Pelvic Floor Exercise

Pelvic floor muscle exercises are often very diverse and provide a variety of information regarding the styles and methods you should pursue when seeking to build pelvic floor strength. Some exercise experts will advise pelvic floor muscle training and engagement that actively contracts both your core and your pelvic floor. Their reasoning may seem valid, as we commonly agree that engaging certain muscle groups can help strengthen them, as they contract and release. However, I believe that there is a lot to be desired with this treatment method of exercising the pelvic floor.

In my programs, I always teach my clients how to properly train their pelvic floors to lift and release appropriately depending on the task and load.

When you contract your muscles, you either make them longer (think slow release of a bicep curl) or you make them shorter (as with a bicep curl). In each case, these muscles are contracting in order to gain strength. In some pelvic floor muscle training exercises, such as kegel exercises, you are contracting (making them shorter) and tightening the pelvic floor muscles.

However, what many people may not realize is that with pelvic floor issues like pelvic floor dysfunction or pelvic organ prolapse, these muscle groups may already be too short, overly toned, and too strong. If this is the case, doing pelvic muscle contractions like those in kegel exercises may only increase various symptoms you are already facing.

In order to properly strengthen the pelvic floor we need to train the pelvic muscles to be responsive to load and movement. To contract as needed and to be able to release as needed. Simple blanket statements of “contract and shorten” all the time is a very one dimensional model.

How to Strengthen the Pelvic Floor

Many of my clients have come to me with the same issues mentioned above – an overly short contracted pelvic floor that makes engagement nearly impossible for them. Your pelvic floor helps support the entire pelvic system and much of your body’s weight – that is a ton of load! If your pelvic floor is too short, it makes movement, engagement, and pressure harder to handle. What we want to do is teach proper muscle training exercises to our clients so they understand how to properly train the correct muscles to handle movement and respond appropriately to their actions, exercises, and movements. Kegel exercises which continue to shorten your pelvic floor are incapable of doing this. So, how do we do pelvic floor therapy correctly?

Are you looking for safe and restorative exercises to heal from pelvic floor symptoms?

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Are you looking for safe and restorative exercises to heal from pelvic floor symptoms?

Learn more about the RYC program

Learn More

How to Do Pelvic Floor Exercises Correctly

The first step to improving the way we approach pelvic floor exercises is pelvic alignment. The position of our pelvis greatly affects the tone and strength of our pelvic floor. First, we must ensure that the client is not tucking their pelvis under all the time. If this is the case, the pelvic floor is too tight and will experience muscle fatigue and will be harder to engage. Muscles cannot go through their full range when they are limited based on posture.

The second step is resolving any chronic tension, holding, and hypertonic patterns if there are any present.

Chronic tension, holding, and hypertonic patterns can lead to a host of painful or embarrassing symptoms for many women. Engaging in proper treatment options may help deter the need for future surgery or other more invasive treatment options. Some of the more common symptoms of poor pelvic health include:

• Urinary stress incontinence in women
• Overactive bladder, poor bladder control, strong urge to urinate
• Painful bladder syndrome
• Fecal incontinence, poor bowel control, pain during bowel movements
• Pain or difficulty passing of wind
• Pain around the pubic bone
• Recurring urinary tract infection
• Sexual health symptoms (pain during intercourse)

In this case, it may be helpful for the client to discuss internal exercises with a women’s health physical therapist. In my program, I would be teaching women and men how to properly re-pattern their movements. In some cases this involves kegel-like exercises, but do not focus primarily on squeezing and tightening the pelvic floor.

The next step would be pursuing neutral pelvic arrangement exercises.

Exercises to Realign the Pelvis:

Simply put, we don’t always need to squeeze or tighten the pelvic floor in order to resolve pelvic floor dysfunction or other additional pelvic floor issues. A responsive pelvic floor will lift up with proper core engagement when the pelvis is properly aligned and there is no chronic holding, tight, tension or hypertonic pattern. The passive lifting of the pelvic floor as a result of proper core recruitment is a much better way to train the pelvic floor. Not only that, but just squeezing the pelvic floor only gets to the more superficial fibers and not to the deeper layers of the muscles.

