Butt Wink, Hip Openers and the Pelvic Floor

Butt wink is the awesomely named tucking under of the bum at the bottom of a squat (loaded and unloaded). Some great blogs on the subject include a great review of the anatomical/structural contributions to the issue by Ann Wendel for Girl Gone Strong and  Dean Somerset had a great review and ways to delineate the potential sources in order to know how best to treat or correct.

I am a fan of sorting out if something is a motor program first, before assuming structure or restriction in tissues as the primary contributing factors. To that end, I wanted to add one more thought to the conversation, the possible role of the pelvic floor for some butt winkers.

The Butt Wink in all its glory. (Photo source here: http://bit.ly/1bZdujt)

 

First, let’s talk anatomy and why you should care about the status of the pelvic floor when looking at Butt Wink:

  1.  The pelvic floor is one of the primary stabilizers of the joints of the pelvic ring . In addition, it has relationships with the Diaphragm  and the TA  that collectively contribute to trunk and pelvic stability. Take away: If local or global trunk and pelvic stability is a piece of the motor control puzzle and butt wink is the compensation, then understanding how your client is or is not recruiting the pelvic floor may be important to add to your thinking.
  2. The pelvic floor interacts with the obturator internus (one of the deep hip rotators) through the arcuate tendon and can contribute to and influence local control of the hip. Chris Powers, PT describes the role of the deep hip rotators as similar to that of the rotator cuff of the shoulder, they act as stabilizers of the hip while larger more superficial muscles move the joint. So the interaction between the pelvic floor and its teammates (see #1) can have a role in anchoring the deep hip rotators, setting up the action of the larger hip muscles engaged in the squat.
  3. If you are familiar with and look for Anterior Femoral Glide in a straight leg raise (ala Shirley Sahrmann), try this. Test the SLR, and then retest on exhale with an engagement of the pelvic floor. I find that with those relationships (#2) in place before movement, the femoral head spins in the socket rather than translating anteriorly. Try it!

Take aways:

  1. The role of the pelvic floor to help create an anchor for the deep stabilizers of the hip is important for optimizing the power of the large hip musculature to both control descent and to create power for ascent in a squat.
  2. Women may either unknowingly over-recruit their pelvic floors for stability alongside heavy abdominal recruitment, or actively over-recruit to prevent leaks while lifting. Either way they may using the pelvic floor in a shortened way or actively shortening at the deepest and most challenging part of the lift which could contribute to the butt winking under.
  3. Chronic overuse of the pelvic floor in a shortened position, subconsciously or consciously, may not allow the pelvic-hip relationship to open fully at the bottom of the squat. (side note: this might also be happening to your yogi patients who complain of tight hips when they try hip openers at class. Or your runners with chronically tight hips post run)
  4. Lots of folks wink their butts under well before the bottom of a squat. This is a motor control or muscle recruitment patterning issue that the pelvic floor could play a role in.

So how does a sports med pro screen to understand if the pelvic floor is contributing to the problem?

First, ask. Some conversation starter suggestions: ‘Are you aware of your pelvic floor while you are doing the squat?’ ‘Do you know what the pelvic floor does and why it is important to your squat (see above if you need answers)?’ A great phrase I learned from my friend, Shelley Mannell, is “I’m/We’re on a new learning curve about…..” in this case about the role of the PF in trunk, pelvic, and hip stability. Briefly educate them and see what they are or can become aware of. This may open a conversation with them about leaking while exercising, and their attempts to stop it with over-recruitment, such as “Yep, I do a kegel all the way thru the squat to try not to leak.” Heads-up for you and them, this strategy likely doesn’t work (see here), they leak any way and they restrict pelvic and hip motion in the process.

A study by Smith et al demonstrated that women that were severely incontinent demonstrated the greatest pelvic floor recruitment in a postural challenge, but they also had the greatest recruitment of external obliques. The continent women had the least recruitment of both. The author’s conclusion was to consider the interrelationship between muscles vs isolated engagement of the pelvic floor as a solution for incontience. The continent women in the study were demonstrating a balanced, efficient, coordinated system. They actually had to work less to pull off continence during a challenge. That is the goal for your client as well, to achieve balance and efficiency again in their continence control system (hint, hint it is the same system for their central stability, see #1). Squeezing one part of the system does not create a balance.

Second, observe. Does you client/patient have a butt wink in their daily life? Are glutes a part of their other movement patterns? If they have no arse at all or often they will have flattened upper bum and junk in the trunk below, they are not utilizing that pelvic-local hip stabilizer-large hip mover relationship well in their day to day. Why would you or they expect it to show up at the bottom of a squat?! Ask your client in upright standing to tense their core and prep for movement or a lift and watch their strategy. Does their butt wink under just as a prep? You have to tune them into their pattern for stability in an unchallenged situation, so they understand how to use their body differently when it is under the gun.

