When people start talking with me about movement, it doesn’t take long before the pelvic floor comes up, especially if we’re anywhere near a trampoline. Pelvic floor issues are one of those open secrets in our society; many people have them but most (understandably) are nervous talking about it.
It also doesn’t help that about the only pelvic floor exercise people have experience with are kegels, which aren’t much fun, don’t feel like an exercise, and often don’t really help.
I know I’m going to sound like a broken record, but like with all things, the key to pelvic floor health requires a whole body approach with just a touch of mindfulness. The program that follows is where I start most of my pelvic floor clients, and one which has helped me feel comfortable anywhere, even on a trampoline.
But first, some background info:
What Is the Pelvic Floor?
The pelvic floor is the cohesive structure of muscles and ligaments at the bottom of our torso. It consists of our deep hip rotators, the pelvic ligaments, and most notably the muscles that control reproduction and elimination.
Our torso is made of 3 connected and interacting cavities; the thorax, the abdomen, and the pelvis. There’s no clear tissue barrier between our abdomen and our pelvis (which is really helpful for pregnancy); consequently what happens in our abdomen impacts our pelvic floor, and vice versa. Because of this the pelvic floor should be considered a fundamental part of our core musculature, and any good core program needs to take into account the function of the pelvic floor.
This article is going to focus on another key aspect of pelvic health; how the strength and mobility of our hips impacts the capability of our pelvic floor.
Pelvic Floor Dysfunction Explained
Pelvic floor dysfunction is a term that covers a wide range of conditions which include:
*pelvic organ prolapse (including rectocele and cystocele)
*persistent bladder issues
Basically, any disruption of the smooth function of any of the pelvic organs can be considered a form of pelvic floor dysfunction.
As you can see, pelvic floor dysfunction is a pretty common and complex phenomenon, and there’s no article or program that could possibly address all possible symptoms and factors. As a movement teacher I tend to look at many issues through the lense of movement, and find what we can do at home with our own bodies in order to make an improvement.
In order for your pelvic floor to function at its best, there needs to be balance in the muscles that surround it. Often people will have a too tight pelvic floor that is unable to respond in a variety of lengths and positions (this is why I don’t recommend doing a lot of kegels). Pair that with tight hamstrings, weak glutes and deep hips, and you have a recipe for sneeze pee. If you want to reduce your chances of pelvic floor dysfunction, it helps to have some lower body exercises that strengthen and lengthen in all the right places.
For pelvic floor health, that means squats.
If you’ve ever had a session or class with me, you know I LOVE squats. They’re a fundamental human movement, as much of our hominid birthright as walking, and as a wide class of functional movement squats have the capability of profoundly reshaping our body. Functional squats require (or challenge) good hip, knee, and ankle mobility, hip strength, pelvic mobility, hamstring strength, and sufficient suppleness throughout our lower body. Bonus, as a fundamental human movement, they’re not just an exercise, but a way of living our life!
People in western culture tend not to squat much, which means many people have lost the ability to comfortably rest in a squat position, at least temporarily. However that ability is easily regained; it just takes some practice and time for your body to adapt.
For most westerners the first limitation in their squat is length in the calf and hamstring, which is one reason why I start almost all of my classes with the calf stretch and the double calf stretch.
With the outside edges of your feet straight, hips distance apart, and your weight balanced on your heels, put the ball of one foot on an elevated surface (half dome, rolled up towel or yoga mat, firm pillow, rock, stump, hill, whatever) and take a small step forward. Make sure not to twist your pelvis or arch your back; your upper body should be stable.
Your small step forward may be behind your stretching foot, and that’s fine. Honor where you are today, observe how it feels, and know that you’re making a positive change in your body.
With the same alignment points as the calf stretch and ensuring your pelvis is neither tucked nor overarched, (https://www.cu-movement.com/what-is-a-neutral-pelvis-anyway/) bend forward at the hips. As you do so bring your attention to your sacrum and feel (or watch in a mirror) how it rises as you bend forward. Once you reach the point where your pelvis no longer rotates, stop; this is your hamstring length. You can rest your hands on your thighs to support yourself if you choose.
In this exercise you’ll get into a full squat position, but without having to worry about the strength aspect. This squat prep exercise is great for working the knee, hip, and ankle range of motion needed for a functional squat, and helps to improve the normal range of motion of the sacroiliac joint.
Begin on your hands and knees, and tuck your toes under. Tuck and untuck your pelvis until you feel you can comfortably find neutral. Then send your weight backwards, stopping before your pelvis begins to tuck. Notice how in this photo I’ve maintained my lumbar curve; that’s your goal.
I like to practice this by alternating with a half plank. It’s a super simple sequence that gets a full range of hip motion and is particularly helpful for loosening up after a particularly sedentary day.
As your squat develops, there will likely be a point where you can get yourself in a mostly full squat, but either can’t get your heels down or hold it comfortably for more than a few seconds. Adding a bit of external support can help bridge the gap between “I can squat” and “I can squat easily.” A rolled up towel or yoga mat under the knees takes some pressure off the knees and gives you a bit more support in the hamstrings, and a half dome or something similar under the heels can make you feel stable and strong as you hang out in a squat.
When practicing squats as an exercise, being mindful of your alignment points is an helpful tool in maximizing the benefit and minimizing the risk of pushing too far. For squats you want to maintain the neutral pelvis (note the lumbar curve!) and a vertical shin.
When you want to squat to pick up the floor or garden or to rest when waiting for the bus, of course, all these rules go out the window!
One way to build up the strength in your squat muscles is to get into a squat every time you get into and out of a chair. In this photo I’m playing around with the whole invisible chair thing, but I promise this is how I get into and out of a chair most of the time.
And I’m pretty sure people don’t think I’m too weird.
So…how much should I do?
Short answer: as much as your body feels it needs.
Long answer: there is no short answer.
With restorative exercise we’re working to gradually reshape your body by systematically creating new loads. This triggers adaptations at the cellular level which will make these exercises easier. This means progress in any restorative exercise program will be highly subjective and likely won’t look like progress in other areas of fitness.
My suggestion is to play around with these exercises. If you work out, incorporate the squat prep and calf stretch into your warm up. Even if you don’t work out, stretch your calves and hamstrings frequently throughout the day. When you are taking a movement break (and you’re doing that, right?) throw a squat or two into it. Be more mindful getting into and out of chairs and you’ll work on developing that hip strength that will support your pelvic floor.