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Beyond Kegels: How the Whole Core Works Together to Support the Pelvic Floor

Updated: Jun 26, 2023

Today's post comes to us generously from a featured guest expert, Physical Therapist Laura Malnati Chambers founder of Peak Wellness. Make sure to read the first part of this education series, Pelvic Floor 101 for Pregnant and Postpartum Moms. Enjoy!!



A pregnant woman sitting on a birth ball in her living room stretching and exercising, used as a n image for a blog about pelvic floor and core health for moms

The pelvic floor gets a bad rap when it comes to all things pregnancy and postpartum and is blamed for everything from peeing on yourself to prolapse to painful intercourse.


While it’s true that the pelvic floor is a very important group of muscles and should be addressed in many situations, it’s also just a part of a coordinated team that all needs to work well together. Like most anything else within the body, we need to look at the issue more holistically.


So, instead of looking at the pelvic floor in isolation, let’s broaden our view and consider the other contributors to pelvic support.



The Core


The word “core” can have varied meanings in the world of exercise and rehab, but for this

article I want you to think of your core as the whole grouping of muscles that provides strength

and stability to the trunk, spine, and pelvis. This includes: the respiratory diaphragm, the 4 layers of abdominal muscles, the multiple layers of paraspinal muscles, the glutes, and the pelvic floor. These muscles all work together to create a canister of support to stabilize our spinal segments, our rib cage, and our pelvis as we move.


While each of these muscles has their own unique function, by themselves they would be unable to effectively stabilize the body. Together, however, they can create strong support on all sides of our midsection. I like to think of the core like a balloon. There is pressure inside pushing out on all sides of the balloon and pressure from the outside pushing back in. These core muscles are like the

walls of the balloon. They can contract to create more pressure pushing into the center or relax to allow more pressure to stretch into them.


From a stability standpoint for our spine, the opposing forces of internal pressure pushing out and external pressure pushing back in creates a lot of rigidity within the core. That’s important because

the spine and pelvis are safer if they’re held strongly in their ideal alignment when you perform heavier activities like lifting, carrying, jumping, running, sneezing, etc. If there isn’t enough rigidity within that core balloon, spine, rib, or pelvic joints can get stretched too far during heavy loads and increase the likelihood of injury.


Now let’s consider a balloon that’s being squeezed. The sides of the balloon being squeezed are now extra strong and exerting too much force for the balloon to maintain its rigid shape. The pressure inside the balloon will be forced to stretch into the top and bottom of the balloon. If that pressure is applied for a long period of time or over and over again, the top and bottom walls of the balloon will begin to get stretched out and weaken. Then, if you take away the squeeze pressure, the balloon may take on a more elongated appearance because the top and bottom are now weaker. Even though the pressure inside the balloon is still the same, now the walls of the balloon aren’t equally strong. More pressure will stretch into the weakened top and bottom walls.


This same thing can happen in our core muscles if they are not coordinating together well. If

the pelvic floor and lower abs are staying stretched out and underactive from pregnancy and

birthing injuries, more pressure from inside the core will be forced into those regions. Also, if

other core muscles like the upper abs or paraspinals are contracting too strongly, more pressure will be forced away from them and can stretch into the pelvic floor.


Our goal is to manage pressure as the smallest group of muscles in the core, the pelvic floor cannot be responsible for taking up the slack for the other muscles for long before something starts to fail. So, instead of trying to create superhero strength in our pelvic floor, let’s work on balancing the pressure from top to bottom so they more evenly matched (which may also include some pelvic floor strengthening but in combination with addressing the other muscles).



Where to Start with Pressure Management


Let’s go through each muscle group in the core and talk about how to start assessing and addressing issues to improve your pressure management.


A side note- these exercises are considered generally safe during pregnancy and postpartum. Of course, always check with your medical provider before starting new exercises if you have concerns. You may also want to modify your positioning for some if you’re farther along in pregnancy to avoid lying still on your back or too much abdominal pressure.


Diaphragm

The diaphragm should be our primary muscle of respiration (breathing) when we’re at rest. This

unique dome-shaped muscle attaches along the lower ribs from the front, along the sides, and

in the back.


When the diaphragm contracts, it’s domed center pulls down. This stretches the lungs down and pulls in air. Like an opening umbrella when the center pulls down, the sides also fan out. That means if your diaphragm is working well, when you breathe in, your lower ribs will expand out due to the attachment of the diaphragm.


