Podcast Episode #40: Pilates for your Pelvic Floor
September 6, 2018

Podcast Episode #40: Pilates for your Pelvic Floor

Today we talk with Iona Ruiter of Pilates in East.  She specializes in pelvic floor health, prenatal and postnatal pilates, and diastasis recti.  She gives us an in-depth look at the health of your pelvic floor and what exercises actually work.  You can listen to this podcast episode on iTunes or SoundCloud.  Be sure to check out our Facebook post for before and after pictures!


Alyssa:  Hello and welcome to another episode of Ask the Doulas.  I am your host, Alyssa Veneklase, and today I’m excited to be talking to Iona from Pilates in East.  Hello!

Iona:  Hello!

Alyssa:  Thanks for coming over here on this very hot day.

Iona:  Thank you for having me.  I don’t have central air, so this is great!

Alyssa:  Is it cool enough?

Iona:  Today has been a little warmer than other days, but in here, yes, it feels great.  I always love going to work, as well, because we are air-conditioned in there, as well.  But home, not so much.

Alyssa:  Yeah, it’s not a hot pilates.

Iona:  No, no.

Alyssa:  Tell me a little about Pilates in East because I only found you through social media because somebody was talking about what you specialize in.  So we love, at Gold Coast, talking about pelvic floor issues and all these things that a lot of moms deal with, sometimes even during pregnancy, but then very commonly afterwards.

Iona:  Yes.  So at Pilates in East, in general, a lot of the group classes are more fitness-based.  Some people will have some issues with herniations of disc and osteoporosis, things like that, in our group classes, but personally, myself, I specialize in pelvic floor health, prenatal pilates, postnatal pilates, and diastasis recti.  But I actually discovered I had diastasis after the birth of my son, and he just turned four.

Alyssa:  And explain what that is for somebody who hasn’t had it.

Iona:  It’s becoming very common, so I think a lot more people are starting to learn what it is, but it was always defined as the separation of your abdominals, your rectus abdominus muscles, but that’s actually an inaccurate description of it.  It’s actually the extreme thinning of your linea alba, which is the connective tissue between the rectus abdominus muscles.  So it causes the abdominals to come apart, but it’s actually the connective tissue in between being extremely thinned.  And it doesn’t come back together after birth.

Alyssa:  Is that just from the stretching?

Iona:  Yes and no.  So that can be an underlying issue, which it usually is, and then that stretching and the pressure on the abdominal wall from giving birth and the growing baby creates this extreme thinning where it doesn’t come back.  There’s also umbilical herniations which is very common with the diastasis, and that is where there is a tear in the linea alba, and your intestines can actually protrude out of the fascia, which is the linea alba.  It’s the connective tissue; it’s called fascia.  And that is supposed to be repaired only through surgery, but I am a big advocate for natural healing.  I believe the body can do wonderful things, and I think the mind can do wonderful things, as well, and I think that’s one of my problems with my own journey of healing.  I think I have a lot of anxiety, and I focus a little too much negatively on it, but the results I’ve seen on other women has been amazing.  And honestly, the results I’ve seen in myself have been pretty amazing, as well.  I have photos that I actually brought here, too, that we can look at after, because it is pretty amazing to see the before and afters, and I really like to document because I think for someone to see the results, sometimes we don’t always feel the results, but to see the results, I think, speaks volumes.

Alyssa:  We could even post those or post a link if you have them somewhere if you have approval to show those.

Iona:  Yes, I did get approval from someone who I did two private sessions with, and then there’s something we call a magic green ball.

Alyssa:  I see it right there.  It just looks like a green ball, so what makes it magic?

Iona:  It’s actually a myofascial release ball, so the first thing I like to start with – this is postpartum pilates, but I do this with women while they’re pregnant, as well, because it does help to relax the pelvic floor area, open up those hips a little bit, get them ready for birth.  But it’s especially essential for the postpartum recovery.  It’s a myofascial ball, so what that means is it’s a ball used to release the fascial tissue and smooth it out and help the body to realign because when we have pulls on our muscles in certain areas, it causes misalignment.  And most of us probably go to chiropractors.  If we’re doing a more natural birth, I feel like chiropractic care is very important.  I go to a chiropractor, as well, but one of the things with chiropractic care is it’s only your bones.  They’re not doing anything for your muscles.  And if your muscles are overly tight and working too hard in certain areas, they’re going to create that pull and pull that bone back out.  You know, there’s only so much.  So the ball really helps to release those overly-tight muscles.

