The Pelvic Floor: The Unsung Hero of Your Core
If you’ve frequented Pilates classes enough, you’ve likely heard a teacher cue you to “engage your pelvic floor.” What does that really mean? And how do you know if you’re engaging it correctly?
We don’t often go into detail about pelvic floor engagement in class because 1) it’s a complicated and lengthy explanation, and 2) it’s an intimate topic! Some instructors don’t feel comfortable talking about it, and many clients aren’t ready to get that vulnerable in a group setting, either. That’s one of the reasons we brought Physical Therapist and pelvic floor specialist Lea Klein on board at The Pilates Collective last year.
Lea works one-on-one with patients to educate them about their pelvic floor, including the muscles that encompass it, how to properly engage it, and how to apply what they’ve learned to everyday life. It’s the kind of thing that, once you’re aware of it, you’ll see how it connects to every movement you make.
So what is the pelvic floor, anyway?
If you think about your pelvis like a bowl, the pelvic floor muscles lie on the very bottom. They stretch across the bony structures like a hammock, supporting the genitals and urinary system and holding the abdominal organs. Though we most commonly hear about the pelvic floor in women in conjunction with pregnancy, men have one too! And it’s equally as important as in women.
In addition to being the support system for the entire base of the pelvis, the pelvic floor muscles are part of the deep core. They are essential in sexual function as well going to the bathroom. And they are also essential for not going to the bathroom—being able to “hold it” when necessary.
If the pelvic floor is too weak, we can experience sexual dysfunction, incontinence, and in extreme cases, an inability to make it to the bathroom in time. A weak pelvic floor can also result in pain in the surrounding areas, such as the lower back and hips. Unfortunately, the most likely cause of a weakened pelvic floor is a common one: pregnancy.
Pelvic Floor During Pregnancy
When a woman is pregnant, the increased blood volume and the weight of the baby puts extra pressure on her pelvic floor. Her body also increases production of relaxin, a hormone that relaxes the ligaments in the pelvis and allows the cervix to widen in preparation for childbirth. After the baby is born, the pelvic floor is stretched and may take time to regain its strength. It’s commonly recommended that women practice Kegel exercises after giving birth to recoup strength.
For people who are not recovering from pregnancy, however, maintaining a healthy pelvic floor is about more than strengthening.
“Most of the time,” Lea explained, “for males and for females it’s actually all about coordinating the pelvic floor so it can be strong when it needs to be strong but also relaxed when it needs to be relaxed. So it’s really about the muscle going through it’s full range of motion.”
If we focus exclusively on strengthening the pelvic floor, we risk tightening it too much. Like any other muscle in the body, a pelvic floor that is overly tight is as unhealthy as one that is overly weak. This is the case for many of Lea’s male patients: it’s more common for men to have an overly tight pelvic floor than an overly weak one. When this is the case, it may cause painful bowel movements and urination. In extreme instances, it might be uncomfortable just to sit down. For these patients, Lea recommends yoga poses to relax and stretch the pelvic floor, specifically happy baby pose.
For both women and men, the key to a healthy pelvic floor is the coordination Lea described. The last piece of that puzzle is tying pelvic floor engagement in with breath, specifically with the diaphragm.
Lea uses the image of making coffee in a French press. “When you inhale, the diaphragm descends and the pelvic floor drops and relaxes.” Picture pressing down on the plunger of a French press to lower the filter. “Then when you exhale, the diaphragm comes up and the pelvic floor follows.” Imagine lifting the filter of the coffee press. The exhalation and lift of the diaphragm makes more room in the abdominal cavity, allowing the pelvic floor to lift into that space.
If we do a reverse breath, attempting to lift through the pelvic floor as we inhale, we’re pressing the diaphragm and pelvic floor towards one another, creating intra-abdominal pressure and bearing down on the pelvic floor. This actually serves to weaken it rather than strengthen.
How to Properly Do a Kegel
All of this culminates in the magic exercise to achieve the balance of a healthy pelvic floor: the Kegel. Here’s the proper technique Lea suggests:
1) Take a big inhale, allowing your belly to expand as you pull air in and letting your pelvic floor relax.
2) On a slow exhale, engage your abdominals and pull up through your pelvic floor. Imagine it lifting up like the dome of a jellyfish.
She recommends exhaling and lifting through the pelvic floor for a full 10 seconds if possible. If you run out of air, it’s ok to gently inhale. If your pelvic floor fatigues before 10 seconds, keep that amount of time as your new record to beat, so to speak. Repeat 10 times.
Then do a second version of the Kegel to work the fast twitch muscle fibers:
1) Exhale and quickly engage your pelvic floor for 1-2 seconds.
2) Inhale and quickly release for 1-2 seconds. Do 10 times.
To integrate pelvic floor engagement into everyday life, Lea encourages the practice of a “pelvic brace.” She describes this as a subtle drawing in of the pelvic floor, glute muscles, and muscles around the spine. She recommends practicing this slight engagement often during the day, such as every time you go from sit to stand, when you squat to pick up the laundry basket, when you walk up the stairs, etc.
With enough practice and awareness, we can train our pelvic floor muscles to engage in just the right way and at just the right time without consciously thinking about it. This not only keeps the pelvic floor healthy, but also allows it to support the rest of the body, reducing back pain and hip.
Lea acknowledges that physical therapy isn’t just for people with injury or dysfunction: it can also serve as a means of deepening the understanding and coordination of your body. Have questions? You can reach Lea directly at lea@kleinphysicaltherapy.com.