Wish I had known them before: Hypopressives

Forget the crunches and really work that core

What are hypopressive techniques (HT)?

HT consist of a series of techniques that, through a sequence of different postures and movements, contract your diaphragm during exhalation, resulting in a negative pressure inside your thoracic and pelvic cavities. In other words, you suck in your guts while exhaling so that the intra-abdominal pelvic pressure is reduced. 

Piti Pinsach

When you exhale, your rib cage usually contracts, but when performing a hypopressive technique, the opposite happens. That's why the intra-abdominal pressure is reduced. Apnea (suspension of breathing) is then maintained for some seconds in order to stimulate a reflex concentric contraction of the core and pelvic floor muscles.

Why are hypopressives better than traditional ab exercise?

Photo: thevoicenotes.com

The key element is the REFLEX CONCENTRIC CONTRACTIONS. While most ab exercises, including Pilates, involve VOLUNTARY CONTRACTIONS and increase intra-abdominal pressure, hypopressives work just the other way round.

This difference is of outmost importance because both, pelvic floor and abdominal muscles, are mainly formed by type I (involuntary) fibers. Therefore, training should focus on these fibers, which are only stimulated by reflex contractions.

Unfortunately, traditional ab exercises, which are hyperpressive (they increase thoracic and pelvic pressure), can even be harmful.

Why are traditional ab exercises detrimental?

Photo: mutusystem.com

The strengthening of the voluntary muscle fibers that occurs through traditional exercises is directly proportional to the deactivation of the involuntary ones. As a result, traditional exercise weakens core and pelvic tone, which in turn leads to:

·       

Photo: nyboneandjoint.com

             urinary incontinence

·         prolapses

·         painful sexual relations

·         back problems like lumbago

·         esthetic issues such as abdominal flaccidity or swollen stomach

This fact was proved in 2007 by Caufriez, the founder of hypopressives. During a 6-week study, 16 women performed traditional ab exercises 45 minutes twice a week. The researchers found a 32.7% decrease in base pelvic floor tone, demonstrating not only the ineffectiveness of such exercises but also showing their prejudicial effects.

Benefits of hypopressives

Waist slimmer & ab toner

pinterest.com

HT increase abdominal and pelvic base tone, which in turn decreases waist girth and leads to a flat, hard midsection.

A 2007 study showed that 20 min of daily HT for 6 months reduces waist circumference by 6%.

A 2014 study showed that an acute 20 min session of hypopressives significantly reduces waist circumference while increasing thoracic amplitude and peak expiratory flow.

HT are especially challenging on the transverse and oblique abdominal muscles, and therefore provide a complete and tough workout that will get you those flat abs and slim waist in a few weeks (provided your fat percentage is low enough. You can spot tone, but not spot reduce so make sure you're also getting your cardio in.)

youqueen.com

Not only do they flatten your abs but they will also respect your vertebral column and won't strain your lumbar spine. While the risks of traditional exercises outweigh the benefits, with HP it's just the other way: all advantages with no drawbacks.

Ameliorates urinary incontinence (UI) issues

Urinary incontinence (UI) is a common issue among female athletes who aren't even aware that they suffer from a condition that negatively impacts their performance.

A 2002 study showed that 32% of British and French women, 34% of German women and 15% of Spanish women had suffered symptoms of UI during the 30 days prior to the study. Females are more likely to undergo UI because of menopause and pregnancy.

The increased base tone that HT provide translates into a better and faster control of your urinary tract, which reduces the risk of involuntary leakages. This occurs thanks to the repositioning of the bladder and the improvements in pelvic strength.

Photo: 34-menopause-symptoms.com

In a 2007 study, 100 women with poor pelvic tone and urinary incontinence performed 20 min of HP everyday for 6 months, resulting in an increase in pelvic floor tone by 58% and in shock absorption capacity by 48%. Furthermore, there was a 20% increment in contractile muscle strength and a significant 6% reduction in waist girth.

Photo: twaamc.com

That same year, another study found akin results when a group of adults, average 68.5 years old, performed HT 4 times per week for 6 months, resulting in an increase of basal tone by 23.5%,  of loading tone by 25.3% and of perineal blocking during exertion by 108,4%. HT effectively solved UI in both sexes as 85.7% of cases were decreased or even disappeared.