We’ll come back to the rib motion in a moment, but besides breathing our diaphragm also plays

an important role in managing the pressure in our core. As the top of our core, the diaphragm can set the tone for how pressure is moved. If it contracts down nicely on an inhale, that contraction with force pressure downward and outward in the balloon.


At first, that might sound like a bad thing since we’re talking about protecting the pelvic floor

against too much pressure, but think about when forceful activities tend to happen…sneezing,

coughing, lifting something heavy. They happen when we exhale. So, getting a good diaphragm

breath for the inhale, sets up a good exhale that allows pressure to rise back up away from the pelvic floor.


Also, because the diaphragm attaches to all sides of the rib cage and expands those sides as it

contracts, the pressure pushed into the core is spread equally to all sides. That means the abs,

parapsinals, and pelvic floor can share that pressure. However, for a number of reasons, our bodies can fall into a habit of using other muscles to help expand our lungs instead of relying primarily on the diaphragm.


This altered breathing pattern can be detrimental not only to pressure management in the core but to other things too like neck and shoulder tension, thoracic and rib mobility, and even hip flexor overactivity. So, let’s take a look at how to train the diaphragm to be our primary resting breathing muscle.


Diaphragm Training

Sit in comfortably tall posture in a chair and place your hands on the sides of your lower rib

cage. Take a nice big breath in and notice what happens. Did your hands widen out from an

expanding rib cage? Did your shoulders shrug up or your neck muscles tighten? Or maybe your

back muscled tensed and your spine slightly arched?


Your goal is to repeat this exercise for 5-10 breaths working to feel your ribs pushing out into

your hands while the rest of your body stays relaxed. Try to sneak in 3-4 sets of these breaths

throughout your day. It may not come easily at first, but by tuning into what you’re trying to

accomplish, you’re helping your body learn.


There are 2 parts to this learning:

First, is improving how well you can do this as an exercise, then second, is gradually integrating the diaphragm more into life. Don’t try to jump to the second until you’ve had a consistently good week or so at the first. Learning a new way of moving takes time!


Once you’ve achieved pretty good control, try applying this to common leak-provoking

situations like coughing and sneezing. Focus on making the breath in for your cough or sneeze

come from your diaphragm. This will set your whole core up to better handle those high

pressures during the forceful exhale.


Abdominals

While the “six pack” ab muscles (rectus abdominis) get most of the spotlight, there are actually

4 separate layers of abdominal muscles. Each has a unique function and importance when it

comes to managing pressure in our core.


Functionally, the abs can be broken down into 2 primary groups:

  • Strong movers- thicker, stronger muscles meant to create movement in our trunk but work in shorter bouts (think- crunches, twists, etc)

  • Deep stabilizers- thinner muscles meant to work more continuously but with less overall strength in order to keep adequate tension in our abdomen.

This distinction is important because if these two groups aren’t balanced, issues can arise. The

deep stabilizers give a sturdy base for many muscles, including the strong movers, to work

from. These deeper muscles create tension within the abdominal fascial system, the webbing

that helps connect all 4 layers together as one strong unit.


Without that fascial tensioning, the front wall of the core balloon has weak spots and is less able to stabilize our trunk. This can lead to compensations from other muscle groups (for example: overactive paraspinals or hip flexors) and the core imbalances become greater.


Deep Stabilizers

The pelvic floor muscles function more like deep stabilizers as well, and they often work together with the deep abdominals. In fact, to achieve a maximal contraction of the pelvic floor, the deep abdominals must kick in to help. That means, if the deep abs aren’t working optimally, likely the pelvic floor isn’t either.


So, a great place to start training the abs postpartum is often with reconnecting to the deepest layer of abs, specifically the transversus abdominis (TA). While this muscle spans the length of the abdominal cavity, we’re going to focus on the lower portion that lies between the belly button and the pubic bone. And because these muscles are stabilizers, our exercise focus initially will be less about “strength training” and more about gaining awareness of how to contract the lower TA and then on building some endurance in it.


To start, lie on your back with your knees bent and feet flat on the ground. If that position isn’t

good for your body, you can also recline back on a bench or pillows so you’re not lying flat. Place

your fingers on the bones that stick out prominently on the front of each side of your pelvis

(your ASIS).


