Physical Therapist Review
As a Physical Therapist with a specialty in Pelvic Health, I find that the most common thing that women do to try to stabilize after pregnancy and childbirth is to use the strong muscles at the back of the pelvic floor and buttock (hip) to grip and hold the pelvis together, also known as “buttock gripping”. This strategy compresses the inferior aspect of the pelvic girdle, causing tightening of the hip and forward gliding of the femoral head in the socket resulting in groin, hip and lower back pain. Weakness of the gluteal muscles and overactivation of the hamstring, adductors and superficial hip flexor muscles occurs, as well as decreased automatic function of the deep core muscles to help stabilize the spine during daily movements. Other than pregnancy and childbirth, this automatic function of our deep core muscles can also be disturbed due to injury, surgery, emotional stress, chronic cough etc.
I find that it is really important to teach my patients how to move with better postural alignment and to teach them how to improve the automatic intuitive function of the deep core muscles as well as to help them improve awareness of optimal hip control without rigidity in the spine, hip, knee and ankle joints. By focusing on buttock strengthening without overactivation of the hamstrings, the goal is then to reduce “buttock gripping” and to change the non-optimal posterior pelvic tilt (with the tailbone tucked under ) to a more optimal anterior pelvic tilt with the ischial tuberosities (sitting bones) remaining “wide”. This then allows the femoral head to remain centered in the acetabulum (hip socket) so that all the proximal hip muscles can work in a more balanced and harmonious manner, preventing too much spine and hip joint compression and instead, allowing for improved stability without rigidity throughout the body during normal daily activities.
I was very excited to try the “honking class” when I heard about it. While performing the biking while standing up, I realized that it really does keep the pelvis open, preventing the posterior pelvic tilt (which results in buttock and hip gripping). As the hips remain more centered in the socket with a more optimal axis of motion, there is less compression in the lower back and hips, allowing the body to move more freely. With better control of the proximal hip muscles while “honking”, one can progressively work on increasing proximal hip strength and challenge the body further by increasing hip, knee and ankle motion with increased speed and resistance without adding any further compression to the back, hip or knee joints, not to mention improving cardiovascular fitness! This is great for rehabilitative purposes, not only for the pelvic girdle but for the whole body! I also found that I was able to recruit the posterior gluteal muscles more effectively if my weight was centered approximately at region of the ankle joint (not too far forward towards the ball of the foot and not too far backwards towards the heel), which also then helped to reduce the compression in the knees which sometimes occurs with activities which are too “quadricep or hamstring dominant”. I liked that there were two positions in standing to vary the hip range of motion and I also liked that there were various hand support positions which allowed for subtle thoracopelvic dissociation to improve the stability of the torso without rigidity in the thoracolumbar region of the spine. The class format was well thought out with intermittent breaks from the “honking” to perform planks, proximal hip strengthening on mats, upper body strengthening using the TRX bands as well as foam rolling to release any myofascial restrictions. I felt invigorated with a lightness to my step afterwards, a very positive experience overall! What a fun way to exercise, knowing that you are stabilizing and strengthening your body in a way that releases the hip joints and decreases or resolves lower back and hip pain at the same time!