The Pelvic Floor and Core musculature

The pelvic floor muscles form the base of the group of muscles commonly called the ‘core’.  These muscles work with the deep abdominals, back muscles and the diaphragm (breathing muscle) to support the spine and control the pressure inside our chest cavity and pelvic region

During exercise, the internal pressure in our chest cavity changes. For example; when lifting a weight – the internal pressure increases, when the weight is put down – the internal pressure returns to normal.

In an ideal situation the regulation of pressure within the abdomen happens automatically. For example, when lifting a weight, the muscles of the core work in synergy with the pelvic floor muscles as they lift, the abdominal and back muscles draw in to support the spine, and breathing is easy. In this scenario, the pelvic floor muscles respond appropriately to the increase in abdominal pressure.

If any of the muscles of the core, including the pelvic floor, are weakened or damaged, this coordinated automatic action may be altered. In this situation, during exercises that increase the internal abdominal pressure, there is potential to overload the pelvic floor causing depression. When this happens many times during each exercise session, over time this may place strain down on the pelvic organs and this may result in loss of bladder or bowel control, or pelvic organ prolapse. If a problem already exists, then pelvic floor symptoms can potentially be worsened.

Pelvic floor muscles need to be reactive to work as part of the core, which means that they need to be able to relax as well as lift and hold. It is common for people to brace their ‘core’ muscles constantly during exercise in the belief they are supporting the spine, but constant bracing can lead to the muscles becoming excessively tight and stiff.

Pelvic floor muscle stiffness (hypertonic pelvic floor; muscles in a constant state of contraction) commonly coexists with core musculature weakness and can contribute to problems such as urinary urgency and leakage.  Other problems often associated with the pelvic floor muscles being too tight include pelvic pain and chronic lower back pain. In fact Pelvic Floor Dysfunction has been found in the majority of women suffering with chronic lower back pain.

What causes Pelvic Floor Dysfunction?

• Childbirth- during childbirth these muscles can become strained or even torn

• Age and Atrophy- As we age these muscles can become weaker via the decreasing in actual muscle tissue and lack of stimulation

• Habitual- Sitting at as desk all day leading to bad posture and sub optimal muscle length tensions (the amount of tension that is produced by a muscle as a feature of it's length)

Does Pelvic Floor Dysfunction or Back Pain Come First?

It’s not always clear which comes first. A major role of the pelvic floor is to help stabilise the core and lower back, so if there is a weakness in either the core musculature and/or lower back stabilisers and extensors, the pelvic floor muscles are required to assist the prime movers and can become overly fatigued. This can overwork the pelvic floor, causing ‘synergist dominance’ (assisting muscles becoming main movers) to form in the muscles and creating additional symptoms. In other cases, the pelvic floor dysfunction may have come first and altered the spine's mobility and stability, thus triggering low back pain. Either way, there is a feedback loop where low back pain and pelvic floor dysfunction reinforce each other. Both must be addressed for full resolution of symptoms.

How to strengthen our Pelvic Floor?

Directly training our abdominal muscles won’t result in a stronger pelvic floor, and as already discussed, the pelvic floor works in multiple synergies, each having a direct bearing on the other. Therefore a holistic approach to strengthening these muscles must be adopted. We are only as strong as our weakest body part, and if we narrow that down still further; we are only as strong as our weakest core muscle, it becomes clear that we must prioritise training the pelvic floor in conjunction with our deep core musculature (transverse abdominis/multifidus/internal obliques) in order to create and maintain a movement system that works cohesively and in harmony with one another.

Kegel exercises focus on tightening and holding the muscles that control urine flow.

To perform this exercise:

• Sit in a comfortable position, close the eyes, and visualise the muscles that can stop urine flow.

• Tighten these muscles as much as possible.

• Hold this position for 3–5 seconds. It should feel as though the muscles are lifting up as a result of the squeezing.

• Release the muscles and rest for several seconds.

• Repeat this up to 5-10 times.

Squeeze and release. This rapid movement helps the pelvic floor muscles respond quickly.

To perform this exercise:

• Sit in a comfortable position.

• Picture the pelvic floor muscles.

• Squeeze them as quickly as possible and release them without trying to hold the contraction.

• Rest for 3–5 seconds.

• Repeat this 10–20 times per set.

• Do two sets later in the day.

• Bird Dogs 4 sets 10 reps

• Deadbugs 4 sets 10 reps

• Banded Pallof Press 4 sets 5 reps each side

• Banded Rotations 4 sets 10 reps each side

• Banded Clamshells 4 sets 10 reps each leg

• Banded Hip Bridges 4 sets 15 reps