Let’s get straight to the point; the pelvic floor is 1/3 of your core. That being said is there any activity or exercise that requires you to NOT use your core? Did you know that when your arm raises overhead you should get core engagement? When you step off a curb, many muscles are working to control the descent including your pelvic floor? Or that when you bend over to lift the toilet seat your pelvic floor should be engaged? Are you wondering what the other 2/3 are still? Don’t worry, we’ll get there.
Wait, so are you telling me I should be walking around doing Kegels with every single thing I do in life? Absolutely not. What I am trying to illustrate is that your pelvic floor matters, male, female, desk jockey, or Olympian. What is also important to know is that pelvic floor engagement should be automatic, just like general core engagement. If you’ve had a back injury and you’ve been to physical therapy most likely and hopefully you’ve been taught how to engage your core. Initially this occurs on demand, but you should eventually be taught that your core should engage automatically without having to specifically focus on bracing or stabilizing. This is why exercises geared on neuromuscular control and progressive exercises are so important. No rehabilitative exercise should ever stop at a single plane and should eventually if not immediately mimic what is functional for you in your life. Do you have any idea what your core/spine/trunk is doing when you open a refrigerator door? No? Pay attention next time and take note to see if you’re twisting and using all arms to open the door or if you using a weight shift.
If your body is utilizing proper body mechanics and you’re not hip hinging like a jerk, your core will automatically engage. If you’re not sure, seek out a good therapist or a pelvic health therapist. Progressive exercises are meant to make sure you have the basics and foundational strength to be successful when performing an everyday task. It’s all apart of the big picture. When we move inefficiently we create microtrauma in our body (e.g., macrotrauma = whiplash is a care wreck, microtrauma = disc herniation in your neck from looking down at your phone repetitively). If you're not properly utilizing your core you are not stabilizing your spine efficiently. *Insert entire other blog post about the importance of preventing microtrauma and protecting your spine*.
Okay, are you ready for the other 2/3? The other 2/3 that work in beautiful harmony with the pelvic floor? Dun dun dun, it’s your abdominal muscles and the diaphragm. So imagine this. When you exert force (whether you’re poopin’ or deadliftin’ or pickin’ up a child), what keeps your guts from falling out of your body? Well yes, there’s the skin, and other things, but there is a big ole’ hole in your pelvis which without would make childbirth a tough[er] situation. Your pelvic floor makes a basket like structure that supports all your internal organs (a.k.a, viscera). It attaches to several structures like the tailbone/spine/pelvic bones, and hip bones. It’s a large beautifully designed group of muscles that are very strong, but become very neglected in our culture from postural lifestyles and lack of body awareness. So we are set up to have a propensity for pelvic floor weakness, overactivity (think like when your shoulders get too tight when working at a desk), or just poor utilization of the muscles that are there (neuromuscular control). Okay, so we have a pelvic floor that may or may not be set up for vulnerability. How do we protect it? You have to tap into the beautiful harmony of a true core contraction that is made up of coordination between the pelvic floor, abdominal muscles, and diaphragm. Who, what, when, where, and why? Let’s go though a basic coordination exercise:
1. Take a big deep breath and let the bottom of your lungs and belly fill with air. Forcefully exhale. Your stomach should flatten’ish as your diaphragm pushes the air up and out of the lungs.
2. Now, engage your abdominal muscles. You are not sucking in or crunching down. Think about the way your stomach tightens when someone throws a ball unexpectedly to you.
3. This part takes a little more effort. You’re going to engage your pelvic floor (or Kegel). The basic way to do this is engage the muscles you’d use to cut off the flow of urine. Make sure you booty muscles aren’t engaging, but your sphincter will be contracted (think classroom setting during a test and you’re trying to keep one from squeaking out...by one I mean a fart). Make sure you have completely relaxed and there is not tension remaining in your pelvic floor muscles. If you have trouble with this I recommend you practice relaxing as this is a major source of pelvic floor dysfunction for a lot of people.
4. Now the part you’ve maybe been waiting for: You are going to inhale nice and deep then as you exhale contract your pelvic floor. Go ahead, I’m waiting. Okay let’s do it together, ready? Inhale, exhale-contract pelvic floor for a count of 4 - 3 - 2 - and 1. Wait, what about the abdomen? Try is again and notice if your abdominal muscles naturally engaged? If they did, awesome! If not, try a few more times and if needed revisit abdominal bracing and then purposefully add it into your sequence. After a few rounds try doing it without intentionally contracting your abdomen and see what happens.
This is just one of many ways of coaching your pelvic floor. If you feel like it’s not resonating with you maybe seek out a professional. There is also ton of resources on YouTube, but beware. Lots of good stuff, but lots of well meaning not great stuff. You can always follow me on Instagram @firephysicaltherapy. I have several quick little instruction videos regarding pelvic floor engagement/kegels and other body mechanics videos. Half the battle is just knowing. Now that you know the world is your oyster! Not really, but you’ll be much less susceptible to issues related to incontinence, painful intercourse, premature ejaculation, pelvic organ prolapses, and oh so much more.