Alyssa:  I’m picturing being on my stomach rolling around on it.

Iona:  So there’s an oblique release, which is essential for the recovery of the diastasis, as well.  I can’t do that one on prenatal women, but I do that one on postpartum and on menopausal women, as well.  For any woman with pelvic floor issues, the oblique release is amazing.  You can also do psoas, which is your internal hip flexor.  It is tight on a lot of people, especially if they’re runners and things like that, but it’s inside of your hip, and it’s really essential.  It helps with the function of the core and pelvic floor, everything.  All of that is connected.  We do release work on glutes, which is your butt, and the hamstrings, which is the back of your legs.  I also do release work on sacrum, which is a really important one for me.  I have some sacrum issues, which is the little triangular bone in between your left and right hip.  The tip of your sacrum would be your tailbone, and then the base of the sacrum is right around where those dimples on people’s backs are.  And then I’ll do all the way up and down the spine, doing some release work there, as well.

Alyssa:  And what does that mean, doing release work?  With this ball?

Iona:  With the ball.  So you actually roll on it or you just hold a pose with the ball in an area to do release in that area, and it’s amazing.  My obliques before I used this ball were very overly developed, and that’s partially because of my rectus abdominus muscles being weakened and overly stretched from my diastasis recti, and this ball has released my obliques so much.  And you notice, like if I show you pictures of me, with my belly button, I had a little bit more of a pull to the right, and so I’ve been doing this release work on my sacrum and the oblique release.  My right side’s much stronger; I have to hold that for a lot longer, but my belly button’s becoming more uniformly round, and that’s one of the things in the pictures, when I show them to you and then if we post a few of them, you’ll notice the difference of people’s belly buttons.  It’s really pretty amazing because there’s so many pulls from these muscles and everything.  So there’s a lot of realigning the body and releasing.  That kind of goes hand in hand, and then I put in some movement work for exercises that people can do at home.  They’re really gentle, easy.  I do all this stuff every night, and it takes me probably — I’m pretty quick at it now because my body has released more in areas, but it probably takes about 15 minutes to a half-hour, so it’s easy.  It doesn’t require a lot of time.  And, you know, you can keep adding on and making it harder, and then the more that your separation comes together or the better your pelvic floor health becomes, then you can eventually join group classes and everything.  But if there is enough interest after this podcast, I’d be more than willing to do some private group classes and if anyone wants to reach out to me, we do special pricing and everything with the more people we get for pelvic floor health, the diastasis, and everything like that.

Alyssa:  So what do you do with this magic green ball for pelvic floor?

Iona:  For pelvic floor, it’s very similar because, again, everything is kind of connected.  So with the diastasis recti and pelvic floor, really, the main source of fascia on your body is the thoracolumbar fascia, which is the fascial tissue along the center of your back, more or less.  And it fans out, and fascia really covers your entire body, and then there’s little pockets in the fascia, and that’s where your muscles lie.  But the thickest, largest part of your fascia is along your back, so that’s why it’s so essential to do that.  But then that fascia wraps around your pelvic floor and comes up to the linea alba, so if there’s some kind of disruption in the back of the body, the pelvic floor, or the front, it can cause the diastasis; it can cause some pelvic floor issues.  There’s just all these little contributors because the body works in funny ways, and everything’s really connected.  It really is, and it’s funny because a lot of times, even in my group classes, I’ll do stretching and I’ll just have everyone lift one arm up, and they’ll be like, oh, my gosh, why does that stretch feel so different?  And when I first started pilates, we’re always like, oh, don’t — people when their cores are weaker will lift their shoulders up, and it’s like, oh, your shoulders aren’t connected to your abs; you need to keep them released, but the thing is, everything’s really connected where these nice long lines and this fascia is all connected, it’s just the muscles might not be connected.  So releasing all of that one.  But a big one — some big stuff I do with pelvic floor work is I like to do a lot of working those external rotators of the hips.  I don’t know if you’ve ever heard of clam exercise.