In 2010 yet another study reinforced the aforementioned results: UI was significantly reduced in an intergroup study of 126 subjects, average 43 years old, who practiced HT daily for 30 minutes 3 times a week during 3 months. On the other hand, the Pilates and control groups showed no improvement.

Better sex life

The pelvic muscles are intimately linked with sexual function, especially in women. Followers of this technique claim to experiment an increase in desire, sensation and control during the sexual practice. This may be due to the increased blood flow and genital sensitivity and a decrease in pelvic congestion.

Stay tuned because in a few days I will upload a post expounding on this topic.

Improved physical performance

HT effectively work the diaphragm and the respiratory muscles. Not only do you acquire a deeper awareness of your body and diaphragm, but your pulmonary, thoracic and diaphragmatic capacities will be dramatically increased. A toned, flexible diaphragm will translate into a better physical performance, especially in aerobic activities.

Photo: yogadonk.com

Photo: fragmenthealth.com

HT involve a phase of apnea, which results in a high oxygen desaturation (decrease in blood oxygen). Studies have shown that after apnea, blood acidosis is reduced and oxidative damage is no longer produced. The same study concluded that apnea can be used to increase tolerance to hipoxemia (low oxygen levels).

Is not that what any athlete would want? To be able to put in a brilliant performance in spite of the oxygen deficit?

Other studies report that HP increase hematocrit, the volume percentage of erythrocytes in blood. Red blood cells are in charge of transporting oxygen to your cells. More red blood cells mean more oxygen carrying capacity and more oxygen delivery to your muscles translate into better physical performance, especially in endurance sports. Many athletes even try to increase their oxygen levels through banned practices like taking Erythropoietin.

Photo: americasblood.org

Studies to definitively prove the reduction in cellular acidosis, the regression in oxidative damage and the increase in hematocrit are still in progress. It is speculated that these effects are the result of reflex splenic contraction or an increment in erythropoietin.

Other studies pending of publication will show a reduced pre-competition anxiety and an augment in self-confidence.

Improvements in posture and biomechanics also account for the improvements in performance.

Back health and balance

The abdominal vacuum and negative pressure in our abdominal cavity cause a traction effect on the vertebral discs which can be extremely therapeutic, especially in the lumbar region, when combined with other postural exercises.

Photo: gimnasia-hipopresiva.com

HT is known to reduce lumbar pain by decompressing the vertebral discs through the reduction in pressure and the axial traction. Lumbago, dorsalgia and other back issues usually lessen or even disappear in the short term.

Photo: drnekessaremy.com/

A 2007 study showed the benefits of doing HP for 10 weeks 1hour per week:

·         -Reposition of the plumb line (better posture)

·         -Decrease in lumbar lordosis (99. 9%)

·         -Reduction in cervical lordosis (99.8%)

·         -Decrease in dorsal kyphosis (99.5%)

·         -Decrease in scoliosis (96%).

·         -Improved postural comfort: better mobility and flexibility, less pain, and feeling lighter (95%).

The positive impact on the lower back and limb flexibility was tested in a 2009 study on patients suffering from mechanical and postural low back pain. Through electromyography, which electrically records muscle and motor neuron activity, it was seen that a training program based on HT improves the internal and transverse oblique activation time, therefore increasing the force they can exert. Bear in mind that not only do these muscles rotate the torso, but they also support the rotation of the spine and stabilize the lower limbs.

Better posture

HT regulate muscle tone by diminishing the excess tone of some muscle groups while increasing the tone of those which lack it. It brings tonic posture equilibrium which translates into a better posture in just a few sessions.

Photo: cdn.lumobodytech.com

Treat and prevent hernias

Photo: medicinenet.com

Hernias are weak areas of a muscle or connective tissue through which an organ or fatty tissue protrudes. 

All hernias (inguinal, ventral, incisional, epigastric, femoral, pubalgia, umbilical, hiatal...) are caused by 2 factors:

·         -An increase in tension

·         -A weak tissue that easily breaks

HT increase core and pelvic strength and activation, which in turn can effectively cope with the high abdominal pressure that any kind of physical effort (even coughing) produce.

