Exercising Your Inner Core

If you've been hanging around the gym or fitness center lately, chances are you're familiar with the term "core muscles." Generally speaking, this refers to exercises designed to isolate and strengthen the muscles located in the core of the body, which includes the lower back, the abdominals, and the hips. Strong core muscles keep your back healthy, hold your body upright, and improve your balance, among other things.

Whether or not you suffer from occasional bladder leakage or weakness, there's no doubt that strengthening the core muscles has many benefits. But a group of female bladder health specialists say many women who suffer from bladder weakness can benefit by isolating and strengthening a deeper set of critical muscles-referred to as the pelvic pyramid-before they work on their more surface core muscles.

The Total Control program, a community-based, biweekly fitness class, is designed to "restore the function of the deep abdominal wall and pelvic floor muscles in order to help restore bladder control," says Diane Lee, owner, director and physiotherapist at Diane Lee & Associates in British Columbia, Canada, and a nationally known expert in thoracic, lumbar and pelvic (sacroiliac) dysfunction. By strengthening and improving function in the pelvic region, many women are also able to sleep through the night and tighten their vaginal walls to improve sexual pleasure.

The 7-week class teaches women to locate, activate, and tone the three key support muscles for the spine and pelvis. Lee uses the term "pelvic pyramid" to identify these three groups of muscles: the transversus abdominis (TVA) muscle, the multifidus muscles, and the pelvic floor muscles.

The TVA is the deepest abdominal muscle, and it helps hold your spine and pelvis stable, says Lee. The multifidus muscles, which resemble a spiderweb running from vertebra to vertebra, allow the lower back to work without pain. The pelvic floor muscles, which form the bottom of the three-pronged pyramid, are a hammock-like muscle system running from side to side and front to back within the pelvis that supports all of the abdominal organs.

With many cases of bladder leakage, the brain has lost the ability to initiate the muscles within one or more of these groups, says Lee. For this reason, step one of the program involves "re-connecting the brain back to the appropriate muscle," she explains. The goal is to isolate and contract the correct muscles without relying on other muscles to do the work, and without holding your breath, she says.

To identify the TVA muscle, for instance, she tells participants "to imagine a line connecting from inside each hip. Then I ask them to find a force in their brain to connect those two points. Once the brain remembers the feeling of connection, you can re-train the muscle to come on at the appropriate time, at the appropriate strength."

Some versions of the program use ultrasound as a biofeedback tool to test whether the correct muscles are contracted, while other classes rely on trained fitness instructors for hands-on assessments. Once the correct muscles are engaged, the participants learn how to hold the contraction while breathing. As the participants progress, they learn how to contract the TVA, multifidus, and pelvic floor muscles as a unit while standing, lifting, squatting, or exercising.

"By being strong and stable in this core, you can potentially make your symptoms of incontinence go away or even prevent them from happening in the first place," says Missy Lavender, executive director and founder of the Women's Health Foundation, which created and oversees the Total Control program. Lavender, working with a team of physical therapists, urogynecologists and other women's health experts, including doctors at Northwestern Memorial Hospital in Chicago, created the program after suffering from a prolonged case of post-partum incontinence.

The classes are currently offered at a number of locations in the Chicago and Denver regions, but the group plans to release a Total Control DVD in the fall. This will allow "women everywhere to do this groundbreaking program in the privacy of their living room," says Lavender. For more information about the program visit www.totalcontrolprogram.com or www.womenshealthfoundation.org. Also, talk to your doctor about bladder control.

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