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Hypopressives? I’ve Got Questions.

March 11th 2013

After the fourth Hypopressives related email, tweet and direct message came my way in one day last week, I decided it was time for a blog! I have been asked about Hypopressives both privately and through social media outlets, but unfortunately, since most of the information is in Spanish, I have had very limited success trying to get a good understanding of the exact methodology. The English website http://hypopresives.com/) helped a little, however it is very poorly translated to the point that some of the explanations were unclear from a medical, musculoskeletal or neuromuscular framework. Despite my own difficulties understanding the material, and I assume I am not alone in my monolinguistic capacity, I have been alarmed at the promotion of the technique through the blogs and social media of primarily pre and post-natal trainers as the next big thing for pelvic dysfunction, specifically for pelvic organ prolapse. Some of these blogs and posts have mashed up and incorrectly used terminology and concepts. Perhaps this is revealing their own attempts to decipher the language barrier? However, what concerns me is that the target audience of these blogs is lay folk, primarily desperate women who will do anything to bring a resolution to pelvic health issues. Until we understand this better, I think we must proceed with caution, particularly before we laud it to the general public.

Here is a video of Hypopressives at work. From what I can decipher, the founder Dr. Marcel Caufriez was looking for an alternative to methods that create too much abdominal pressure and therefore downward pressure on the pelvic floor. I am all for that! However, it appears he has achieved this by taking the descent of the diaphragm out of the picture and relied on hyperinflation and overuse of the intercostals to reduce diaphragm descent. This changes the pressure gradient between the thorax and the abdomen, and according to Hypopressives claims, creates a vacuum of sorts that causes an involuntarily drawing in of the abdominals and up of the pelvic floor.

Here’s the thing, we need that pressure gradient and fluctuation of pressure created by the diaphragm in the abdominal cavity for a host of functions: it triggers breath (take Mary Massery’s course everyone!), contributes to circulation of lymph and blood, massages organs and contributes to bowel movement, sets up rest/work cycles of our postural muscles, and contributes to postural control.

So here are my questions:  How do Hypopressives address these other functions of the global system that impact continence, digestion, circulation, respiration, postural stability, etc? How does the person return to function when downward pressure from normalized breathing resumes (perhaps normalized breathing never does?) Or the downward displacement of impact loading occurs?

Our body is designed to simultaneously perform all these physiologic functions, maintain postural control and support movement. We are just starting to grasp how it achieves this through balancing all these systems, following an imbalanced decade+ of over-focus on one element of the system through overtraining abdominals. While Hypopressives is also trying to move us away from this extreme that caused so much abdominal pressure, have they done it with yet another extreme? Hypopressives feels to me like our over-focus on abs all these years….a willingness to sacrifice other parts of the system for the sake of one part. Our previous path has taken its toll on the pelvic floor for sure. But does this new, Hypopressives path ultimately create yet another imbalance. For example, in the video above you can see there is a huge use of neck muscles (Sternocleido-mastoids are very prominent) to pull this off. So they have improved prolapse (which really is awesome, don’t get me wrong) but now do they have headaches and jaw pain? For some that is worth the risk. And from an aesthetic point of view…are we trading unflattering bellies for barrel chests?

Some final thoughts, and really more questions. The drawn in position of the abdominal cavity is highly suspicious to me in terms of added pressure to the pelvic floor. Where’d the organs go?  Are they sure they are up? And finally, yes, the pelvic floor needs to go up…but it still needs to learn to go down too, even if you have a prolapse or incontinence, and handle impact loading. How do Hypopressives address this need?

I did get a chance to “try” a basic Hypopressives activity at this years APTA Combined Sections Meeting. The session leader readily indicated this was her interpretation of the activity and I am readily admitting it was my attempt at interpreting that in my own body. The result was I could feel my pelvic floor get sucked up involuntarily as I performed the maneuver. But it only stayed up as long as I held my breath and had my diaphragm in a locked position. The diaphragm is the crossroads of all the systems (continence, digestion, circulation, respiration, postural stability) noted above, I am pretty fond of having mine move on a regular basis, 14x/minute at least! What happens when things go back to “normal”? Or is breath holding their new norm? More questions.

In some of my conversations, colleagues have said we owe it to our patients to explore new ideas. I absolutely agree. When I started promoting integrative pelvic floor ideas in social media years ago I am sure I sounded crazy to some. However, I will end this blog as I began it, with a word of caution. Social Media is fantastic because it opens our eyes to other’s ideas, introduces us to new concepts, and informs us constantly! But Social Media can also be dangerous, particularly as info trickles down to lay folk. And even more so as it trickles down to the desperate women that want solutions for pelvic health issues. Let’s figure this out, hear it in English, put it through the filter of our current understanding and research, then if it stands up to investigation, promote it and provide it to clients.