Visceral relocation and bye-bye prolapses

It also prevents internal organs from ''falling down''. Gravity, weight lifting and traditional abdominal exercises, push your guts downwards resulting in that typical stomach where the upper part is flat or even hollow but the lower abs look bloated.

Photo: alignmentmonkey.nurturance.net

ingernder.com

The aspiration that HT involve reduces intra-abdominal pressure, which in turn has a suction effect on the pelvic organs, decreasing ligament tension and easily relocating the bladder, rectus and uterus within the abdominal cavity. This has been demonstrated through magnetic resonance imaging (MRI). Therefore, HT are effective in treating organ prolapses, whether uterine, anterior (bladder) or rectal.

Fight constipation

The typical American lacks fiber and exercise, which lead to constipation, which in turn produces intestinal issues like colon cancer. It is of outmost importance to have a plant-based diet and exercise regularly, but HT thanks to the negative abdominal pressure can accelerate bowel movements.

Improved respiratory function.

Photo: selfication.com

HT efficiently work your diaphragm, which plays a key role in breathing, as well as the muscles in charge of inhaling and exhaling, resulting in an improvement of respiratory (peak flow) parameters and respiratory conditions like asthma. This also leads to better sports performance.

Post-partum recovery

After pregnancy the body needs to recover its previous state by toning the core and reinstating pelvic floor rigidity. Unfortunately, it is very common for mothers to maintain abdominal and pelvic flabbiness after giving birth, which leads to poor vaginal muscle tone, unsatisfying sexual relations, flaccid stomach and urinary incontinence.

Say NO to depression

It is known that in order to prevent postpartum depression, an exercise program can be of great help to achieve a feeling of well-being, reduce anxiety and increase self confidence.

A recent study showed that:

• 90% of women had a negative image of their body after delivery

After an 8 week HT program:

• 89.48% felt harmony and a positive impact on their abs and 75% in their pelvic floor

• 64% increase in self-esteem

•40% reduction in anxiety

•32% reduction in cognitive anxiety

• 100% better posture and pain reduction.

In conclusion, HT enhance self-esteem and confidence during pregnancy and postpartum when hormonal changes and various emotional situations occur.

Better vascularization and venous return

During pregnancy, intra-abdominal pressure increases due to the expanding uterus, blood volume and other factors which contribute to the development of varicose veins in the legs and pelvis. HT is known to activate the musculature, ease venous return and improve lower limbs vascularization.

Photo: webmd.com

Scar and surgery healing

People who have undergone surgery or women who have had a cesarean section or episiotomy can benefit from HT as it diminishes myofascial tissue (tissue around the muscle) traction, aiding to heal tissue adhesions and scars.

Abdominal diastasis

Photo: mutusystem.com

Between 30 to 70% of women suffer from abdominal diastasis during and after pregnancy. 

Abdominal diastasis is defined as a separation of about 2.7 cm between the two sides of the ab muscle. During pregnancy the linea alba widens to make room for the baby and, although it should recover after delivery, more often than not it stays distended.

Photo: momsintofitness.com

This gap hinders the integrity and functionality of the ab muscles, causing low back pain and lumbo-pelvic instability. Not only is recovery essential for aesthetics (a broad linea alba leads to a protruding stomach) but it is also vital for maintaining good posture and motor efficiency.

Thanks to the strong respiratory and postural action that HT derive, the core gains back its stability and is able to function again as a corset.

A 2014 study showed that after a 3-month program of weekly HT in 44 women (average age of 45.6) diastaisis is significantly decreased (1.1 cm).

Moreover, the Spanish Association of Physiotherapists (AEF) recommends HT for post-partum recovery. There is a plethora anecdotal evidence of health professionals, midwives and physiotherapists, who advise these exercises and corroborate their benefits. 

Photo: sportlife.com

References

''Abdominal Efficiency and Rectus Separation.'' International Journal of Medical Pharmaceutical Science and Engineering. 7(1), 44-48. 

"About." Hypopresive Techniques. Accessed January 24, 2016. http://hypopresives.com/about.

Apelle R., Bourcier A., Latorre F. (1998). Pelvic floor dysfunction. Roma: Scientific Internacionale. 

