By Courtney Edgecomb, DPT, PHRC Los Angeles
Even before gyms and group fitness classes closed for COVID-19, I was a big fan of at-home workouts. Don’t get me wrong, I love the community, atmosphere, and variety of equipment available from gyms and classes, but the price can get high and I run like the wolves to avoid traffic or parking in Los Angeles. Some days it is easier for me to wake up in the morning, get my yoga mat and home equipment out, and start moving. I usually select a focus for my at-home workout: core, hips and legs, arms and back, full-body, or flexibility. I also choose the type of workout that matches my mood or energy: strength training, functional movement, cardio, yoga, or stretching. Lastly, I start with high or low intensity, and adjust as needed depending on how the workout flows.
Okay, so you have your workout categories picked out, but then what? It can feel intimidating to pick the series of exercises that match your ideal workout. Should you run through each exercise one-by-one, in a circuit, try a superset, use a timer or count your reps? What happens if you don’t have any equipment? Are you remembering to breathe this whole time? If you don’t have all of the answers, first of all it’s okay, and second take advantage of the millions of online workouts available these days. Confession: I use online videos weekly. And now, I am making one for you.
This 25 minute at-home circuit workout is developed specifically for many of those who are dealing with pelvic health issues: urinary incontinence, pelvic organ prolapse, diastasis recti, pelvic girdle pain, low back pain, sacroiliac joint dysfunction, prenatal and postpartum women, and those who know they struggle with core weakness. It is focused on core stabilization and pelvic floor activation, with functional movements in mind, to teach your body how to engage the diaphragm, transverse abdominis, multifidus, and pelvic floor muscles throughout daily activities. It is low-intensity, but will give your core and glutes a good burn when focusing on the techniques. You do not need any equipment for this workout, however, resistance bands or weights (or babies) may be incorporated. If you are looking for a higher-intensity or longer duration workout, this routine pairs well before a walk or run, before glute-focused strength-training, after a stretching session, or in combination with upper body and back exercises.
Most importantly, have fun and enjoy a movement break! Comment below if you have tried this workout or need help with some modifications. We love to see our PHRC community get active!
Disclaimer: I highly suggest you consult with a pelvic floor physical therapist to see if these exercises are fit for you, as it can exacerbate pelvic pain (or other symptoms) and pelvic floor muscles that are already too tight. However, I will go through some modifications and considerations that may apply. A couple considerations that I want to point out now:
- Diastasis recti: watch for any coning or doming in your abdomen while performing these exercises. If you see coning or doming, focus on coordinating abdominal engagement with your breath. You may need to use one of the modifications. If you continue to see coning or doming, it is best to seek advice for that particular exercise.
- Pelvic pain: If engaging the pelvic floor causes pain, focus only on abdominal engagement with the breath. You may need to use one of the modifications. If you continue to have pain, it is best to seek advice for that particular exercise.
Watch and go through the full workout video with me!
Warm Up:
Perform each exercise for 30 seconds. Additional stretches or activation exercises can be included.
Circuit 1:
Perform each exercise for 1 minute. Take a 10 second break between each exercise. Complete 3 sets of these exercises.
Bridges
Exhale, pull your belly button to your spine (to engage transverse abdominis) and gently lift the pelvic floor. Continue exhaling as you squeeze your glutes and lift your hips up to form a straight line. Inhale as you lower down.
Modifications: Do not lift as high if you have lower back pain during the exercise. Perform single leg bridges for a progression. Place a weight (or your baby) over your hips for a progression. Use a resistance band around your knees to increase gluteal activation. Bring your heels closer to your buttocks to decrease hamstring engagement.
Sidelying Hip Abduction
(30 seconds per side, or 1 minute per side)
Exhale, pull your belly button to your spine and gently lift the pelvic floor. Continue exhaling as you lift your top leg up towards the ceiling, using your gluteus medius (where my hand is on the hip. Inhale down. Keep leg in line with your body and do not let hips rotate forward, this prevents the hip flexors from compensating.
Modifications: Perform with your heel against a wall for proper form and support. Use a resistance band around the ankles for progression.
Dead bug
Exhale, pull your belly button to your spine and gently lift the pelvic floor. Continue exhaling as you lower opposite arm and leg to the floor. Inhale back to starting position. Repeat on other side.
Modifications: Move only your arm or leg at once if the coordination is too difficult, or you cannot keep abdominals engaged. Start in a table top position for a progression. Hold a weight (or your baby) and only move your legs for a progression/modification.
Circuit 2:
Perform each exercise for 1 minute. Take a 10 second break between each exercise. Complete 3 sets of these exercises.
Bird Dog
Exhale, pull your belly button to your spine and gently lift the pelvic floor. Continue exhaling as you extend opposite arm and leg out. Inhale and return to starting position. Repeat on other side. Maintain a neutral spine, and do not let the hips rotate. Keep the shoulders engaged as if punching through the ground. Inhale back to starting position.
Modifications: Move only your arm or leg at once if the coordination is too difficult, or you cannot keep abdominals engaged. Place a broomstick across your back, and keep it there, to watch your form. You may use dumbbells or ankle weights for a progression.
Squats
Exhale, pull your belly button to your spine and gently lift the pelvic floor. Continue exhaling as you lean forward, squeeze your glutes, and stand up. Watch your knees stay over your middle toes. Keep a neutral spine or slight arch in your lower back. Inhale as you sit.
Modifications: Use a resistance band around your knees to increase gluteal activation and to keep your knees from moving inward as you stand. Perform a squat without a chair for a progression. You may also hold weights or your baby or household items (laundry detergent, gallon of milk, etc) for a progression.
Fire Hydrants
(30 seconds per side, 1 minute per side, or 1 minute alternating)
Exhale, pull your belly button to your spine and gently lift the pelvic floor. Continue exhaling as you bring one knee out to the side (yes, like a dog going to the bathroom). Inhale and return to starting position. Maintain a neutral spine, and do not let the hips rotate. Keep the shoulders engaged as if punching through the ground. Inhale back to starting position. Repeat on other side.
Modifications: Place a broomstick across your back, and keep it there, to watch your form. To modify, lie on your back with your knees bent and feet flat on the floor, keep feet down and move one knee slowly out to the side with control. You may use a resistance band for a progression.
Cool down:
Perform each exercise for 1 minute. Additional stretches or foam rolling can be included.
If you are having trouble performing these exercises, are noticing increased symptoms, or are noticing an improvement and think you could benefit from additional exercises, reach out to your pelvic floor physical therapist today. At PHRC, we can discuss your situation, check your form, and teach you progressions or modifications at any of our clinic locations, as well as online via virtual appointments. If you are interested in a personalized home exercise program to fit your pelvic health needs, schedule with me today!
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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 $85.00 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
No equipment? What about the black band? I don’t have one!
Vivan,
These exercises can be completed without the use of a resistance band, however if you are needing more resistance or weight as you move up in your exercise routines, a band can be useful. You can find them online or at a local yoga shop, or even at your pelvic floor PTs office.