Today on the Pelvic Rehab Report, we hear from Dustienne Miller. Dustienne wrote and teaches the Yoga for Pelvic Pain course, which is available in Cleveland, OH on July 18-19, and in Boston, MA on September 12-13.

"It feels like my pelvic floor just sighed."

Grounding in Mountain Pose

As musculoskeletal professionals, we have a sharp eye for postural dysfunction. We explain to our patients that the ribcage is sheared posteriorly to the plumb line and how gravity magnifies forces at specific structures. Some physical therapists perform the Vertical Compression Test (VCT) to allow the patient to feel the difference between their typical habitual posture and a more optimally aligned posture. This works well to “sell” your patients on why their newly aligned posture allows for more efficient weight transfer through the base of support. In addition to the VCT, I utilize Tadasana, or Mountain Pose as an additional kinesthetic approach to postural retraining.

Last week in the clinic, I was teaching my client postural awareness using Tadasana. I asked her to close her eyes, or lower her gaze if she was not comfortable closing her eyes. Working from the ground up, we started bringing awareness to her base of support. She noted that she was standing with her weight mostly in her heels. When I encouraged her to bring her weight forward, hinging from the talocrural joint, she had an “aha moment.” She said, “It feels like my pelvic floor just sighed.” She was unaware that her habitual posture was to stand with her weight mostly posterior to plumb line, thus encouraging her posterior pelvic floor to remain in an overactive state. Once she balanced her body from the ground up, she felt a major release in her holding patterns.

At our follow-up session, the client remarked that her postural awareness increased dramatically. She was surprised at how often her pelvic floor was in a habitual pattern of over-firing. Additionally, she reported increased awareness while practicing standing yoga postures during class. She feels more in control of her body after experiencing embodied optimal alignment and has had success with carrying over postural awareness outside of the clinic setting. Self-awareness and empowerment are two major goals of my physical therapy practice, and using yoga to achieve these goals makes my clinical practice even more enjoyable.

For more info on the Vertical Compression Test, click here. For detailed instruction on Tadasana, click here.

A recent literature review addressing the effectiveness of yoga for depression reports that the positive findings are promising. The 2007 National Health Interview Survey (NHIS) found that yoga was one of the top 10 complementary health approaches used among adults in the United States. (The linked page for the NHIS also includes a video of the scientific results of yoga for health.)

Yoga is not only about bodies bending- ancient yoga traditions offer physical, mental, and spiritual techniques that are designed to be holistic in nature. Many instructors in the US focus on the many physical benefits of yoga, yet there are many types of yoga, many instructors with varied levels of training, and many health issues that require an individualized program of yoga therapy. In relation to the potential effects of yoga on depressive symptoms, theories in neurobiology point to the potential positive effects on the HPA (hypothalamic-pituitary-adrenal) axis, according to the linked article by Lila Louie.

While none of the articles described in the literature review are specific to the one patient group or population, the subjects studied include incarcerated women, older patients, university students, and patients from the general population who struggle with depression. One group of patients known to be at risk for severe depression is postpartum women. The definition of postpartum varies, and a generous definition may include any issue that, once imparted in a postpartum period and left unaddressed, could persist throughout a woman's lifetime. This is commonly seen in the clinic as uncorrected postural dysfunction, pelvic floor dysfunction, or gait changes, for example.

Because both yoga and exercise "appear to ameliorate depression," the author of the literature review states that motivation and compliance towards either modality should be considered during treatment planning for patients. Louie further states that yoga practice of asanas is safe, cost-effective, versatile, and can be used on its own or as an adjunct to medication. If you would like to learn more about the use of yoga for the postpartum population, sign up for Ginger Garner's continuing education course: Yoga as Medicine for Labor and Delivery and Postpartum offered in Seattle in August. To read about Ginger's Yoga as Medicine for Pregnancy course, click here.

H&W instructor Dustienne Miller, CYT, PT, MS, WCS wrote this post.

As specialists in pelvic health, we have the honor of being trusted with very private information. Our patients trust us with their secrets, their emotions, and their bodies. Sometimes patients reveal traumatic personal stories, both past and present. Even if our patients have not suffered emotional, physical, or sexual abuse, we can assume that the diagnosis of pelvic floor dysfunction is traumatic itself. Bouncing from clinician to clinician and inability to share their pain and experience with coworkers and friends is enough to increase baseline anxiety and depression levels. Yoga has proven to be an effective method in helping to heal Post Traumatic Stress Disorder and other mental comorbidities associated with pelvic floor dysfunction. But where do you start? How do you make your patient feel safe?

In David Emerson and Elizabeth Hopper?s book Overcoming Trauma through Yoga, there is guidance on how to appropriately guide your patient or yourself through a yoga program that feels safe and appropriate. As clinicians, we are very aware of monitoring patient response in the treatment room. If we notice guarding or dissociation we do not continue the session according to the goals we have set for the patient, rather we meet the patient where they are at that time on that day and work accordingly. I recommend we utilize the same sensitivity with our patients when creating a home program and working with our patients in open gym areas. What might feel great for us (ie: downward facing dog) may trigger trauma for another. Be mindful of the transition from the emotionally charged manual treatment to a less contained room like an open gym. Instructing a patient in pelvic tilts and bridging with other people around could trigger an emotional response, especially if their emotions were primed after myofascial release in the pelvis and abdomen. Bottom line: take the sensitivity you have at the plinth and carry it over into the exercise component of your treatments. Your patient will lead the way.

Dustienne Miller is a board certified women?s health clinical specialist and Kripalu Yoga teacher. She is the creator of the DVD Your Pace Yoga: Relieving Pelvic Pain, a musical theatre performer, and a terrible cook. Her two day class offered through Herman and Wallace, Yoga for Pelvic Pain, is being offered in San Diego next March.