Amostegui, J. (1999). Incontinencia Urinaria en la mujer deportista: fisioterapia. Archivos de Medicina del Deporte. 16, (74): 639-645.

''Benefits and basic principles.'' Low Pressure Fitness. 

Bernardes et al. "Efficacy of Pelvic Floor Muscle Training and Hypopressive Exercises for Treating Pelvic Organ Prolapse in Women: Randomized Controlled Trial." Sao Paulo Med. J. Sao Paulo Medical Journal 130, no. 1 (2012): 5-9. PubMed.

Caufriez, M., Fernández-Domínguez, J.C., Fanzel, R. & Snoeck, T. (2006). Efectos de un programa de entrenamiento estructurado de Gimnasia Abdominal Hipopresiva sobre la estática vertebral cervical y dorsolumbar. Physiotherapy. 28(4), 205-16.

Caufriez, M., Fernandez, D., Esparza., S; Schulmann,. D. (2007) Estudio del tono de

base del tejido músculo-conjuntivo del suelo pélvico en el postparto tras reeducación

abdominal clásica. Fisioterapia. 29 (3):133-8.

Caufriez M. (1993). Thérapies Manuelles et instrumentales en Uro-gynécologie. Tome 1. Bruxelles: MC Editions. 

Caufriez M.(1998) Measurements of pelvic floor function in perineal reeducation. Publications of international conference on the pelvis floor. Montreal. 

Caufriez, M. , Pinsach, P., Fernández, J.C. (2010). Abdominaux et Perinée, Mithes et Realitées,MC Editions, Mallorca. 

Caufriez M., Fernández J., Deman C., Wary-Thys C., (2007). Contribución al estudio sobre el tono del Suelo Pélvico. Prog Obstet Ginecol.50, (5):282-91. 

Caufriez M., Fernández-Domínguez J.., Fanzel R., Snoeck T., (2006) .Efectos de un programa de entrenamiento estructurado de Gimnasia Abdominal Hipopresiva sobre la estática vertebral cervical y dorsolumbar. Fisioterapia, 28,(4): 205-16.

Esparza, S. (2002). Efecto de la gimnasia abdominal hipopresiva en el tratamiento y prevención de la incontinencia urinaria de esfuerzo. En: 

Espuña M (coord.) I congreso nacional sobre disfunción del suelo pelviano. Barcelona: Ediciones Mayo; 89-91. 

Espuña, M; Rebollo, P; Puig, M.( 2004) validación de la versión española del International Consultation on Incontinence Questionnaire-Short form. Un cuestionario para evaluar la incontinencia urinaria” Med Clin , Barcelona ,122 ( 8 ): 288-92. 

Fernández, C. (2007). Gimnasia Abdominal Hipopresiva en la 3º edad. Congreso franco español del suelo pelvico y pelviperineología. San Sebastian. Galindo, T.,

Espinoza, A. (2009). Programa de ejercicio en lumbalgia mecanopostural. Revista mexicana de medicina física y rehabilitación. 21: 11-19.

Healthline Medical Team. "External Oblique Muscle Origin, Function & Definition." Healthline. November 4, 2014.

Hunskaar, S., Lose, et al. (2003) Prevalence of Stress Urinary Incontinence in Women in Four European Countries, 2002. ICS: UK. 

Jácome, Cristina, Daniela Oliveira, Alda Marques, and Pedro Sá-Couto. "Prevalence and Impact of Urinary Incontinence among Female Athletes." International Journal of Gynecology & Obstetrics, 2011, 60-63. 

Joulia, F., Steinberg, J., Faucher, M., Jamin, T., Ulmer, C., Kipson, N., & Jammes, Y. (2003). Breath-hold training of humans reduces oxidative stress and blood acidosis after static and dynamic apnea. Respiratory Physiology & Neurobiology, 137, 19-27.

Junquera Landeta, Mikel. "GIMNASIA ABDOMINAL HIPOPRESIVA: BENEFICIOS Y PRINCIPIOS BÁSICOS DE REALIZACIÓN." Fisioterapia Online.

Junquera Landeta, Mikel. ''¿POR QUÉ NO HACER EJERCICIOS ABDOMINALES Y SI HIPOPRESIVOS?''. Fisioterapia online.