Based on what I can decipher, Hypopressives appears to be another form of a static positioning and holds to achieve central stability. Another non-functional strategy when dynamic central stability is the goal. It seems to me that by following this path we are trading one extreme for another. I would love for a prolapse miracle solution to arrive, but we need a lot more info before this one can take that honor.  I readily admit that my questions and thoughts do come out of my preference and bias for seeking  balance of the systems and functional clinical models. I look forward to the feedback of some colleagues after they have taken an English course offered later this Spring. I’ve got questions!!

 

 

 

 

34 Responses to “Hypopressives? I’ve Got Questions.”

  1. Thank you!! Asking the right questions is the best way to get to the root of everything.

    Also thank you for not using the blog to entertain and promote but using it responsibly and catiously with the aim to find a working wholebody solution to a very common and distressing problem and trying to validate this method with more than subjective scientific opinion.

    • Julie Wiebe says:

      Thanks Christine for the kind post, I appreciate it. Trying hard to do just that! I do try to be entertaining too :). Thanks for taking the time to weigh in!

      Julie

  2. Meredith says:

    I had never heard of hypopressives, so I watched the videos. I also don’t speak spanish and I’m really confused. Do they just hold their breaths for a while? Eventually they exhale, but what kind of exhale is it? Are the organs pushed down with the exhale or can they revert to an abdominal exhale that pulls them up even more? Also, this seems to only take into account a limited version of prolapse. At physical therapy, I learned that release of the pelvic floor is just as important as strengthening and that too much tension is bad, that is why to release this tension you should focus on feeling the downward movement of diaphragmatic inhalation (I was told some people that also have diastasis also unconsciously revert to costal breathing for fear of expanding the belly, which makes everything at the bottom more tense). Admittedly, I’m not a PT, just a patient, but I’m having a hard time understanding the visuals of the hypopressive and how it is supposed to actually be used. Would it be used during actual workouts?

    • Julie Wiebe says:

      Add your questions to the list Meredith!! It sounds like you were well educated by your PT (send them a thank you note!).I cannot answer any of your questions on Hypopressives….which is sort of my point in the blog :)! I am so glad to hear a well-informed patient looking at this through educated eyes. If you can’t sort it out, and it doesn’t make sense to you based on what you have been taught as a lay person, and I as a practitioner can’t sort it out…then we have problem. Thanks for weighing in. Julie

  3. Well said Julie! Thank you so much for taking the time to break down the issues concerning this supposed fix for incontinence/prolapse! I agree with all the points you have made here 100%!

    All my best, Steph

  4. Kelen Farias says:

    Hi Julie :) After taking your webinar I was thinking about sending you an email and asking you what was your opinion about the hypopressive method. I believe it can be a good method of work but I have lots of questions too cause I have no experience and I must confess my head is going crazy with so much different information…

    I’m going to show your text to the person who is going to give the course in Canada. Maybe she can answer the questions you have.

    Thank you!

    • Julie Wiebe says:

      Hi Kelen!
      Thanks for commenting. Yes, my webinar would/should bring up a lot of questions regarding hypopressives. One major contrast I didn’t mention in the blog but is an issue I talk about a lot in my webinar is alignment. The alignment ( posterior tilt and rounded lumbar spine assumed during the exercises and/or statically held high chests by those in the videos) is a major contrast to the neutral alignment that we understand optimizes the relationship between diaphragm and pelvic floor. The Hypopressives website promoted a study that they did that showed increase in lumbar kyphosis. Again, not the lumbar and pelvic position that optimizes pelvic floor resting activation. So that is another concern/question for me.

      Thanks for passing the info on. Would love some answers.

      All the best- Julie

  5. Kaisa says:

    Hi Julie,
    I’m the current master trainer for English speaking countries for the Hypopresive Method. It is understandable that you have questions as limited info is available in English and the method is very unique. My initial reaction was the exact same. :) I’m on my phone so I will answer questions later but to let you know for now that most of your assumptions are incorrect. I look forward to clearing things up. Greetings!