From there, move your fingers about an inch in toward your belly button. If you press into your abdomen at rest, your tissues should feel soft and squishy. Conversely, why you contract the muscles in that location, you should feel the area firm. This is a nice way to tell if you’re getting the right contraction as you practice.


There are a couple different strategies to use when trying to learn a TA contraction. The first is by doing a kegel since the TA kicks in to help with stronger contractions. With your fingers in place, try to contract your pelvic floor starting with a small contraction and gradually squeezing tighter. Notice if/when you feel firming under your fingertips. That’s your TA turning on! If you feel it, work on holding this contraction for a few seconds then fully relaxing everything. Repeat up to 10 times and gradually increasing how long you hold each contraction.


If you don’t feel your TA kick in with a pelvic floor contraction, you can try to contract it by itself. Imagine there is a string connecting the 2 bones on the front of your pelvis (your ASIS’s).

Try to contract the muscles that would pull along that string to bring those bones together.


It may take several attempts or even several days or weeks to really feel this contraction. Because it’s a deep muscle that doesn’t create significant movement in our bodies, it can be tricky to

find at first. Stick with it, though, because it’ll be worth it.


Once you’ve practiced this isolated TA control, try integrating it into other exercises and activities like planks, lifting something heavy, coughing, etc.


Strong Movers

One other aspect of abdominal control to address here, is that sometimes those strong mover

muscles can overwork and try to do the stabilizers’ work too. That can lead to problems, however, if those stronger muscles are constantly overpowering the stabilizers.


A great example of this is something called “upper ab gripping.” The external obliques are strong movers that originate from the lower ribs and attach to various places more toward the midline

of the body. Sometimes, the upper portion of this muscle can become overactive which means it too aggressively or too often pulls tension on the front, top of our core balloon.


The result of this upper ab tension can be increased pressure being forced down into the pelvic

floor. What that looks like in the body is often a notable crease line across the middle/upper

abdomen. Regardless of body weight, if you look at the skin of your abdomen in the mirror and notice a faint crease line a few inches below your ribs, odds are you tend to excessively clench those upper abs. While you may also need to employ other strategies, a primary focus for you would be to start tuning in and noticing when you “grip” or tense these muscles and try to release that tension.


Paraspinals

The paraspinals are a grouping of muscles that roughly run along the length of the spine. As a pregnant woman’s center of gravity moves forward to accommodate the growing baby, these muscles often must work harder to help keep her spine strong and stable. Sometimes postpartum, however, these muscles stay in this overactive role. That can lead to several key core changes:

  1. the paraspinals activate more than the abs or the glutes

  2. lumbar curve stays increased and creates an anterior pelvic tilt

  3. the back portion of the diaphragm cannot expand for breathing

  4. more pressure is forced away from the back of the core balloon and into the front

Because of this common pattern, often (but definitely not always) a key place to start working

the paraspinals is actually with soft tissue release. The goal is to reduce the body’s tendency to

automatically recruit the paraspinals instead of the glute, abs, or other muscles.


One of the simplest ways to do this is with a tennis ball. Stand with a tennis ball pressed between your back and a wall. The ball will do the work of pressing into tight/sore places in the muscles while your body moves to change its location, angle, and intensity.


For this exercise we’ll focus more on the lower paraspinal muscles, but you could use this technique on most any muscle. The main “rule” for this exercise is that is should “hurt good” meaning the kind of pain that makes you want to keep working that spot. If it “hurts bad,” your body may not be ready to mobilize that tissue yet.


You don’t want the ball directly on the central bony part of the spine but anywhere from just

off to the side of the bone to several inches to the side. To know where the best location for

you is to do this soft tissue mobilization technique, you need to do a little exploring.


Start leaning into the ball with it just next to your spine and the lower lumbar area. Then, bend your knees slowly to squat down making the ball roll up higher on your spine. You can also slightly rotate your body back and forth to roll the ball to different tissues.


When you find those “hurt so good” spot, you know you’re in the right place. You can hold

pressure in that location for 5-10 seconds and then look for another spot. Try spending 2-3

minutes on each side of your spine.


Glutes

The glutes are key stabilizers and power houses that connect the whole spine and pelvis with

the lower body. When this group of 3 separate muscles is functioning optimally, they can directly impact function from our spine all the way down to our feet. They work to help stabilize the spine, the pelvis, and the hip, and to move the hip into extension for all things from standing from a chair to sprinting up a hill.


