Pelvic Floor Training Beyond Kegels
One of the biggest things I’ve learned the last year is that pelvic floor rehab doesn’t need to be BORING. Once you’ve mastered the basics, it’s time to get on our feet. Because that’s where life happens.
Pelvic floor contractions (kegels) definitely have a place, but shouldn’t be the ONLY thing within your rehab program. Maybe you need them, maybe you don’t (a Pelvic Floor PT is super helpful here). You also may need to learn how to perform a pelvic floor contraction correctly and coordinate with your deep core system. On the ground at first, but then - WITH strength work.
Postpartum I dealt with a lot of leaking/urgency issues, low back pain, an extremely tight pelvic floor, etc. I’m in such a better place now using these strategies, which is why I’m so eager to learn and share about pelvic floor rehab, progressive loading, and supporting moms in their return to sport and #momlife activities.
What does pelvic floor training look like?
There are so many ways we can train the pelvic floor without actually realizing it, and without a ton of kegels ;) As a coach I take a whole body approach to strength training for postpartum mamas. The pelvic floor doesn’t work in isolation.
Summary of topics covered:
Yielding and Overcoming Activities (Dynamic training): because many moms want to get back to jumping, running, and higher impact, I touch on this first ;)
The rib cage: how the rib cage and pelvis are deeply connected
Happy Hips for a happy pelvic floor
Hip shifting and glute length
Core training and pressure
The Feet
While I don’t cover it specifically in this post, the “stack” is also something to explore.
Pelvic Floor Training Beyond Kegels
1.Dynamic Activities:
When progressing pelvic floor work I like to work through:
Breathing and Position: being able to feel the pelvic floor lengthen and initiate an exhalation from the bottom up
Isometrics: learn how to lengthen and contract the pelvic floor under load without compensating
Absorb Force:
Facilitate a pelvic floor contraction as you yield into a movement. Almost “catching” yourself with a bit of stiffness
Absorb force in preparation for jumping activities (getting ready to rebound again)
Propel: propel forward with a responsive pelvic floor
In today’s post, I’ll focus on Yielding and Overcoming activities.
What is the difference?
Overcoming: max effort of force. There is a ton of tensioning in the body, almost like pulling up against an immovable object. The movements tension your big muscles so the little ones (like your pelvic floor) can let go. These moves are great for people that are more narrow and mobile (like a lot of mamas) to create stability.
Overcoming —> Force production/distribution —> internal rotation —> build tension and pressurize the core canister to stiffen connective tissue
Example: Standing up from a squat. We need to drive through the ground to push ourselves up.
Yielding: Instead of moving against an immovable object, you are “letting things go” and letting yourself lengthen / relax into something. Yielding is learning to accept energy, making the connective tissue more compliant and "elastic.” There’s less overall force output and more holding against gravity.
Yielding activity —> getting sinky, accepting energy —> force absorption
I like to think of yielding activities in terms of lateral lunge hops/skaters, chops, drop catches, etc. From a pelvic floor perspective, you are essentially thinking about adding the exhale to facilitate a pelvic floor contraction as you land in a more lengthened position. Exhale and “catch.”
While these are movements we can work up to and build confidence around, it’s important that we progress up to movements where we can trust our relationship with the ground.
Where do these types of movements apply in everyday life?
- Taking a quick step off a curb
- Catching a flying baby (it happens)
- Playing tag with your kids at the park
Check out this Instagram post for a breakdown.
More dynamic pelvic floor work with overcoming and yielding examples in this post.
2. The rib cage and rotation
The whole body is deeply connected, and it’s so important to also consider what’s happening at the rib cage when thinking about pelvic floor symptoms.
Most mamas I see have a very narrow rib cage. This often means there is a lot of pressure pushing down because there’s nowhere for it to go up top. We need to create space in the upper rib cage to allow the lungs to fill on inhalation: front to back and side to side.
I often utilize different breathing positions to create the expansion in the right place so we can actually breathe and take a good inhale, and exhale without “crunching down” so to speak. It’s very common for the external obliques and rectus muscles to take over! Instead of exhaling to get “the ribs down,” I think exhale to “bring the ribs back.” We can then reinforce this within our strength training.
Strength training is inherently compressive, but integrating breathing + mobility within your strength work can be a game changer. Also helpful if you’re short on time.
Similar to the pelvis, our ribs have the ability to move into an externally rotated position (inhale) and an internally rotated position (exhale). We need that reciprocal motion to occur in daily movement both at the rib cage and the pelvis. This keeps our hips, shoulder, and pelvic floor happy too.
Check out this Instagram post for a breakdown.
Check out this Instagram post on why the rib cage may be the missing link to Pelvic Floor symptoms.
I have found that thinking about the rib cage and movement up top throughout strength training has made a huge difference. I feel more OPEN after lifting vs tight and locked down.
Why rotation checklist?
Movement up at the rib cage directly impacts what’s happening at the pelvis / pelvic floor.
Unlock major mobility gains. One of my favorite ways to breathe AND train at the same time.
Facilitate compression AND expansion in different parts of the rib cage. We need expansion in order to move into that area.
When the rib cage can move and expand you can also get a better inhale/exhale, which also impacts your pelvic floor and overall pressure pressure management.
Check out this Instagram post for more.
3. Pelvis and Rotation
The hips and the pelvic floor are BFFs. They share many important muscular attachments and are so close to one another in the pelvis.
When it comes to hip rotation we can think about both internal and external rotation. Having access to both leads to a happy pelvic floor and improved movement quality. Sometimes we have greater range in one vs. the other and have differences side to side. An easy visual is to think internally rotate (knees in) or externally rotate (knees out).