  6. Piti Pinsach says:

    Dear Julie,
    Congratulations on your concerns about the Hypopresive Method and for your excellent work in teaching pelvic floor fitness programs.
    I sent your blog Hypopressives? I’ve Got Questions.
    March 11th 2013 to Dr. Caufriez, creator of Hypopresive Method, and I hope he give you timely response.
    While you allow me, as Director of Training Hypopresive Method,I try to provide information that I value your interest.
    I’ve seen your videos and and I verify you lot agree with Dr. Caufriez and Hypopresive Method. You talk about alignment, anterior tilt axis,… They are basic guidelines in Hypopresive Method practice.
    In a few months my colleague, Tamara Rial, read your European Doctoral Thesis which is about Hypopresive Method, I think it is of interest to you. I tell Tamara Rial to contact you, I consider of interest to all.
    While this article can help you understand more about Hypopresive Method http://www.pitipinsach.net/images/stories/hypopressure%20techniques%20a%20paradigm%20shift%20in%20abdominal%20training.pdf
    If you have chance to attend a training course, you will agree with me that it is easier to get first hand information than on Youtube. There is a course in Toronto: http://www.metodohipopresivo.com/index.php?option=com_virtuemart&page=shop.product_details&flypage=flypage.tpl&Itemid=61&category_id=6&product_id=120
    You can find some information on the web http://www.metodohipopresivo.com/index.php?lang=en
    It would be a pleasure to contact you on Skype (Piti Pinsach) and you have me at your disposal for everything.
    All the best,

    Piti Pinsach
    D.E.A. Medical morphology
    Director of Education, Investigation and Development MH Caufriez
    Bachelor of Physical Activity and Sports – Collegiate 7467
    Member of the Society of Anti-Aging Medicine
    Tel 0034 609368176 / 0034 986460590
    http://www.pitipinsach.net
    http://www.marcel-caufriez.net
    http://www.metodohipopresivo.com

    • Julie Wiebe says:

      Hello Piti,

      Thank you for your response. I wanted to post a reply after I had time to look in depth at the article you sent, but a morning of prior commitments allowed me to only look at half of it. I want to post your response though so others could look at it and draw their own conclusions. I appreciate the invite to attend the course in Toronto, I am however already committed to teaching my own courses in the weeks on either side of the Toronto dates and cannot do both (and the Toronto course is very expensive at $8-900 per person). I will take the time to read your info carefully, but I wanted to clarify the parallels you think you saw in what I am suggesting and what I see in the info on Hypopressives that I have looked at so far. First, I think where we may agree is the end goal. We are both pursuing an alternative way of providing relief and restoration to issues such as prolapse, and to move folks away from the abdominal strengthening model. To find a way to address appropriate positioning and pressures as it relates to the pelvic floor, and the central stability system. Our intentions are good and shared by many.

      Where I think we may disagree is the path to achieve that. I have readily admitted here in the blog my own lack of understanding of the Hypopressives methodology. My own approach is often misunderstood as well, so I invite you to my courses to clarify what I am suggesting, b/c I do not see the overlap between our approaches that you saw in my vlogs. To make an analogy, I understand that if you sprain your ankle, you may need crutches for a while to give the tissues a chance to heal, to take the pressure off. I see the value of that for some, and I can see how Hypopressives might be the “crutches” that gives pressure relief that gives the pelvic floor a chance to heal? (Again, I know I am speaking out of limited understanding). But the goal is to move off crutches and bear weight as soon as possible, to restore function. I want to know what happens when that ankle, (and pelvic floor) bear weight again, I want to train and balance the complexity of that. You can’t eliminate the ankle from the system or change its job in the system, it has to learn its job again, and do it well. That is what I am trying to teach from the start.

      That is the complex line of restoring function I am trying to suggest in my approach, to mimic the balance of systems achieved by the body and brain in our day to day. Not easy to achieve, and I certainly don’t have it all figured out yet. I think with each clinical innovation and research effort we get windows into that complexity as we try to walk that line to help folks heal. Balance is not easy to achieve, but that is my starting point and maintaining it is my end point.

      Thanks for continuing the conversation. I look forward to hearing from some colleagues who are attending the Toronto course. Julie

  7. Amy Wagner says:

    Julie,
    I am glad to see you share a healthy skepticism about non-evidence based methods. That being said, I hope there will be quality research regarding this topic; not just one study, but multiple center RCT and systematic reviews so we can base our decisions on solid findings. I wouldn’t mind even doing such a study. But until then, we do need to have healthy doubts about unproven techniques!

    • Julie Wiebe says:

      Hi Amy,

      Thanks for commenting. I wish that for so many things we are working through clinically. Clinical questions and innovation drives research, thanks for your willingness to make that happen. We need both ends of the spectrum!