Next, try an alternative approach. Teach them to let go/open/lengthen their pelvic floor and inhale on the way down (unloaded first as you train the motor program, and then gradually controlled as you add submax loads; strategy will change with higher percentage loads and may include breath holding). A great cue is ask them to let their tailbone lift as they inhale on the descent. This will promote a more optimized position of the pelvis (neutral range) for loading and support on the way down, all the way down. A neutral pelvic position also optimizes the availability of the pelvic floor to participate with the rest of the system and they may find it is easier to control leaks. This is also a great cue for your yogis, allowing the pelvic floor to open and tailbone lift during poses will help to keep the hips open as well. An added bonus will be that they don’t feel “tight” in the hips during or after a set or a pose. 

Free up the hips of your butt winkers, runners and yogis. A few simple cues and interventions can rule out or in the pelvic floor as a part of a faulty motor plan. 

Want to learn more about treating or training Female Athletes? Check out online courses here.

 

  1. Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing – a dynamic MRI investigation in healthy females. Int Urogynecol J. 2011;22(1):61–68.
  2. Powers C, Sahrmann S. The Functions and Dysfunctions of the Hip. California Physical Therapy Association Conference. Los Angeles, California; 2012.
  3. Smith MD, Coppieters MW , Hodges PW . Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourol Urodyn. 2007;26(3):377-85.

 

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11 thoughts on “Butt Wink, Hip Openers and the Pelvic Floor”

  1. susan pollack says:

    Excellent article! Love the tail bone lift cue! Thanks for your guidance and insight! ( Wink wink)

    1. Julie Wiebe says:

      Thanks Susan! Appreciate the feedback. Julie

  2. Tianna says:

    Thanks Julie, came to your session at the CPTA conference last weekend. Loved all the information to add to the pelvic floor piece. From more recent education, I’m realizing it’s implicated in more than I had thought. And now definitely more aware of it in my yoga students.

    1. Julie Wiebe says:

      Thanks Tianna! I appreciate the feedback. THe pelvic floor is involved in so much, we are all just learning its potential! Thanks for weighing in!

      Take care- Julie

  3. Leyla says:

    This is so amazing but hard to understand for a lay person so I would like to ask if you know of any PTs that do this type of therapy in NYC? I did see a PT about two months postpartum but she wasn’t this detailed and ended up recommending a lot of levels which made everything worse…

    Appreciate any leads! My pelvic floor is in trouble and now I finally know why the top of my butt has flattened and I’d love to get it back in shape.

  4. Leyla says:

    *Kegels not levels

    1. Julie Wiebe says:

      Hi Leyla,

      Sorry to hear you have had trouble finding help. I will try to find you a systems thinker in NYC (I haven’t had anyone in NYC take my live professional course). In the meantime, I do have a DVD (also available as an online course if you prefer) that helps to pull the elements of the system together (pelvic floor with the diaphragm and TA) to re-organize your center and re-establish your foundation for movement and fitness. It is geared for lay folk, and it is where I would love all post-partum women to start before they return to fitness. Then to integrate those ideas into their choice of fitness. That is what the blog is striving to do…incorporate these ideas in a functional and higher level fitness activity.

      Take care and I will see what I can find- Julie

      PS What I am suggesting is very different than isolation activity like kegels. I hope the blog spoke to that! You can check out the online course/DVD for women on my website http://www.juliewiebept.com/products/

  5. Leyla says:

    Julie,

    Thank you so much for your quick reply! A DVD would more realistically fit into my life since I stay at home with my one year old. It’s great how you connect all the dots instead of just focusing on one little muscle. I hope more PTs take your courses!

    Off to order and thanks so much!

    1. Julie Wiebe says:

      Thanks Leyla! Enjoy and I look forward to your feedback! Julie

  6. Allison Oswald says:

    Julie,
    Great post! The more I learn, the less I teach anything in isolation to my patients. With the influence of Clare Frank in the last couple of years I have changed my entire approach, focusing on the alignment of the entire system and coordinated/efficient movement patterns. My patients with pelvic floor dysfunction have responded so well…and all of my postnatal patients are better prepared to return back to fitness and the physical strains of being a mother. Thanks again, I love reading your blog!

    1. Julie Wiebe says:

      Amen! Gary Gray was one of my early influences to think functional and whole system. Our “pelvic floor” patients are, in many cases, expressing the dysfunction in the whole system in their nether regions. It is just where they are manifesting the issues. We must approach them with the whole system in mind.

      I appreciate you weighing in. Take care- Julie

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