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For many people, even the word “sphincter” causes their sphincters to contract.  And yet, sphincters in our bodies are so vital to our health.  Sphincters are circular ring-like muscles surrounding a bodily passage or opening.  They are normally constricted, but they relax in order to allow passage through the opening.  These muscles are all about either “letting go” or “allowing in”.  There are over 50 sphincter muscles in the human body, most of them involuntary.  The majority of them are found in our digestive tracts.  There is one at the upper portion of the stomach, to prevent acidic contents from moving up into the esophagus (“hopefully”), as well as at the lower end of the stomach, in between the small and large intestine, and to control secretions from the liver, pancreas and gallbladder into the duodenum.  We also have them in and around our eyes, to control the amount of light our eyes allow in, to blink and to keep our eyes closed during sleep.   Of course, there are the all-important sphincters in our urethras and ani to control the excretion of our waste materials.  We have two in each area, and one of each of these is (finally!) a voluntary sphincter.  If we have so few voluntary sphincters, meaning ones we can actually control, then why bother talking about them?

I will rewind to the 1970’s and to perhaps the most famous midwife in the United States, Ina May Gaskin, author of Spiritual Midwifery and Ina May’s Guide to Childbirth.  She dedicated her life to fighting for natural childbirth and for the right to birth at home.  She contributed much to the midwifery movement over the past 45 years, but she is not without controversy.  She has been credited with “The Gaskin Maneuver”, a method of resolving shoulder dystocia during childbirth, which she “borrowed” from a Guatemalan midwife, thereby appropriating indigenous ideas without proper attribution.  She has also received criticism for putting forth “The Sphincter Laws”, rules by which she claims the vagina, cervix and anus abide.  Her critics harp on these “Laws” because neither the vagina nor the cervix are technically structural sphincters, although she describes them as such.  She also discusses the sphincters of the mouth and throat, but recent evidence has shown that the round muscle surrounding the mouth which was previously believed to be a sphincter is probably four separate muscles.  Her anatomy piece can appear a little loosey goosey, in the eyes of her critics.  However, I don’t believe it’s necessary to throw the baby out with the bath water.  The fact remains that Gaskin attended over 1200 births as a midwife, and she helped thousands of other women indirectly.  She is a birth expert – and while her style may not resonate with everyone, the patterns she recognized in birth should not be ignored.  Perhaps a slight reframe is in order.  It is my belief that her work surrounding the pelvic sphincters (or functional “sphincters”) can still have a lot of value.  By these I mean the cervix (which is not a sphincter but functions as one during pregnancy and childbirth – explained here) and sphincter ani externus, the external voluntary muscle around the anal opening.  Understanding how they work can help us relax and open up, which many women have found invaluable during childbirth.  The good news is that you don’t have to be pregnant to keep reading, because these properties work for ease in bowel movements, too!  (I hope it’s obvious that while I am drawing a parallel between childbirth and bowel movements in that both involve passage through a functional pelvic sphincter, I am in no way comparing or equating the two.)

From my experience, the following three properties of Gaskin’s Sphincter Laws are the most helpful to keep in mind for ease in “letting go”.

• Relaxing the mouth miraculously seems to relax the “sphincters” at the other end.  Holding tension in the mouth and jaw makes it harder to allow the vagina to open.  In contrast, releasing tension in the mouth also releases tension in the pelvic floor, cervix and vagina during labor.  Below are some great ways to do this.  The same rules apply to the anal sphincter, so try doing any of these things during your next bowel movement to see if they make you more comfortable:
  • Laughter
  • Slow, deep breathing
  • Opening the mouth and making low, deep “sexy” sounds
  • Making “raspberries” or “horse lips”
• Pelvic “sphincters” do not respond well to commands.  If you have ever tried to command yourself to poop, you know this doesn’t really work.  By the same token, trying to will the cervix or vagina to open during labor doesn’t work either – they don’t respond to pressuring.  Instead, try using gentle coaxing through visualization.  Imagine the vagina to be big, soft and open.  Make this a mantra and repeat it out loud.  Another trick learned from Penny Simkin, author of my favorite birth companion book (The Birth Partner), is focusing on the 3 R’s: Rhythm, Relaxation and Ritual.  She writes about these in the context of pain coping, but these strategies work wonderfully to open the body’s southern sphincters, too – and not just during childbirth. (Most women I know have a morning ritual, which at least involves relaxation, to encourage them to get on what my boyfriend affectionately calls “the poop train”.)
• Pelvic “sphincters” perform best in an atmosphere of intimacy and privacy.  A quiet, calm environment with low lighting and the least number of people tends to work best.  Before you say “Duh, Julie”, think about the environment in most hospitals!  Bright lighting and lots of hospital staff coming in and out – this environment is not conducive to relaxing and opening.  It is well documented that cervical dilation can be going along great at home and stop or reverse the minute a laboring mom reaches a hospital.  I am not saying don’t labor in the hospital;  if that is where a mom feels the most safe, that is where she should be.  I am saying:  1.  Relax at home for as long as possible before going to the hospital, and 2.  Make the environment in the hospital as intimate and private as humanly possible.