      All the best. Julie

  8. Kelen says:

    Hi Julie! Not sure about the alignment though. In the hypopressive method we do not have a posterior tilt and we actually start the exercises in the ski position. when I watched your webinar I thought some things you said were similar to what I learned in the hypopressive course. Well, I’m sure someone with a lot more knowledge about it then me is going to try to answer your questions so let’s wait for it :)

  9. Big thanks to you, Julie, for taking the time and exposure to any/all feedback to tackle this discussion. With what I know of the body, function in general, the pelvic floor, breath, and abs specifically, and hypopressive methodology, I share your concerns whole-heartedly. I’m open-minded enough to consider that they may ultimately be allayed, but in the meantime I’m a little tripped up on a primary premise of protecting the pelvic floor from intra-abdominal pressure altogether. Is this a limited premise? Given that part of the pelvic floor’s function is to help in control and modulation of IAP, I would think that a program (judiciously tailored to respect the particulars of any individual’s presentation, such as prolapse, incontinence, etc) would want to gradually train/re-train the pelvic floor to participate in this all-important function. Further, I also would think that some (again, judicious and gradual) loading is a necessary component of tissue remodeling (a la Davis’ Law).
    Thanks, again, for your post, Julie! I look forward to continuing to see these conversations and practice unfold!
    Jessica

    • Julie Wiebe says:

      Thanks for posting Jessica! Love that you noted the function of the pelvic floor is in part to “control and modulate” intra-abdominal pressure…that’s its job, it must relearn that. And your point on loading tissue remodeling is well taken. Well said!

      Thanks for chiming in, much appreciated! Julie

  10. Piti Pinsach says:

    Thank you very much for your answer and for your time Julie, Jessica and Amy.
    It is true Amy that in many methods we have not yet absolutely scientific evidence but we can consider that there is science and empirical reasoning. You know that the scientific evidence comes after the clinics.
    I’m agree w Jessica and Julie: The function of the pelvic floor is in part to “control and modulate” intra-abdominal pressure…that’s its job, it must relearn that. And my question is how you can relearn that?
    The problem, I think, is not the pressure increases, logical in everyday life and sports, but as the pelvic floor, abdominal, multifidus…manages these pressure increases. You will agree with me that an abdominal hernia, umbilical, inguinal, disc or vaginal (prolapse) occurs by two things: An increase in pressure and a
    muscle connective tissue that has failed to properly manage the pressure.
    The question is how you can properly manage the pressure?
    I’m totally agree w Julie, as you say very well in one of the videos, in which multifidus, abdominal binder, pelvic floor and diaphragm should advance to gestures and efforts. Must have a “timing”.
    It is very interesting Julie, to know how you achieved this “timing” back with your method and what scientific reasoning and research that support it.
    With Hypopresive Method we use patterns that manage activate this muscles without the person having to do so voluntarily and add them together to expiratory apnea and serratus contraction. We verified clinically improved timing. We advise you to check with the correct protocol Hypopresive Method.
    A boy or girl with a laugh or a cough note that your abdominal muscles contracted and your pelvic floor also. With age,inactivity, efforts,… the “timing” is lost. When you, adult, cough, notice that makes your abdominal muscles and your pelvic floor. Contract or distend? As we recover this “timing”?
    X. Courtiol et coll (2003): significant link between abdominal competition (cough test), the bladder pressure and effort Peakflow. It is of great interest to verify that happens, after practicing the Hypopresive Method with this indicative test. Also verify that happens with transperineal ultrasound.
    Thanks for continuing the conversation.

    • Julie Wiebe says:

      Hey Piti,

      First I agree with you on clinical innovation often proceeding research verification, as clinicians we don’t always have the luxury of waiting for the results of a research study when a patient is standing before us in need of relief. We need to try new things to address their immediate needs. But glad folks like Amy are willing to look into why clinical innovations get results.

      I apologize I am having some difficulty understanding some of what you have written, but admittedly your english is way better than my spanish, so I appreciate your efforts at communicating on all this. As I said in my previous note, I think we are both trying to address “how can you properly manage the pressure”. I think we are both using the same elements to manage it, but just coming at it from a different angle. I discourage breath holding (which I think you are referring to as expiratory apnea), primarily because of the contribution of the diaphragm to the systems I previously mentioned. I also think deep breathing impacts the autonomic nervous system and down regulates the fight/flight/pain response. I think pressure is part of the stabilization design, and I think we can harness it versus eliminating it, in order to mimic function. Again, this is the path I have taken with the system design.I am also learning a lot about the contribution of the glottis to the postural and pressure system through the work of Mary Massery. We all still have a lot to learn!

