By Admin
Disclaimer: I’m a PT and a Pilates instructor. Often, patients ask if Pilates is the answer for their pelvic floor dysfunction. You know that old saying, “Kegel-ing all day, keeps the urine at bay.” Well, unfortunately, this is not always true. At times Kegel-ing can make actually make your symptoms worse, be it urinary urgency, frequency, incontinence or pain! Sometimes these type of symptoms are due to the pelvic floor muscles being too contracted. Since a Kegel is a contraction of your pelvic floor muscles, you can see how contracting muscles that are already too contracted may exacerbate symptoms. Take a look at Liz’s post to get a little more info.
So, since that’s a bit more settled let’s get to the purpose of this post: Pilates exercises for the short/tight, or in other words, too contracted pelvic floor. Pilates provides a breadth of repertoire that focuses primarily on contracting or “up-training” pelvic floor muscles along with the rest of the “core” to do certain movements. However, even though all of pilates repertoire may not be appropriate for all people, there are some helpful themes and sequences that can be beneficial when performed safely and precisely.
Since most of pilates is uptraining, i.e. tightening your pelvic floor muscles, I’m going to first introduce some downtraining exercises, i.e. lengthening/relaxing your pelvic floor, as a baseline for movement. I found in teaching that starting from this baseline actually improves students understanding of the pelvic floor and success in the practice. Also, it challenges the assumption that most of us have loose/weak pelvic floors that we need to strengthen, when the actual problem is lack of awareness (*more on this later blogs).
Please note: Although these exercises are primarily directed towards those with tight or hypertonic pelvic floor musculature they can provide awareness training for any pelvic floor, big or small, tight or loose, weak or strong.
Disclaimer: None of these exercises should increase pain or symptoms. Feel free to limit the range of motion/movement to what is tolerable and outside of pain. If you are unsure please seek advice from your physical therapist or a rehabilitation pilates professional who has experience with pelvic pain.
Since most of us don’t have pilates studio in our house I’ll be going through some exercises that can be done at home on a yoga mat and with small props as necessary. Considering setting aside ~ 10 minutes to give yourself the time to focus and experience the exercises.
Breathing
Purpose: improve awareness of breath and mobility of the body when breathing
Start lying on your back with your knees bent feet flat on the floor with shoulders broad and palms turned up.
Feel the weight of your body on the floor and sense your breath moving in your body. As you inhale feel the rise and as you exhale feel the fall. Where does the breath go? Just observe this for a few moments…for many people this movement happens at the collar bone and upper chest, for others it’s softly in the belly or sometimes even shared between both areas. Now we are going to send the breath into other areas.
Do you know how big your lungs are? Do you know they are not only in the front but in the back too? They are actually longer on the sides and in the back then they are in the front.
See if you can breathe wide, try putting your hands on the sides of your rib cage and feel the movement, wide and down into your fingers. Try this for a bit…
Now see if you can breathe back, try putting your hands or a small folded towel behind your midback to feel the movement of your back ribcage. Some imagery that can be helpful here: Imagine you are creating deep groves in the sand with the expansion of your rib cage and it washes away as you exhale…or the imagine your back ribs are like the wings of a lady bug that are lifting and lowering.
Get the idea, there is so much movement in the rib cage that we barely even use.
Now we are going to try some belly breathing. Same start position. But place your hands on belly.
Inhale wide and easy. Just follow where the breath goes. Which hand moves more?… See if you can allow the bottom hand to fill up a little more, like a big Buddah belly. Try this for a couple breaths…as you feel like you can fill up your belly, can you send the breath a little lower, just down to your pubic bone. Allow the breath to flow all the way down to your belly and pelvis then back up again. Easy inhale, easy exhale. Now you may feel some movement in your low pelvis. With your inhale, feel an easy stretch of your pelvic bowl (i.e. your anus, or vagina or scrotal area), and with you exhale, feel an easy recession. No problem if you don’t sense anything right away, just keep breathing. If you do feel this easy stretch then see if you can start sending you breath down and wide towards your perineum between your sit bones. You can try sending it more towards the front- vagina/ base of the penis, or towards the back- anus. Just allow it to be easy. Continue for 5 minutes or so.
