Core Pelvic Strengthening

Monday October 7, 2013

Written By: Susan Kroll, MS, PT

Do you fear going to bounce house or trampoline places with your friends or kids because you’re afraid you will embarrass yourself?  When your boot camp instructor brings out the jump ropes, do you cringe? …And it’s not because of the hard work. Did you have a baby and now suddenly you are having hip or knee pain?  Do you have to stop walking when you cough, sneeze, or laugh hard?  Do you find that you have and know more and more people with back pain who are regular exercisers?

Well it happens to almost all of us and almost no one is talking about it.  We will and we will show you what you can do about it, so that you don’t have to live a life with fear of or actual incontinence.

Why??

  1. The function of the core is to prevent excessive torso rotation, transfer force, and stabilize the spine.
  2. The importance of core far exceeds wanting the look of washboard abs.  And the go to core exercises many do such as sit ups and back extensions can even injury your spine when done in isolation because of the shear forces on the spine.
  3. The core consists of more than just the superficial abdominal (rectus abdominus) muscles.  Other essential core muscles include transverse abdominus, internal and external obliques, the diaphragm, multifidi and paraspinals (deep spinal muscles), and pelvic floor muscles.
  4. Our pelvic floor is a central component of our core musculature and acts in conjunction with our other core musculature to create an internal corset to protect our spine.  Strong pelvic floor muscles also support pelvic organs, sexual sensation, and sphincter control for continence.  Gravity, child birth, hormonal changes, and many other factors make this progressively weaker unless you actively work to keep it strong.  
  5. 50% of adult women will have incontinence at some point.  With proper strengthening there is an 85% chance of complete resolution.
  6. Poor posture, particularly a rounded back, causes the thoracic cavity and abdomen to press on the bladder.
  7. Core bracing – learning to simultaneously co-activate muscles of the core teaches your body to stabilize with a neutral spine.  Then when you jump with a jump rope, or lose your footing, or suddenly cough, your core muscles will automatically engage to protect your spine as well as prevent incontinence.

So how do I do it?

  1. Learn proper technique.  Meet with a trainer or attend a core stabilization class, if unsure of proper technique.
  2. Focus on proper breathing and posture to support core.
  3. Abdominal bracing (see description under sample program below) should be performed during all core and whole body strength /stability training.
  4. Maintain your lower back’s neutral spine to minimize stress on the spine

Sample Basic Core Pelvic Strengthening Program:

  • Abdominal Bracing:
    • Pretend you are going to be punched in the stomach
    • Now do again without holding your breath and using deep back/diaphragmatic breathing which is essential for maintaining posture and control during exercise
    • Do with all strength training exercises
    • Kegel:
      • Lie down on back with knees bent and feet shoulder-width apart.
      • Take a relaxed breath in and out – breathing deep into rib cage
      • Now without breathing in, slowly draw the pelvic floor muscles up and in as if you are attempting to stop urine flow. Inhale.  Hold  for 3 seconds
      • Gradually relax the pelvic floor muscles for 6 seconds.
      • Repeat exercise as above, however slowly draw pelvic muscles up and in as if you are preventing gas from escaping. Hold 3 seconds.  Relax for 6 seconds and repeat.
      • 3 – 10 reps.  Hold for 3 seconds, increase to 15 seconds gradually, 3 times a day.  Once mastered lying, press to sitting, standing, or squatting
      • Bridge
        • Lie down on back with knees bent and feet shoulder-width apart.
        • Brace abdominals (as described above)
        • Bridge body up and off ground balancing weight on shoulders and mid-foot keeping pelvis neutral.  Hold 30 – 60 seconds
        • Advanced: Extend one knee until straight and level with flexed knee.  Ensure the abdominals are engaged and hips are held high off ground.
          • Drop hips to ground with extended knee engaging gluts and hamstrings to lower and return leg to original position.  10 – 15 reps /leg
          • Plank
            • Lie facing down propped on elbows and toes with equal weight on all 4 points of contact.
            • Hold 30 – 60 seconds
            • Advanced:  Engaging abdominal muscles, lift one leg straight 12 inches off ground by engaging the gluteal muscles.  Hold at top of lift and return to original position and repeat with other leg. 10 – 15 reps/leg.
            • Note:  Do not progress to advanced exercises until can hold pelvic floor contracted and abdominal bracing during basic exercises.  Otherwise your stronger muscles will take over,  your pelvic floor will not be stabilized, and you will end up with a relative weakness.

If you have any questions, please feel free to ask a UNC Wellness Center Personal Trainer for guidance or to help you build an individualized program.

Physical Therapist, Susan Kroll, MS, PT, will offer two different small group training classes at UNC Wellness Center NW Cary.  Level 1 class will focus on Pelvic floor stabilization with basic exercises and in every-day activities.  Level 2 class is for those who have a good sense of stationary pelvic floor strengthening and are regular exercisers and will teach you to progress becoming aware of your pelvic floor in active sports activities, so that your muscles will automatically kick in when you need them (like that sudden sneeze or jump).