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Quotes from Research

Re: Trunk as pressure system

"Abdominal and erector spinae muscles and pressure control in thoracic and abdominal cavities are critical components of upright posture."

- Massery et al., 2013 - Effect of airway control by glottal structures on postural stability

"Pressure control in trunk and abdomen relies upon coordination of postural stability and breathing mechanics".

" Coordination of postures and movement requires generation, regulation, and maintenance of trunk and abdominal pressures"

- Massery, PTWA, 2016 - Breathing and Posture; A Multi-system Event. 


Appropriate posture requires belly muscle and back muscle control and stability in order to tolerate pressure changes in our chest and belly as we breathe.  This stability is also necessary in order to move, whether as small as reaching forward, taking a step, squatting, or jumping.

Physical therapy application: 

We educate and reteach breathing so that the pressure changes that occur with every breath do not create abnormal force through, or vulnerability of other structures. We incorporate these breathing techniques as we teach core strengthening in order to optimize postural control with the ultimate purpose of decreasing inappropriate stress on structures not built to tolerate said stress. 

Respiratory dysfunction frequently occurs with pelvic floor and low back dysfunction.

- Carriere & Feldt, 2006 - The Pelvic Floor

Breathing difficulties, Urinary incontinence, and allergies are more associated with low back pain than inactivity and body mass index (BMI)

- Smith et al., 2006 - Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity

In low back pain and pelvic pain, increased vertical motion of rib cage is often observed

- Magee et al., Orthopaedic Physical Assessment; Trunk: Breathing 

Adequate compression of joint surfaces must be the result of reaction forces acting across the joint if stability is to be insured; Adequate: ideally tailored to existing situations using least amount of compression for stability or "efficient neuromuscular control"

- Vleeming et al., 2008 - European Guidelines Treatment of Pelvic Girdle Pain

If your back hurts and you're having pelvic floor pain or dysfunction, it may be because you're breathing wrong. 

Weird as it may sound, but in physical therapy, we do spend a decent amount of time teaching people how to breathe appropriately. Did you know that it's not always as easy and natural as you think?! Physical therapist will look at where your breathing is happening (high chest with a lift of shoulders? mid chest with rib movement? belly breath with belly expansion?

Physical Therapy Application: 

Often I find myself telling patients that they don't have to use all their muscle power to achieve the desired action. Smaller is often better when it comes to control. When we ask you to complete a movement slowly, purposefully, with good control, it is because we are working to train your muscles to use the least amount of force to get the job done. 


Lowest portion of the pelvis where our inside tubes exit the body.

  • These tubes include our:

    • reproductive tract (vagina or penis)

    •  urinary tract (urethra)

    •  gastrointestinal tract (anus)

This area contains our external genitalia

  • Male

    • Penis​

    • Scrotum containing testicles

  • Female

    • Mons Pubis​

    • Labia (majora and minora)

    • Clitoris

    • Vaginal opening

What does a "normal" perineum look like? 

There is no such thing! Every perineum or vulva will look differently. When initially evaluating a perineum or vulva, we want to be able to observe whether the skin appears symmetrical, healthy or "angry" - meaning discolorations or irritation, and the presence of any lesions or scars. 

Diastasis Recti Abdominis

Diastasis = separation

Rectus Abdominis is the muscles often referred to as your "six pack". The left side and the right side are joined together to form a wall of stability that extends from the bottom of the sternum (xyphoid process) through the ribs, and down to the pelvis. 

A person may experience a diastasis recti abdominis at, above or below the belly button. 

Men and Women can develop a DRA

The function of the rectus abdominis muscle is to distribute force actively through muscle control, and passively through the tissue that connects left to right at the linea alba. We must be able to tolerate these forces both statically or dynamically. When you are at rest, there needs to be some level of rectus activation for optimal posture and pressure adaptation as you breathe. When you are active - whether reaching, running, lifting, pushing, pulling - your rectus abdominis assists in transfering power from the legs to the arms and vise versa. Without stability of the rectus abdominis, as seen with a diastasis recti, other structures through the pelvis and spine are forced to accept those forces and distribute them if they can. 

Think of muscle as the shocks in your car. If you drive down a gravel road with good shocks (good rectus abdominis control) you'll have a smooth ride. However, if you loose your shocks (diastasis recti abdominis) you may experience a lot of bumping, jumping, jarring, shaking, rattling around as the car frame is unable to stabilize against the bumpy conditions. 


DRA is most often thought of during or after pregnancy. In fact, 33% of women at 21 weeks pregnant will demonstrate a diastasis recti, 60% of women will have one at 6 weeks post partum. (Spersad et al., 2016)

Other risk factors include: 

- >33 years old, having multiple pregnancies/gestations, having a larger baby or increased weight gain during pregnancy, or if pregnancy resulted in a c-section. 

Urinary Incontinence

Pelvic Pain

Painful cramping with period

Pain with intercourse


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