Take a moment just to feel if the ease or tension has changed in your body and specifically in your hips and pelvic floor area.
Pelvic Clocks
Purpose- to improve awareness and mobility of the pelvis, hips, lower back and related muscles, i.e. pelvic floor muscles.
Pelvic clocks are used in many exercise regimens, whether you know it or not. You can do this exercise on your back with your feet flat on the ground, broad shoulders, palms on your hips.
NEUTRAL
Essentially the idea is to move you pelvis in a full circle, or through all the numbers of the clock. Let’s get started. Feel your pelvis resting on the ground beneath you. Feel the heaviness of the right back pelvis and the left back pelvis. Feel where you pelvis starts to make contact at the base of your sacrum, and where it curves away, at your tailbone. Generally you want to be in your “neutral” or “neutral zone” where you are evenly balanced right to left and forward to back.
Now see if you can start rocking your pelvis easily forward and backward. Slowly rock your tail under, feel your low spine press into the ground and your tail lift a little. This position in Pilates is called an “imprint” or “flat back.”
EASY ROCK BACKWARDS, “IMPRINT”
DON’T SQUEEZE BOTTOM, KEEP IT EASY AND SOFT
Slowly start to rock you pelvis the other direction, past your start position, you may feel your low back pull off the floor even more. Go slow and easy.
STICK BOOTY OUT A LITTLE, PELVIS WILL TIP FORWARD, LOW BACK WILL COME OFF FLOOR
Continue to go slowly and easily between these two positions, ideally your legs, feet and buttocks are relaxed and you feel as if your bones are just rocking back and forward. Let’s call the “imprinted” spine 12 o’clock, and the booty out position 6 o’clock. So now you’re rolling easy between 12 and 6 slowly and comfortably. Start with only doing about 5 or so.
Now pause in the middle of 12 and 6, so you’re back to your start position, or perhaps at the center dial of your clock.
Slowly tip your pelvis over to the left, your 3 o’clock. You should feel weight come off of the back right pelvis, and become heavy on the back left pelvis.
Then slowly come back to the center. Now, tip your pelvis slowly over to the right, to your 9 o’clock. You should feel weight come off of the back left pelvis, and become heavy on the back right pelvis.
Now you’ve got your clock 12, 6, 9, 3. Try going slowly and easily up and down and side to side, don’t be too forceful with it, just imagine your bones are moving and your muscles are easy and quiet. See if you can let your legs and feet relax so you’re only moving your pelvis.
If your still not sure take a look at this video.
Once you try this 4-5 times you can now try doing a full circle, or going around the clock. Start at 12, tip over to 3, then 6, then 9, then 12 again. Return back to neutral, then go the other direction or “counterclockwise”, from 12 to 9 to 6 to 3 to 12. Try this 4-5 times keeping your legs relaxed and muscles relaxed. You can take a look at this video if you are completely lost. When in doubt keep it easy and smooth.
Bridging on Wall
Purpose- To integrate your legs and back into pelvic movement to move and massage the pelvic floor muscles.
Start with your feet on the wall, legs bent to ~ 90 degrees. Feel how heavy your pelvis is on the ground and how you can allow your pelvis can sink deeper into the ground and settle.
Now slowly start to tip your pelvis backwards, as if just the bones were moving. Press firmly but softly into your feet and start to roll your pelvis and low back off the ground so your pelvis can hover just off the ground. Let your pelvic floor and hips feel loose, relaxed and easy.
Take a breath there at your top of the movment and slowly start to roll down one vertebra at a time towards the ground. Once one vertebra presses into the ground see if you can lengthen your hips away towards the wall and drop the next one down, and so on and so on. Keep it easy. Try this ~5 times.
Take a look at the video with some additional cueing. Remember, only go as high as is easy and comfortable.
Mermaid
Purpose- To stretch the side body, hips and pelvis and improve expansion of the rib cage and pelvic floor muscles with breathing.
Sitting with your legs in a mermaid position- one leg turned out in front one leg turned in behind.
Or, if this is not comfortable at your hips or your knees you can sit cross legged or on a blanket so your pelvis is above your legs.
