Should you focus on length before strength with pelvic floor dysfunction (PFD)? This is a question I am often asked. Maybe you are wondering what this even means? Length would imply stretching exercises such as yoga and strength would imply strengthening such as lifting weights. Some may quickly jump to the answer that you should lengthen if your muscles are “tight” and strengthen if your muscles are “weak”, however, it is not that simple. For one, tight muscles are not strong. Also, if you have weak muscles, other muscles will have to take the load so it is inevitable that you will have some muscles that need to lengthen and some that need to be strengthened.

Back in 2015 when I was facing a life of incontinence following pelvic mesh removal, I felt that strength was very much needed in order to prevent leakage. The thought of lengthening was frightening as I also had a rectocele (a form of pelvic organ prolapse). Back then, my understanding of pelvic organ prolapse was based on what my gynaecologist had told me; my rectum was falling into my vaginal passage due to tissue laxity. The idea of organs falling made me tense up. I almost wished my vaginal opening had a zip so I could ensure none of my organs would drop out.

Thankfully, through years of diligent investigation, education and training, I have changed my understanding of pelvic organ prolapse and pelvic floor dysfunction in general. With this change in understanding came a change in practice that saw an end to my PFD symptoms. Whether you are suffering from prolapse or pelvic pain, this article should provide some valuable information to propel your journey to empowerment.

Nervous system control

The management of both strength and flexibility is governed by your nervous system. The nervous system utilizes both the musculoskeletal system and the connective tissue system to manage the balance of tension throughout your body. It is this balance of tension that dictates if you have hypertonicity (tightness) or hypotonicity (laxity).

The nervous system can be viewed as an electrical system within the body that is responsible for protecting organs, muscles and joints so they can function optimally keeping you safe and ensuring your survival. This understanding – that the nervous systems primary goal is to protect –  holds the key to relieving the symptoms of pelvic floor dysfunction (incontinence, pelvic organ prolapse, pelvic pain etc.).

Regardless of whether you choose to stretch with yoga or to do strength exercises, you are simply communicating with your nervous system as all movement is a form of communication with this amazing system.

Your thoughts also communicate with your nervous system. Maybe you have noticed this before. When remembering something horrible from your past, you might have felt a visceral response in your body. This is because your brain cannot tell the difference between a horrible memory from the past and something horrible that is presently happening.

What you think about your pelvic organ prolapse, pelvic pain, incontinence or any other pelvic floor dysfunction, can dramatically impact how the condition manifests in your body. Let me explain…

Survival Instinct

Your autonomic nervous system is focused on protecting you and keeping you away from danger. At the core of your autonomic nervous system is a primitive survival instinct. The autonomic nervous system subconsciously controls major functions such as heart rate, breathing, digestion, urination and sexual function. There are two major subdivisions of this system: the sympathetic nervous system (“fight or flight”) and the parasympathetic nervous system (“rest and digest”).

Negative thoughts have the power to influence your autonomic nervous system triggering the flight or fight response. This causes an increase in heart rate and respiration while pausing digestive function to prepare your body to escape imminent danger. Along with these autonomic changes, it is common to have an increase in muscular tension. This is where the term “a tense moment” originates. It indicates a state of nervous strain that creates tension in your tissues.

Autonomic Nervous System - PNS & SNS

From the nervous system’s perspective, the tension added during “fight or flight” moments could be viewed as a pre-tensioning of muscles in preparation for leaping into action. Whereas pre-tensioning is a general requirement for functional movement, cycles of endless negative thoughts can accumulate unnecessary tension in your tissues contributing to muscular dysfunction. This type of tension is commonly held in the torso either around the upper body (neck/shoulders/upper chest) or the lower body (hips/pelvic floor).

The business of movement

To gain a better understanding, we can explore the business of your body’s movement. The function of muscle is to shorten (contract). From the nervous systems perspective, the shortening of muscle is a protective response to prevent overstretching and muscle fiber damage. It is this shortening of muscles that moves your joints to create motion, therefore, you can view movement is an important function in your survival.

Your muscles are connected to your bones through tendons; part of your connective tissue network. The connective tissue network which mechanically distributes tension throughout your body, stretching from the top of your head to the soles of your feet.

