It is a true marvel for women of our time to have lived to see the rise and fall of pelvic reconstructive surgery for the common conditions of prolapse and incontinence. While the fall is nowhere near complete, it is clear that old institutions are slowly crumbling under the new paradigm of wholeness and the stability of natural female design.
Taking the place of the traditionally male role of surgical “correction” of prolapse and incontinence are postural systems created exclusively by women. Several women have developed an understanding of the critical relationship between pelvic organ support and spinal alignment, and are pioneering a conscious return to more natural human posture.
While these researchers herald a new age in the treatment of chronic pelvic and back disorders, there remains the unresolved issue of what exactly constitutes natural human posture. I would like to illustrate why I believe Whole Woman™ posture is the only truly natural human posture yet described. Clarifying this distinction is essential as we move ever closer to a worldwide teachable field of postural health for women with disorders of pelvic organ support.
We must begin by understanding that the fundamental problem of universal design or evolutionary purpose has always been about how land animals regulate the forces of intra-abdominal pressure. Arguments about pelvic organ support have always revolved around this elemental dynamic since Paramore1 and Keith2 first described the evolution of the pelvis.
From primitive fish on, animals devised more and more complex strategies for coping with internal pressures created by their external environments. Air-breathing bodies had to be arranged in ways that allowed for release of excrement, eggs and offspring, yet prevented extrusion of internal organs. Early amphibians aided the intra-abdominal vacuum necessary for breathing by simply sitting on their perineal orifices.
The term “intra-abdominal pressure” is commonly used to describe the dynamics inside the abdomen and pelvis. However, I challenge the widely held belief that static pressure is significantly increased or decreased inside these cavities. While a true pressure gradient exists between intrapulmonary and atmospheric pressure, allowing us to breathe, such pressure changes inside the body can only be very slight. This is due to the fact that internal organs and structures are largely composed of water, and water cannot be compressed.
I propose the new term, intra-abdominopelvic displacement to describe the dynamic movement that occurs during breathing and muscular activity. This more accurate description provides a useful impression of what actually happens when we take a breath or pull in the abdominal wall. Abdominal and pelvic contents are not placed under greater pressure, but rather dis-placed to other locations. An elastic abdominal wall allows for this movement.
Each time we breathe in, or inspire, the respiratory diaphragm expands downward, displacing abdominal and pelvic contents down and forward. The results of this movement are pelvic organs that bend ninety degrees from their channels to become positioned against the lower abdominal wall.
Esther Gokhale (the Gokhale Method℠) states that, “The chest and spine move the most during breathing at rest.”3 However, the accuracy of this statement is dependent upon bodily posture. When the abdominal wall is pulled in, even slightly, internal pressures cannot displace the organs fully forward. Therefore, the chest is displaced upward instead. When the lumbar curve is fully in place and the abdominal muscles lengthened, belly breathing predominates and chest breathing is minimal.
We have only to observe the bodies of children to comprehend what constitutes natural human posture. The upper abdomen is puffed out and the lower abdomen follows in a gentle arc from breastbone to pubic bones.
The only reason this posture is not carried forward into adulthood is because artificial posture is imposed upon us from the outside by the cultures we live in. There are no other reasons we should ever lose our natural posture. Yet today, virtually every system of postural and exercise therapy is taking us further away from our intrinsic design.
At the core of contrived human posture is an abdominal wall that is “engaged”, “active”, or otherwise contracted. Gokhale promotes the concept of an “inner corset” that is essential for postural and spinal health. She states that, “When an African or Indian village woman carries a heavy weight on her head, she is not passive under that weight, which would cause her discs to compress. Rather, she actively engages her inner corset; her torso becomes more slender and her spine becomes longer. In this way she protects her discs from the weight she carries.”4
Clearly, this statement is refuted by a world of women who still carry loads in this way, including those illustrated in Gokhale’s book. The upper abdominal wall is puffed out and the lumbar curve strongly in place. Any level of “engaging” the abdominals or “anchoring” the rib cage compromises the human posture developed from early childhood.
Studies show the same dynamics that create pelvic organ support are only increased when additional pressure is added from above. The same dynamics in a standing body at rest are maximized under further pressure. This is most evident in advanced pregnancy when contracting abdominal muscles has no bearing on postural or spinal health. Chronically pulling in the abdominal wall opposes the innate mechanics of human posture and displaces pelvic organs to the back of the body.
The human torso developed a level of both rigidity and flexibility unseen in the rest of the animal kingdom. These qualities allowed full use of the voice box and arms while seated upright. If you lift the front legs of a seated cat, she will likely lose her balance because she has not developed a shape that can easily stabilize in this position.
Organ displacement while breathing under the forces of gravity developed the structure of the human torso. The stiffness of fully lengthened abdominal muscles, and their connecting fascia, provide the primary function of the abdominal wall – to contain the abdominal and pelvic contents under dynamic pressure. Contracting the musculature affords secondary functions such as bending, twisting, coughing, sneezing, defecating, vomiting, pulling, and heavy lifting.
Any discussion of human posture must take into consideration the differences between the male and female spine. To accommodate birth, the female pelvis is wider and her lumbosacral angle more acute. The shape of her lower vertebrae are genetically female, all of which give her a more pronounced lumbar curvature than men.
These differences result in a straighter and more cylindrical male torso. The Dinka tribe of southern Sudan best illustrate these natural differences. Male tribesmen wear tightly beaded corsets that accentuate the straightness of their figure. These men are not in danger of pelvic organ prolapse because the front triangle of their pelvic floor is closed. The “genital hiatus”, or opening in the pelvic floor musculature, is strictly a female anatomical feature. Female Dinka wear beaded attire as well, but theirs are fashioned as long, loose necklaces, allowing for the natural curvature of the abdominal wall.
Pulling in the abdominal wall is a classically male objective. Yoga, Pilates, calisthenics, and physical therapy have all been deeply influenced by an anatomical model that is essentially male. Male laborers and fitness devotees easily obtain a flattened abdominal wall. High levels of testosterone also factor into this area of male anatomy. A flat, rippled abdomen is much more difficult for women to achieve, particularly those with a history of full-term pregnancy. This does not mean the female abdominal wall is weak. Natural exercise combined with innate posture build musculature that is strong, flexible and elongated.
Practitioners like Katy Bowman (Alignment Matters™) understand that the pelvic floor is only wholly functional when stretched to its full dimensions. However, this same understanding is not extended to the other major body wall, the abdomen, when in fact the very same dynamics apply.
We share with primitive fish abdominal muscles that wrap around a transverse pelvic bar (pubic bone) and continue on to the pelvic outlet and “tail”. We also share oblique muscle fibers on our “ventral” side, which fish use to lay copious amounts of eggs. We have much greater need for muscle contraction and therefore possess more highly developed musculature than fish. However, the primary function remains the same.
Abdominal wall strength is a result of breathing and moving with lengthened musculature. Forcing the body to live in a contracted state is compromising a very old evolutionary design.
Next month we will discuss the importance of the feet in human posture and how contracted abdominals lead to another common misalignment – placing most of the weight on the heels.
1 Paramore RH The evolution of the pelvic floor in nonmammalian vertebrates and pronograde mammals. Lancet 1(98): 1393-1399. 1910
2 Keith A Certain phases in the evolution of man. British Medical Journal 88: 788-790. 1912
3 Gokhale E Adams S 8 Steps to a Pain-Free Back. Pendo Press 2008 p. 23
4 Ibid pp. 112-113