Compensations made for the growing baby during pregnancy often put women into postures that aren’t ideal for the glutes to work. What that can mean is that after a few months of reduced activity, the glutes may not jump right back on board after baby is delivered. And with all these important functions if the glutes aren’t working optimally, the body has to find ways to

compensate.


This can manifest in a number of ways, but an important one to address now is overactivity of

the pelvic floor. If the spine, pelvis, and hip aren’t getting enough stability from the glutes, the

pelvic floor will often become overactive to compensate. If you have signs or symptoms of

pelvic floor overactivity like pain with penetration, constipation, or deep buttock pain, you may

need to do some release work for your pelvic floor to help it function optimally, learn more about this HERE.


At the same time, training your glutes will help offload your pelvic floor so it doesn’t have to work so hard moving forward. There is no shortage of glute exercises in the world of fitness these days, but the primary problem with any exercise is this- the exercise is only as good as the intention you put into it.


What I mean is that if you want to work your glutes, you must pay attention to what happens in

your glutes as you work. Too often I see people exercising but paying no attention to what they’re actually doing. So, it’s less about finding the “right” exercise, and more about knowing how to do glute exercises.


Let’s apply this to a simple exercise: the bridge. For the basic bridge, lie flat on your back, knees

bent, feet flat on the floor. The exercise is raising and lowering your hips from the floor. That’s

it. But now let’s make sure you can feel your glutes work as you do it!


To start, place your hands on the fleshy part of your butt cheeks in the starting position. Like I

described with the TA above, you’re going to feel for tightening of your glutes under your hand. Without actually moving your hips, squeeze your glutes.


This may feel like trying to squeeze your cheeks together. You should be able to feel your glutes squeeze without your hamstrings, paraspinals, or abs kicking in. If not, you may need to start just at this level to build more glute awareness.


Before moving to the next step, which is raising your hips off the floor, let’s talk about pelvis positioning. For a glute dominant bridge, you want to keep your pelvis neutral, meaning not tilting forward or backward. Tilting the pelvis forward (increasing the arch in your back) may recruit more quads and paraspinals while tilting it backward (flattening the spine toward the ground) may recruit more hamstrings.


From this neutral position, lift your hips as high as you can focusing on lifting through the bony

points on each side of the front of your pelvis (your ASIS’s). You can even place your hands on

these bones to help cue your body to lift through your pelvis, better engaging the glutes.


Try this a few times and notice: can you feel your glutes working? Do you feel them working a little more if you hold and slightly pulse at the top? Can you feel your glutes release when you come back down?


Again, tuning in to answer those questions is important because you’re bringing your attention to the glutes and learning about them. This will help you use them more! Let’s talk about a few adaptations to the bridge that can help you fine tune this a little more.


For more challenge to the glutes: you can start with your feet elevated (using a chair or bench) and

then perform the bridge. Conversely, you can elevate your upper body by resting your shoulder blades on a chair. The hip motion and tuning in stay relatively the same, but elevating either

end will increase the challenges.


If you have pelvic floor tightness: Squeeze a rolled towel or a block between your knees as you

do the bridge. This helps turn off the deep pelvic muscles that often compensate for glutes and

will help the glutes do more of the work.


If you have weakness throughout your pelvis without pelvic floor tightness: tie a resistance

band around your knees that requires you to pull the band apart to spread your knees to hip

width before starting the bridge. This will better recruit the deeper parts of your glute complex.



Bringing it Back Together

My main goal is to bring hope to women that their bodies aren’t broken postpartum. The body

makes so many compensations to adapt to pregnancy and then needs healing after delivery, but just because it doesn’t “bounce back” within the first months or even years postpartum,

doesn’t mean it can’t.


There are a lot of influencers on the pelvic floor, and it may take some time to work through all those parts. But your body can heal! You are strong and you deserve to feel that way!

Laura is a wife, a mom, a stepmom, a coach, a PT, a runner, a gardener, a farmer, a lover of exercise, a former collegiate athlete, and a person on a mission to create a life that balances her professional passions with her hobbies and the family that she loves.


Connect with her more in these spaces:




Although we are licensed midwives by profession, we are not YOUR midwives. All content and information on this website is for informational and educational purposes only, and does not constitute medical advice. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice. For more information, click here.

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