Latorre, G., Seleme, M., Resende, A.P., Stüpp, L. y Berghmans, B. (2011). Hipopressive gymnastics: evidences for an alternative training for women with local proprioceptive deficit of the pelvic floor muscles. Fisioterapia Brasil, 12(6), 463-466.

Pinsach, and Rial. "Hipopresivos: Preguntas Y Respuestas." Low Pressure Fitness. May 6, 2014.

Pinsach, Rial, Caufriez, Fernandez, Devroux, and Ruiz. "HYPOPRESSIVES, A PARADIGM CHANGE." COPLEFC. 

Pinsach, P. (2010). Técnicas Hipopresivas, origen, evolución y aplicación práctica. Abstracts. III Congreso Internacional de Ciencias del Deporte y Educación Física. Pontevedra 

Quintana, A. (2014). Práctica de 12 semanas de ejercicios hipopresivos por un grupo de practicantes de fitness. Pte de publicar.

Rett, M.T., Knicker, M., Bernardes, N., Andrade, S. (2009). Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Rev Bras Fisioter., 13(4), 275-80. 

Rial, and Villanueva. "Conceptual Approach to Low Pressure Fitness." Low Pressure Fitness.

Rial T. (2013). Efectos de la gimnasia hipopresiva en la incontinencia urinaria de la mujer adulta. Facultad de Ciencias de la Educación y el Deporte. Departamento de Didácticas Especiales. Universidad de Vigo. Tesis Doctoral. 

Rial, T. y Pinsach, P. (2010). Entrenamiento abdominal e incontinencia urinaria. VI Congreso Internacional de la Asociación de Ciencias del Deporte, Elche: Alicante. 

Rial, T., Ribeiro, L., Garcia, E. & Pinsach. P. (2013). Efectos inmediatos de una sesión de ejercicios hipopresivos en diferentes parámetros corporales. Cuestiones de Fisioterapia, 43(1), 13-21.

Rial, T.; Chulvi-Medrano, I.; Fernández, T. HEMATOLOGICAL RESPONSES OF DIAPHRAGMATIC ASPIRATION ON SPLENECTOMIZED SUBJECT. A CASE STUDY. (2014). Universidad Católica San Antonio De Murcia.

Rial, T., Chulvi-Medrano, I. , Pinsach, P., Navarro, I. "Yes: Low Pressure Fitness Reduce Belly Circumference!" Department of Special Didactics, University of Vigo, 2014.

Rial. ''HOW TO IMPROVE ABDOMINAL DIASTASIS WITH LOW PRESSURE FITNESS ?'' Low Pressure Fitness.

Rial. "WHAT ARE THE ADVANTAGES TO CARRYING OUT LOW PRESSURE FITNESS (LPF) PROGRAM DURING POSTPARTUM?" Low Pressure Fitness.

Snoeck T, Philipot A, Caufriez M, Balestra C. (2009) .Incidence de l´Aspiration diaphragmatique associée à une apnée expiratoire sur la circulation de retour veineuse fémorale: étude par écho-doppler. Kinésithérapie scientifique, 502 : 27-30.

Soriano-Segarra, M.L. (2014). Efecto de la Gimnasia Abdominal Hipopresiva sobre el tono del suelo pélvico y otros parámetros antropométricos y funcionales relacionados con el riesgo cardiovascular en mujeres. Facultad de Ciencias de la Actividad Física y el Deporte. Universidad de Castilla la Mancha. Tesis Doctoral.

Soriano-Segarra, M.L., Corbí, B., & González-Millán, C. (2012) Valoración subjetiva de las mujeres tras un trabajo de Gimnasia Abdominal Hipopresiva. I Primeras Jornadas Nacionales de Psicología del Deporte de la UCAM: Murcia.

Thyl, S., Aude, P., Caufriez, M., Balestra, C. (2009). Incidence of l´aspiration diaphragmatique associée à unites apnée expiratoire south the circulation of retour veineuse fémorale: étude even échographie-doppler. Kinésithérapie scientifique, 502, 27-30. 

Valancogne, G., Caufriez, M., de Gasquet, B., Gullarme, L., Dumont, P. (2001). Reéducation perineologique et pressions dans lénceinte manométrique abdominoperinéales. Congrés de la SIFUD. Lyon.