      I think you are asking about the timing piece of what I suggest? Here is a sample of the studies that were game changers for me to look at recruitment order and try to mimic that clinically. If you care to, you are welcome to check out my webinar for more of how I arrived at my thinking on all this.The webinar is primarily theoretical, with a sample of how I apply that clinically and a case study. Forgive me if I am not understanding your thoughts in this portion of your response.

      Hodges PW, and Gandevia SC. Activation of the human diaphragm during a repetitive postural task. J Physiol. 2000; 522 (Pt 1): 165-175.
      Hodges PW, Butler JE, McKenzie DK, Gandevia SC. Contraction of the human diaphragm during rapid postural adjustments. J Physiol. 1997;505(Pt 2):539–548.
      Hodges PW, Moseley GL, Gabrielsson A, and Gandevia SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res. 2003; 151, no. 2: 262-‐271.
      Hodges PW, and Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997; 114, no. 2: 362-370.
      Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurouro Urodyn. 2007;26(3):362-371.
      Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil. 2001;82(8):1081-1088.
      Smith MD , Coppieters MW , Hodges PW . Postural activity of the pelvic floor muscles is delayed during rapid arm movements in women with stress urinary incontinence. Int Urogynecol J. Pelvic Floor Dysfunct. 2007;18(8):901-11.

      I appreciate that you pursue this passionately bc you have had good outcomes for the people in your care. I am hoping a future attendee of the full TO course will be equipped to answer the question on how this gets integrated back into function b.c. that is the piece I am still unclear on.

      Thanks, Piti, for supplying additional information here for folks to consider and draw their own conclusions.

      All the best-Julie

  11. Estefania Garcia says:

    Hi Julie,

    Congratulations on your blog, it has a lot of interesting posts. My colleague Kelen Farias told me nice things about you and we agree that your mechanism concept is similar to the hypopresive method. The body is the structure, the techniques are the tools but we need to know how the structure functions in different activities…

    I’m a physical therapist and I work in women’s health. I was introduced to the hypopresive method in 2006 and I have experienced fantastic results, mainly improvements in the quality of connective tissue, at rest and in effort, decrease of urine leakage (I have attached the abstract of my thesis, which is related to the hypopresives and the UI), improvements in the respiratory parameters, with greater respiratory volume and exhale forced capacity, through better function between the thoracic and the pelvic diaphragms (the effects are ampler movement of both structures, but with better tonus of the pelvic floor and a more elongated thoracic diaphragm)… And more…!

    Thousands of women with urogynecological pelvic floor and sexual dysfunction have already benefited from the effects of the hypopresive method.
    I am part of a hypopresive team with Kaisa, Piti, Tamara… I’m the current master trainer for Portuguese speaking countries for the Hypopresive Method. If you need other clarifications, please tell us!

    Best wishes!! Estefania :)

    THESIS. Title. The effect of Hypopressive Techniques in UI symptoms and QOL of women. SUMMARY. Introduction. Hypopressive Techniques can be beneficial as physical therapy treatments, especially for treating pelvic floor disorders such as urinary incontinence (UI) and vaginal organ prolapse as these disorders substantially impact women’s quality of life (QOL) by causing embarrassment and social isolation. The goal of this investigation was to analyze the effect of Hypopressive Techniques in UI symptoms and QOL of women. Methods. The research model used was quasi-experimental comparing two groups of women, age from 25 to 60 years (mean = 46), with UI symptoms. The experimental group (n=21) completed 12 weeks of hypopressive exercises while the control group (n=28) did not receive any treatment. The outcome variables were severity of UI symptoms and QOL measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Data was analyzed using the t-test and the ANOVA for repetitive measures. Results. Both groups improved, however the hypopressive exercise group had more significant improvements (F (1, 47) = 38.68. p<0.01), with a 70% reduction in UI symptoms. Conclusion. The results confirm that Hypopressive Techniques are effective on the reduction of UI symptoms and increased QOL in women. Future studies are recommended to confirm these results.
    Key Words: Hypopresive Techniques, Urinary Incontinence, ICIQ-SF, Pelvic Floor

    • Julie Wiebe says:

      Hi Estefania,

      Thanks for the information, I am happy to share your thesis here (congrats), again so folks can draw their own conclusions. I appreciate that both you and Kelen see overlap in the methodology/approaches, while I still see quite a bit of contrast. I am still unclear on how this methodology prepares for return to function, movement, when “normal” breathing resumes…these are my original blog questions. I think it is clear that this is best explained through course attendance, and I look forward to my colleagues exploration of that at the English course in Toronto.