Alyssa:  No.

Iona:  It’s where you lie on your side and your knees are bent.  Your feet stay flat together, and your legs are about a 90-degree angle, so they’re straight out from your hips.  And you have to make sure that your top hip does not roll back.  That’s very important because if it does you’re not giving yourself the exercise you need, but you just work by opening and closing that top leg.  That’s a great pelvic floor exercise, and everyone listening could do that at home right now, even.  But realigning the body, again, really does help with getting everything to function as it should.  So that’s why the myofascial ball is so important, or the magic green ball, as we call it.  But the pelvic floor release is another great one for pelvic floor issues because, again, just because someone has pelvic floor issues doesn’t mean that they have a weak pelvic floor.  It just means it might be weak in certain areas.  There’s certain areas overworking, probably, and other areas underworking.  So we want to get it to work together, and so that pelvic floor release is really important to that.  I love squats.  I think squats are another great thing.  It’s a natural pelvic floor engagement, just lifting up every time you stand back up, but making sure you come up all the way tall.  A lot of times I watch people do squats, and they come up, but they don’t come up all the way.  That last little bit’s important, just for your whole entire body, for your kneecaps and everything, getting that last little lift.  But yeah, those are just a couple simple little things that people can do at home and everything with that.

Alyssa:  I’m curious about that.  You have a deflated balloon looking ball.

Iona:  Yeah, so this is called a soft gym ball, but yes, it’s deflated.  A lot of times with pelvic floor issues, as well, and possibly with diastasis recti, just all kinds of postpartum issues, we’ll place this in between their thighs, but not their knees.  You want it pretty high up, closer to the pelvis.  And we don’t ask people to press into it, but your legs naturally will press in and engage.  So if I have someone doing a bridge, which I think everyone knows what a bridge is, probably — a pilates bridge is a little bit different.  It’s not so extended; your ribs stay in.  But a lot of times if people have weaker pelvic floor, their knees tend to fan out as they do a bridge.  Their legs don’t stay inward, and so it creates this uneven tension in certain areas, wrong muscles overworking, weaker muscles underworking.  So if you place this ball in between, you can’t open your knees out because you’ll drop it, but you’ll notice this natural inner thigh, your adductors, working, which is going to help work the muscles inside the pelvic floor and everything as well, because all of that is attached to different areas of your pelvis.  In the past, women were always told to do Kegels to strengthen the pelvic floor, but looking at this photo of your pelvic floor, there’s actually two layers of your pelvic floor.  The two areas are your pelvic diaphragm area and then your urogenital triangle.  So the pelvic floor is more intricate than a lot of us realize, and when you’re doing just a Kegel, you’re only working actually the superficial muscles of the pelvic floor, which would be more of the urogenital triangle.  So if you’re doing that, you’re really just strengthening the sphincter area, but there’s all these muscles here that aren’t really engaging.  So this would be the pelvic diaphragm, which actually, it’s called the diaphragm because like our breathing diaphragm, it actually does move.  So another good exercise for people with pelvic floor issues is pelvic tilts, so getting on hands and knees and then bringing the tailbone to pubic bone, pubic bone to chest.  That’s a really good movement of the pelvic diaphragm.  It’s getting to move; it’s getting to slide, so you’re getting kind of a Kegel, but you’re getting more than a Kegel because you’re actually exercising the entire pelvic floor, especially by adding that little bit of tilt.  And that’s something pregnant women can do, as well, because that will help if your baby is either occipital-posterior or breech.  So those pelvic tilts are really important, and I think they’re just important for women’s health in general.

Alyssa:  Now when you do the pelvic tilt, I’m picturing like a cat-cow, but you don’t have to do so much?

