In order to find out the best pelvic floor exercises, we need to understand what the pelvic floor is. Failure to do so is how some treatments fail or only partly work.
To make it simple, I will give an example that you can relate to and then dive into the parallel in the body and proceed with the specific exercises.
Where is the Pelvic Floor?
Imagine a paper bag with a top that translates to the following:
- The bottom of the bag is the pelvic floor muscles and the pelvic diaphragm
- The sides are the side of your
body (abdominal obliques) below your chest bone - The front is the front of your body below the chest bone (rectus abdominis)
- The back is the lower part of your mid-back, lower back, and the back part of the pelvis.
- The 4 corners of the bag are the front and back parts of your hips connected to the pelvis.
- The top of the bag is your abdominal diaphragm.
If you thought you only have one diaphragm, here is another eye-opening fact. Watch the video below to see how the 2 main diaphragms in your torso play a huge role in the health of your pelvic floor and how every breath counts.
We are talking about biological breathing, the type of breathing that all babies innately do. The same kind that creates a strong axial line in the center of your body to build a foundation for all movements to revolve around.
Typically, when it comes to pelvic floor dysfunction, people think of this dysfunction in terms of incontinence, pelvic pain, and pain during intercourse then associate those issues with childbirth, aging, and obesity.
I am going to tell you that this list is only a partial list and therefore, only partly true!! Think about it, how come some women don’t have any issues with incontinence or pain in the pelvic area while pregnant and after child birth? There are plenty of people that are in their fifties (that is the average age that surgeries for these issues take place now) who have no such symptoms.
Now I won’t argue about obesity because that definitely involves the area. Before you get excited about what you just read let me explain something. Incontinence is not always due to pelvic floor dysfunction; for instance, you can have a disc herniation in the lower back where the nerve to the bladder comes from and have issues with incontinence, and then there are plenty of people with pelvic floor dysfunction who do NOT have incontinence.
There are men with pelvic floor dysfunction who are not obese, clearly never been pregnant or given birth, and are younger. So how does this work? Not everyone is a round peg to be pushed into a round hole so remember that!
What Muscles Are Involved in Pelvic Floor Dysfunction?
Now that you understand where the pelvic floor is and how you can’t just work on the ‘floor’ of the bag and expect the magic to happen, let’s identify the areas and muscles connected to them since those are the exercises we need to work on. These muscles include:
- Pelvic floor muscles such as Levator Ani, the sphincters muscles, and the Perineal muscles
- Front area: Rectus Abdominis
- Side area: Transverse and oblique Abdominis
- Back area: Iliacus, Psoas, Quadratus Lumborum, Multifidi
- Corners: Obturator, Quadratus Femoris, Pectineus, Adductors, Abductors, Hamstrings
Then, of course, we have the connective tissues and ligaments that keep the pelvic bones, the bones of the spine, and hips connecting to the pelvis joints intact and together.
In order to properly and fully address pelvic floor dysfunction, all of these areas have to be addressed. Don’t get distracted by this partial list of muscles that you now know about. The nice thing about them is they work in groups (but when it comes to movement, there is a sequence of an order they follow) and so there are plenty of great exercises that will address them all.
One thing I want you to know is that pelvic floor dysfunction can show up not in incontinence only, but in cases with chronic lower back pain, mid back pain, hip(s) pain, pain in the front of the pelvis, or any part of the pelvis including the sacroiliac joint and SI joints.
What Type of Exercises Are Best for Pelvic Floor Dysfunction?
The best exercises are the ones that involve the whole body moving while the ‘spot’ light is on specific body parts! If movement is a concert, the body parts are musicians and while the spotlight can be on let’s say the pianist, the other musicians still play their part. Right?
Well, the problem is that in our society we, for some reason, isolate the area of pain, stretch, strengthen, do ‘stuff’ to it, and then let it go to ‘play’ with the rest of the playmates, aka, body parts. That is partly why treatments don’t last (the other part is many times people don’t do what they spent time and money learning to do to better care for themselves).
