How do I engage my core?

Many of my clients ask me what is my "core" or "pelvic floor" and how do I engage it. Here is some information I found useful after a recent fitness conference. The presenter Rick Kaselj is a physiotherapist in Delta.

What IS the pelvic floor?

The pelvic floor is a sling of muscles connecting the pubis to the ischial tuberosities that act to support the internal organs and maintain the alignment of the pelvis. These muscles are the levator ani (iliococcygeus and pubococcygeus) and the coccygeus muscles. Pelvic floor dysfunction is defined as excessive tightness or weakness of these muscles and is often associated with problems in the SI joint, coccyx, hip or low back. As was mentioned in a previous post, a common cause of pelvic floor dysfunction is pregnancy and childbirth, regardless of whether birth was vaginal or via C-section.  Conditions related to the dysfunction include urinary or fecal incontinence and possibly pelvic organ prolapse, among others.

Why do we need to worry about it?

Not only can pelvic floor dysfunction lead to urinary or fecal incontinence and possibly pelvic organ prolapse (to name a few conditions), the muscles of your pelvic floor are also part of the core’s inner unit.  In addition to their function in supporting the pelvic organs, these muscles work in concert with the transverse abdominus, multifidus and diaphragm in stabilizing the spine during movement.

How do we activate it?

To activate the pelvic floor muscles, inhale deeply, as you exhale use your diaphragm to push some more air out. Try it again and this time, imagine you are trying to push the air out all the way from your pubic region. Another way to achieve this is to try and stop the flow of urine when you have to ‘go’.  A way for men to figure out how to activate is for them to picture themselves wading into very cold water. There will be an elevation of the perineum and testicles to prevent them from touching the water.

Once you can activate your pelvic floor muscles, you can do a variety of exercises:

• Squeeze ‘ems – rapid contractions of the pelvic floor muscles
• Elevators – imagine going up an elevator to the 10th floor, stopping at every floor for a moment. Start with a small contraction and increase the intensity at each ‘floor’
• Long slow hold – can be done in time with a long, deep inhale and exhale. Tighten on the inhalation and relax on the exhalation.
• Stoplights – when you are driving, tighten and hold the contraction while the light is red. When the light turns green, slowly release the contraction as you do your traffic check before pressing on the gas.

To isolate portions of your pelvic floor muscles, think of them as being a baseball diamond. Home plate is right around the vaginal area, second base is opposite home plate – the muscles surrounding the anus, first base is on the left side of the pelvic floor and third base is on the right side. Try to activate these areas individually by ‘running the bases.’ Start by pulling up on home plate, relax them and pull up on first base, relax and pull up on second base, etc. Then try and run them in the opposite direction. It is harder than it sounds and is really difficult for pregnant women or other people who are ‘disconnected’ from their pelvic floor muscles.

But how do we deal with a tight pelvic floor?

It seems counter-productive to activate a tight pelvic floor and, to some extent, it is. Part of learning to relax these muscles, though, is to recognize when they are tight. Using the ‘long slow hold’ exercise mentioned previously, focus more on the relaxation portion. Lengthen the exhalation such that the pelvic floor slowly and almost completely relaxes. This becomes very important for women in the final stage of labour when they are trying to push a baby through a vagina surrounded by tight pelvic floor muscles!

Take home message

The pelvic floor muscles are not obvious to you or your client. In the absence of a pelvic ultrasound, you won’t truly know their condition unless your client experiences pain and dysfunction so it is important to practice prevention. In my practice and classes I get many prenatal women who are unable to ‘connect’ with their pelvic floor. This is pretty common due to the baby and uterus pressing down on the entire floor. It is still important for these mothers-to-be to continue to find the ‘connection’.

More info

• Chiarelli, Pauline. Postpartum stress incontinence: Prevention and rehabilitation. ISMJ. (2003); 4(6): 1-10.
• Herschorn, Sender, MD, FRCSC. Female pelvic floor anatomy: The pelvic floor, supporting structures, and pelvic organs. Rev Urol. 2004; 6(suppl 5): S2-S10.
• Price, Natalie; Dawood, Rehana; Jackson, Simon. Pelvic floor exercise for urinary incontinence: A systematic review. Maturitas (2010); 67: 309-315.
• Salvesen, K & Morkved, S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ (2004); 329: 378-80.