Iona:  Yeah, you’re actually not going to be going between the cat-cow.  It’s more of a hands and knees, and then you just want to really let your neck relax.  If it wants to hang down, that’s fine.  Just let your upper body relax more, but then your body is going to be more in a neutral position, so more of a flat back.

Alyssa:  And try to just move your pelvis?

Iona:  Yeah, and just move your pelvis.  A lot of times when people do cat, it goes into their upper back, which is called their thoracic spine, and it’s more of the lumbar spine which is your lower part of your spine.  But again, it’s more of the pelvic floor and the tailbone, sacrum, hip area that’s moving.  So it’s a really easy cue, and it’s one I learned when I did my pelvic floor diastasis course, but it’s just coming into hands and knees and then bringing tailbone to pubic bone; very gentle; you’ll feel a little glute engagement as well.  And then pubic bone to chest, where your low back should go more flat.  Because our backs — if you look at anyone standing, their low back naturally dips in.  That’s the natural curve of the lumbar, but you’re getting your low back to come more flat.

Alyssa:  So all of this stuff — let’s say someone hears this and says, oh my gosh, I have to do this.  You only do these in private classes, or you also kind of talk about it in group classes?

Iona:  So the great thing about Pilates in East is we are given kind of an outline for our class on how every class has to go, so there’s certain things we have to do.  We have to do arms, legs, standing, abs, things like that, but we are given free rein on what we do, and we all have our own specialties and different things that we’re interested in, so all of our own personalities come across in the classes.  And then the other great thing is every single class, we kind of have, whether people realize it or not, a little lesson that we talk about in the beginning of class, and we kind of stick with that for our theme as we teach the class.  So there’s other parts of the body — if you have low back pain, there’s this area along your spine called the multifidus, and that’s something I really like to do as well because I suffered from low back for a little bit after the birth of my daughter.  She liked to be held a lot, and the way we hold our children isn’t always the best for our body, even if you’re doing a baby carrier.  It can be hard, so the multifidus is a nice way to create more length in your back to help cushion.  You can kind of think of it as the balloons that they do balloon animals with, and you think of them being one on either side of your back.  And a good way to find your multifidus is if you place your fingertips on the center of your spine, so where you feel the bony part that protrudes, that’s your spinous processes.  And if you just slide your fingertips off to the side where it dips in a little.  And then the best way to feel is actually if you walk around.  You can feel the muscles kind of puff, puff.  Do you feel that?

Alyssa:  Yes!

Iona:  So that is your multifidus.  There’s more superficial muscles that are working, as well, but if you just think of when your drawing your abdominals in, puffing that area out just a little bit, even just breathing in and then exhale; just gently think of that area that you just felt puffing out a little bit.  It creates more space in that low back because that area typically is stronger.  It does run all the way up along your spine, but people don’t usually feel it up here.  But the low part of the back is usually stronger.  Those muscles are usually bigger, as well, so it’s a great way to feel less discomfort in the low back and everything as well, just thinking of that puffing up of the balloons or of the multifidus.

Alyssa:  It’s always funny when an instructor who knows what they’re talking about says something little, like puffing.  If you had just told me to puff up the back of my back — like, what?  And then you feel it and you move, and you’re like oh, okay, yeah, I do feel myself puffing up.

Iona:  That’s a hard one for a lot of peoples, so a lot of times I will have everyone feel it first, if I know it’s going to be something hard for everyone to comprehend at first.  It’s like, okay, I know most people are not visual learners; they’re hands-on learners, so how can I teach you where you feel it, and then see the outcome; get to understand that connection and everything.  One thing a lot of women do notice that have had a C-section is numbness down low, and part of the reason is — so we were talking about fascia earlier, and the fascia — think about looking at a piece of meat.  So the red part is the muscle, and then the white part is actually the fascia that we call fat.  So the fibers — we all know that meat has fibers, so there’s a direction; you know, when you’re cutting your beef.

Alyssa:  Against the grain or with it.

