We'll be discussing Women’s Pelvic Health and why Vivienne believes Hypopressives will soon be used within the Clinical Practise of every Pelvic Floor Physiotherapist.
Hi Vivienne, welcome! I’m really excited to have you here. Could you introduce yourself, to those who don’t know you?
Yes, Hi everyone, I’m Vivienne and I’ve been working as a Physiotherapist for 19 years and Specialising in Pelvic Health for the last 7 years. I’ve always had an interest in the Pelvic Floor (PF) and my Dissertation, back in 2001 was on Pelvic Floor Muscle (PFM) contraction. I’m also currently finishing my training as a Women’s Health Coach with The Integrative Women’s Health Institute.
I’ve always been passionate about movement and empowering women. I have a special interest in Pelvic Organ Prolapse (POP), and I see it as my duty to have as big a toolbox as I can as a Health Professional. I currently use manual techniques including visceral work, brain science, mindfulness, exercise & functional rehab; a psychosexual approach, Real Time US, health coaching, support of pessaries and education as part of prolapse care within clinical practise. I aim to empower women so that they can manage their condition and ultimately be the expert of their own bodies.
I am also a qualified Fit Pro, and Yoga and Pilates Teacher. In my personal life I am a mother of 2 young boys and enjoy all activities including music and Crossfit.
And of course, I’ve recently trained in the Hyopressives Technique, with UK Hypopressives.
It’s so great to have the opportunity to talk to an experienced Women’s Health Physiotherapist about pelvic health and Hypopressives.
What’s your opinion on the overall value of practising standard Pelvic Floor Exercises (PFEs), three times a day?
Yes, so this is the recommended daily amount that Women’s Health Physiotherapist’s (WHPs) prescribe. The research supports this amount to maintain strength gains achieved after a period of training, so therefore this will often be our starting point.
When learning a new skill, we know the brain initially is only trying to get the connection to the action / muscle in question, so small frequent attempts are what embeds that activity, and it becomes easier.
However, my own clinical practice has changed in the last few years.
Like with any muscle that has deconditioned or weakened we isolate to train it to catch up, BUT then we use global functional exercises, because the PF does not work in isolation, but functionally like all muscles.
the Pelvic Floor does not work in isolation, but functionally like all muscles.
As a Health Coach (and human being!) I’ve also learned that if I ask someone to do something 3 times a day and it’s unrealistic, they are less likely to do it at all, and then you have the added guilt of ‘I failed at that’, which is not helpful to anyone.
The other issue with this prescription is if the woman has a lack of range in the PF (not full movement) in therapy terms described as tight/short with or without pain. In this case it would not be appropriate and could actually worsen some symptoms. That’s where a physical pelvic floor examination can give women a starting point and knowledge about what’s going on with their body.
So these are just some of the ways that expert knowledge has progressed since the 1940s, when targeted PFEs were invented?
Yes, I think for years Pelvic Floor Therapists were Pelvic Floor-centric and it was all about the Pelvic Floor and not what it worked with, etc. Our assumptions about HOW it worked were also not questioned.
Previously there was a poor crossover between WHPs and MSK Physio’s and you need a background in both for the best overall approach. Purely because the body works as one unit.
Also, our Toolbox was quite limited years ago. It was all about the exercises which are very important - but it’s ALL the education, understanding and rehab around this, that gets the best results.
We are acknowledging now that every issue is not about ‘Weakness’ which is really important, and are also exploring our biases as WHPs. This is being helped by some great clinicians getting involved in asking questions, interpreting research and looking outside the box. We want our Pelvic Floor to be 'Reactive'. Forget about focusing solely on strength.
We want our Pelvic Floor to be ‘Reactive’. Forget about focusing solely on strength.
So what do you think Hypopressives can add to this, and Women’s Health in general?
I think Hypopressives primarily re-activate, mobilise and ‘switch on’ the pelvic floor by stimulating it through movement.
Everything is governed by the brain, and I think the technique reminds the brain what full function of the Diaphragm and Pelvic Floor should be, moving the organs with it and thus promotes more REFLEX activity. I think Hypopressives primarily re-activate, mobilise and 'switch on' the pelvic floor by stimulating it through movement.
The inhale in Hypopressives is very directed and gets results in terms of increasing the Diaphragm’s range of movement. Most people have some lateral stiffness of their ribcage, so it's a quicker way to get things activated rather than relying on lots of sessions of practicing gentle ‘belly breathing for several minutes a day.
I think the Apnea encourages the diaphragm to go into its most elevated position in the chest cavity due to the negative pressure built in the chest cavity and the pelvic floor therefore follows due to its fascial connections. As the body always follows the path of least resistance, in terms of soft tissue tension, it’s more pro-active as a breathing technique.
The Pelvic floor is made of muscle, fascia and nerves. A Healthy Pelvic Floor ‘contracts’ when needs (active strength), ‘supports’ as needs (passive strength and endurance) and ‘let’s go’ as needs (sex and bowel movements).
The beauty of Hypopressives lies in the fact that it’s relatively easy for most people to learn the lateral breathing and really connect with the Active Breath.
This makes it easier to use the Diaphragm to drive movement rather than trying to visualise the pelvic floor and feel its movement and or release, which is more difficult for most people.