Settle into this position for one or two breaths just allowing your jaw, shoulders and pelvic floor muscles to let go. Slowly reach your right arm up to the ceiling, keeping the shoulder easy. Let your left hand provide some support on the ground as you reach up and over to the left. Think about creating more length in the spine then just compressing the left side of your spine. Take a breath intoour right side body and rib cage.
Happy Side Bend (Correct form)
Sad Side Bend (incorrect form)
You can play with going to either side, left and right.
You can also try rotating your trunk slightly towards the ceiling or towards the ground to move the stretch and find more ease. As long as it feels good.
Slow return to your start postion. Once you have completely on side, switch your legs and repeat right to left. If you are in sitting in a criss-crossed position you can switch which leg is on top and repeat the stretch again either side if you’d like.
*You can try these poses daily. You should always feel better or no change in your symptoms. Though you may feel some stretching these exercises should never create more pain. When in doubt talk to your Pilates rehabiliatation professional or physical therapist. For more great exercises to improve pelvic floor mobility check out Casie’s blog on Yoga Poses for Pelvic Pain!
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Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
WOW, thank you so much for sharing this valuable tool for stretching and working out the pelvic floor. I will be adding this link to my site, so that others with pelvic floor pain have some safe exercises to try. Thank you!
Very well done, Britt. I treated PFD in the early days when none of these wonderful tools were available. Thank you.
It can be upsetting when you cannot control your bladder during stressful circumstances, like when you sneeze, cough or laugh out loud. The reason for this can be pregnancy, childbirth, abdominal surgery or being overweight can weaken the pelvic floor muscles which can cause urinary incontinence. Kegel exercises are helpful in regaining the muscle strength.
As a Pilates Instructor and sufferer of pelvic pain (internal pelvic treatment for lavator ani really helped a lot) I appreciate these exercises. I was told not to exercise and to not do Pilates while I focused on relaxing. I appreciate these exercises and will do them when symptoms return. My PT in Beverly Hills, Felicia, was so wonderful. There is a total connection to the mind that I can not explain, but I acknowledge is somewhere buried inside of this tight muscle. I feel the dilators and the manual manipulation really helped, and for me so did Wellbutrin. I suffered a car accident where I have a L4/L5 disc bulge and she tells me this is common so we do massage first for 30 mins, then she does the manual manipulation. Sex was almost always tight or a bit painful as a young adult and I was diagnosed with many unconfirmed UTI’s. I even had fibroids removed due to pain, which I now question if that was needed as they were small. The book Headache in the Pelvis was recommended, and if it weren’t as think as the Bible I would be through it 🙂 If you have other exercises please let me know xoxoxo
Hi, This comment is to” Summer”. If you happen to see this, I wanted to ask about your internal Pt for Levator Ani .I was told my local (and long term PT) that my rectal pain (sitting pain etc) could be helped with internal work on those muscles. This was painful. I saw her for a couple years hsd some minor improvement through her work and re-assuracne etc. (esp the “Headache in the Pelvis “) which applies to the emotional part of my pain. My question is did your PT help eliminate your pain in the Levator Ani muscles (ie anal rectal) area? And how long did it take? I know we are all different. I was still in pain after a couple years of PT so, I am seeing a new PT who found a structural /spine alignment issue. He has given me exercises. His approach is quite different .Just wanted to ask you about your healing experience, as I’m making some decisions about my treatment.. Thanks so much in advance and I hope you are well!
I will definitely be doing these for the floor! Just watching your videos makes me feel better..
Thanks for sharing.
Physical therapists can receive extra training in pelvic floor dysfunctions that enables us to palpate the pelvic floor muscles vaginally and rectally. This allows us to determine is muscle flexibility and tone are WNL, but muscle weakness is the primary problem affecting continence. The other side if the coin which the author was addressing was problems where the muscle flexibility is not WNL and this limits the client’s ability to effectively strengthen. Pilates instructors and athletic trainers are not able to assess this specifically, but they should be aware that many clients do not know how to relax the PFM and may not be able to do this without some physical therapy intervention. It is also helpful to know therapists that do this work for referral purposes.
See I was told I jave dysfunction with tight muscles but then also have issues of urine leakage when coughing or sneezing. Is it.possible to stretch and strengthen the pelvic floor without causing flares?
