#PTonICE Daily Show – Monday, October 2nd, 2023 – Breath manipulation & the pelvic floor

In today’s episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jess Gingerich challenges the notion of associating the word “safe” with breath and movement, particularly during pregnancy. She questions why breath suddenly becomes a determining factor for safety in this context. While she acknowledges that the pelvic floor experiences increased demand as the fetus grows, she also affirms that it is a muscle that can strengthen with appropriate exercise.

Jess encourages weightlifting as a means to strengthen the pelvic floor during pregnancy. She explains that stronger muscle fibers are more resilient, sharing this information with her clients in the clinic. She also highlights the fact that individuals are not instructed on how to manipulate their breath when coughing or sneezing, which exerts similar force on the pelvic floor as lifting 35 pounds. Since this natural phenomenon is beyond our control, it is unreasonable to expect individuals to exhale on exertion for every activity.

Jess also address the misconception that breath holding is detrimental to the pelvic floor. She explains that breath holding actually increases spinal stiffness, enabling individuals to lift more weight and become stronger. However, She clarifies that breath holding with a bear down to the pelvic floor is not recommended. She differentiates between different positions of the pelvic floor, referring to the basement (during bathroom use or childbirth) and the first floor or attic for other tasks.

Overall, the episode aims to alleviate fear and promote understanding of the pelvic floor. Jess emphasizes the importance of educating individuals about their pelvic floor and its functions, highlighting its potential for strength and dispelling myths and misconceptions surrounding breath and pelvic floor function.

Take a listen to learn how to better serve this population of patients & athletes.

If you’re looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don’t forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!



Good morning and welcome to PT on Ice daily show. My name is Dr. Jessica Gingerich. And I am on faculty here with the pelvic division here at ICE, which means it’s the beginning of the week. So happy Monday. We are going to talk about breathing in the pelvic floor. This is a hot topic in the pelvic space. often referred to specific breathing strategies that are like safe or protective to the pelvic floor. And in reality, it’s just not that simple. So let’s start with a few housekeeping items. We are currently in our last cohort of the year for the online course. So if this is something that you’ve been wanting to get on, we’re about to put the pedal down starting January 9th. So head over to the website to sign up for that online course. In the month of October, we will be in Brookfield, Wisconsin on the 14th and 15th in Corvallis, Oregon, October 21st and 22nd. So again, those courses are all on the website, so head over there and snag your spot. They are filling up fast.


Okay, let’s talk about breathing during exercise and how it stresses the pelvic floor. How many of you, as moms, clinicians, or just someone with a pelvic floor, hint, all of you, have been told to exhale on a lift or exhale on exertion? My bet is behind your phone, you are silently raising your hand because you’ve heard that. Whether it’s for yourself or for your clients, wherever you are in the exercise space, you’ve probably heard that. When we think about this, so there’s a lot of information from fitness professionals or medical professionals in the exercise space saying a lot of different things and boy is it confusing. This is especially true in the pregnant and the postpartum population. These clients typically come in having some kind of, have done some kind of research around breathing and lifting, and they’re worried about their pelvic floor. So how do we help them understand how to manipulate their breath with exercise? So firstly, let’s take the word safe out of it. If I am a non-pregnant female versus I get pregnant, Why is my breath all of a sudden making something safe or unsafe with a particular movement? There is more demand placed on the pelvic floor, especially as the fetus grows. Sure, yeah, that happens. Is the pelvic floor a muscle? Yes, it is. Do muscles get stronger as we place appropriate demand on them? Also, yes. We need to encourage weightlifting to some capacity during pregnancy so the muscle gets stronger. Stronger muscle fibers are harder to break. I love telling clients this in the clinic. We don’t ask someone to manipulate their breath when they cough or they sneeze. which by the way is the equivalent of lifting 35 pounds or putting 35 pounds of force through the pelvic floor because it is a natural phenomenon that we cannot control. We don’t tell them how to manipulate their breath there. So having someone exhale on exertion for everything is unreasonable. There are times where that can be helpful, especially early postpartum or if there are symptoms. But have you tried to exhale an exertion with double unders or box jumps or lifting 80% of a one rep max? You can’t control your breath, like during movements where your heart rate’s up. It’s virtually impossible because your heart rate’s up, your respiration rate’s up. And as for the 80%, your body is just going to do what it’s going to do, which is probably gonna include a brief breath hold or maybe even one that’s longer so you can get through that movement well. Secondly, breath manipulation should be initiated one of two ways. Are they symptomatic? No. Continue what you’re doing. Are they symptomatic? Yes. Let’s change a bracing strategy or breath manipulation to see if we can continue that volume and that weight without symptoms. From there, we continue to scale as needed. And lastly, Breath holding during exercise. And what I mean by this is someone is lifting a heavy barbell or let’s say both of their wiggly children at once from the ground. And Oh, by the way, one is screaming their head off. They’re going to brace their core, hold their breath and lift the weight or their babies. Have they just ruined their pelvic floor or has their body just done what it’s going to do naturally? My answer is the latter. We cannot always manipulate the breath, especially in life, especially life as a mom. We need to stop scaring moms and over-medicalizing breathing when in reality, our bodies are going to just do what it needs to do to get through a task. We believe in this so heavily that we teach bracing mechanics in detail, in depth, in our live course. So I mentioned those live courses at the beginning. Get on that. Like you, whether you’re treating this population or not, you’re going to see it. So to recap, there are no safe and unsafe exercises. It’s simply, are we ready for that particular demand, whether that’s weight or volume. We modify due to symptoms. We aren’t ruining the pelvic floor by holding our breath. Breath holding increases spinal stiffness, which allows us to lift more weight, which also allows us to get stronger. And that’s huge. Now, I do wanna be clear. Breath holding with a bear down to the pelvic floor is not what we want to do. When our pelvic floor goes down, and what we like to refer to that as in the basement, that’s when we’re going to the bathroom, right? That’s when we are actually having a baby. any other time our pelvic floor is likely going to be on that first floor or in the attic and somewhere in between depending on the task at hand. So let’s start taking the fear out of this. Let’s start encouraging moms, really anybody, to do what their body’s meant to do, and let’s help teach them. It’s something that we can do, we can teach them. Your pelvic floor, we can’t see it, right? We can see how our shoulders move and how our neck moves and head moves. We can see that. We can’t see how our pelvic floor moves unless we’re laying down with a mirror between our legs doing an active Kegel, and that’s not realistic. Also, knees go over toes when squatting. I hope everyone has a great Monday.

08:13 OUTRO

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