      Thanks for adding to the information stream.

      Julie

      PS I hope Kelen still has nice things to say about me when this is all done :).

  12. Kaisa says:

    Hi Julie and everyone reading the posts,

    It is great to see a community of people who are dedicated to improving quality of life for women with pelvic floor issues learn about the Hypopresive Method. As you can imagine it is difficult to describe something in short blog posts, you tube videos when the skills and theory behind the method takes 60 hours to teach. It is also understandable that you should have doubts and questions as information in English is limited and the method is very unique.

    Here are answers to some of your doubts.

    This technique has been around since the 1980s so it isn’t new but it is just now making an entrance in the English speaking world. It is part of hospital procedures and postpartum recovery protocols in Belgium where it was first discovered and studied by Marcel Caufriez. Over 6000 therapists have been trained in the method and almost 2000 fit pros as well. Thankfully finally we have trainers in English speaking countries so you are finally hearing about the method. Since it has been used for years by uro-gyno physios to treat prolapses and incontinence it has a strong clinical backing.

    We’re reviewing the English texts but do remember that the science concepts have been simplified for clients so most certainly they are incomplete for a professional. The neurophysiology concepts behind the method are very complex. Please see this blog for the 3 requirements for an exercise to be considered hypopresive: http://hypopresives.com/hypopresives/three-requirements

    The neurophysiology concepts include hypopresives stimulating the pneumotaxic center (pontine) of the brain via hypopresive postures that are amplified by the apnea and ribflare causing hypoxia and hypercapnea. The neumotaxic center, which is responsible for the resting tone of the respiratory muscles (diaphragm, ab wall, pelvic floor, serratus anterior, etc.), responds via neurological divergence that stimulates an activation or decrease in tone in the various muscles. The neurophysiology concepts are far too complex to answer here. They are fully explored in the 60 hours of HM training our master trainers receive.

    HM seeks to normalize the postural tone of the diaphragm and the results here are excellent. The concept is full unrestricted mobility of the diaphragm and to normalize its resting position. Not sure where you got the idea that HM “takes the descent of the diaphragm out of the picture”. Also the rib flare comes from the serratus anteriors which are the postural antagonists of the diaphragm and thus help relax the diaphragm. It isn’t the change in pressure that causes the involuntary contractions of the core when performing HM (it was the original hypothesis but it was proven incorrect via research as the contraction comes before the change in pressure when measured by a pressure gauge in the rectum/esophagus and deep EMG of the pelvic floor).

    “Here’s the thing, we need that pressure gradient and fluctuation of pressure created by the diaphragm in the abdominal cavity for a host of functions: it triggers breath (take Mary Massery’s course everyone!), contributes to circulation of lymph and blood, massages organs and contributes to bowel movement, sets up rest/work cycles of our postural muscles, and contributes to postural control.”

    Of course and that is why HM helps to normalize the diaphragm function. HM also improves vascularization and the latest studies are looking at lymph circulation which is also improved. HM also improves intestinal transit and it fantastic for correcting posture.

    “So here are my questions: How do Hypopressives address these other functions of the global system that impact continence, digestion, circulation, respiration, postural stability, etc?”

    HM is a global system that does just that. Via neurological divergencies muscle resting tone is improved which is the main reason for the improvements in continence, injury prevention, etc. HM stimulates the sympathetic nervous system which causes improvements in these areas as well. The rhythmic performance of the exercises works with the emotional system. Through the neurological divergencies muscle tone is normalized which aids in postural improvements, proper mobility, etc. The autoelongation used through the techniques normalizes curvatures of the spine (does not cause lumbar kyphosis like you commented) and allows for rehydration of the intravertibral disks. Respiratory parameters are improved via normalization of the tension in the upper airway muscles, improving the functionality of the diaphragm as well as changes on a cellular level such as improvements in hematocrit and EPO. Again, it is hard to summarize something that takes hours to explain during the courses.

    “How does the person return to function when downward pressure from normalized breathing resumes (perhaps normalized breathing never does?) Or the downward displacement of impact loading occurs? “

    HM reprograms the core to properly manage intra-abdominal pressures so daily function improves and risk of injury from prolapses is reduced. Removing excess postural tone from the diaphragm also is an important factor in optimal function. When people return to their previous activities (perhaps with impact) their bodies can handle these activities better with less risk.

