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Happy pelvic floor: exercise prescription and progression


Pelvic floor dysfunctions like pelvic pain, incontinence, urgency or pelvic organ prolapse can result from a weak or overactive pelvic floor muscle. In either situation, pelvic floor is inefficient to perform its function,and needs assessment and treatment.


It is important to know the baseline through internal assessment, i.e. the strength and tightness of the pelvic floor, so it is treated appropriately


A tight or weak pelvic floor muscle can be compensatory response to an dysfunction in another area of your body. I have seen cases where a weak hip abductor or a poorly aligned foot, even a thorax, can impact the pelvic floor function. It is critical, thus, to do a full-body assessment to get to the bottom of the issue.


I am giving here a progression to patients who have been assessed and are doing some pelvic floor exercises.



 

For an overactive or tight pelvic floor, use the following:


CONNECTION BREATH

Breathing into your belly, as simple as it may sound, is a very important way to relax the diaphragm and create a slow relaxation response in the pelvic floor.


The pelvic floor moves with the breath. It is a very effective way to relax an overactive pelvic floor. If you have pelvic pain or urgency because of overactive pelvic floor, take help from your diaphragm!


Women tend to breath into their chest and, pain or urgency can result in shallow breathing. It's important to intentionally breath into your belly 4-5 reps each time, multiple times in a day to relax the pelvic floor.


OBTURATOR INTERNUS STRETCH



Obturator internus is a part of inner thigh muscle group. It is an effective stretch to relax the pelvic floor that can be done lying on your back or while standing. Draw your knee up, and then out. In the same flow, draw your foot up and in and hold the pose for 30 seconds. 1 repetition for each side.


Connection breath (described above) while doing this stretch helps further relax the pelvic floor muscles.







CALVES ON A CHAIR



This is great for decreasing pressure on perineum (very useful in case of pelvic organ prolapse) and generally releasing tension in the pelvis.

Your lower legs should be parallel to the floor, and feet are level with your knees.

This position is also ideal for connection breath to create relaxation of pelvic floor muscles.



  • PLIE SQUATS




Plie squats in combination of breathing helps in relaxation of pelvic floor muscles.

It's important to remember the breathing pattern for this squat.

As you go down, notice the stretch in your inner thigh and continue to breathe deep into your belly. As you come up, breathe out.

7-10 repetitions, twice daily.











4 POINT FLEXION/ EXTENSION (CAT/COW STRETCH)



On all fours: breathe in, allow your spine to sag towards the floor while looking up with your neck and lengthening the pelvic floor and rectus abdominis.

As you breathe out, slowly round your spine towards the ceiling, activating your multifidus, and tucking your head in.













 

For a weak pelvic floor and pelvic organ prolapse, use the following:

CONNECTION BREATH

The pelvic floor moves with the breath.If you have weakness in pelvic floor muscles, take help from your diaphragm!

When you do forceful or resisted breath out ( blowing a candle), it helps in activation of pelvic floor muscles.

It's important to intentionally breath into your belly and the breathe out like blowing a candle 4-5 reps each time, multiple times in a day to strengthen the pelvic floor.





KEGEL'S EXERCISES

Pelvic floor contraction (lying down on your back) with the help of cues like:

  • Pull the vaginal muscles in and up

  • Pulling the pubic bone and tailbone together

  • Pulling the sit bones together

  • Lifting a marble or blueberry into the vaginal space

Common mistakes when performing a pelvic floor contraction are breath-holding or straining, or using compensatory muscles such as the glutes, adductor (inner thigh) muscles or abdominal wall. Pelvic physiotherapist assesses your pelvic floor contraction to know if you are performing them correctly. Once there is a good contraction, its time to progress in different positions like:


  • All 4's

  • Cat- Cow

  • Dead bug

  • Downward bog

  • Bridge

  • Sitting

  • Sitting with rotation

  • Standing

  • Squats

  • Plie squats

  • Lunges

  • Lunges with rotation


Once the contraction is perceivable in sitting, you can also start with core activation with pelvic floor cue. Here is the link to core progression https://www.integrityphysio.ca/movement-progression-for-core-activ


For pelvic organ prolapse, calves on the chair is a very effective reset to be practiced during the middle of the day and end of the day (2 minutes)






I hope this helps and if you have any questions, I am available at:


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