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Physio Detective Blog

Are your pelvic floor exercises making you weaker?

Purpose - to challenge your thinking and beliefs...and those of your therapist!
Method - questions and answers, haven't had a chance to look at the research
Summary - my beliefs were challenged...I hope yours are!

***i will add pictures and formatting to this post when I get home 🙂 ***

Do your kegals!
Switch on your core by using your pelvic floor!
Do more pelvic floor to increase your core stability!
A strong pelvic floor will help your back pain!

We have heard it all before...but do you (and your therapist) understand what the implications are?

These are my musings about the hysteria about pelvic floor exercises and how it affects your back pain and performance. I have not read about this mentioned anywhere in the past so if you find resources, please let me know. The closest I have found is Taryn Hallam from WHTA in Sydney...brilliant woman.

Your pelvic floor muscles are the Levator Ani group - puborectalis, pubococcygeus and iliococcygeus. These muscles form the pelvic "sling" that helps keep your pelvic and abdominal organs from falling out your pelvic cavity!

Many people are taught to "use your core muscles" and the pelvic floor is part of the "traditional" "core" - diaphragm, transverse abdominis, multifidus, and the pelvic floor. People have perverted this concept (with good intentions) and now it has come to mean anything abdominal - so obliques and erector spinae are included, it gets called all sorts of names - core, midline, trunk, etc stability. It is all so confusing and hard to keep up with!

So some of the ways that the pelvic floor is used is for continence - good! That is part of its job 🙂

Another cue for the pelvic floor include using it to activate your transverse abdominis and multifidus. But how does that work exactly?

How exactly does the pelvic floor stabilize the pelvis anyway?

And if you have a strong pelvic floor, how hard do you need to contract it to stabilize your back and pelvis? It is taught to back pain patients around the world...but why? Why only 3-30% strength? Does that make sense to you?

1. The pelvic floor attaches from the pubis and ilium to the coccyx/lower sacrum. Assuming your coccyx is intact and sits well with your sacrum, a pelvic floor contraction will cause *counternutation* of the sacrum, meaning it will put your SIJ in a position that is less ideal for stability.
2. If your pelvic floor contracts, it will pull your coccyx and sacrum towards the pubic bone since your pubic bone isn't going anywhere! Well, unless it is broken in two places...then you have REAL trouble!
3. If your pelvic floor is stronger than the muscles that nutate the sacrum (multifidus and erector spinae), then counternutation will occur.
4. If your pelvic floor contraction is met evenly by the nutaters, then you are likely to be in a better position for pelvic stability.

Use your pelvic floor to activate your transverse abdominis or multifidus. This is similar to saying "activate your biceps to make your triceps turn on - don't let you elbow bend!" I think it works because you pull on the coccyx/sacrum from below which produces a counternutation force. The nutaters then activate to resist this.

Have you ever noticed that if you go too hard, stability is not the result? You become WEAKER! I think that is because you have overcome the system and messed up the most efficient way of doing things. Simple isometric testing will show these results.

Ideally, the pelvic floor force should be matched by the nutating forces for optimal stability. Btw, I think it also goes in reverse - a gentle transverse abdominis or multifidus force can help activate the pelvic floor but not an excessive force that stretches out the pelvic floor too hard too fast...

A balanced system requires all components to be within a certain threshold/tolerance. If you focus too much on one muscle group, you can unbalance the system. When you think about it,, the most stable systems have vectors of force stabilizing from different directions. So multifidus extends a bit, the diaphragm, transverse abdominis and pelvic floor flex a bit from different angles. It isn't as simple as that but basically it still fits. There are also side bending and axial rotation planes to consider.

Why is all this important? Because I don't think people realise that excessive pelvic floor (or anything really) is good for your back and pelvic stability.

A. Excessive counternutation is not ideal for loading situations. It is the "loose-packed" position of the SIJ. It causes flexion at the L5/S1 disc (which may be undesirable if you have a L5S1 disc bulge

B. The pelvic floor can help activate the other muscles but I think the reason why "they" always want you to use 30% is so you don't overpower the nutaters or get in the way of the brain. On that point, you shouldn't HAVE to think about activation before doing something...that is a topic for another blog!

C. Make sure your system is in balance. If you are unsure, ask someone who knows...but test them with the stuff in this blog post and these questions.
1. What action does the pelvic floor produce on my pelvic joints? - answer should be counternutation.
2. How does using the pelvic floor gently help switch on the other muscles? - answer should be about pulling in the opposite direction to get the other muscles to resist. This is not proven but I think it makes sense...more sense than other reasons I have heard!
3. Should I just keep doing kegals? Answer - only in conjunction with the other muscles ensuring the whole system is balanced which can be tested using strength tests

All this is just my holiday musings. I will come back and do more reading and make this post all pretty but I wanted this out there to stimulate discussion.

What do you think?

Have you heard these ideas before? Where?

3 Responses

    1. Thanks. Finally found it. Glutes can counteract the counternutation but the attachment is so small. It would seem that the multifidus and erector spinae do the job as well from a long lever arm and more attachment space. Thanks for the reference though 🙂

  1. Kathy E Golic PT

    Christiane Northrup MD presents these concepts as well (though stated differently) in her book The Wisdom of Menopause, suggesting correctly applied squats as an adjunct to the Kegels

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