Do Squats Strengthen Pelvic Floor Muscles?

Resources

Resources

Do Squats Strengthen Pelvic Floor Muscles? Insights for Movement Professionals

By Lauren Ohayon 07/30/2024

6 Min Read

If you’re a movement professional and work with clients who have pelvic floor issues, you may have encountered questions from them about whether squats or kegels are better for their pelvic floor. You will be able to easily answer those questions once you’ve finished reading this article.

Table of Contents

The Pelvic Floor and its Functions

The pelvic floor is an essential part of multiple systems in the body–respiration, elimination, and reproduction. While the state of pelvic floor education among the general public is much better than it was several years ago, your clients may not be aware that pelvic floor function extends beyond not peeing when they sneeze. Thanks to the popularity of devices like the Elvie and the Perifit, people are aware that the pelvic floor muscles can be trained. What they may not know is how to train them effectively based on their unique bodies’ needs.

A little pelvic floor strengthening history may be appropriate to introduce here: Before the Elvie, there was the Kegel (popularized with the idea that “100 Kegels at a stoplight” keeps the pelvic floor in good condition). During the mid-late 2010s, a counter-Kegel movement argued in favor of squats instead of Kegels. In fact, both are useful exercises for the pelvic floor. Rather than frame Kegel vs. squat as some sort of contest or debate, I prefer to help my clients understand the mechanisms of both within the context of a whole-body approach to pelvic health. Instead of answering the question of whether squats are good for the pelvic floor with a yes or no, I tell them that learning how to squat effectively is part of good pelvic floor maintenance.

The Pelvic Floor Muscles in Detail

The pelvic floor sits at the base of the trunk, and it is involved in supporting all of the functions of most of the organs that are contained within the pelvic cavity. They directly affect the bladder, uterus or prostate gland, rectum and lower digestive tract. The pelvic floor muscles are also part of the core system and coordinate with the abdominal and back muscles to stabilize the spine as you move throughout the day. The pelvic floor muscles are also part of the respiratory system, moving in coordination with the diaphragm to help modulate intra-abdominal pressure.

In the diagram above, you can see how the pelvic floor supports the contents of the abdomen. Not visible is the connection between the muscles of the pelvic floor and the hip joints and glutes or the muscles connecting the pelvic floor and the torso; these connections are essential to pelvic floor function. And this is where the squat vs. Kegel “debate” comes from–Kegels are essentially a concentric contraction followed by relaxation of some of the pelvic floor muscles, whereas squats can eccentrically load the pelvic floor muscles – strengthening them in a lengthened position. This is a vital movement for the pelvic floor and is not achieved by doing Kegels, which is why squats are so beneficial for pelvic floor health.

Squats as a category ask multiple muscle groups in the legs to work together. The challenge for movement professionals is to be able to identify whether their clients have the strength, mobility, and core engagement strategy to move in and out of the squat without compensating. Breath-holding, bearing down, needing to support their weight with the arms, and of course leaking urine, are some indications that the load of the body and/or any additional weight used exceeds what your client is able to do.

A note on breath-holding and bearing down: One of the major factors in pelvic floor dysfunction is intra-abdominal pressure. As movement professionals specializing in pelvic health, our goal is twofold:

Help our clients learn how to move better
Teach them to better manage intra-abdominal pressure

This management includes developing a strong, supple pelvic floor that can withstand increases in intra-abdominal pressure. Such increases occur during various activities, including running, jumping, and even sneezing.

How Does Exercise Affect the Pelvic Floor?

Our goal as movement professionals is to guide our clients in supporting their pelvic floor muscles within the context of their preferred exercise and daily activities. Almost any exercise can have positive effects on the pelvic floor, provided the client doesn’t generate excessive intra-abdominal pressure during execution. Exercises, like squats, bridges, and exercises like heel slides that engage the deep core musculature, are particularly useful for strengthening the pelvic floor. Others, like child’s pose and psoas release can help the pelvic floor relax.

The pelvic floor needs to be able to withstand load, e.g., to retain urine while running, while also yielding to some loads, such as during childbirth. We can all agree that exercise is generally beneficial for the pelvic floor. However, in some cases, intense physical activity may lead to pelvic floor muscle overactivation. Many athletes who engage in strenuous exercise present as having overly active pelvic floor muscles–this is sometimes referred to as hypertonic pelvic floor or tight pelvic floor muscles. If you are working with a client who says they have tight pelvic floor muscles or cannot relax their pelvic floor muscles, you will need to focus initially on helping them relax their pelvic floor. If the muscles are overactive, they will not be able to relax enough to contract when needed.

