Are you an athlete? Someone who loves to move and try new forms of workouts? Someone who is experiencing symptoms of pelvic organ prolapse, urinary leakage, constipation, pelvic congestion? OR feeling stressed? — Well, this one is for YOU.
What is Low Pressure Fitness Training/Hypopressives?
This blog is all about low pressure fitness, a training method that combines postural methods and breath work to help improve posture, myofascial mobility, and breathing. The breath work is focused on lateral costal expansion or outwards movement of the rib cage, and the postures in this training method range from supported positions where you are lying on your back, to more challenging poses where you are in tall kneeling, supporting your body on all fours, and standing. In addition to the breath work and postures, there’s a component called hypopressives or the abdominal vacuum used in the system of low pressure fitness training. You may have seen this technique performed if you ever watched a weight lifting competition. The abdominal vacuum technique is commonly used by weight lifting competitors during posing, as it helps by improving posture and thus showcases the musculature of the abdomen and trunk better. This component addresses these systems by decreasing pressure on the lower abdomen and pelvis. The abdominal vacuum method is a key concept in this training method as it says in the name itself: “low pressure” fitness training.
To help understand the mechanism of action with low pressure fitness training, imagine this: you are sipping on a refreshing glass of water on a Sunday morning, self-care Sunday. As you are taking your next sip, you draw the water up through the straw, but you stop the flow before the water enters your mouth. The amount of water in the cup decreases slightly, but if you let go of the stop on the straw, the water moves back into the glass and the volume in the cup returns to the same level you started with. This is the same concept used in low pressure fitness. We are closing off the glottis, an area in the throat that helps you breathe, and vocalize, but you’re taking a pretend breath in, pulling up pressure from the belly and pelvic area. This creates less volume of pressure on the pelvis and abdomen, but the minute you relax the glottis and breathe in again, the pressure returns to the starting state. Now you may be thinking, if the start and end pressure are the same, why should I practice low pressure fitness? Well, as you are developing the ability to breathe in and create the abdominal vacuum, you are using muscles! You’re developing the muscles that help you control inhalation. In addition, the focus of the low pressure fitness training on posture is largely beneficial in creating a lasting change to off load pressure from poor postural control. This combined with improved control of breathing will help to create a lasting change.
Why should I be interested in trying Low Pressure Fitness Training?
1. Improves symptoms of pelvic organ prolapse
2. Improves symptoms of pelvic congestion
3. Helps healing for diastasis recti
4. Decrease symptoms of stress urinary incontinence – leakage due to coughing/sneezing/laughing/ exertion
5. Create more abdominal tone
6. Improve athletic performance
7. Improve nervous system regulation – turn on your calm
There are many benefits of low pressure fitness training. Through the abdominal vacuum maneuver, it helps decrease pressure on the lower abdomen and pelvic floor muscles. This can be useful for people with pelvic organ prolapse and pelvic congestion as pressure from above is lifted. It can also help those healing from diastasis recti, as the active postures help tone and stabilize the abdominal and pelvic musculature, and the hypopressive technique helps minimize exacerbating forces that may be creating outwards pressure on the healing tissue. Low pressure fitness training can also be used to help treat those with symptoms of stress urinary incontinence through its ability to help with retraining the pressure system. In addition, this method can help improve athletic performance. It helps to improve coordination of muscle movement and improve control of your breathing. It may help with strengthening your inspiratory and expiratory muscles. If that’s not enough, it also helps with overall fitness as it helps to tone the deep core muscles in the body.
Lastly, low pressure fitness training helps improve the state of your nervous system. If you’re not familiar with the topic of the nervous system, to understand it on a surface level, it’s composed of the central nervous system and the peripheral nervous system. These networks are related to the brain, spinal cord, and their connections to the rest of the body. Within the peripheral nervous system, we have the somatic and the autonomic nervous systems. The somatic nervous system controls voluntary movement while the autonomic nervous system controls involuntary movement. For the somatic nervous system, think of things like walking, running, exercising, eating. For the autonomic nervous system, think of things like sweating, digesting, and breathing. Within the autonomic nervous system, we have the sympathetic and parasympathetic nervous systems. For the sympathetic nervous system, think “fight flight” response and for the parasympathetic nervous system think “rest and digest”. Diving deeper within the parasympathetic nervous system, we have the ventral vagal system and the dorsal vagal system. The ventral vagal system is responsible for calmness while the dorsal vagal system is responsible for freezing or a shutting down response. To be effective, and live a healthy life, we want to have a balance in our nervous system. If we find that we live in a state of stress, have very busy lives, find it hard to calm the mind, or are quick to lose our tempers, you may benefit from ventral vagal activation strategies. Strategies to help promote rest, digest, relaxation, and calmness. Low pressure fitness training is the perfect fit in terms of exercise strategies to help promote ventral vagal activation. The rhythmic breath work used during the gentle training can help activate the ventral vagal system.
So, I hope after reading about the benefits you find a fit for trying this practice. As you continue to read, I recommend you try some of the techniques, but give yourself time, patience, and opportunity to learn. This practice is greatly beneficial, but like all new things, it can be quite challenging to learn with 100% expertise. Speaking from personal experience, even as a pelvic floor physical therapist and one who loves to try new exercises and challenge my body with a range of movement, I found learning low pressure fitness training and learning the hypopressive techniques extremely challenging. It required great concentration, practice, and repeated attempts daily with a variety of cues to nail it. As I have learned it and now even teach it in my practice to my patients, I frequently practice flows on my own intentionally to continue to strengthen my muscles and improve my practice.
