The Pelvic Floor and Pilates
There are many myths and misconceptions about what your pelvic floor muscles should be doing during Pilates exercises. Should they be relaxed? Contracted? And does attending a weekly Pilates session count as doing your pelvic floor exercises? Hopefully after reading this you will understand firstly what the pelvic floor muscles are and secondly what their role is in Pilates.
The pelvic floor is made up of muscles and connective tissue that sits under the bones of the pelvis like a hammock. If you bring your index fingers together and your thumbs together to make a triangle, this is about the size of your pelvic floor muscles. These muscles connect to the pubic bone (pubis), sitting bones (ischial tuberosity) and tail bone (coccyx).
There are three main functions of the pelvic floor muscles: to support your abdominal and pelvic organs, to be able to contract so you can maintain continence or relax so you can go to the toilet and they also have a role in sexual function. The functions of the pelvic floor muscles are performed by contraction and relaxation and hence the importance to be able to do both of these actions (Messelink et al., 2005). The main pelvic floor muscles is called levator ani and when you look back to the Latin origins of these words some of the translations are “to lift, wings, lip, anus, ring” which might help give you more understanding of their role. To contract your pelvic floor think about lifting your pelvic floor upwards and forwards from the back passage to the front passage. As you do this the bottom muscles (gluteals) need to stay relaxed and your must keep breathing. If you have difficulty doing this contraction you can have a real time ultrasound or internal examination to check that they are functioning correctly.
During Pilates a lesser pelvic floor contraction needs to happen. But this contraction must be activity and load specific. If when you do pelvic floor muscle exercises you contract at 100% then during Pilates you will contract at between 30-50% depending on the exercise. For example a lunge where slightly more power is required to maintain stability of the pelvis and continence against gravity compared to a side lying leg lift. However a vital thing to think about is the relaxation of the pelvic floor therefore in between each repetition or in between each set there should be a relaxation of the pelvic floor back to baseline.
A study by Culligan et al. (2010) compared the strengthening of pelvic floor muscle training (PFMT) versus Pilates sessions directly on the pelvic floor strength. There was a similar improvement in both groups but neither was considered to be better. However the ladies in the trial did not have any reported pelvic floor dysfunction. Also there was no measure of pelvic floor relaxation which is a very important role of the muscles especially when defecating and during labour.
Ideally pelvic floor exercises should be performed daily if you have no pelvic floor dysfunction and 3 times a day if you do. Although Pilates may help to strengthen the muscles there is no evidence that says it is enough in isolation.
To find out more about how to do pelvic floor muscle exercises please see this fact sheet
If you have any questions about the pelvic floor or need further advise please talk to your women’s health physiotherapist. Alison Ward
Women’s health physiotherapistReferences
Culligan, P. J., Scherer, J., Dyer, K., Priestley, J. L., Guingon-White, G., Delvecchio, D., & Vangeli, M. (2010). A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. International urogynecology journal, 21(4), 401-408.
Messelink, B., Benson, T., Berghmans, B., Bo, K., Corcos, J., Fowler, C., ... & Nijeholt, G. A. (2005). Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourology and urodynamics, 24(4), 374.
Payne, Jacqueline. 2016, November, 10. Pelvic Floor Exercises. Retrieved from https://patient.info/health/pelvic-floor-exercises