I had a horrible case of bronchitis back in January that lasted a few weeks, and I coughed and coughed and coughed.  At times, my bronchi (breathing tubes) filled up with so much phlegm that I couldn't breathe, and I had to cough HARD in order to clear them out.  I think most of us have probably experienced this type of thing before, and it wasn't pleasant.  However, I decided to use the situation to do a little experiment in order to find out:  Do I practice what I preach to my pelvic floor patients, and does it work?

An important part of pelvic PT is improving the coordination between the diaphragm (your main breathing muscle, located across the bottom of the entire rib cage), the pelvic floor muscles, and the abdominal wall muscles.  In a standing position, as you inhale, your diaphragm moves downward, your pelvic floor muscles relax and drop downward, and your abdominal wall muscles relax and move outward.  As you exhale, the opposite occurs:  your diaphragm moves upward, your pelvic floor moves upward, and your abdominal wall moves inward.  During a relaxed exhale, you don't need any extra effort from the pelvic floor or abdominal muscles.  However, during a strong exhale against resistance, such as during coughing, your pelvic floor and abdominal muscles should actively contract in order to improve the strength and effectiveness of the cough, and also to prevent the force of the cough from moving downward toward the pelvic floor (which can contribute to incontinence, prolapse, and pelvic pain).

Using these muscles correctly involves good spinal posture.  Imagine you are standing with your back against a wall.  If you flatten your low back against the wall, your pelvic floor and abdominal muscles get shorter, and if you arch your low back away from the wall, those muscles get longer.  About halfway in between these two extremes is the optimal position for your muscles to work (in PT-speak, this is called the optimal "length-tension relationship").  However, as I learned, keeping your spine in an optimal posture during coughing fits is MUCH harder than it sounds.  Your body's instinctive motion during a cough is to bend forward with a forceful contraction of one of the abdominal muscles (the rectus abdominis, which runs vertically from your sternum to your pubic bone), and your body tends to stay in that bent-forward position until the repeated coughing is over.  So my experiment, more specifically, was:  Can I override my body's instinctive motion of bending forward, and instead keep optimal spinal posture (and thus optimal muscle function) while coughing?

I'll be honest - some of my coughing episodes were so bad that all I could do was suffer through them, because being able to breathe at all was more important to me than trying to use good muscle function!  But, I tried to contract my pelvic floor and abdominal muscles correctly as much as I possible, and whenever I could, I also actively arched my low back to counteract the instinctive motion of bending forward and flattening my low back.  One (expected) result of my experiment was that contracting my pelvic floor and abdominal muscles really did prevent the force of the coughs from moving downward toward my pelvic floor.  Another (expected) result was that keeping my low back in optimal posture while I contracted those muscles protected my pelvic floor even more.  However, the most surprising result was that keeping my low back in optimal posture actually increased the effectiveness of my cough - instead of having to cough 5-8 times in a row in order to clear my bronchi, I could clear them with 1-2 coughs.  Wow!!  The difference was very surprising to me.  It was also surprising to me how hard it was to override the body's instinctive coughing posture (i.e. bending forward), but with practice, I got better at doing it.

So the answer to my experiment was:  With concentrated effort, yes, I can practice what I preach to my pelvic floor patients, and yes, it works!  I hope that you will try keeping an optimal spinal posture the next time (and every time) that you cough, sneeze, laugh, etc.  And, if you need to improve your pelvic floor coordination, contact one of the pelvic PTs at CTS - we'd be happy to help.