle system is applicable to everyone.


As an assessment and treatment strategy I strive to incorporate a whole body approach to the concerns of the patient and thus seek out educational courses that aim to address this whole body approach to ultimately address the root cause of the problem. By doing this, I believe we can create longstanding changes in health and wellness.


Julie Wiebe has compiled an online course which effectively guides the practitioner through a systematic process of evaluating both muscular and postural factors necessary in assessing and treating core function. Her course is chalk full of insightful clinical tidbits, and reinforced by a plethora of high grade evidence which is clear and applicable. She has, so to speak, hit the nail on the head when it comes to creating a way for practitioners to better understand the interplay of the core system.


Wiebe describes our core as the dynamic interaction of the pelvic floor, transversus abdominus, multifidus and diaphragm which functions as a unit, much the same as a mechanical piston.


For those of you who are not an engineer or mechanic, a piston and cylinder functions to displace pressures evenly to optimize force production. A piston also compresses and allows for absorption of shock.


Wiebe speaks to the importance of muscular strength, but also, and perhaps more importantly to the postural elements which, when enhanced, provide the framework for balancing pressures effectively and optimizing the interaction between the anticipatory and reactive core system.


This blog post is limited in the amount of information I can relay, so let’s start at the basics.


Wiebe describes the diaphragm as being the driver for proper core function. However, so often in our clinical practice the diaphragm is over looked. She explains that during inhalation the diaphragm contracts and descends in the abdominal cavity, filling the lower lungs. During this movement the pelvic floor and transversus abdominus relax as the intra-abdominal pressures increase. Conversely, during exhalation, the diaphragm lifts back up, intra-abdominal pressures decrease, and an elastic recoil of the pelvic floor and transversus abdominus occurs, contributing to the muscular forces necessary for the central stability system.


How often though do we find that the strategy for patients contracting their pelvic floor is to either perform a Valsalva (breath hold) or, Inspire, sucking in at the waist (also a breath hold)? Clinically, this is what I see the majority of the time. These strategies are not only non-functional but they reinforce an alteration of the basic coordinated movement of the core. We therefore, must tap into the basic rhythmical elements associated with the breath, to reinforce this primal relationship between the muscles of the core. When we have mastered this basic relationship, we can then begin training the core in ways that challenge the anticipatory and reactive system.


Backed by research, Wiebe describes within her course that the pelvic floor and transversus abdominus are entirely responsive to diaphragmatic work. Therefore, contrary to the `popular` belief of the pelvic floor being the core driver, we now know that the diaphragm is leading the charge, so to speak.


When it comes to the pelvic floor and core function, Wiebe is challenging our ideas of hyper-focusing on the training of the pelvic floor and instead has conveniently laid out the research to show us why training the diaphragm first is a more important treatment strategy.


Wiebe also explains that pressure is a big part of proper functioning of the core system, but it can become our enemy. Clinically we see a lot of women who adopt strategies to try and maintain continence or prevent prolapse, or lift that heavy bag of groceries by gripping through the abs. By doing this we limit the ability for the diaphragm to lead the charge in terms of movement, restricting its ability to descend, and thus limiting the ability of the pelvic floor and transversus abdominus to recoil. As such, an increase in intra-abdominal pressure is created which the pelvic floor can often not counter over time. Therefore the piston is unable to properly function.


Stay tuned for Blog #2 where we explore Wiebe’s insight into assessing posture to reinforce the optimal performance of the deep core muscles, and to ensure of course, that our patients are setting themselves up to breathe well.


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 1/22/2018.


Written by Michelle Vanderpol

Michelle Vanderpol
Lab Assistant