Author Britt Van Hees says:
Thanks for the question. Often when a muscle is too tight it can’t do it’s job right. Healthy muscles need to be able to contract and relax/stretch to work properly. It sounds like your pelvic floor muscles are too short/tight and thus cannot contract enough to stop urine leakage. In this case, it’s a great idea to do these relaxation exercises to lengthen the pelvic floor muscles. This allows the muscles to return to their normal length and actually work better. Generally relaxation exercises do not cause flares or pain. If you have any increase in symptoms you should stop doing the exercise and check with your physical therapist.. I would not recommend any pelvic floor strengthening exercises right now for you if you have a short/tight pelvic floor.
As a Pilates Instructor and sufferer of pelvic pain (internal pelvic treatment for lavator ani really helped a lot) I appreciate these exercises. I was told not to exercise and to not do Pilates while I focused on relaxing. I appreciate these exercises and will do them when symptoms return. My PT in Beverly Hills, Felicia, was so wonderful. There is a total connection to the mind that I can not explain, but I acknowledge is somewhere buried inside of this tight muscle. I feel the dilators and the manual manipulation really helped, and for me so did Wellbutrin. I suffered a car accident where I have a L4/L5 disc bulge and she tells me this is common so we do massage first for 30 mins, then she does the manual manipulation. Sex was almost always tight or a bit painful as a young adult and I was diagnosed with many unconfirmed UTI’s. I even had fibroids removed due to pain, which I now question if that was needed as they were small. The book Headache in the Pelvis was recommended, and if it weren’t as think as the Bible I would be through it ? If you have other exercises please let me know xoxoxo
Can someone progress to more advanced exercises after these examples if they are treating a tight pelvic floor?
Author Britt Van Hees says:
Hi Christopher,
Good question. If muscles are too tight, i.e. treating a tight pelvic floor, then it is more appropriate to do lengthening and relaxing exercises so that the muscles can return to a normal resting position. Advancing strengthening exercises would only make these muscles tighter and exacerbate your symptoms. Take a look at Exercises for a Short/Tight Pelvic Floor as it is focuses on improving mobility of tight pelvic floor muscles. Also, check in with your local pelvic floor PT if you have more specific questions.
Thank you!
So glad to have found this article and excercises. I’ve been taking Pilates reformer classes for five years now and it is the only excercise I truly love! In November I have a small intestine twist that I had to have surgery for and have recovered well from that. For the last month I’ve experienced low intermittent stabbing pains ~ worried that I was heading down the same path I saw my Dr that did my surgery today and that outcome was that I was having pelvic floor spasms. My first thought was nooooooo I’m not going to give up Pilates! I know we do many things in class to strengthen the pelvic muscles. Thank you for showing that these excercises that I already do are the ones that will help me. I’ll speak to my 2 teachers about what I can adapt in class so I don’t make these muscles tighter. Again thank you ~ what a relief not to give up reformer!
Hello..
I would just like to ask if any of you know what exercise is the best for a pregnant women who had a CS before. I failed at a Pelvimetry Test that was why I had undergone a CS when I gave birth to my 1st child. Now, I would really like to deliver my 2nd baby normally. Can anyone help me with this problem?
Thanks!
Author Britt Van Hees says:
Thank you for asking Zulicka. Generally the pelvimetry test does not limit you from given birth vaginally, but it can play a role. Remember, a C-section birth still counts as giving birth, it isn’t less “normal” then vaginal birth. That being said, if you would like to try giving birth vaginally I would recommend you work with several practitioners. First, you want to find an MD who works with moms who are interested in VBAC (vaginal birth after cesarean). It can also be helpful to find a midwife to help with coaching and positioning to aid during labor. A pelvic floor physical therapist can help you develop your ability to bulge (lengthen your pelvic floor muscles and contract your abdomen) and perhaps take a look at your pelvic bones to determine their mobility. Feel free to give the office a call if you have any specific question or need referrals.
good day
i am a male that is 23.
i have problems passing stool because i have pains in the rectum.i feel the urge to go however i cant,also have frequent bladder and pelvic pains in the groin area. what would you suggest
Hello,
We recommend being evaluated by a pelvic floor physical therapist,. You can use the link below to find one in your area.
https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/
Regards,
Admin
Thanks for these gentle exercises though!!!!!!