The best type of exercises are Developmental Kinesiology exercises following the principles of Dynamic Neuromuscular Stabilization (DNS). I know, that was a lot of mumbo jumbo but you can click on those words and read what I wrote about them.
Now that we know what type of exercises are best for pelvic floor dysfunction, let’s see what exact exercises will give us the best outcome.
What Are the Best Pelvic Floor Dysfunction Exercises?
We need to use our knowledge about the human body function to our advantage here, which starts with proper breathing. Proper breathing is not something someone, somewhere came up with. Proper breathing is what we innately did during the first 3-4 years of life. That means we are programmed to breathe like that, it’s a simple fact!
If all babies, regardless of our many differences, breathe the same way, then we are designed to breathe that way and that design is essential to everything else including our movements. This type of breathing established a strong ‘barrel’ and midline, head to toe, and allowed for strengthening of the body parts built on the 2 sides of that ‘line’ in which movement could be built against. Axial line strength is a huge first step to ALL musculoskeletal issues and yes your pelvic floor dysfunction is a musculoskeletal issue.
Here is a video on how to do that and where you get introduced to the pelvic diaphragm which is just above the muscles of the pelvic floor!
For pelvic floor muscles specifically, you know about kegel exercises. I don’t know about you, but after doing about 10 of them (when I remember and that should be, let me think, once or twice a YEAR), I am done. The best way to do it is to just cut to the chase and use the Emsella machine which is FDA approved to treat incontinence by working on the pelvic floor muscles by producing kegel exercise contractions.
I have this machine and use it for all of my patients with pelvic floor dysfunction and that means plenty of people without incontinence. This machine produces 400 kegel contractions a MINUTE. That is more than one per second!!
The other exercises are all the DNS exercises related to stabilizing the neck and torso. If your stabilizing muscles, located in the front, sides, and back of your neck and torso, are doing their job then the arms and legs can do their jobs. When the stabilizers don’t do their job and the lower or upper extremities have to ‘help out’, then they have to do their job and the stabilizer’s job(s) and that is when the dysfunction happens. Here are a few examples of these exercises that, btw , you already know because between the ages of newborn to about 4, you were doing them and doing them perfectly!!
These are all related to building the lower abs, stabilizing the ‘barrel’, and coordinating movement with breath while moving the upper and lower extremities. We did them when we were 3-4 months of age and yet doing them right now is much more difficult than they seem.
What I want you to get from this blog is to not limit yourself to working on just the bottom of the bag, but on every part that is connected to the bottom. Remember the bottom is not free-floating and should not be looked at with a single lens!
Pelvic Floor Dysfunction is a lot more prevalent than people realize. All sports injuries specifically, ballet, dance, skiing, and snowboarding are sports that put us at a high risk of the legs going from under us and should be assessed for pelvic floor dysfunction. They don’t lead to incontinence but do set the seeds for issues related to pelvic floor dysfunction.
What Are the Worst Pelvic Floor Exercises?
Now that you understand pelvic floor dysfunction and the structures that are involved (including the ones that influence the floor), you need to work on the whole area in movement and not in isolation!
No abdominal crunches, abdominal obliques, no glutes, no upper legs, no hips, no IT bands, no muscles in isolation but all in movement. Remember, babies never go to a gym to use a dumbbell, kettlebell, bands, or resistance bands; they automatically do the moves necessary to not only strengthen the developing muscles but to work on the neurology behind every move. You are programmed to do it that way as if that is the app you come programmed with and cannot delete from you.
When proper preventative and palliative exercises are not done, drastic cases such as prolapse can occur. Hemorrhoids are an example of such prolapse and should be looked at as a potential sign of pelvic floor dysfunction. To learn about the surgical intervention in those instances, listen to my podcast interview with Dr. Sam Siddighi, a Female Pelvic Reconstructive Surgeon from Loma Linda, Riverside, CA.
Remember, your decisions impact your health directly. Think outside the box because the way we have been looking at things has not worked and is getting worse.
Dr. Shakib