All techniques and modalities have their place, but I think first we need to get full movement of the Pelvic Floor before we worry about 'weakness' and that is why I'm excited about Hypopressives.
We need to get full movement of the PF before we worry about ‘weakness’ and this is why I’m excited about Hypopressives.
This is also the premise for all Soft Tissue Rehab - movement before strengthening. This is our hypothesis for Pelvic Floor Muscle training too; that we eventually ‘automatically’ activate it on movement or when needed under pressure.
I hypothesis that Hypopressives works in other ways too, to improve symptomatic prolapse on the following basis:
The increased movement is powerful for pelvic congestion and stimulates the lymphatics which may have a lot to do with the ‘dragging sensation’ felt by women who have a prolapse - which even for Grade 1 - 2 prolapses can be rated quite high.
Organ like joints have Articulations - meaning when we breathe or move they move in specific ways not just squish together. The actual movement improves any visceral restrictions (e.g. caesarean sections, old appendix issues, being pregnant, with your organs restricted in a certain way for 10 months), which I would usually work on manually - so it’s a perfect Home Program for women. I think the Hypopressives technique reminds us how we should move.
I have found already clinically for some women it lowers the tone of tight/high tone pelvic floors. I hypothesis it's just getting the Pelvic Floor moving properly through Co-activation with the Diaphragm and this in turn can have an added bonus of helping the bowel empty which again, I have already seen happen with clients practising Hypopressives.
Constipation is a risk factor in Prolapse and Low back Pain so if you’re constipated, your prolapse can appear worse.
We know when an exhale is held longer than an inhale it promotes the parasympathetic nervous system to balance our rest and digest mode so that’s another positive.
The postures within the Hypopresives technique help stimulate all the musculature of the posterior chain, which are generally not optimally strong in most people, so that’s valuable too.
We know/say in the Physiotherapy world that Posture, Constipation and Diaphragm Movement are highly important for full Pelvic Floor Function and Hypopressives Hit all Three - so why would I not have it as a Tool? It's a no brainer!
What I also love is its takes less than 10 mins a day so it’s ‘doable’. I am an advocate for Mindfulness, Yoga or Pilates Daily and Diaphragmatic Breathing but that in itself can be overwhelming for those who feel time poor or under pressure and it becomes another stress for them to try to add all of this into their day. So Hypopressives are the perfect antidote for modern day living.
Hypopressives are the perfect antidote for modern day living.
Yes, a lot of us are busy mums and something which is doable is so important both physically and mentally.
It’s also really interesting what you said about decongesting the pelvic area. Heaviness or dragging ranks really high with most women with prolapse symptoms, in terms of impact on their quality of life, and in my experience, women frequently note that this is the first symptom to significantly improve or disappear, which can be life changing for them.
Hypopressives have been use by Physiotherapists in Europe for about 40 years now. Why do you think it’s taking a while for Health Professionals in the UK to get on board?
Is it lack of ‘really good’ research? Maybe? But research always lags behind clinical practice. If more WHPs were doing it, we would catch up.
Also, one or two Highly Rated Women’s Health Physio’s, who aren’t trained in Hypopressives, nor use it with clients, have offered opinions of being unsure of it. Once the Big Gun’s talk the rest tend to follow, and because there are a plethora of techniques we as WHPs could potentially train in, if there is even one negative comment on a technique, a Physiotherapist is more likely to spend their money elsewhere.
What do you think the next 5-10 years is going to bring in Women's Health?
I truly believe Hypopressives will be a tool in the box of every Pelvic Floor Physiotherapist.
You cannot comment on something you haven’t experienced, that is my personal belief/bias. If I can bring a simple safe tool to help women and men why would I not do that?
While some of the apparent benefits of Hypopressives could potentially be gained from other forms of exercise, rehab, manual techniques and breathwork, its uniqueness lies in its ability to quickly change the movement range of the Diaphragm and therefore indirectly influence the Pelvic Floor. It is this influence and change of Posture, mobility of the Pelvic & thoracic Diaphragm and most likely lymphatic and parasympathetic changes, that improve the symptoms of Prolapse and other Lumbo Pelvic Dysfunction.
I am also particularly interested in its longer term effects on High Tone/ Tight Pelvic Floors which I think are clinically just the Pelvic Floor not being able to move correctly whether from a poor breath pattern and/or visceral restriction and/or stress which I feel Hypopresives could address easily. If you only focus on the area of symptoms you rarely get resolution.
Either way it’s exciting to have a simple usable tool that to me makes sense as to why / how it's effective. I’m happy to keep track of my clients progress to add to the data supporting it. Nothing is a one size fits all or fixes all tool. However, Hypopressives is definitely a beneficial tool for Pelvic Floor Dysfunction.
Thank you so much Vivienne, it’s been really great talking with you, and I hope women and clinicians will find this a helpful overview of Hypopressives and what it can bring to Women’s Health. It’s also exciting that more Physiotherapists in the UK are offering Hypopressives within their clinical practise, and I’m looking forward to seeing what the next few years bring.
Vivienne Byrne (MISCP) BSc (Hons) Physiotherapy
Body Balance Physiotherapy & Sports Injury Clinic, Navan, Co. Meath