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Core Reconstruction: Martha’s Story

One day after class Martha, an active 72-year-old student of mine who had been coming to classes for a number of years, confided in me that she was experiencing pain and bloating in her lower abs. Her doctor had ordered tests. Eating was difficult; there was no room in her belly for food. Something was growing in her abdomen, taking over her body, pressing on her bladder and leaching calcium from her bones. Test results showed that Martha had clear cell, stage two ovarian cancer, a particularly rare, aggressive cancer.

Martha was one of the stronger students I’d had the pleasure to work with. For 21 years she held down a very physical job working on diesel engines for the Canadian National Railway. Once she shared with me how her previous job involved ‘tearing down locomotives right to the nuts and bolts’, and then rebuilding them to ‘almost like new status.’ After she retired, she enjoyed lawn bowling, long walks, Pilates, and particularly loved doing weight training. She kept 12-and-15- pound weights at home and used them often. She loved the way her body felt after lifting: the pleasurable release that rushed down her arms when a set was finished. It reminded her of when she was ‘strong like a bull’ with very little fat. In Pilates classes we do not usually use very heavy weights, as we often work in conjunction with the instability of the ball, but I kept a couple of large weights in the back of the studio closet for clients such as Martha who liked to use them.

Surgery was scheduled for the end of the week. Martha told me that she would be withdrawing from her Pilates classes, for how long she didn’t know. She would be starting chemotherapy immediately. Chemo would last for 18 weeks. She would have a month off and then five weeks of radiation. I was stunned. I had many questions but said nothing. Her last words to me were, ‘Don’t google clear cell ovarian cancer. It will frighten the wits out of you.’

From time to time Martha emailed me during her treatment phase. Chemo brought on intense fatigue, while radiation gave her ringing in the ears and painfully tingling feet. She did no upper body exercises. ‘My weights are tucked under my bed, untouched’, she wrote. She valiantly tried to keep up her walking; even after chemo treatments she tried to walk, but often had to take a taxi to get home.

After her treatments were finished, Martha was still too weak to come to class. She emailed me that abdominal exercises were the only thing she had the energy to do. She had no strength to do weight training, not even light weights. She began with ab exercises because she suffered with sciatica for years and wanted to keep it managed. Also, she could rest on the mat between reps.

I didn’t want her doing too much too quickly, so I suggested she start with the variations where she worked her abs but did not lift her head up off the mat. These excellent exercises will be featured in next week’s blog. I also reminded Martha not to forget about the pelvic floor. The pelvic floor is the sling of muscles and ligaments that extends from the tailbone and ‘sitz’ bones underneath the pelvis to the pubic bone in front (pelvicfloorfirst.org.au). Why are these muscles important? Not only for bladder and bowel health, but because the pelvic floor forms part of your core as it neurologically connects through the nervous system to the deep abdominals.

Good Pelvic Floor Health

Why is retraining weak pelvic floor muscles as important to men as well as women?  Because of how this hammock of muscles connects through the nervous system to the deep abdominal muscles. An ideal situation is when pelvic floor and core muscles work together. If the pelvic floor is weak this connection may not happen, leaving the low back vulnerable to pain and injury.

A strong pelvic floor also helps with stress incontinence, one of the many embarrassments associated with getting older. This condition occurs when pressure within the abdomen causes urine to leak out involuntarily during coughing, laughing or exertion. Pelvic floor training can further help with urge incontinence, a frequent urgent need to urinate that can impact negatively on older adults’ lives.  Pregnancy and vaginal delivery can also result in poor pelvic-floor control.

Sometimes there is the potential to overwork the pelvic floor. This has happened to some yoga and Pilates teachers who I know. The muscles down there are too tight. Then exercises are necessary to relax the overworked muscles (www.pelvicfloorfirst.org.au). Today, in the audio file that follows, we are focusing on the opposite: strengthening the pelvic floor.

After my last message, Martha emailed me back: ‘Pelvic floor—yes,’ she wrote. ‘I don’t know if I could do pelvic floor and the seat belt separately. For me, it’s part of the same move.’

When Martha wrote ‘seat belt’, I knew she meant the deepest abdominals: transversus abdominis. These are the deep muscles that roughly run horizontally across the so-called bikini line. With my students I often use the cue ‘tighten the abdominal seatbelt from hip bone to hip bone,’ to get my student to gently draw in and tighten the abdominal wall. I felt touched that Martha remembered this cue. And that she recalled that tightening the pelvic floor (often referred to as ‘drawing up the pelvic floor’) can help women, as well as men, find the deep abdominal connection.

Colleen Craig

Colleen Craig

Colleen is the author of Pilates on the Ball, Abs on the Ball, and Strength Training on the Ball, and the producer of the Pilates on the Ball DVD.

Disclaimer: I highly recommend you watch the video two or three times before attempting an exercise.  Listen carefully for watchpoints. Check with your doctor or health care practitioner to be sure these exercises are suitable for you. Pay attention to modifications and stop if there is any discomfort. If in doubt, avoid an exercise.

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