The muscles of the pelvic floor are integral to the body’s interconnected system, not an isolated entity. They interact with and are influenced by other muscle groups and structures throughout the body. I often encounter clients whose tight shoulders and upper body affect their pelvic floor function. While this article focuses on squats and their role in pelvic health, the best approach to pelvic floor function is a whole-body approach.

Squats in Pelvic Floor Health

Squats are a major component of most strength training programs for good reason, and variations on the squat appear in all kinds of exercise modalities, including yoga, pilates, and dance. Squats engage multiple muscle groups at one time, and they are a functional exercise. Almost everyone makes a movement that resembles a squat, even if it’s only sitting down on and getting up off the toilet. While deep squats might not be immediately accessible to everyone, most individuals can learn a modified version. Gradually increasing strength and range of motion through squat variations is a straightforward process.

Using a modified squat as a starting place for people to get their glutes engaged can help your clients start developing a mental map of their body in space. Developing this skill will help your clients tune into other parts of their body, and can help them recognize when something feels off and needs medical attention.

Proper Squat Technique for Pelvic Floor Health

These guidelines are general recommendations; your particular clients may need assessment by a medical professional if their pelvic floor symptoms increase or are so severe that they are unable to perform the modified movements without discomfort.

The traditional deep squat is not always recommended for people with pelvic floor dysfunction–not only because it may increase symptoms, but they may lack the strength and mobility to execute it well. The squat variations below build strength and pelvic floor responsiveness. These exercises are given as part of a comprehensive exercise program that includes other movements for strength and mobility.

Vertical Shin Squat

If your client cannot balance well standing away from a wall, begin with the vertical shin chair squat variation below. If your client is practicing on their own, ask them to use a mirror so they can check their form. Otherwise, instruct them as follows:

Stand with feet parallel and a little wider than pelvis width apart
Bend your knees and rest your hands on your thighs
Really stick your butt out–make sure they’re lifting the sit bones, not tucking the pelvis
Don’t let the ribs sink and collapse
The lifting of the butt is going to put the glutes on a big stretch as you strengthen them–that’s what your pelvic floor needs
Inhale, and exhale as if blowing out candles, so that the abdominals corset in
Then take the hands off, one at a time
Holding this position, check the form before
Pushing down through the legs to come up to stand
Repeat several times
The focus here is on keeping the knees stacked over the ankles (shins vertical) and the butt moving back at the same time
Ribcage should stay neutral–sometimes it can help to cue clients to look ahead a few feet on the floor tucking their chin instead of looking straight forward
Troubleshooting:

Watch out for excessive pelvic tucking or untucking, and check that knees are stacked over ankles.
Notice your client’s breathing pattern and core engagement strategy: are they holding their breath or bearing down? Can you help them find gentle deep core engagement instead?
Cue your client to press down through heels but keep big toe planted firmly to engage the glutes here

Chair Squat

Have your client sit on a chair with their feet parallel and slightly wider than pelvis width
Begin with shins vertical and weight on the stibones (not a tucked pelvis)
Have your client lean forward slightly, hinging from the hips, and press their feet into the floor to bring themselves to stand
Troubleshooting:

If your client moves their feet back so the shins are no longer vertical, you may need to raise the height of the seat so they can keep their knees stacked over their ankles
Have your client look forward as they stand
If they are rocking or using their hands on their thighs, you may need to raise the seat

Raise the “seat” of the chair by adding bolstering until you find a height that allows your client to come to stand with a minimum of extra strain, and have them repeat the “squat” to stand several times

Additional squat variations and preparatory exercises, especially for clients whose joints are hypermobile can be found here.

Alternative Exercises for Pelvic Floor Strength

If squats aren’t suitable for your client, there are still plenty of ways to strengthen and lengthen the pelvic floor muscles. Any exercise that targets the glutes, lateral hips, and inner thighs will help improve pelvic floor function. Bridges, clams, pelvic lists, and variations on all of these exercises are all good choices. The primary goal is not perfecting your client’s squat technique, but rather enhancing their overall well-being. Success should be measured by improvements in strength, mobility, and most critically, pelvic floor function. While a proper squat form is beneficial, the focus should remain on these functional outcomes that directly impact your client’s quality of life and honors their physical abilities.

Integrating Squats into a Pelvic Floor Strengthening Routine

You can best integrate squats for pelvic floor strength into a more comprehensive routine by making them a regular part of your client’s programs.. For a client with limited mobility or stamina, a modified chair squat toward the beginning of your session can be a great way to get their whole body moving. You can follow it with a variety of smaller, more targeted exercises including floor or additional chair work involving the core and upper body.

