Physio, Pilates and your Pelvic Floor

By Michelle Perkins

A pelvic floor – we all have one (males and females), but, like most of our body parts, we don’t think much about it until something goes wrong. Unfortunately, something goes wrong with our pelvic floors pretty darn often. In fact, according to statistics, over 5 million Australians experience bladder or bowel control problems. This translates to 1 in 3 women having some type of urinary incontinence. However, most women seem to just accept this as “part of the package”, and very few seek help for this most treatable of issues.

Your pelvic floor muscles are like any others, they can be trained, but they need the right trainer. Many people have been given an exercise sheet and told ”just do these exercise so many times a day and you will be right”. In one study, six out of ten women tested with urinary incontinence, were unable to activate their muscles correctly, making the exercises a waste of time. Doing these exercises correctly and diligently, can lead to better bladder control and quality of life.

As a Physiotherapist and Pilates Instructor, some clients are referred specifically with pelvic floor dysfunction. However, in my initial assessment of any new client wanting to start Pilates, one of the first questions I ask is “How’s your Pelvic Floor?”.  Some clients look a little shocked, maybe embarrassed, but the most common answer I get is: “It could use some help!”

Most people think of Pilates as “core strengthening”, and this is true, but what is your “core”? Your core is like a cylinder of support for your spine and internal organs, made up of the pelvic floor at the base, diaphragm at the top, deep abdominal muscles in front, and deep spinal muscles in the back. They all need to work together to keep everything up and in!  Teaching clients how to coordinate these muscles is vital before they start their Pilates Programme.

Pilates, taught by a Physio or fully trained Pilates instructor, is safe and will help improve your awareness of the importance of engaging your pelvic floor muscles correctly with every exercise.

If a client is having continuing difficulty activating these muscles, I will often refer them to a specialist Women’s Health Physiotherapist so we can work together to get the best result.

Excessive abdominal training such as crunches, leg lifts etc, can be one of the worst things for your pelvic floor as the increased intra-abdominal pressure will push down and stretch and weaken these muscles.  The popular High Intensity Interval Training programmes have been associated with an upsurge in young women suffering urinary incontinence, and wearing pads during workouts to avoid embarrassment. The pelvic floor needs to be correctly engaged, strong, and have great endurance to counteract these excessive forces.

The oft-heard gym instruction of: “pull in your core” is often just a call to arms for the big outer abdominal muscles to switch on and brace, which just reinforces bad habits. The better instruction should be: “pull up your floor”!

If you are having pelvic floor issues, see your doctor or Physio and ask for help. It may just be life-changing.

Principal Physiotherapist and Certified Pilates Instructor, Physio Plus Pilates Noosa.