On Wednesday, I discussed pelvic floor health beyond the commonly prescribed Kegel exercise. But if not Kegels, then what exercises can you do to improve the health of the musculature at the base of the pelvis? The best place to start is attending to your pelvis – specifically, the alignment of your pelvis.
Your pelvic floor works best when your pelvis is in neutral. The neutral position refers to both points at the front of the pelvis (ASIS) and the pubic bone being in a vertical plane. Ideally, practice this alignment of your pelvis several times a day and in as many different positions as possible – sitting in the car, squatting in the bathroom, lying on the floor, standing in the grocery checkout line, or walking in the park, to name a few.
The big issue with chronically maintaining your pelvis outside of neutral position (meaning your pelvis habitually tucks under or sways) is that you are not only affecting the skeletal tissues and all muscles that maneuver the pelvis, but any change in position will also affect the pressures placed on your internal organs. As a result, changes in position of organs will influence the pressure within the pelvis, which will completely change the loading on your pelvic floor. Before you know, you start getting those embarrassing leaks!
Besides restoring your pelvis alignment, you want to look out for training muscles at the back of the pelvic floor, namely your glutes. You gluteal muscles, the tissues attaching to the back of the sacrum (which is also the attachment of your pelvic floor muscles), need to be very strong. Unfortunately, due to our over reliance on sitting in chairs and the constant tucking of our pelvises, the sacrum moves closer and closer towards the pubic bone, continuously weakening the posterior muscles of the pelvis. This results in no butt strength and incredibly tight pelvic floors. The moment you begin to get a ‘’little leak’’ while sneezing, you try to naturally protect yourself from embarrassment and start to ‘’tighten’’ and grip your pelvic floor – developing even more tightness!
If you don’t have strong glutes, walk around with tucked pelvis, use chairs all the time, and avoid squatting- you simply cannot have strong and pliable pelvic floor.
The Kegel itself is not bad – my issue with Kegels is that they are not understood correctly and are just a tiny piece of whole-body issue that pelvic floor disorders often stems from. As a quick fix, your Kegel treatment might be a balm – but as a long term solution, you really need to begin to ‘’think all around the pelvis’’ and invite your gluteals to give you a full architectural support for healthy functioning pelvic floor.
Try this super-effective exercise, shown in the video below, to strengthen your glutes while working on neutral pelvis at the same time.
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I hadn’t considered that glute strength would affect the pelvic floor, but now that you’ve pointed it out – it makes total sense. Trying the exercise right now! I also like rolling the sacrotuberous ligament. It’s nuanced but helps me feel more at ease in my pelvic floor.
As growing attention is focused on women’s health, there’s been an evolution in the understanding in pelvic floor. I don’t think Kegel exercises are bad but as mentioned, often they are poorly understood. Many women are prescribed Kegel exercises but then they are left alone doing them with no one assessing if they are being done correctly or not. Internal pelvic floor assessments are crucial in understanding how the tissues are actually behaving, if they hyper/hypo tonic, and provide information to give proper treatment. There are many exercises and yoga asanas that can actually strengthen the pelvic floor but it requires breaking down the posture or changing the posture so that it emphasizes not only the muscles of the pelvic floor but the ones that stabilize the pelvis.
It never ceases to amaze me now that I know that strengthening the very thing you think should be strengthened is actually the opposite. The glutes that support the pelvic floor is such a great reminder to start at that place instead of trying to over stretch or over stimulate the muscles that are supporting the pelvic floor. I appreciate the video as well!
Good article! There is still a lot of work to be done to educate people.
Wonderful information, I’ve learned so much about the pelvic floor with my pre/post natal yoga pregnancy training, and this will add to the knowledge I already have, being well informed is important for self and for helping others.
For sure Kegals are not (the only) answer! When I went to a PT post birth I discovered that my PF was too tight. I had good strength in my PF, but global pelvic muscles such as my gluteus and adductors were weak. I worked on strengthening those areas as well as releasing my PF. At a certain point my PT had me do Kegals, but in the context of working on the release, not the squeeze.
This is a great exercice even for proprioception of the pelvis… so many people can’t tell or feel how their pelvis is positioned.