When I work with clients who have POP, I emphasize the fact that recovery is not usually linear and often feels more like two steps forward, one step back. Or sometimes it feels like you're not even making progress at all.
I'm living this advice right now.
About two weeks ago, I really started being a lot more aware of my prolapse. If you have POP, you know exactly what I mean. It doesn't necessarily hurt or feel uncomfortable (although it can), but you're getting little warning signs that may or may not signal a symptom flare up. This didn't surprise me; I was ovulating. If I have symptoms, they're almost always worse at that time of the moment, even worse than when I'm having my period.
(This is SUPER common, so if you're having trouble figuring out a pattern to your symptoms, that might be something to consider).
I pulled back a little on my workouts, like I usually do if things are feeling noticeably heavy or draggy. It didn't work, though -- I didn't feel better. I started waking up with symptoms, which is rare for me. This made me SUPER nervous.
I noticed that certain movements would predictably make it worse: partial Turkish get-ups (even just rolling to my shoulder felt weird and off), and any core-type exercise that I did lying on my back, like variations on heel slides. I tried changing my breathing, I tried using different pelvic floor strategies, and none of it mattered. I was feeling crappier by the day and really starting to freak out, since even one hour of teaching made me feel like I desperately needed to get off my feet for a while.
I made an appointment with my pelvic floor physical therapist just to make sure that everything was still ok, structurally speaking. It was!
So that means it's a strategy issue.
She watched me do some of the troublesome movements, and could see even without touching me that I was bearing down.
I KNOW better. I TEACH this stuff, for crying out loud. I know that bearing down is bad and breathing is good, and it turns out I was both holding my breath AND bearing down, even for something that should be really, really easy, like a mini crunch. I'm also WAY over-recruiting, which means I'm using far too much effort for a relatively easy movement.
The only way we were able to get my pelvic floor and TA (transverse abs) to relax was to elevate my shoulders off the floor and do a mini crunch from there.
Talk about humbling. Deadlifting my bodyweight is cool and totally fine and doesn't bother my pelvic floor AT ALL, but a crunch is too much?
So that's my homework. Mini crunches while I teach my muscles to freakin' RELAX. Our working theory is that supine rectus-dominant activities (that's PT-speak for "ab exercises on your back") is, for my brain, REALLY REALLY SCARY. Because that's what we're often taught in the perinatal fitness world, right?
CRUNCHES ARE BAD AND EVIL AND YOU SHOULD NEVER EVER DO THEM BECAUSE YOUR ABS WILL SPLIT WIDE OPEN AND YOUR PELVIC FLOOR WILL COME SHOOTING RIGHT OUT.
Except that's not true. The research doesn't support that conclusion, and neither does real life. What matters is HOW you do them, and I'm just not doing them very effectively right now.
This all happened at the same time as I was starting Haley Shevener's AMAZING kettlebell course (the perfectly-named "SNATCH"). She mentioned in the private facebook group that when she filmed some of the basic exercises for the course, she realized that her strategy was off on some things, and she was actually sore from doing exercises that, in theory, she should've been able to do in her sleep. Her point was that revisiting the basics is never a bad thing, and even she had some things to work on -- and it's her course!
I wanted to share all of this with you guys for two reasons:
1. I think it's important to realize that POP is not necessarily a "fix it and forget it" type thing. Strategy is always going to be important.
2. It's literally my job to know this stuff and I needed to work with my physical therapist to figure out a better strategy (YOU HAD ONE JOB).
I'm not perfect. Neither is Haley. Neither are you. I mean, we're all pretty freakin' awesome, but we're also fallible. We go on autopilot. We fall back on our deeply-engrained tendencies in times of stress.
Taking a step back is not a bad thing and it doesn't mean you fail at POP rehab or management. It means you're human and you just need a helping hand or another set of eyes to get you back on the right track.