Pelvic Floor Exercise

Pelvic floor exercise routines are often very diverse
in 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 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 pelvic floor 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 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 floor to be responsive to load and movement. To
contract as needed and to be able to release as needed. Simply
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 – overly short contracted pelvic floor that make 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 the client how to properly train their pelvic
floor to handle their movements 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 this correctly?


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 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. 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 Re-Align 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.