‘Mula bandha should be ON for life!’ Said Derek Ireland my first teacher of Astanga Vinyasa yoga. I think most yoga practitioners would agree that to constantly engage mula bandha is extreme, yet many believe it’s a practice that’s ‘good for you.’
WHAT IS MULA BANDHA?
Confusion is common as to what exactly needs to happen in the application of mula bandha. Many yoga practitioners understand mula bandha to be a subtle, energetic practice that involves some muscular activity. In women this would be an internal lift towards the cervix, in men this would be a lift from the perineum. Often a general instruction is given in yoga classes ‘to lift the pelvic floor’ rather than any specific instruction or explanation.
Renowned Astanga Vinyasa teacher – Richard Freeman maintains that you don’t ‘do’ mula bandha because ‘that would require a rigid ego structure’. For him the constant interplay of prana and apana is the key to the Astanga system. He teaches that mula bandha arises through the bringing together of prana and apana. Freeman also teaches the importance of pelvic alignment and awareness, in order to facilitate the manifestation of mula bandha. Sarah Powers is known to have described mula bandha as the lightest lift – ‘as light as a tug on a spiders web’.
Historically, mula bandha was first learned as a practice on its own by experienced yogis, before the possibility of inclusion in asana. However mula bandha (and uddiyana bandha) is fundamental throughout the asana of Astanga Vinyasa Yoga. I don’t know whether the extensive use of mula bandha in asana was developed by Pattabhi Jois, or derives from the teaching of Krishnamacharya, or has earlier origins. Whichever is the case, these days the instruction to apply mula bandha is frequently given in many styles of asana practice, not just Astanga.
TEACHING MULA BANDHA
Yoga teachers may give clear explanation and instruction for the application of mula bandha but their students can easily begin on the wrong track, because differentiation in this area of the body is often difficult. A gross tensing of the whole pelvic floor may be applied, when a more refined, subtle action is required. Another difficulty is that yoga teachers can’t know what any of their students are actually doing. (Except perhaps Pattabhi Jois, who allegedly checked out his students’ perineums.)
The ‘lift the pelvic floor’ instruction – without any explanation – becomes a practice that’s more akin to kegels/pelvic floor exercises commandeered from the fitness industries, e.g. Pilates, than the practice of mula bandha. In this way, mula bandha gets mixed up with kegels.
KEGELS – PELVIC FLOOR EXERCISES
The aim of kegels/pelvic floor exercises is to strengthen weak pelvic floors. The exercises can be helpful when pelvic floor muscles are truly weak – for example if a woman has had a difficult delivery and the muscles have become over-stretched. But there seems to be a widespread belief that every woman should practise kegels/pelvic floor exercises. And recently men have been advised in the media that they’ll get lots of benefit from practising them too. Almost everyone seems to believe this – doctors, yoga teachers, fitness teachers, Pilates teachers, et al.
I’ve learned from Pelvic Floor Physiotherapists/Physical Therapists that people who have a guarding response/hypertonic pelvic floor, should not practise kegels/pelvic floor exercises, or even mula bandha. But as yoga teachers, we don’t know if any of our students have a pre-existing hypertonic pelvic floor. It isn’t something that’s likely to appear on a ‘Beginning Yoga Health Questionnaire’. Even if the question was posed, it would be pointless, because most people don’t know if their pelvic floor muscles are hypertonic or not. That is, until they develop a range of extremely unpleasant symptoms.
CHRONIC PELVIC PAIN SYNDROME
Once a hyper-tonic pelvic floor has led to unpleasant symptoms, the condition is known as Chronic Pelvic Pain Syndrome. The symptoms can involve pain in the perineum, bladder, vulva, penis, urethra, anus, sitting bones, coccyx, or the pelvic floor as a whole. Symptoms can also involve dysfunction such as urinary frequency, urinary urgency (resembling a urinary tract infection) incontinence, difficulty in urinating, sexual dysfunction. Irritable bowel syndrome may also be part of the picture.
People develop hyper-tonicity, i.e. short and tight muscles, in the pelvic floor for various possible reasons. An individual may have tensed their pelvic floor from childhood through stressful experiences. Or the stressful experiences could have happened at any time in a person’s life and tensing the pelvic floor is that individual’s way of responding to the stress. CPPS (Chronic Pelvic Pain Syndrome) is common in people who’ve been sexually abused. Tightening the pelvic floor may also arise through feelings of shame; an outward sign of this may be a ‘tucked under tail’. Shame could arise from the experience of sexual abuse, or may be simply because this area of the body deals with urination, defecation, menstruation, sexual intercourse, which are not functions that everyone is entirely comfortable with.
There’s often a trigger that sets off the pain and dysfunction – a hyper-tonic pelvic floor does not in itself necessarily mean there will be pain and/or dysfunction. These are some examples of triggers: a urinary tract infection, an extremely upsetting emotional event, extreme activation of abdominal muscles, very long cycle riding – especially when over rough terrain. It is likely to be a combination of factors that trigger the pain and dysfunction of CPPS.
When the muscles of the pelvic floor are contracted over a long period of time, less oxygen is available to the tissues – this can be a cause of pain. The contracted tissues can also impact on nerves within the pelvis, particularly the pudendal nerve. The effect of reduced oxygen on the pudendal nerve is that it can become swollen and irritated in its pathway from sacrum to perineum.