Disclaimer: Considerations for circumstances where Low Pressure Fitness Training may not be appropriate for you.
Okay, I am so happy you have made it here. Before we get started on how to perform the abdominal vacuum technique used in low pressure fitness training, I want to review some contraindications for low pressure fitness training. If after reading this section you are in limbo or unsure, please speak to your doctor to get further advice on if this training is appropriate for you.
Red flags:
- Hypertension
- During Pregnancy – no breath holding
- Cardiac issues that can be affected by apneas
- Stomach/gastrointestinal dysfunction DURING a flare up
- Endometriosis
- Less than 3 months post abdominal surgery
Yellow flags:
- Post partum
When considering low-pressure fitness training, there are several important factors to keep in mind based on individual health conditions and life stages. One being hypertension. It is important to avoid activities such as low-pressure fitness that can elevate your blood pressure. Next, we recommend low pressure fitness training for those who are currently pregnant. Breath holding can slow the movement of oxygen to the fetus. In addition, postpartum we recommend waiting 3 months post c-section before starting low pressure fitness training. We want to ensure scar tissue healing, as this method can stretch myofascial tissue, and we want to wait until it’s fully healed before mobilizing it. Post vaginal birth, please wait 6 weeks post your 6 week follow up with your ob-gyn and check in with your physical therapist if applicable. We want to avoid low pressure fitness training too early in this case to wait until the uterus is involuted before beginning this. We also want to avoid low pressure fitness training for those with cardiac issues that can be influenced by breath holding, and for those with stomach or GI issues with an active flare up, as tissue shortening may exacerbate the pain flare. For similar reasons, those with endometriosis and those less than 3 months post abdominal surgery are not appropriate for low pressure fitness training.
If the above doesn’t apply to you, let’s jump into it.
“I’m in! I want to learn!”: The Abdominal Vacuum Technique
Let’s jump into the abdominal vacuum concept or hypopressives. This technique looks like a lift and opening of the rib cage. Imagine an umbrella opening, as the umbrella opens there’s a 360-degree movement of the fan of the umbrella rising and spreading – the same way the rib cage creates a spreading when performing a hypopressive. Now, how do we accomplish this? You can use your muscles around the rib cage. By activating the muscles that surround your diaphragm and rib cage, you can accomplish lifting and peeling the rib cage away from the underlying contents. Let’s try out this technique!
Guided hypopressive/abdominal vacuum:
Step 1: Find yourself in a comfortable position, lying down on your back with your knees bent,
Step 2: Place your hands on your rib cage – the bony area that encloses your trunk.
Step 3: Close your mouth, relaxing your lower jaw to ensure your teeth are not touching.
Step 4: Inhale through your nose, breathing into your rib cage for a count of 4.
Step 5: Hold for 4 counts.
Step 6: Exhale for 4 counts, allowing the rib cage to slowly relax back to the start position. Step 7: HOLD your breath, closing the throat, mouth, and nose (feel free to pinch your nose) to help yourself with this step. Holding your breath, lift and peel your rib cage for a count of 4. The lower
abdominal muscles stay relaxed, you are using your deep trunk muscles to elevate your rib cage to reduce pressure on the trunk and pelvis. You may feel a suctioning inward of your pelvic area.
NOTE: If you are having trouble with this part, try holding your breathing and pretending to take a deep breath in. This should help you create the abdominal vacuum.
Step 8: Slowly inhale for a count of 4, breathing into the rib cage. It’s important not to quickly inhale as this may create a sudden increase of pressure in the pelvis and abdomen and could interfere with our goals for performing this exercise.
Cues to Help you Create an Abdominal Vacuum:
If you are struggling with the vacuum, there are several strategies you can use. Try warming up first! Opening up the ribcage and diaphragm can be so helpful! To do this, try applying gentle manual pressure along the length of the rib angle. Gently applying stroking pressure here can help you gradually free up restrictions from the tissue. You may also try doing an exercise called “open books”- laying on your side with a pillow under your head and arms out in front of you, inhale as you open the uppermost arm towards the opposite side and exhale as you return back to the start position. You can repeat this 8x each side daily to start.
You can also try changing your physical position. Lying on your back with knees bent is typically easier than learning to kneel, standing, or sitting, but try changing your position to see if this helps! You can also change the location of your hand placement. Try putting your hands on your rib cage. If this doesn’t help, try moving them more towards the back or front portion of the rib cage. You can also try using the web space of your palms around a specific part of the rib cage to give you more direct pressure along a specific part of the rib cage. Another strategy is using some soft, gently overpressure from your palms. Try applying soft pressure with your hands over the ribcage as you inhale and exhale to help with gaining connection to the area. Mirror feedback can also be useful! Standing or sitting in front of a mirror for practice can help you visually see the movement of the rib cage and the changes in pressure occurring in the abdomen and stomach. Personally, when I first started using this technique, I spent a couple minutes a day in the mirror using my hands on the rib cage and visualizing the movement I was creating as I tried the maneuver. It took time, but with practice, I was able to see the change in control and activation that I had.
I hope you loved this!
Thank you so much for taking the time to read this piece. Low pressure fitness training has changed the way I exercise, move, and feel. Also, as a physical therapist at Beyond Basics PT, I have used this technique with many patients who find immediate symptom relief and report positive change. My hope is that it brings many of these benefits to your life too!
