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If you want to improve your voice, it’s imperative that you start with understanding the role of the pelvic floor. We rely on the pelvic floor for so many things, most of which we probably take for granted.

A healthy pelvic floor helps to hold your internal organs, aids with your bowel and bladder function, is necessary for sexual health, and even supports a strong and healthy voice. With everything this area does for us, how do we take care of it?

In this episode, we’ll dive into the second part of the NAP meditation. This is all about the diaphragm and ribs. Are you breathing optimally?

You’ll learn what your ribs should be doing ideally when you breathe in order to maximize your capacity for whole body health. 

Watch the episode below on YouTube OR listen wherever you get your podcasts.

Watch on YouTube

Resources

1. Season 3 – Episode 1: Are You Pushing Your Voice Too Hard?
2. Umbrella Breath YouTube Video
3. https://garnerpelvichealth.com/the-voice-to-pelvic-floor-connection/
4. Ready for More Voice to Pelvic Floor Connection?  Join the Waitlist for our Upcoming YouTube Membership.

Transcript

Dr. Ginger Garner PT, DPT (00:02)

0:02 – Do you want to be heard?

Hello everyone and welcome back to the Living Well podcast. I’m your host, Dr. Ginger Garner. This is episode two of season three and the question here is, do you want to be heard? Why starting at the pelvic floor is key. 

If you haven’t listened to episode one yet, don’t worry, you can go back and listen to that later or you can stop and go listen to it now. It’s not very long. But if you haven’t, you can definitely listen to it out of order.

In fact, I often start out with the A of nap before the N. You may be asking, what is the nap? Well, in part one, or the first episode, I explained that the N stands for neutral larynx, and the A stands for apposition, and the P stands for pitch. But what does it mean? Well, the NAP meditation is a way to manage your stress response while optimizing your voice to pelvic floor connection.

Your voice to pelvic floor connection is very important because it is in control of pretty much all body functions. From the way you manage stress to the way that your gut either digests food or doesn’t. It’s in charge of sexual function, the ability to create sound, to breathe properly, and that pretty much, and even birth. So that pretty much covers everything from cradle to grave in terms of…our daily body functioning. 

And you know, most of us depend on our voice for our livelihood, to be able to work our careers, to connect with our partners, to be curious and learn. And it’s also a survival mechanism too, because if we can’t voice properly, we might even actually have swallow issues and breathing issues. 

So it can be a really good red flag and a really good vital sign to pay attention to. In fact, I believe that the voice should be a vital sign along with checking blood pressure, respiratory rate and heart rate, for example. 

2:09 – The Role of the Pelvic Floor in Body Functions

So here we go. If you want to be heard, you’ve got to start at the pelvic floor. But let’s talk about a healthy pelvic floor first. What should it be capable of? Well, we need to get things out, right? If you consider that we’re just a tube open at the top, open at the bottom, that’s the basis of the voice to pelvic floor connection.

Things have to come in, things need to go out. And one of the things that people first notice, especially in women’s health, but also all genders really, is that if they have a problem with the pelvic floor, all of a sudden, peeing and pooping are not quite coming out okay. So the pelvic floor is in charge of pee and poop control. 

It also lets things in, right? A pessary, a tampon, fingers for an examination. And then you have other things. Like in pelvic health, we have dilators, therawands, vibrators. And then in sexual health, we have the same things plus anatomy, right? Things like the penis.

3:17 Maintaining Control with the Pelvic Floor

So you get my point, right? Things go in, things come out, the pelvic floor does control it. So also after things have gone in, stuff usually does come out, okay? Like after nine months, a baby comes out, right? When you eat, you have to pee or poop. That comes out too. 

The point is, you’ve got to be able to control those things. Controlling pee and poop when you need to. When you sneeze, right? You don’t want to be peeing on yourself, or worse, pooping on yourself. So you’ve got to have control of the pelvic floor, right? Plus, the pelvic floor also kind of holds the organs in the right place.

