Many people think of their abdominal muscles when asked to engage the core muscles, but, unless someone has gone through pregnancy or incontinence issues, the pelvic floor muscles are a relatively unfamiliar yet critical component of core activation. Exercises that strengthen these pelvic floor muscles through isometric contractions are commonly referred to as Kegel exercises named after gynecologist Dr. Arnold Kegel. The basic premise is to “contract and release” the pelvic floor muscles, and includes variations that increase the number or duration of contractions. Using imagery and guided instructions can help your client find the core’s foundation.
The following verbal instruction series can be taught individually or in a group environment.
DIAMOND IMAGE: Describe the pelvic floor as a diamond shape consisting of points at the pubic bone in the front, sit bones or ischial tuberosities forming the sides of the diamond, and the tail bone or coccyx at the back.
STACKING TRIANGLES: Divide the image of the bottom and top half of the diamond into two separate triangles cutting on the coronal plane and approach each section individually.
Back Triangle (both sit bones and tail bone): Instruct your student(s) to engage the anal sphincter without squeezing the cheeks of the buttocks as if stopping gas from escaping and then release. Once the area is isolated, contract with a small intensity, then medium, then large intensity contraction consecutively without release and then let go of the large contraction to start again. Do this twice through.
After this is achieved, try doing the small, medium, large intensity contraction followed by a small release with a “catch” of the contraction three times to create what feels like a small, medium, and large release of the contraction. A conscious effort must be made to reestablish the contraction each time or the release will feel like one action instead of three.
The purpose of the small, medium and large intensity contractions is to make the exercise more precise and challenging. This will make a plain isometric contraction feel like less work and easier to maintain. Note that if you are teaching this individually, you can hold your client’s hand and mimic the intensity squeeze of the small, medium and large contraction for guidance.
Front Triangle (both sit bones and pubic bone): Instruct your student(s) to engage the urethral sphincter as if stopping urine flow without squeezing the anal sphincter or cheeks of the buttocks and then release. Once the area is isolated, contract with a small intensity, then medium, then large intensity contraction consecutively without release and then let go of the large contraction to start again. Do this twice through. After this is achieved, try doing the small, medium, large contraction followed by the small, medium and large release as done above with the back triangle of the diamond.
SIDE TRIANGLES: Now divide the diamond into right and left triangles cutting on the sagittal plane.
Left Triangle (pubic bone, left sit bone and tailbone): Instruct your student(s) to engage the left side of the pelvic floor without squeezing the cheeks of the buttocks and then release. Once the area is isolated, contract with a small then medium then large contraction consecutively without release and then let go of the large contraction to start again. Do this twice through. After this is achieved, try doing the small, medium, large contraction followed by the small, medium and large release as done above.
Right Triangle (pubic bone, right sit bone and tailbone): Instruct your student(s) to engage the right side of the pelvic floor without squeezing the cheeks of the buttocks and then release. Once the area is isolated, contract with a small then medium then large contraction consecutively without release and then let go of the large contraction to start again. Do this twice through. After this is achieved, try doing the small, medium, large contraction followed by the small, medium and large release as done above.
FIGURE 8 IMAGE: Now relate the front and the back to engage the entire pelvic floor in the initial diamond image (pubic bone, both sit bones, tailbone). A figure 8 or infinity sign could be drawn around the anal sphincter and urethral sphincter. Squeeze each opening individually as you would pucker the mouth to kiss or as if tightening the cord on a duffel bag and cinch them together while drawing them upward toward the internal organs as if sucking on a straw. Once the feeling of this is established, try the small medium and large contraction pattern as established on the previous preparatory sections.
Understanding the contraction of the pelvic floor is the gateway to engaging the rest of the core muscles and facilitates the engagement of the deeper transversus abdominnis muscle. A study entitled “Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing,” on the U.S. National Library of Medicine National Institutes of Health website concludes that “Instructing healthy subjects to co-contract pelvic floor muscles results in greater increase in transversus abdominis thickness during low abdominal hollowing in four-point kneeling.”
As well as improving core stability, strengthening the pelvic floor muscles can help with urinary incontinence, but should be practiced with an empty bladder. According to the Mayo Clinc website “Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles, as well as lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.”
Guided instructions using imagery can help your students isolate and contract the muscles of the pelvic floor. Once you have established the muscle memory from the above exercises you can use the imagery in cueing. For example, “cinch your figure 8” or “suck the pelvic straw.” The mind is better able to direct the body when the target is clearly understood. Strengthening the pelvic floor builds the foundation on which the other core muscles can be explored.
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