Iona:  Exactly, exactly.  So that’s the direction of your muscle, and our muscles are the exact same way.  They have these fibers that are in certain directions.  Your fascia is exactly the same way, so they have directions that they move and lie.  And just like our skin, our fascia, and the rest of our body, it’s all made up of a lot of water.  Now, what happens is when your abdominal wall and your fascia and your skin is cut into, everything — if you think of a book, where everything is this smooth surface where the pages are, and I’m thinking more of a soft-cover book, everything has this nice directional line.  If you end up being cut with something, like you have an appendectomy or a C-section, what happens is that fascia, as you put it back, it doesn’t live in its nice place.  It’s put together so that — almost like if you were to put your fingers together and lace them together, that’s how it normally is, and then when you’re cut open, it’s almost like putting your knuckles together.  So you notice that it doesn’t really fit.  So you really want to break that scar tissue up, so one of the first things I always ask women with a C-section is, do you massage your scar?  Because that is the number one most important thing that you could possibly do after having a C-section.  And it’s really a matter of when it feels comfortable for you.  They say your skin takes a full year to heal, and I think you can massage your scars sooner than a year, but if you don’t feel comfortable for a year, that’s completely okay.  You can start by just using two fingers and rolling the area that the scar is, but the best way is to actually get your fingers into the scar and then pull up or pull in towards the center line of your body.  Obviously, me doing it on someone is the best way to show someone, but yeah, with C-sections, diastasis is actually very common after that, as well, because of the uneven pull of the fascia system.  And that’s what I had actually learned with my diastasis, because I for the longest time was like why did I get this?  Why did I get this?  Everything I read says women over the age of 35 that are not fit, you know, have weaker abdominals.  I’m like, I’m a pilates instructor; my abdominals were strong.  I’m 32 years old.  I shouldn’t be having this issue.  Why am I having it?  And when I did the course that I had taken, it answered a lot of questions because I had also noticed a lot of women with C-sections having the diastasis, and what I didn’t realize is one, I had my appendix removed when I was seven, so that caused uneven pulls on my fascial system.  So my body had to find new ways to kind of move and shift.  The skin had to find new ways to pull, and the muscles, too.  And then I actually was in a car accident at 17 years old where my sacrum was fractured diagonally from the top all the way to the opposite side.  So my sacrum ended up not living in the place that it should have, which caused uneven pulls because you don’t get sacrum surgeries or things like that.  People do hip replacements, but they don’t do actually surgeries on the bones themselves.  You can’t do anything, and you can’t put your pelvis in a cast, so…

Alyssa:  Were you just sitting on a donut?  What did you?

Iona:  Yeah, when I had the car accident, I was given a claw to grab things, and I was given a donut to sit on, and that was basically it.  Yeah, so what I found was my body wasn’t aligned as it should, and that’s why that myofascial release, again, is so important.  So women with a C-section or anyone who’s had back surgeries, it’s really important.  They’re going to be more prone to a diastasis as well or maybe pelvic floor issues, things like that, because of that all being connected and wrapping up and around the pelvic floor.

Alyssa:  That makes a lot of sense.  Well, I think it’s encouraging for moms to know that if they have pelvic floor issues or even have back issues or have issues with their abs, that they don’t just have to deal with it or they don’t have to go get surgery, or there’s at least some options to try for a while.  How do people find you?  Is the best way through the website?

Iona:  The website or my email.   People email me a lot, or you can message me on Facebook.  That’s always a lot of people messaging me on Facebook through Grand Rapids Natural Parenting and a bunch of different sites, but my name is Iona Ruiter, so you can Facebook message me.  Otherwise, iona.ruiter@gmail.com is another great way, and that’s just my personal email that I use for the studio and everything like that.

Alyssa:  Awesome.  Hopefully we can get some interest through this.  I know that once we click stop here, I want to have you show me a couple things.   Thanks so much for joining us today!

Iona:  Thanks so much for having me.  It was great.

Alyssa:  Hopefully you guys will look her up!  As always, you can find us at www.goldcoastdoulas.com.  You can email us with info or suggestions at info@goldcoastdoulas.com.  We are on Facebook, Instagram, and you can listen on SoundCloud and iTunes.  Thanks!