    “While Hypopressives is also trying to move us away from this extreme that caused so much abdominal pressure, have they done it with yet another extreme? Hypopressives feels to me like our over-focus on abs all these years….a willingness to sacrifice other parts of the system for the sake of one part.”

    HM is a global system that takes into consideration not just the biomechanical parts but also the parasympathetic vs sympathetic nervous systems, the emotional system, the person’s diet, even the temperature of the room and color of the lights. It goes well beyond just abs and seeks to reprogram the person’s body map and balance out their nervous system as well as the musculoskeletal system.

    “For example, in the video above you can see there is a huge use of neck muscles (Sternocleido-mastoids are very prominent) to pull this off.”

    What you are seeing is yes, activation of the SCM but what makes it seem more prominent than it is is the decrease in thoracic pressure which creates indents at the collarbone.

    “So they have improved prolapse (which really is awesome, don’t get me wrong) but now do they have headaches and jaw pain? For some that is worth the risk. And from an aesthetic point of view…are we trading unflattering bellies for barrel chests?”

    Actually HM doesn’t cause headaches or jaw pain. Yes, some people in the beginning will have a hard time activating their serratus anteriors and will over use upper traps etc. But this shortly gets improved and the end result is less pain and activation of the proper muscles. HM doesn’t seem to create barrel chests. After the 30+ years of its use this hasn’t been noted.

    “Where’d the organs go? Are they sure they are up?”

    Organs are lifted up. It has been studied via ultrasounds and MRIs.

    “And finally, yes, the pelvic floor needs to go up…but it still needs to learn to go down too, even if you have a prolapse or incontinence, and handle impact loading. How do Hypopressives address this need?”

    HM seeks to improve resting tone of the pelvic floor and for it to have proper shock absorption abilities (including responding to pressure by moving down and back up). Marcel Caufriez has actually developed a “tonemeter” that measures the resting tone of the pelvic floor in addition to its ability to produce force.

    “I did get a chance to “try” a basic Hypopressives activity at this years APTA Combined Sections Meeting. The session leader readily indicated this was her interpretation of the activity and I am readily admitting it was my attempt at interpreting that in my own body.”

    It would be nice to know if the session leader had been trained by Marcel Caufriez or has just tried to understand the method via youtube… If she isn’t fully qualified to teach HM then she most likely wasn’t able to explain the method to everyone correctly.

    “The result was I could feel my pelvic floor get sucked up involuntarily as I performed the maneuver. But it only stayed up as long as I held my breath and had my diaphragm in a locked position.”

    HM has certain benefits that are very immediate and others that are achieved after the reprogramming phase is complete. Eventually the resting position of the internal pelvic organs changes but no, it does not happen after one day.

    “What happens when things go back to “normal”? Or is breath holding their new norm? More questions”.

    HM sessions usually last about 20 minutes during which people perform apneas and rest breaths. “Normal” breathing never ceases except during the apneas.

    “Based on what I can decipher, Hypopressives appears to be another form of a static positioning and holds to achieve central stability. Another non-functional strategy when dynamic central stability is the goal.”

    Your deciphering is a bit off track which is understandable due to the lack of information available to you. HM does just what you promote, improves dynamic central stability as it reprograms the core to do its job involuntarily.

    I hope that has helped to answer some of these questions (and perhaps brought on some others). My initial reaction to this method was a bit like yours so I understand where you are coming from. I spent some years writing to associations in the USA for opinions and information (back in early 2000s) and none was available. So, please have some patience as it is a lot of work to get the information translated and available to the English speaking world. Plus the method is complex so the best way to learn is by doing the full courses and trying the techniques on yourselves and clients to see the fantastic results first hand. It is also important to note that we have thousands of colleagues around the world who are using these techniques with great success. That was what “won me over” in the beginning. I realized that pelvic floor physios wouldn’t continue to use a method that didn’t produce the desired results. Realizing that HM was the main rehab technique used for postpartum propelled me to learn more about it and trust that my colleagues were onto something that improved the quality of life for women.

    Sunny greetings from Spain! Please let me know if I can be of further assistance.