I think of the pelvic floor sphincter muscles as the muscles of “letting go”.   Understanding these three properties can help us let go with greater ease, regardless of whether we are discussing something as magical and otherworldly as childbirth or as mundane as the morning elimination.

 

When most of us think about our rear ends, we automatically think of our gluteus maximus muscle.  This mighty muscle is large and extremely powerful, plus it is the most superficial and thus most visible muscle in that region of the posterior chain.  However, just because it steals the spotlight doesn’t mean this muscle acts alone.  The “glutes” consist of three muscles, each with a different yet important role to play in the activities of daily living.  In addition to gluteus maximus, this muscle group also contains gluteus medius and gluteus minimus.  In this post, I will highlight gluteus medius, because it is problematic for many of my clients (and for me, too!).

Anatomy:

Gluteus medius comprises the middle layer of the glute muscles.  It originates on the lateral posterior surface of the ilium, or hip bone, and attaches to the greater trochanter of the femur, or the bony protrusion at the outer top of the leg bone. (If you prefer a video, here is a video.)

 

Function:

Gluteus medius is a powerful abductor of the leg, meaning it is the muscle we use when raising our leg out to the side.  Since it has both anterior and posterior fibers, it is also responsible for both internal and external rotation at the hip.  However, this muscle’s most important role in the body is that of pelvic stabilizer.  It provides stability to the pelvis while standing on one leg, for example.  Considering that we stand on alternating legs every time we take a step to walk, it becomes clear how important this little muscle is!  During the gait cycle, each leg takes a turn holding up our entire body weight as the other leg leaves the ground and swings forward.

Pathology:

If gluteus medius is weak, when we lift and swing the opposite leg forward, we can not hold the pelvis up.  In that case, that opposite hip dips down rather than being maintained upright.

Normally in order to compensate for this weakness, we use our back muscles to shift the torso over the affected hip in order to create more stability through an altered center of gravity, which in time can lead to the dreaded low back pain.  (A recent study found that pregnant women with weak gluteus medius muscles were 6-8 times more likely to have back pain than their “non-weak” counterparts.)  This weight shift can also result in torsion forces in the knee, which can contribute to knee pain.  Other muscles, such as the tensor fasciae latae, which attaches to the iliotibial band, may compensate for the lack of hip stability, which can lead to painful inflammation of the IT band.

My mentor, Ed Buresh, underscores the importance of the gluteus medius by highlighting its relationship to the psoas, a muscle which has definitely reached celebrity status.  Just as the psoas provides stability to the spine, the gluteus medius provides stability to the hips.  The two must work together.  The psoas is often identified as a source of low back pain.  However, one of the things I learned from Ed early on is that if we ignore the role of the gluteus medius in that scenario, we are missing half of the equation.  In my experience, the psoas tends to be tight and the gluteus medius tends to be weak.

The best way to gently build up weak gluteus medius muscles is to start incorporating non-weight bearing exercises, like the clam shell (figure to the right),

and gradually move toward more advanced movements like pelvic lists.

 

 

Here is Katy Bowman explaining the pelvic list:

For some in between exercises, here is an excellent resource I found online:

gluteus medius strengthening

The gluteus medius is often overlooked, although it is commonly one of the weakest muscles in the hip and thus directly involved in various soft tissue dysfunctions.  Becoming aware of the health of this muscle is key to maintaining proper gait biomechanics.  In my clinical experience, most of us could benefit from incorporating some strengthening of the lateral hip into our weekly movement program.

RESOURCES:

Yoganatomy  (for my yoga people)

Physiotherapy Exercises (other good ideas from same resource in article)