Also, during the day as you move, with a functional pelvic floor – your muscles would lift to support you and the load, rather than squeeze to support you. Yes, that lift does have the same feeling as a muscle contraction but it is not the squeeze tight feeling of a traditional kegel.

5 Pelvic Floor Exercises for Women

Reflexive Breathing

I have discussed this in many of my previous blogs and articles – the importance of proper breathing mechanics. The way we breathe can greatly affect the alignment of our pelvic floor, the way we engage our abdominal muscles, and the load we place on our pelvic floor, especially during exercise.

Many people breathe into their belly when they are exercising. This can cause the belly to bulge and increase intra-abdominal pressure on our muscles and organs. Our pelvic floors are not designed to handle that kind of pressure on a regular basis. Training ourselves to utilize our rib cage when we breathe can help release this pressure and help us reorient our pelvic floors.

The pelvic floor is connected to the function of our core, so when we are looking at resolving a pelvic floor issue we are essentially talking about a core issue as well. Belly breathing is not only hard on the pelvic floor, but it can also make having a functional core very difficult.

To learn more about proper breathing mechanics, considering watching my video covering how to breathe through your ribcage.

Once you have mastered proper breathing mechanics, you can continue on into the next few exercises.

Reverse Marching

Reverse marching is a great beginner exercise that helps engage your core and promote pelvic floor health. To perform a reverse march:

Begin by laying on your back on a yoga mat or other flat surface. It may help to have a neck cushion or a support for your head. It may be helpful to imagine a dandelion in front of you and that you’re trying to blow it out. This helps you begin to work on your breathing patterns to begin the exercise.

It is important to feel a sense of reflexive tightening deep in your abdomen as your core begins coming together. Before you begin the reverse march, it is important that your pelvic bone and your hip bones are positioned in the same plane – a neutral pelvic position. Firmly place your sacrum, the bone your tailbone is connected to, into the mat, this will prevent your hips from shifting as you march. Inhale, and as you exhale and begin feeling that reflexive movement, you want to lift one leg up off the floor. Repeat this movement 5-6 times with each leg, using the opposing leg in succession.

Table Top

Once you master the reverse march, you can then transition into table top while in the same position.

As you come into table top, it is important that you refrain from bulging your stomach, but keep it controlled, contained, and reflexive. To perform a table top: lift one leg at a time into a reverse march until both legs have been lifted off the ground into a neutral position. Slowly place one foot down at a time. Remember the proper breathing method mentioned above while performing this exercise. Repeat 5 – 6 times per set.

Goddess Pose with Side-Bend & Twist

The next move is a goddess pose, which is a standing pose. You want to place your feet wide apart with your hip bones positioned under your shoulders and with your butt back behind you, keeping your weight primarily on your heels. Then you want to lift your arm up above your head and pretend that someone is trying to push you into your side bend movement. You want to feel as if you are resisting being in this position. However, you don’t want to resist with your neck or shoulders, you want to feel this resistance in your core.

Another helpful movement while in the goddess position is twisting side to side. You basically want to approach this with the same idea: slight resistance while being stable and grounded in your position. As you move side to side, you want to feel your whole core activating – your obliques.

Repeat either of the above exercises 5 times on each side and rest.

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fear, pain or discomfort

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Lunge with Twist & Chop

This position requires an important step. While getting into a comfortable lunge, you want to find a neutral pelvis. You want to make sure that your hip bones and your pelvic bone are in the same plane. Our natural tendency is to be pulled forward, so making sure that you’re positioned upright and in a neutral pelvic position ensures correct alignment for the exercise.

Next, you want to lift your arms up with your palms together and inhale. As you exhale, you will then begin to twist and chop (bringing your arms down, together, to your side), once again creating that pretend resistance. Your twisting and chopping should be done from your chest and not from your arms alone.

Repeat 5 – 6 times on each side and rest.