Tuesday, October 20, 2015

The Core, week 4: Pelvic Floor Muscles

The Core, week 4: Pelvic Floor Muscles

“Because you know I’m all about that bass, ‘bout that bass, no treble” 
(Meghan Trainor's fantastic lyrics from “All about that Bass”)

Abdominal core stabilization is not complete without activating the muscles at your base--a group of muscles located at the bottom of your core. You may know them as “Kegel” muscles. They are your pelvic floor muscles (PFM). They play a role not only in core stability, but also in urinary  function, fecal function, and sexual health.

If you don’t want any “trouble” (such as leaking urine, prolapse, or ineffective core activation) then it's time to learn to use your “base”.

How do they (PFM) make my core stronger?

A strong core gives your spine stability when you move or lift something. The core muscles work together to add pressure inside of your abdomen so your spine is stable. If the rest of your core (diaphragm, abs, and back muscles) are all contracting and adding pressure, but you have no “floor” to resist that pressure, then you get a leak of pressure. This leak at best means you don’t build enough pressure to stabilize your spine. For some, it means you leak urine.



How do I strengthen them?
This is the question we are asked at CTS all the time. The answer seems backwards. Most women I see are not weak because they haven’t done enough Kegels, but because they are Kegeling too much, making their muscles short and tight. Or they are long and weak because they bare down often-straining to poo or pee. Or they have scarring from childbirth that keeps the muscles short. And for both men and women I see pelvic floor muscles that are confused or de-activated after a surgery. So here are my best generalized tips on how to strengthen your pelvic floor muscles.

So where are these muscles anyway!?! This is a front view of a model of a female pelvis with bones and muscles showing. The white represents the bones of the pelvis. The brown is the pelvic floor muscles (PFM). They span from the pubic bone to tailbone. 
Here is a sideview.


1.Relax. Do a diaphragmatic breath that you learned last week. Can you feel your pelvic floor muscles stretch when you inhale? If so, you are doing a good job relaxing.
-Are you someone who holds stress in your pelvic floor? Many people do!  Throughout the day, think about tension levels in your pelvic floor and do a diaphragmatic breath to relax if you feel tension.
-Relax when you defecate and urinate! No straining!!

2. Try a basic Kegel, it works for many people. For women it feels like a closure and lift of the vaginal opening. For men it feels like a slight lift of the scrotum. This is the same contraction you do to stop the flow of urine.
                -How long you hold depends on how strong you are. Start with just 2 seconds and build up to 10 seconds. More importantly, rest completely for 20 seconds.   So, if you are new to Kegels, then hold for 2 sec, rest for 20 sec. Only do 10 reps. Three times a day. These are teeny tiny muscles you are strengthening, so they will fatigue quickly and you won’t be doing good if you try to do all 30 in one set.
                -Don’t hold your breath while contracting. No need to use full force effort to contract, a gentle contraction is all you need. Also, keep your hips, buttocks, and legs still. If you do the contraction right, no one should be able to see that you are contracting :)


Do I contract all of my abdominal core muscles together, or is there a better order?
There is a better order! Stay tuned until next week to learn how to activate the final two muscles of your abdominal core and most importantly, how to coordinate them. For now, get really good at both contracting and relaxing your pelvic floor muscles in isolation so you can use them when needed, and give them the break they deserve when not needed.

Week 1: Let’s get acquainted, Core.
Week 2: Alignment - build the scaffolding to support your weak spots while they heal and repair
Week 3: Diaphragm and what Queen Elsa got right
Week 4: Pelvic floor muscles
Week 5: Transverse abdominis and multifidus muscles
Week 6: Shoulder girdle and hip
Week 7: Functional core exercises
Week 8: Round robin demonstration of CTS Physical Therapists’ favorite core exercises.

Happy Moving!

Crystal Hazelton, PT, MPT, OCS

This article is not medical advice. If you have pain or concerns, consult your physical therapist or physician.