So sometimes, pessaries, which is just a little silicone ring, sometimes they’re cubes, sometimes they’re little knob shapes that are small and easy to put in and take out, and they have to be used when the pelvic floor just isn’t capable, or maybe someone has hypermobility in tissue. Now we call them tissue issues of hypermobility, and the pelvic floor is just not up to it.

So the point is the pelvic floor does control a lot. It also is known to contribute to hip pain, back pain, tailbone pain, sacroiliac joint pain. I mean, with all that to do, it’s pretty critical. 

4:36 From Pelvic Floor to the Respiratory Diaphragm

So guess what the next diaphragm up is from the pelvic floor that connects to it? The respiratory diaphragm. And so when we talk about the A part of the nap meditation, which is a way to manage your stress and manage your pelvic floor, and your voice and your core. 

Our first stop, or really our second, since we’ve already done one stop in episode one, is good breathing. Good breathing. What does good breathing look like? Well, first of all, you got to start out with pretty good anatomy and anatomy shape. And so the A stands for apposition, the angle of the diaphragm. So if you put your fingertips together and you make a nice dome where instead of your hands coming together like a prayer,

Right? Like you’re praying, open up the hands, but keep your fingertips together. And as the wrists move away from each other, if they move too far away, right, then you end up with flat hands and the fingertips just touching. But if you will dome up your palms, that’s the shape the diaphragm should be. So when I look at that with ultrasound imaging in the clinic, that’s the shape I want to see. I want to see a nice tall apposition.

Most of the people that come in though, they already have existing voice to pelvic floor problems and they don’t have that. So how do you tell if your diaphragm is domed? Well, if you can’t whip out an ultrasound like I can and image it, then you want to measure this particular thing. And it’s called lateral costal flare. Now, there are other names for that. We don’t have to use this fancy name.

And we don’t have to get all nerdy with anatomy and physiology. So instead of calling it a lateral costal flare, which we can imagine it like this. Imagine if you pick up a bucket by a handle. Do you see how the bucket handle kind of goes out and then up, right? That’s what we want to do. Also think of it as an umbrella, all right? So your rib cage is an umbrella opening. You can think of your ribs…

Angling up like a bucket handle and you’re all your rib cage opening like an umbrella all the way around.

6:51 Practicing apposition with your breathing

Okay, so I hope that makes sense with what we’re talking about. Once you get that imagery in your head, I want you to start breathing like that. If you were my patient, then I would say, okay, let’s start practicing that. You can put your hands on your rib cage. 

So if I actually angle my camera down a little bit here and sit up, you can actually see my ribcage. Can’t see my eyes anymore, but you can definitely see my ribcage. What I’m looking for in the clinic is when I take an inhale, do you see how my ribs go out to the side? And if you’re just listening and not watching, I want you to feel it. Put your hands on your ribcage like a C shape, thumbs in the back, fingers in the front, take an inhale.

I want to see about three to five centimeters of expansion. What I don’t want to see is an anterior flare. What the heck does that mean? It just means I don’t want to see the ribs really flaring forward. I don’t want to see the chest rising and the neck muscles standing out. 

I only want to see bucket handle breathing. I only want to see that umbrella breath, right? That is easier said than done. That means, in a nutshell, what I’m describing is you want flow, not flare. 

So as I wind down this little chat with you on apposition of the diaphragm. This may be a new term for you, and the other easier terms to remember, which is bucket handle breathing or umbrella breathing, I want you to think, well, really, we’ll stop thinking, let’s feel. Hands on the rib cage, get rid of your exhale wherever you are.

If you’re taking a run or a walk, you can put your hands around your ribcage and still walk and still run, and you’re going to inhale, two, three, four, maybe five, maybe six, and exhale, two, three, four, five, six. Inhale, two, three, four, five, six.

And exhale, I’m breathing with you as I do this. Four, five, six, one more, inhale. No tension through the neck, no chest rising. Only umbrella breathing, only bucket handle breathing, and then let it go.

09:28 Master your breath to change your life

If you really want to start changing your stress response, if you really want to start changing your pain perception, if you really want to start changing your mindset, and you really want to improve the voice to pelvic floor connection, then that’s where we start. With very good apposition, and day by day, it will get better and better and better until you are a master breather.