Dr. Ivy Colbert from Empower Physical Therapy is back on the blog today with her top 10 exercises to help strengthen and relax the pelvic floor muscles. Most people don’t realize the significance of the pelvic floor and that lower back, tail bone and nagging hip flexor pain is likely the result of pelvic floor dysfunction. If you haven’t read her first blog post on pelvic floor therapy, I highly recommend going back and reading it! It will help you understand the importance of taking care of your pelvic floor muscles during every stage of life. I’ll let Dr. Ivy take it from here!
Introducing Dr. Ivy
Typically when someone hears about pelvic floor therapy exercises, the first thing that comes to mind is “Kegels”. But there is so much more to the pelvic floor therapy than that! The point of today’s blog is to demonstrate that there is so much we can do to help heal the pelvic floor; and that the exercises we give in pelvic floor physical therapy aren’t just ones that involve kegels lying flat on your back!
The pelvic floor is complex and interacts with the rest of the body. We train the pelvic floor by involving other muscles and joints through functional movement. Although there is no cookie-cutter approach to dealing with pelvic floor issues, there are some exercises we commonly recommend that focus on pelvic floor strength, relaxation, and coordination. Most people don’t realize that you need all three for a healthy pelvic floor. The exercises we review in this blog post will touch on each of these three factors.
The diaphragm, abdominal muscles, and pelvic floor work together like gears; as part of a system. These components make up our core and when they aren’t functioning properly, it can result in low back pain, pelvic pain, urinary leakage, or other issues related to the pelvic floor. Because breathing largely affects the way our pelvic floor functions, it is an important component to take into consideration when trying to improve the health of the pelvic floor. That is why I always start with discussing the importance of breath first because it lays the foundation for how to perform the rest of the exercises.
1. Diaphragmatic Breathing + Deep Core Engagement
Instructions: Imagine there is a ring around your lower ribs. Inhale to expand the ring 360 degrees and as you exhale, blow out as if you’re blowing through a straw and imagine drawing your two front hip bones in together, activating your deep core. Hold your core activation for a couple seconds. Repeat 20 times.
2. Hip mobility warm-up
Having good internal and external hip rotation is important for our pelvic floor muscles to lengthen and contract. This warmup is one of my favorites for increasing hip mobility.
Instructions: Sit on the ground with your knees bent and feet flat on the floor, reclining back on your arms. Keeping your chest facing forward, focus on dropping your left knee in towards the ground and hold for 10 seconds. Repeat with the right knee and hold for 10 seconds. Repeat this exercise 10 times on each side.
Once you have warmed up with the breath and hip mobility exercises, the next six exercises are meant to help with the coordination and strength of your pelvic floor.
3. Elevated Bridges
Instruction: To begin, place your mid-back on your couch or a plyo box, with your knees bent and with your feet flat on the ground and shoulder-width apart. Take a big inhale and then exhale as you lift your hips in the air, keeping your spine as neutral as possible. Then inhale as you lower back down. Complete 2 to 3 sets of 10 elevated bridge repetitions.
Instructions: Stand with your feet shoulder-width apart. Sit your bottom back, keep your chest up and maintain a neutral spine as you lower down; as if sitting in an invisible chair. Straighten your legs to lift back up. You’ll inhale to lower and exhale to lift. Complete 2 to 3 sets of 10 squat repetitions.
5. Lateral Hip Sliders
For this exercise, you will need a slider. If you don’t have one, you can improvise by using a towel on a hardwood or tile floor. Start by standing up straight with one foot on the slider or towel. Begin by shifting all your weight to the standing leg, sit your bottom back and slide the other foot out laterally while maintaining most of your weight on the standing leg. Slide back up to the standing position. Inhale as you lower and exhale to lift. Complete 2 to 3 sets of 10 on each side.
6. Airplanes (Hip Internal and External Rotation)
Instructions: Stand on one leg leaning slightly forward while keeping your opposite leg slightly bent and in the same position at all times. Keeping your chest, belly button, pubic bone in a straight line, rotate your body outwards, back to neutral and then inwards as you balance on your standing leg. Try not to hold your breath. Complete 2 to 3 sets of 6 on each side.
7. Jump squats
Instruction: Begin by standing and as you lower to a squatting position, inhale. Then exhale throughout your push-off and jump, so that you are exhaling on the impact of the jump. Land back in the squat position to absorb the landing and then stand back up. Take a complete breath. Complete three sets of 6 jump squats. Practice landing as softly as possible.
8. Single-leg step up to lunge
Instruction: Step up onto a box or bench and drive the opposite knee upwards. Hold the standing position for a couple seconds to maintain your balance and then slowly lower yourself down to the ground, keeping your pelvis level. Step your opposite leg back behind you to lower into a lunge. Remember to do this slowly and with control. Complete 3 sets of 6 step ups to a lunge on each side.
Not only is it important to have strong pelvic floor muscles, they also have to be able to relax and lengthen as well. If your pelvic floor is too tight and overactive, this can also lead to symptoms such as urinary leakage, pelvic pain, and prolapse. The following exercises help to work on the relaxation of your pelvic floor muscles.
9. Child’s pose
Instruction: Sit your bottom back on your heels, rest your forehead on the ground and reach your palms out in front of you. Focus on relaxing your jaw, neck, and hips. As you inhale, imagine breathing into the space between your hips. As you exhale, allow everything to collapse and relax. I recommend 3 to 5 minutes in child pose after completing your exercises.
10. Legs up on the wall
Instruction: Scoot your bottom as close to the wall as possible and place your legs up vertically on the wall. Allow your legs and pelvis to unweight and relax. Breathe into the space between your hips. Staying in this position for at least 3 to 5 minutes relaxes your pelvic floor and can be very beneficial for lower back pain.
While these exercises can be done at home to help improve the strength and health of your pelvic floor, there is no “one-size-fits-all” approach for treating pelvic floor dysfunction. Everyone has different levels of strength, different issues, medical history and certainly, our recommendations for exercise and treatment can vary based on our evaluation of these factors. Therefore, as pelvic floor therapists we cannot say, “If everyone does these 10 exercises, everyone will get better!” One certain exercise may not be appropriate for where a person is at in their stage of healing. And for others, an exercise may not be challenging enough to progress. As physical therapists, we evaluate individual strength, alignment, joint mobility, flexibility, movement patterns, breathing mechanics and pelvic floor coordination. From there, we find it beneficial and more effective to prescribe individualized exercises based on how a person presents at an evaluation.
During a pelvic floor therapy session, we perform bodywork to ensure that the body is aligned, pelvis is balanced, muscles are relaxed, and joints are moving well prior to doing the prescribed exercises. This sets our clients up to get the most out of their workout. After everything is moving well, we then train the range of motion through therapeutic exercise and something we like to call “neuromuscular re-education” 🙂
Lastly, if any of these exercises result in any pain, pressure (vaginally) or leakage, we advise you to stop and seek the help of a pelvic floor physical therapist.
We hope this information was helpful! If you are in San Diego and interested in seeing us at Empower Physical Therapy, please do not hesitate to reach out! We’d love to chat.
Learn more about Dr. Ivy and Empower Physical Therapy – https://www.empowerphysicaltherapy.net/about