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A workout to overcome incontinence ó and look good too

January 11, 2016


Forceps helped bring Cristin Taylorís first child into the world, a joy that outweighed the pain of the fourth-degree tear Taylor suffered in her perineum during the birth. The wounds closed, but Taylor still struggled with urinary incontinence. Sheíd leak when she ran, coughed or brushed her teeth.

A decadelong battle with her bladder raged through Kegel exercises, the birth of another daughter and physical therapy (not with a pelvic floor specialist). Taylor resorted to surgery to insert mesh support, in hopes of correcting what had been diagnosed as a tilt in her bladder neck. After six weeks of recovery, the incontinence continued ó now accompanied by numbness that dulled her sex life. "It was like a foot that had fallen asleep."

In 2011 Taylor and a friend tried a new fitness class at a gym near her home in Satellite Beach, Fla. Called Fluidity, the class uses an adjustable-height barre to strengthen all muscle groups but particularly the lowest and innermost structures of the core, what Fluidity founder Michelle Austin calls "the inner unit."

"Michelle talked a lot about the pelvic floor and alignment awareness," Taylor said. "They had three classes a week, and I came every time I could. Within six months, I was noticing huge changes in my life, including a wonderful, more connected sex life with my husband."

Women like Taylor were the original target for Austinís Fluidity regimen, which has been taught at gyms and rehabilitation centers around the country for over a decade. But in the last year Fluidity has been noticed and recommended by Microgate USA, a company that specializes in movement analytics to help everyone from professional athletes to the elderly and Parkinsonís patients.

Anyone can benefit from the regimen, Austin said, which revolves around a barre with a backboard that rises from the floor. The ability to adjust the Fluidity barre to hip height is key, Austin said, because it reduces the tendency to perform exercises in a posterior tilt, which compromises alignment and effectiveness of some barre workouts.

Fluidityís goal: to correct pelvic instability that can contribute to chronic complaints such as incontinence, back pain, sexual dysfunction and loss of balance as we age.

The concept emerged from Austinís resolve to rehabilitate herself after cancer and a full hysterectomy at age 42, combined with her training in the Lotte Berk barre method, which Austin taught in the 1990s in New York City.

"In hysterectomies, theyíre taking out an organ, if not several, and thereís no rehab," Austin said. "Itís ridiculous."

Fluidity classes now are held at rehabilitation centers and gyms around the country. An at-home counterpart includes a collapsible barre, DVDs, mat, ball and bands.

The pelvic-floor muscles often become dysfunctional after childbirth, gynecological surgery, illness such as urinary tract infections, or just from disuse, says Cindy Neville, a physical therapist specializing in womenís health who is on clinical faculty at the University of Northern Florida.

That dysfunction can contribute to pelvic organ prolapse, where the vaginal walls or cervix drop, as well as incontinence, estimated to affect 30 to 40 percent of middle-aged women and 30 to 50 percent of elderly women.

Many women suffer in silence. If they seek treatment, doctors sometimes recommend a surgery like Taylorís. Of the 400,000 pelvic floor surgeries annually in the U.S., 120,000 of those are repeats, Neville said, suggesting that surgery isnít solving the problem.

"But people are afraid to talk about the pelvic floor muscles; itís like breast cancer 20 years ago; to say the word breast was almost pornographic in our culture," she said.

Neville recommends Fluidity to some of her patients.

"In Fluidity thereís not an emphasis on bending forward or rounding forward, itís more balanced with the front and back of the body, versus always being the front of the body, which so many things focus on," Neville said. "The neutral pelvis and engaging the deep core, including the pelvic floor, are very effective."

Peter Gorman, the president of Microgate USA who holds several patents on heart rate monitors, met Austin at a deli counter in Florida over Thanksgiving in 2014.

"I didnít know what Fluidity was, but she and I were speaking the same language," he said. "As you lose integrity in your core, especially your inner core, things happen; you can get physiological changes from anatomical deficiency."

He was curious enough about her method to observe her Fluidity class, where Austin guided participants into what she calls the "neutral pelvis" position: Wrap thumb and index finger around the right hip and around the left hip and tilt the pelvis all the way forward and all the way back. When you find the position where the wrist feels relaxed between those two places, thatís neutral pelvis.

In that position, the muscles can contract and relax more effectively to not just tone the body but re-establish the stability of the inner core and pelvic floor.

Gorman thinks the Fluidity regimen has applications beyond fixing incontinence, which he views as an early warning sign for problems that become life-threatening as we age.

"As we march through life, we lose our balance control," Gorman said. "The average 53-year-old should be able to stand on one leg with eyes closed for 15 seconds. If she canít, sheís at a higher risk (of deadly falls). So, what if we put her in a program where besides just feeling good and losing some pounds ó hey, letís all go to Ipanema together! ó but also, her balance, timing and coordination improved? By doing that sheís basically learned to grow younger."

A year after starting Fluidity, Taylor visited a cranial sacral therapist who evaluated her muscle control.

"She reported I have 360 degrees of strength in my pelvic floor, which to her was phenomenal, regardless of what I recovered from," Taylor said.

Fluidity isnít a cheap or instant cure, she noted. When she is busy and goes on hiatus from her Fluidity workouts, she notices her bladder control starts to lapse. Itís one reason she invested in the barre system for her home.

"I feel like I have this tool," Taylor said, "and I can always heal myself."

 

 



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