    Kaisa Tuominen
    Hypopresive Method UK Country Master Trainer

    • Julie Wiebe says:

      Hi Kaisa,

      Thank you for taking the time to write a fuller explanation of the Hypopressives method (HM) and to try to answer some of the questions posed in the blog. I am posting your response so that folks can investigate your premises themselves and draw their own conclusions. I encourage readers, particularly the lay folks who are following this conversation, to investigate the information you have provided as I am unfamiliar with some of the concepts as presented and the terms you are using and therefore cannot form an adequate response. For example neither my neuro expert colleague, google or pub med searches could define “neurological divergencies” for me, however this seems to be a critical HM concept. And conceptually the HM focus on enhancing Sympathetic System dominance runs counter to my clinical understanding of how that global fight or flight stress response impacts pain states and emotions. Some of this may be language barrier or descriptive differences between Europe and North America (neither bad nor good just different), for example an “apnea” looks like conscious breath holding, and for me breath holding will effectively “take the diaphragm out of the picture”.

      My intent with the blog was not to compare your technique to mine, or convince you of mine. But many commenters have noted overlap. As I noted to Piti I think the primary similarity is that we share the same end goal: reprogramming the central stability system. However, your letter confirms for me that the path we use to get there is different. Perhaps we can end our dialogue on a positive note and agree to disagree on the path, but agree to continue to pursue optimizing that central stability system and function for the people in our care.

      All the best-Julie

  13. Piti Pinsach says:

    Thank you very much to all.
    Must be formed to have information.
    Dr. Caufriez is alive, he teaches.
    I highly recommend going to the source.
    Julie Allow me to say something about your opinion about the price of the course.
    You say: “…the Toronto course is very expensive at $8-900 per person” You agree with me that things should be evaluated after knowing them.
    All the best
    Piti

  14. Kelen says:

    Hi Julie! Of course I have nice things to say about you ;) I really want to take one of your courses once I move to Canada! If they were available online I’d take one right now. I’m very curious!

    And I’m also very curious about the HM :) Want to learn more about both methods!

    thank you!

  15. Sherrie Palm says:

    As a POP advocate rather than a PT, I’d like to toss a question into the mix (if I’ve missed this info I apologize, scanned thread to save time). I keep coming back to concerns related to rectocele; this is as common in women with POP as incontinence. When stool is “locked in the pocket”, it concerns me what impact will occur to the bowel, same with enterocele-intestines are positioned low in the pelvic cavity. Additionally, I read somewhere that Hypopressives would improve grade 4 in women-I’m not aware of any modality beyond pessary or surgery that is of long term benefit to women with grade 4. Can someone address how procidentia can be helped with hypopressives? Hard to imagine how you’d get the uterus to remain in upright position once the suction is released.

    We are all looking for the best treatments to assist women navigating POP. Often women newly diagnosed do not know all the types of POP they are experiencing (I went into surgery to address grade 3 cystocele and rectocele and a huge enterocele was discovered), much needs to be addressed with the screening process in general-something APOPS is working toward. I speak with women frequently who’ve suffered increase in symptoms/grade because of activities/treatments; it’s pivotal insights we provide “first do no harm”. I’m hopeful additional info can be shared regarding these concerns.

    Thanks much!
    Sher

    • Julie Wiebe says:

      Thanks for weighing in and for your questions. I am in no position to answer, but hope that some of our colleagues taking the May course can help to clarify for both of us. Take care Sherrie! Julie

  16. Hello Ms Wiebe,

    I am the first and only American to complete the entire Metodo Hipopresivo Training to the Masters level.
    I am living and teaching now in New Mexico and have taught classes around the country.

    Perhaps I can answer your questions. I travel all over the US and would like very much to visit you and show you in person what the work is about.
    I will email/call you to schedule a time that is convenient for you.

    All the very best,
    Raymond Kurshals
    info@PilatesSantaFe.com
    (505) 670-2235

    • Julie Wiebe says:

      Hello Raymond,

      Thank you for your generous offer, but no thank you. I am on a few different learning curves right now that are my priority.

      Take care-Julie

  17. Hi Julie,
    interesting discussion. Something similar is done in Yoga. There is one type of breathing called
    “KAPALBHATI PRANAYAM”
    THIS INVOLVES PULING THE ABDOMEN IN AND LIFTING THE DIAGRAM. iT IS ONLY DONE IN SITTING AND YOU DO ONE BREATH EVERY 2 SEC. sTART WITH 10 AND INCREASE EVERYDAY. tHE MAXIMUM BREATHS AT A SITTING THAT YOU CAN PERFORM ARE FOR 15 MINS BUT THAT TAKES ABOUT 6 MONTHS TO ACHIEVE
    SORRY ABOUT TEH UPPERCASE . HAD THE CAPS LOCK ON

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