Postpartum we often find ourselves with more external rotation at the pelvis and tight glutes. This is often accompanied with a lack of hip internal rotation. When we lack internal rotation at the pelvis, we often compensate down the chain, like a knee that caves in, or a foot that rolls towards the ground. Unlocking internal rotation will unlock so much for moms, and help address any lingering niggles.
I personally love training closed-chain exercises when looking at the hip (we do want both!)
- Closed chain: foot is stable. Think pelvis-on-femur rotation. I love this specifically because it helps lengthen the glutes and hip rotators and opens up the posterior pelvic floor muscles to lengthen, which typically feels really good. You can utilize these movements for lengthening purposes and/or strengthening depending on the goals and exercise.
- Open chain: Femur-on-pelvis rotation. the foot is not secured allowing the ball to rotate in the socket
At the pelvic floor:
Hip internal rotation ➡️Pelvic floor muscles become taut and ascend
Hip External Rotation ➡️Pelvic floor muscles on slack and descend
Assessing BOTH of these hip ranges is important for a happy pelvic floor.
Below are some examples of pelvis-on-femur rotation (closed chain). Progressing in difficulty. Love adding these to my client programs.
Also a favorite: Walking lunges and rotation
Check out this Instagram post for more examples for happy hips.
4. Hip shifting, glute length, and releasing the pelvic floor
Following up happy hips and rotation with more talk about hip shifting.
As mentioned above, the pelvis changes shape during pregnancy. Your hip bones take on a more externally rotated position (waddle waddle) due to shifts in pressure and a growing baby up top. This position also enables baby to descend during labor :)
In this position, the glutes and posterior pelvic floor are in a shortened position. As the top of the pelvis wides, the bottom narrows —> they have an inverse relationship. This position can play a role in tight glutes + pelvic floor, tailbone pain, leaking, piriformis pain, the need to constantly foam roll your booty, etc. This position makes hinging and squatting tough, and plays a role in hip, knee, low back pain, etc.
Two things I love to work on are:
1. Open up the booty and free up space in the back of the hip (think about the space between the sacrum and your sit bone). Breathe here. In order to shift into that hip, we need space.
2. Master a hip shift. Load into one side.
Current favorites:
1. Bear hip shift with foot drag: the wall reference really does it for me and feels oh so good. You may notice a difference side to side. Make sure you are OVER the working side and watch for movement in your lumbar. Once you master supine positions (side lying, bear, 90/90), you can take it more upright. I like half kneeling, split squat variations, lateral lunges, single leg hinges, etc.
2. Load the hip shift: I really love a lateral lunge for loading into the hip shift. Once you get the hang of it, I also love loading in more of a hip shift squat.
Opening the back of the booty has made a HUGE impact for my clients and my own postpartum recovery.
Check out this Instagram post for more on hip shifting.
Check out this Instagram post for a visual on pelvis position and a tight butt.
5. Core Training and Pressure
Pressure management is key to consider postpartum. In the past pressure was labeled as “bad,” but let’s rethink it a bit. Pressure is needed in our daily lives: we pick up kids, push strollers, and perform heavy tasks. One of the things we can work towards is to work with pressure and build our body’s capacity and tolerance to increases in pressure, and learn strategies to do so. Meaning, as things get harder, we’re prepared for it and feel confident versus fearing a movement altogether.
Early rehab exercises are essential for building a baseline, rebuilding the connection, and integrating into your tasks of daily living and exercise routine. Don’t skip the breathing!
But, then it’s time to load.
Early rehab exercises are not always enough to stimulate the tissue. Muscles need a challenge to wake up and work. If they’re not being stimulated enough, they have no real reason to change. They can already handle the demand being placed on them.
We need to add challenges progressively. Make things harder than what you’re used to. The body has to adapt.
Pressure management goes hand in hand with introducing more difficulty in your exercise and core training. With added load comes an increase in pressure that we have to manage. The tissue is like - “hello! Now I need to work!” By adding challenge we build up our tissue’s capacity to handle pressure.
This is why some may not see a lot of change until after we start loading and waking things up.
✅Learn
✅Control
✅Load
✅Explode (can be more explosive and dynamic once we have the foundation build)
Building your body’s capacity for managing pressure and challenge is key to managing pelvic floor symptoms, and building strength! As a coach I help equip clients with strategies to do so with confidence.
TLDR: don’t be afraid you add challenge. You got this mama.
6. The Feet
I love learning about the foot, and I’ve experienced first hand how impactful footwork can be on your body. Since actively doing foot drills my shoe size has gone up a full size, I don’t have phantom foot pain, and my feet just look more relaxed and centered.
Why an increase in size? High arched rigid feet —> lengthened relaxed feet better able to access pronation. Think lengthening and spreading into the ground. Naturally my foot may actually appear longer.
Things to consider with the feet:
- If my center of mass is pushed more forward/I’m pushing into the forefoot, the calcaneus (heel bone) is often not moving the way it’s supposed to.
- A foot that moves well also directly impacts what’s happening at the pelvic floor, pelvis, rib cage, etc. If you have a foot that struggles to sense the ground, this may also impact symptoms while running, jumping, etc.
- Many people are pushed FORWARD. By getting you back on your heels we can get more range at the foot, which also makes it easier for the pelvis to get in a better position.
My favorite way to teach foot drills initially is to focus on heel contact / foot pressure. If standing is a bit tricky, we can start in a half kneeling position.
From here we can progress to standing variation and full pronation drills. Pelvic floor training is WHOLE body training, and it’s important to consider what’s happening at the feet, as this can be a direct reflection of what is or is not happening up the chain too.
Zooming out to address Pelvic Floor symptoms is key to symptom management and getting stronger! These are just a few areas I take into consideration for postpartum clients. If you’re looking for small group training in San Diego, virtually, 1:1 support, or DIY programs, I’d love to support you.
xoxo,
Erica