Within your muscle tendons, there are sensory organs which monitor the stretch of your tendons. Again, this is a protection mechanism. As a muscle’s fibers shorten, the tendons at both end of that muscle are being stretched. Your nervous system will inhibit the contraction to save your tendons;  another protective reflex that helps to ensure your survival as muscle tissues repair faster than connective tissues.

This business of your body’s movement is complex and, in my opinion, extremely fascinating! We manage to achieve amazing feats with our movement every day – just standing up or walking around requires an amazing balance of tension through the entire network of tissues that make up your body. The body, being a self-healing organism, is always striving to rejuvenate and repair. It attempts to do this as efficiently as possible while expending minimal energy. Such a complex system is not without flaws, especially when we live such busy, stressful lives. It becomes easy to forget that what we think and do each day is sending subtle messages to the nervous system that can change the balance of tension in the body.

Changing the question

So, when it comes to the question of length before strength, I think we need to change question; What are we communicating to our nervous system through our thoughts?  When you suffer from pelvic floor dysfunction, it is hard to ignore the fear and worry that accompany it. With this fear and worry comes added tension. Can you see how this can contribute to an accumulation of excessive tension? Functional movement requires equilibrium – a balance of tension through the system in which all muscles are doing their job without becoming overloaded (hypertonic) or underutilized (hypotonic).

You need to remove the tension created by thought before beginning a movement practice for rehabilitation. How can you do that? By changing the pattern of negative thinking. I asked myself what I wanted to communicate to my nervous system. I wanted to communicate safety. To communicate hope. I wanted to believe that things could get better and that I was not doomed to a life overwhelmed by my symptoms. I wanted to live beyond pain and dysfunction. I wanted to improve my quality of life. I didn’t care if it was yoga or Kegels that would restore my pelvic function, I just wanted to feel normal again. So the place to be is neither length nor strength, it is the rested state, right in the middle. The rested state can only be achieved when you begin with your thoughts.

length before strength with pelvic pain

Establishing the rested state

Step 1

Change negative thoughts – There are many different methods you can use to change the pattern of negative thinking. I found Byron Katie’s “the work” was a very simple and effective form of cognitive behavioral therapy (CBT) to change negative thoughts. You can do “the work” or simply get a pen and paper and write down the thoughts you have about your pelvic floor dysfunction.List out what you believe about your symptoms. Once your list is finished, turn those thoughts around. For example: “This is never going to get better” would be changed to “This is going to get better”.  Your new list can be affirmations or positive mantras that send a message that will contribute to the release of mental tension and stress.Once you know what you want to communicate to your nervous system, you can begin and end each day looking at your list and bringing those positive thoughts to the forefront of your mind. Sending these positive messages to your nervous system will help to release the excess tension that accompanies negative thoughts. The net effect of this move towards positive thinking is a change in the balance of tension in your body bringing you closer to equilibrium.

Step 2

Release physical tension – Having started with your thoughts, you should then focus your attention on releasing physical tension. I recommend Yoga Nidra body scanning meditation. This type of meditation presents an opportunity to learn how to find and release physical tension throughout your body. Yoga Nidra relaxes you and creates a deeper connection between you and your body. It is a practice in letting go, an absolute must if you are to find the rested state.

length before strength

Moving from the rested state

From the rested state, you should be ready to begin with the next vital step in nervous system communications – movement. You can finally ask the question if length should come before strength. At this point in your journey, length does come before strength! You can gracefully progress from the rested state with some yin yoga to release any additional pelvic tension.  This gentle stretching will trigger the tendon organs to inhibit contraction which is a major step in releasing excessive muscular tension.

Once hypertonicity has been reduced, you can begin the process of enhancing your mind to muscle connection within your pelvic floor. To do this, first focus on sensing the various muscles and then activate gentle contractions. Slow and steady wins the race. Enhanced body awareness, one of the major benefits of the yoga practice, will allow you to better manage the balance of tension as you progress. You can use some gentle yoga that stretches the tissues to start the journey of enhancing body awareness. These were the first vital steps in my journey of empowerment and I hope that they can help you on your journey towards empowerment of your flower.