Why does a “hip shift” help decrease bladder urgency/frequency.
Great question! I would LOVE to tell you!
But it’s going to require some background so bear with me.
One of the foundational things that I have learned from the Postural Restoration Institute is that the body is NOT symmetrical and this is GREAT. It’s not meant to be the same on both sides!
There is some DEEP rabbit holes we can go down describing the complexity of the neuro-physiology all of these asymmetries but the TLDR (which will probably not be that short) in how it relates to bladder urgency/frequency relates back to this foundational concept that our pelvic floor and respiratory diaphragm (muscle at the bottom of our lungs) work together.
When we INHALE our respiratory diaphragm contracts and moves downwards to let air in to our lungs. This downward movement of the diaphragm takes up real estate of the abdominal cavity and so to regulate this abdominal pressure our pelvic floor “should” lengthen, or relax, or expand if you will.
The trouble with this is, the function of the left and right side of our diaphragm is quite different. We have a bigger right diaphragm, the attachment of the right side of the diaphragm onto the spine is larger on the right than the left and goes further down on the spine on the right. The right side of the diaphragm is supported by a large dense liver that increases efficiency of the right respiratory diaphragm.The left side is not as big it has a smaller lung on top of it and has a heart that sits on it. The left side diaphragm’s attachment on the spine is smaller and it doesn’t go as far down on the left. Even in this animation you can see the smaller left lung, the lower left diaphragm and the heart shifted over to the left.
This central internal anatomical asymmetry causes us to make compensations in our body. Again, there is much much more to be said about that than I will go into that in this post but that’s a good place to start.
So, we have this bigger, dominant R diaphragm above this pelvic diaphragm or pelvic floor. The compensatory pattern that evolves from this in the pelvis in PRI is called the Left AIC pattern. I won’t dive into ALL the details of this pattern but an article giving more info on the L AIC pattern can be found HERE
In the Left AIC pattern the RIGHT pelvis tends to live in a state of relative extension, adduction and internal rotation. Conversely the LEFT tends to live in a state of flexion, abduction and external rotation.
What this looks like in a body. Is someone who likes to stand on their right leg, keeps their center of gravity more onto the right side. There are some fun examples of this preferential pattern documented in art.
David by Michelangelo is a fantastic example of this asymmetrical pattern. We can see the pelvis is oriented to the right, and the center of gravity is over to the right. The pelvic inlet or the crest of the pelvis on the right is more extended, adducted and internally rotated. The femur (thigh bone) follows into adduction and internal rotation also. The left half of the pelvis is flexed, abducted and externally rotated with the femur (thigh) following also.
While these pictures are an exaggeration of how much movement there is. These pictures show this patterning in the pelvis.
Let’s zoom in on the middle picture. This is called the pelvic outlet. This is also where the pelvic floor happens to live.
You can see how the orientation of the left and right sides are different here!
In this pattern we have shortening of muscles in the right front, lengthening of muscles in the left front and the reverse in the back parts of the pelvic floor.
These pics can be a bit confusing but we are looking up at the bottom of the pelvis as if the person way laying on their back. So the right side of the pelvis is on the left side of the picture to help you get oriented.
So, if you’re tracking with me so far, AMAZING!
Now into the original question… why does the hip shift help suppress a false bladder urge?
The standing hip shift is a modification of a postural restoration technique.
You place the left foot slightly behind the right, bring your center of mass over towards the left keeping your hands grounded onto the surface.
You keep your left knee pressing into a ball or towel and imagine you are turning your zipper slightly towards the left toe.
When you do this you should feel a stretch in the back of the left hip pocket, and you may feel the muscles of your left inner thigh, left back of leg and some left abdominals.
This hip shift is on a very basic level, flipping this circle from above.
A more in depth clip HERE
Your bladder sits in the front half of this circle. If we tend to stay asymmetrically oriented the overactivity of the right anterior quadrant of the pelvic floor can “pull” the neck of the bladder. This tension can give us the feeling of urgency despite not having a full bladder.
The right side of our body also tends to be more “sympathetically” driven. Meaning out “fight or flight” side of our nervous system. Shifting over to the left not only helps balance tension across the pelvic floor biomechanically, but can also help with a shift in the nervous system from fight/flight to more rest/digest or “parasympathetic” state which can also remind the bladder that it’s not an emergency and you don't need to rush to the bathroom right away.
When we come out of the hip shifted positions we are hopefully a little more balanced landing here.
While the goal is not ever to be perfectly balanced, simply reducing this asymmetrical tension can have a positive impact on your bladder health!
If you still have the urge to go after doing the hip shift for a few breaths. You may just actually have to go pee! That’s fine! Go! But might be time to check in with a urologist and a pelvic floor PT to get to the root of your bladder urgency and frequency.
If you think taking this approach will be helpful to help you manage your pelvic floor I work 1:1 with clients all over world virtually. You can learn more about it HERE
I'd love to hear if this helped your understanding! I'll be in Lincoln Nebraska Teachign Pelvis Restoration Oct 13-14th 2023 if you want to dig even deeper