Intra-abdominal pressure (IAP), deep breathing, simple right?
The only problem we face is that as simple as it seems and as easy as the practical application may be, for the body to function in the correct manner and compliment your conscious efforts is another ball game.
I mean, faulty breathing mechanics is one of the many reasons millions of people live with back pain. From my personal experiences it’s also one of the root causes that leads to other compensation patterns all over the body.
To help you understand this let’s start with what intra-abdominal pressure actually is. A steady amount of pressure concealed within the abdominal cavity would be a pretty good explanation of IAP. The pressure concealed within this cavity is concealed with the purpose of stabilising the lumbar spine, not to mention the pelvic region.
To do this all we really need an affective inhale and proper function of the diaphragm including the participation of the pelvic floor to help take some of the weight of the organs being pushed down as the diaphragm drops, when standing anyway, which we do most of the time.
The problem we’re faced with as human beings is our emotional wellbeing and limbic system. What is it we allow to trigger us in life so much so that it effects our breathing patterns? Positive or negative, well in fact perceptual. What is it that catches our breath and takes it away? That gasp of air, of relief, or even of fear can lead to a breath hold. This known as a Valsalva manoeuvre and causes the diaphragm to lock in place at the top of our ribs.
Anxiety and worry can lead to chest breathing and tight pecs, stress and a hectic routine can cause the neck muscles to tighten and the accelerator nerve to force you to a sympathetically dominante state, inhibiting the function of the vagus nerve s you can no longer slow down your nervous system and start to rest and digest. The amount of emotional overdrive we experience and the ways in which this can affect our breath is endless.
Once these emotions have been controlled and resilience has been built you then have the obstacle of trying to balance out the mechanics of the muscles. Anatomically the amount of muscles that functionally get involved with respiration is huge. Over developed chest muscles for atheistic reasons and underdeveloped core musculature can create a simple imbalance between inhalation and exhalation leaving the diaphragm stuck and unable to move, blowing out any dream of creating intra-abdominal pressure at all.
Some thing as small as this can lead to huge knock on effects, without movement in the diaphragm the pelvic floor can’t drop, and from here, the trouble really starts.
Without the pelvic floor functioning and supporting the base of the deep core unit, true intra-abdominal pressure and stability can never be created.
Sacroiliac joint compression is a very common strategy used by our brains to keep us safe and increase our stability, the problem is our brain expects us to sort this out pretty sharpish rather than carrying on huffing and puffing throughout the day.
Once the organs become stuck, other complications in relation to continence, or even incontinence can occur. A dysfunctional pelvic floor can be the root cause to compensations with the hip capsule leading to hip compression and osteoarthritis, ligamentous issues can lead to excruciating pain and hip decompression; not allowing the hip to properly move in its joint and trigger other imbalances of someone’s gait cycle, knee valgus or varus in relation to ankle pronation or supination.
Medial knee pain from poor function of the adductor complex and frontal plane motion of the femur can spurt from the pelvic floor with the anterior quadrants sharing the same bony landmarks. All the foam rolling in the world wouldn’t help resolve this issue as the primary cause, anatomically anyway, is in the pelvic floor, in fact is with the diaphragm, sorry the core, I mean the over developed chest.
The trail can go on and on and on, hopefully now you can see why weeks of physiotherapy can come to no end result and without professional support people can be left chasing pain for months on end.
Finally, just to help prevent any you tube views of pelvic floor exercises, when considering the function and role of the pelvic floor, the advice of Kegels to strengthen the muscle is probably the worse advice you could be given.
The pelvic floor is hugely unique in the fact that it’s made up of primarily 70-80% of slow twitch muscle fibres and as a participant in creating IAP is known as what’s called a tonic muscle, a muscle which is designed to stabilise the surrounding structures rather than them moving in a phasic action. What’s more, the pelvic floor spends most of its time eccentrically loaded and on stretch, so a squeeze and concentric action of these tissues is that last thing you want, even if it could be done correctly.
Nine out of ten times most people attempting Kegels won’t be contracting their pelvic floor but more forcefully contracting their sphincters and the complications that this can lead too are highly dangerous. With the wrong intent the pudendal nerve can be compressed creating detriment to sexual functions. Lack of sex drive let along the ability to become erect are some of the less serious issues, the ability to have sex without pain for females is another issue that follows, even leading to the trauma of not being able reproduce. All because you forgot to take a deep breath and check in yourself from time to time.
IAP when executed correctly can be a gift to helping towards creating intrinsic spinal stability, although from what you’ve just read is easier said than done. Daily breathing practice to raise consciousness of your where you’re holding your breath is a great start. Therapeutic interventions are a must if deep abdominal breathing can’t be done, then once the function of the diaphragm is corrected the pelvic floor assessments or exercises can be started, but only then.