How The Ribcage Can Affect Pelvic Floor Symptoms
Written by: Carlin Davinsizer, PT, DPT
It may be surprising to learn that Pelvic Health Physical Therapists care quite a lot about the ribcage! The ribcage isn’t something that is usually addressed or specifically targeted in traditional exercises. When we think of squats or push-ups, we easily understand what muscles (or even just limbs ha!) these movements are aiming to strengthen. But when a pelvic floor PT brings up the mobility of the ribcage and how to change that through exercise, it may be confusing.
Why do they care so much about these weird looking bones that make us think of a skeleton? Well, it houses our lungs, various blood vessels and nerves, and the magnificent diaphragm muscle, which lives at the base. THIS muscle is what they are actually after; THIS muscle is what directly affects the function of the pelvic floor. In order for the pelvic floor muscles to do their job well and keep you symptom-free, the diaphragm must be functioning optimally. The way in to the diaphragm is from the outside: the ribcage.
The diaphragm attaches all along the innermost aspect of the ribs, has a right and left tendon that attach down onto the lumbar spine, and forms a connective tissue sheath in the center up top, with a hole in the middle for the esophagus, and the lungs rest above. The ribs attach to the thoracic vertebrae of your spine and wrap around to the sternum in your chest, with the last few ribs on each side attaching to each other and floating in the thorax. Together, they are responsible for breathing.
Normal quiet breathing looks like this:
Inhale:
Change in pressure pulls air into the lungs
Diaphragm contracts down, flattening its shape and helping to pull air in
Ribs expand on all sides (360degrees) like bucket handles, belly and chest rise
Organs of abdomen get gently pushed down onto pelvic floor
Pelvic floor slightly relaxes
Exhale:
Change in pressure lets air leave lungs
Pelvic floor ascends back to resting position
Diaphragm ascends back to its normal resting dome-shape
Ribs come back down and in to resting positions
This is what normal, quiet breathing looks like, however it doesn’t always work this way. If you’re experiencing any pelvic floor-related symptoms, like stress or urgency incontinence, pelvic organ prolapse, diastasis recti, or back, hip or pelvic pain, then likely something in the breathing process isn’t doing what it should. This relationship between the diaphragm and pelvic floor via breathing is what the PTs are assessing and aiming to restore, so that these muscles can be happy and you can be symptom-free.
By looking at the ribcage and its mobility and control during breathing, they can see what may need a bit of encouragement in the right direction toward improved breathing. For instance, if the whole ribcage moves up and down vertically during breathing, then there is no 360 degree movement of the ribs in all directions, which means that the diaphragm is not acting as the primary respiratory muscle. The secondary muscles of respiration are working to breathe (aka neck muscles) which is indicative of a shallow breathing pattern. The diaphragm doesn’t get to experience its happy dome-shape upon exhale; it is stuck in a short, flattened, inhaled state. The pelvic floor does not like a shallow breathing pattern; it doesn’t have the chance to experience the wave of abdominal organs gently pushing down on it and then rising via the diaphragm. This is when symptoms like leaking and prolapse creep up. Your neck muscles and overall mood might not like this either!
How can this tight ribcage and stuck diaphragm be addressed? By breathing into those sticky spots via various positions, we can encourage the ribs to expand in the needed directions and allow the diaphragm to experience full exhales. This will restore its proper resting length, allowing it to be the primary respiratory muscle again, and help improve pelvic floor symptoms indirectly. Here are examples of two breathing exercises that address the stickiest of spots: the upper back and the sides of the ribs under the armpits.
Rockback breathing with ball [video]
Sidelying breathing [video]
Give these a try and see if it makes breathing or pelvic floor symptoms feel a little bit better!
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