The elusive pelvic floor.  Maybe you’ve heard your instructor mention this before, or maybe this is an all new term.  Bear with me, but this piece of anatomy is important! You may not be aware of it, but it’s there, working for you all the time.  The pelvic floor is a group of muscles, ligaments, connective tissues and nerves that sit like a hammock in the bowl of your pelvis that support your reproductive and pelvic organs.  A healthy pelvic floor supports the bladder, rectum, and in women, the uterus and vagina.  The pelvic floor helps these pelvic organs function.  On a slightly more fun note, a strong, healthy pelvic floor also contributes to increased sexual sensation and orgasmic potential 😉

Great, now we all know about our pelvic floors and want ours to be healthy and strong, but why and how does this come into play for exercise? Are we supposed to be purposefully isolating and exercising the pelvic floor? Does that cause any other problems?

First up, how to find those muscles.  They are deep internal muscles, but they can be isolated and consciously controlled.  One way to find these muscles as a test, is to stop the flow of urine briefly when you are peeing.  This is just an exercise to find those muscles but isn’t an exercise you want to continue doing as it can irritate your bladder.  If you’d like more tips on finding your pelvic floor muscles visit the site Pelvicfloorfirst.org.au.

Now that you’ve found them, do we want to purposefully exercise just the pelvic floor?  In the late 1940’s and 50’s, Dr. Arnold Kegel prescribed exercises that isolate and tone the pelvic floor to help prevent stress incontinence (unintentional loss of urine when a stress like coughing, laughing, or exercise is introduced) in women after childbirth.  But he later found that most women (and we include men these days) can benefit from a strong pelvic floor. Commonly known as Kegel’s, these exercises are simple clench and release exercises of just the pelvic floor muscles and have been used by many to try to achieve better tone in the pelvic floor.   So what’s the problem? Not everyone has a weak pelvic floor – sometimes dysfunction can be caused by a tight pelvic floor, or sometimes it is tight and weak.  Isolating and continuing to tighten these muscles will exacerbate the issue. Dysfunction can come in many forms – sometimes it is incontinence, pain when engaging these muscles, or pulling of the pelvis out of alignment – if you suspect that your pelvic floor is not functioning normally, then it is best to see a specialist to isolate what issues you may be dealing with.

The approach to pelvic floor exercises that most resonated with us came from Shari Berkowitz, a master Pilates instructor and bio-mechanics specialist.  Basically, like any muscle or muscle group, you never want excessive tension.  Tension doesn’t equal strength, and having a very tight pelvic floor does lead to issues and imbalances in the pelvis.  She eschews the practice of isolating exercises, like traditional Kegels, for a more integrated approach.  The body doesn’t work in isolation – it isn’t enough to have a strong pelvic floor if it isn’t working in the right way with the other muscles in the torso.  The pelvic floor muscles should work naturally if the torso is aligned and if the muscles of the abdominal and back are also strong. But as Shari says, “you can do all the exercise in the world (including Pilates) and it might not help you be healthy and functional.  It’s about what you’re doing and how.”

Shari goes on to explain what is really going on in the torso and how an imbalance or wrong firing pattern leads to weakness in the pelvic floor.

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“You see, the health of the pelvic floor is utterly reliant on the balance of muscles in the torso. Utterly. [T]here is a balance and coordination of the muscles that create and maintain intra-abdominal pressure. They include: the pelvic floor muscles (PF), transversus abdominis (TA), multifidi (M) and the diaphragm (D). If these 4 muscle groups work in good coordination with each other, barring any surgeries or traumas to the PF (including the natural trauma of the labor of childbirth and unnatural episiotomy {cutting of the perineum}) then there is no problem. However, if there is imbalance…and then misfiring…problems occur.”

 

Another resource we found helpful was an article from Bruce Crawford, director of the Center for Pelvic Floor Medicine in Reno, Nev. He is a board certified gynecologist, pelvic floor specialist, and the creator of the Pfilates Method of pelvic floor rehabilitation (www.pfilates.com), a plyometric pelvic floor fitness training program. Crawford is also creator of the VESy System of pelvic floor rehabilitation (www.vesylab.com).

He echoes Berkowitz’s thoughts on training the pelvic floor in integration with other muscles of the core.  He includes strengthening and training the abdominals, gluteals, lower extremity adductors and external hip rotators as well.  Crawford gives a great example,

“It is a basic principle of conditioning to engage a muscle in a way that challenges its natural purpose. It would be absurd to attempt to rehabilitate the quadriceps by having the patient sit in a chair and contract his quadriceps over and over again. Rather, we would recommend the patient perform a series of movements that engage the quadriceps naturally.”

Crawford has developed a method that specifically addresses rehabilitation of the pelvic floor, but he sites a study done in 2010 by Culligan et al. published in the International Urogynecology Journal, that reported on a randomized trial of 12 weeks of pelvic floor muscle training in comparison to a Pilates exercise program found that both groups demonstrated greater pelvic floor strength with no significant difference between the groups.

Crawford also emphasizes the Pilates tenet that all movement starts from the powerhouse (core).  If you can learn to move correctly in your exercise, then you can take these principles into daily life motions to not only maintain balance, but continue to tone correctly.  Crawford offers this example, “for instance, it’s possible to learn to use the squat to change the way one moves from a standing to a seated position. If this can be habituated, we have automatically introduced 50-70 reps of improved pelvic floor contractions daily. I believe that once patients learn to move differently – from the core – they may no longer require a separate program for pelvic floor fitness.”

How do we keep all this in mind in our Pilates, Gyrotonic, or Yoga program? Correctly using the pelvic floor muscles to draw in and up with the abdominals, in conjunction with your other core muscles should prevent the feeling of bearing down and adding extra pressure to your pelvic floor.

Knowledge is power and now you can go forth and achieve the pelvic floor tone you never knew you wanted!

Sources:

Shari Berkowitz: https://theverticalworkshop.wordpress.com/2013/06/14/at-long-last-the-pelvic-floor-article/

Bruce Crawford: http://physical-therapy.advanceweb.com/Features/Articles/Pilates-and-the-Pelvic-Floor.aspx