Clients who have a baseline level of conditioning that allows them to spend significant time on their feet and to get up and down from the floor easily will benefit from squats that come in a variety of forms–you can build a whole sequence around slowly engaging the glutes with increasing resistance from a variety of angles. A basic shallow squat or lunge, followed by some work on inner thigh strength and flexibility (or lateral hip work, or even work with the upper body). Returning to the initial squat or lunge often reveals improved stability and strength. This approach seamlessly integrates pelvic floor work into your client’s routine without drastically altering their existing program.

Remember that taking time to slow down at the beginning or end of a workout can be part of good pelvic health. The pelvic floor responds to emotional stress and tension by becoming more tense; give your clients the opportunity to fully integrate their movement practice before sending them off for the day.

Precautions and Considerations

What to watch out for: if your client shows signs of pelvic floor overload while squatting, lower the load, adjust the angles/depth of the squat, or switch to other exercises that are less demanding. Although the ultimate aim is to build tolerance for heavier loads, focus first on movement quality before increasing weight or range. This approach builds a stronger foundation. Also, keep in mind that your client’s everyday movement patterns might be hindering their pelvic floor function. Addressing these habitual movements could play a crucial role in their overall progress.

Signs of pelvic floor strain due to improper squatting include:

Bearing down or breath holding while performing the exercise
Leaking urine
A sensation of increased pelvic pressure or pain
An increase in symptoms during the days after performing the exercise that does not seem to diminish

Can Squats Strengthen Your Pelvic Floor? Yes.

Your clients should know that they can absolutely use squats as part of their pelvic floor exercise routines, but you may need to guide them to movement patterns that allow them to engage the muscles that influence the pelvic floor correctly. If your client comes to you with concerns about their pelvic floor strength, make sure that you ask them about whether they’ve worked with a pelvic health specialist, such as a physical or occupational therapist or a urogynecologist (for cases of pelvic organ prolapse). If you are going to train your client to perform deep squats, make sure they can handle the additional strain that lowering their body close to the floor requires before adding load. When in doubt, refer them out to a healthcare provider, so that your client can better explain to you what their unique needs are. And if you’re serious about truly mastering the pelvic floor and guiding clients to safely and effectively access it and heal through movement, the Restore Your Core® Professional Training is the training where you get it all.

FAQ

1. Can squats worsen pelvic floor dysfunction in some cases?

Yes, squats can potentially worsen pelvic floor dysfunction if performed incorrectly or if your client has a pre-existing condition. Excessive downward pressure during squats can strain the pelvic floor muscles, leading to or exacerbating issues like incontinence or prolapse. Make sure that clients with pre-existing pelvic floor concerns have been evaluated by a healthcare professional before they begin any new exercise routine.

2. Are there specific squat variations that target the pelvic floor more effectively?

While traditional squats can benefit the pelvic floor, certain variations may engage these muscles more effectively. A shallow, vertical shin squat is more accessible for most people and can help better engage the glutes. A wide-legged squat can also be effective, provided that your client is able to keep their knees aligned with their feet. Variations on a shallow squat that incorporate ankle mobility work can also be very effective for the pelvic floor.

3. How does body posture during squats affect the pelvic floor?

Keeping the spine neutral, avoiding excessive forward leaning, and ensuring knees track in the same direction as the toes can help prevent excessive strain on the pelvic floor.

4. Can pelvic floor strength be measured before and after incorporating squats?

Yes, pelvic floor strength can be measured before and after incorporating squats into your routine. This can be done through methods such as pelvic floor muscle testing by a healthcare provider, using devices like biofeedback tools, or self-assessment techniques like the ability to stop urine flow midstream. Tracking improvements over time can help determine the effectiveness of your exercise routine.

5. Are weighted squats safe for someone with weak pelvic floor muscles?

Weighted squats can be safe for someone with weak pelvic floor muscles if performed with caution and proper technique. It’s important to start with lighter weights and gradually increase the load as strength improves. Consulting with a healthcare provider or physical therapist is recommended to ensure appropriate modifications and to avoid exacerbating any existing pelvic floor issues.

6. How do I know if I am performing squats correctly for pelvic floor benefits?

One of the best ways to know whether you’re performing squats correctly is by feeling the right muscles working: You should feel engagement in your glutes, thighs, and pelvic floor muscles without strain in your lower back or knees. Changes in symptoms can be another indicator: Improvements in pelvic floor function, such as reduced incontinence or pelvic discomfort, can indicate correct performance. And of course, seeking professional guidance: A physical therapist or fitness trainer specializing in pelvic health can provide personalized feedback and corrections to ensure optimal technique.