THE PUDENDAL NERVE
This is a description of the pathway of the pudendal nerve: it emerges from the sacral plexus S2 – S4, and initially runs close by the sciatic nerve, and anterior to the piriformis muscle, it leaves the pelvis via the sciatic foramen and then re-enters via the lesser sciatic foramen to travel alongside the ischial spine (between sitting bones and ‘pubic bone’), thence to innervate the perineum, external genitals, external urethral sphincter and anal sphincter. The pudendal nerve has motor, sensory and autonomic fibres.
On understanding this pathway and also the proximity of the pelvic floor muscles to all the other muscles of the pelvis, it isn’t surprising that sacro-iliac dysfunction and other ‘back pain’ problems, often present themselves as part of the CPPS picture. Physical therapists treating CPPS will always begin by treating the muscles/trigger points in the outer pelvis, along with the abdomen, spine and possibly the thighs, before attempting to treat the pelvic floor muscles and nerves.
REFERRED PAIN
The site of the pain therefore, may not be the where the problem arises. Pain is often referred from other structures and is likely to occur via the fascia. This may be from one part of the pelvis to another, for example: from the pelvic floor to the bladder, from the piriformis and gluteal muscles to the bladder. Referral points for pain may be even further removed from the site where the pain is actually experienced, for example: from the external obliques, or the rectus abdomini to the pelvic floor/bladder/anus.
Pain can be perpetuated i.e. become chronic – through central nervous system sensitisation, whereby a kind of loop or vicious circle of pain arises. In turn pain can cause dysfunction, for example bladder pain may cause a constant need to urinate. (day and night) Another reason that dysfunction arises is through the involvement of the autonomic nervous system in certain components of the pelvic floor – for example the pudendal nerve mentioned previously.
Some of the muscles of the pelvic floor are similar to the diaphragm in that, in a sense, they’re active all of the time, again through the involvement of the ANS. In addition they are a type of muscle that’s designed for ongoing low-level endurance. They should not be suddenly worked out as if they were biceps or quadriceps in weight lifting.
As yoga teachers/practitioners, it’s important to remember therefore that extreme activation of pelvic floor muscles and/or superficial abdominal muscles can trigger both pain and dysfunction in susceptible individuals. Once someone has developed CPPS the only really effective treatment is from a specialist pelvic pain physiotherapist (see practitioners mentioned below) Additional resources that can help sufferers on their road to recovery are meditation and breath awareness.
DIAPHRAGMS MOVING WITH THE BREATH
Most people know they have a thoracic diaphragm – the main breathing muscle. There are other muscles/groups of muscles/fascia that respond to the movement of the breath as diaphragms: the vocal diaphragm that’s situated between the trachea and the base of the tongue; the tough fascial tissue inside the skull that’s called the tentorium; the inner layer of pelvic floor muscles comprising the pelvic diaphragm and the outer layer of muscles comprising the uro-genital diaphragm; the ‘diaphragms’ in our feet and hands consisting of intrinsic muscles known as the lumbricals.
On an inhalation, the thoracic diaphragm will ideally release down and broaden, with all the other diaphragms responding sequentially, thus allowing breath movement all the way into the body’s end points. It is healthy for the pelvic diaphragm to descend on an inhalation just as the thoracic diaphragm does. Astanga teachers instructing the maintenance of mula bandha on the inhalation need to be aware that this is an unnatural practice, which could lead to CPPS in certain students. Those actually suffering from CPPS will be helped towards recovery by allowing relaxed breathing to happen, and through feeling breath sensation all the way into the pelvic floor.
CONCLUSION
Yoga teachers need to employ care in their instructions when teaching mula bandha, because the practice may be ‘good’ for some people but it definitely isn’t good for everyone.
If you’re feeling stressed and ‘uptight’ you may be one of those people – perhaps your pelvic floor muscles are not lengthening in healthy response to your breath. In this case, here’s a practice to enhance your yoga practice and help prevent CPPS: See if you can feel the breath into your ‘end-points’ all the way into your extremities. Think of your body as having six limbs – your head, your hands, your feet and your tail. Let the breath move readily into the diaphragms of each one of your limbs – especially your tail and pelvic diaphragm!
NEWS It’s Bladder awareness month – find out more about pelvic pain and treatment.
RESOURCES
Yoga video to help with Chronic Pelvic Pain
Pelvic pain practitioners
Bill Taylor at http://www.taylorphysiotherapy.com/
Stephanie Prendergast and Elizabeth Rummer at http://www.pelvicpainrehab.com/
Ruth Lovegrove-Jones at http://www.ruthjonesphysio.co.uk/
Maeve Whelan at http://pelvicphysiotherapy.com/
Books
– on CPPS
‘Chronic Pelvic Pain and Dysfunction’ edited by Leon Chaitow and Ruth Lovegrove-Jones
‘A Headache in the Pelvis’ by David Wise and Rodney Anderson
‘Teach us to sit still’ by Tim Parks
– on the sixth diaphragm – the lumbricals in the hands and feet
‘Exploring Body-Mind Centering’ edited by Gill Wright Miller, Pat Ethridge, Kate Tarlow‘
Websites
