Note: You should consult a healthcare professional before starting this or any exercise program to make sure the movements are right for your needs.
Experiencing low back pain, pelvic pain and discomfort, or leaking urine while exercising? These symptoms can indicate that it may be time to give your pelvic floor some attention.
What role does the pelvic floor play?
The pelvic floor is a group of muscles located between the tailbone and the front of the pelvis that support the bowels and the bladder, but did you know that this is not the pelvic floor’s only function?
The pelvic floor muscles are responsible for the 5 S’s:
- Support of pelvic organs
- Sphincteric control of bladder and bowels
- Sexual function
- Sump pump activity (moving blood/lymph fluid back to heart from the lower body)
- Stability (for the joints of the pelvis and the core)
The pelvic floor, in conjunction with the other trunk musculature, form the “true core.” The stability created from this allows the body to move optimally during all activities but can be of particular importance when exercising.
What does it have to do with exercise?
Have you ever been told to turn on your core or keep a straight spine while exercising? These are common cues that are used in the fitness world, but what effect do those cues have on our pelvic floor and our body’s ability to perform and maintain stability?
To understand the role of the pelvic floor and the “true core” in exercise, we first need to understand the job of the pelvic floor muscles in pressure control. This can be explained through the concept of the pelvic piston.
The pelvic piston
The pelvic piston is formed by the diaphragm at the top, the abdomen and back at the sides, and the pelvic floor at the bottom. As we breathe in, the diaphragm contracts and moves downwards, the ribs and abdomen expand, and the pelvic floor descends, allowing the body to accept the added pressure. As we release our breath, the diaphragm relaxes and moves back upwards, the tummy and ribs return to their starting position and the pelvic floor recoils.
If any portion of this process is compromised, the body’s ability to control movement and manage the pressure changes of breathing, or other additional pressure or loads on the body, may result in the pelvic floor accepting more stress than expected. Just like any other muscle in our body, the pelvic floor musculature can only take so much before problems arise.
Let’s consider the position that the cues of “engage your core” or “keep your spine straight” put the body in. It may change the body’s ability to control pressure and loads efficiently and alter your breathing pattern through disruption of the pelvic piston action.
Now imagine what happens with higher intensity exercise: you breathe harder and faster, and you add load to your body. If you’re not breathing and controlling pressure optimally, the added pressure from exercise will not be distributed properly.
The pelvic floor will be forced to accept more stress than it is designed for and instead take on some of the “heavy lifting” that is better left to bigger muscles of the body. This can result in pelvic floor related problems. Some signs that may indicate a pelvic floor related problem are:
- Lower abdominal pain
- Low back pain
- Urgency to pee
- Peeing frequently
- Urine leakage with activity
- Pain in the pelvic region
- Pressure in the pelvic region
- Bulging of tissues
For more information on the pelvic piston, watch the video below:
6 tips to reduce stress on your pelvic floor when exercising
1. Use a diaphragmatic breathing pattern
Imagine your rib cage as a motorcycle, and the abdomen as a side car. As you breathe in, your rib cage “drives” out to the sides, and your stomach, the side car, tags along for the ride. This breathing pattern allows the pelvic piston to function most efficiently for your pelvic floor.
2. Avoid holding your breath
When performing lifting tasks, make sure to breathe through each repetition. For example, when performing squats, breathe in on the way down. Then, coordinate the breath out to help power back up against gravity. This will help you to move the weight more efficiently and safely while optimizing the strain placed on the pelvic floor.
3. Avoid over engaging your core
While core coordination is vital for optimal movement, abdominal bracing or excessive intentional pelvic floor activation beyond the requirements of the task can cause the pelvic floor to try and take on the added stress of the lift. Leaving the “heavy lifting” to the bigger, stronger muscles of the body can help to avoid added pressure to the pelvic floor that may lead to dysfunctions.
4. Squat inside your body’s range of motion
Perform squats inside your natural range of motion where you can maintain your form. Focus on maintaining your form and range of motion before increasing weight.
5. Keep the normal curvature of the lower back
Your pelvic floor muscles perform better when the spine is in its natural curvature. Keeping a small amount of natural curve to our spine will engage the pelvic piston and balance the forces on the pelvic floor.
6. Optimize your pelvic floor muscle function
The pelvic floor muscles and the pelvic piston system are active with every breath we take, that can be around 24,000 repetitions per day! If we don’t take care of these muscles and use them efficiently, it may lead to complications. A pelvic floor physiotherapist can help you to determine the needs of your pelvic floor and create an individualized program to meet them. Getting assessed may help prevent the potential for future complications or help you to deal with current ones.
To schedule an assessment with a Lifemark pelvic floor physiotherapist, check out our locations page to find a clinic near you or book online.
This blog was written by Katie Humhej, a physiotherapy student at the University of Toronto.