Exercise and Pelvic Floor Tension
By Beth Safarian, PT
A common scenario we see at the clinic is a patient presenting with increased tone of their pelvic floor muscles. We see this quite frequently as the pelvic floor is an area of the body that guards and protects when our nervous system is upregulated from stress, anxiety, pain, etc. It is similar to the upper trapezius in how common there is tension among the general population. So once a patient hears this information, their next question is usually “what exercise is safe for me to do so I don’t make the tension worse?”
I want to start by saying that I will rarely ever respond to this question with a straight forward answer of “these exercises are safe and these exercises are not”. I will always begin the discussion with asking the patient what types of exercise do they enjoy and want to do. We start here because in the grand scheme of things, I want my patients to move their bodies. The benefits from any sort of exercise or activity are almost always going to outweigh the risks. So if it comes down to someone not moving at all or doing an activity that may create some temporary pelvic floor tension, I will always encourage the movement route. It may just require some adjustments to the frequency, intensity and/or technique of the workout.
With that being said, it is helpful to be aware of what types of exercise may increase tension in the pelvic floor. I have found clinically that activities that require a lot of abdominal activation are often where we see the most tension. Some examples include core circuits, pilates, high intensity interval training and heavy weight lifting. There are some scenarios where I suggest taking a break from these activities to allow the muscle tone to reduce, but most of the time we can implement strategies to allow the client to continue with their workout of choice. What I usually end up discussing with my patients is how to balance tension producing activities with mobility. For example, after completing a 20 min core focused pilates session, follow it with a 5 minute yoga flow for pelvic floor relaxation. I refer to it as a “pelvic floor cool down”. Some of my favourite stretches for a pelvic floor cool down include butterfly pose, happy baby, cat/cow, child’s pose and puppy pose. This is my favourite way to support patients with their exercise goals, while still addressing their pelvic floor tension concerns. It’s all about balance!
The other concept to be aware is your breath and abdominal patterning when exercising. Many people doing high intensity exercise are often breath holding. This type of strategy creates rigidity and a lack of movement of the pelvic floor. Focusing on breathing into your lower abdomen/ribcage will help produce a natural descent and lift of the pelvic floor throughout exercise. Along with breath holding, it is extremely common to see over recruitment of the outer abdominals (internal obliques, external obliques and rectus abdominus) and lack of engagement of the inner abdominals (transverse abdominus). Your physiotherapist will work with you to help detrain your outer abdominal compensations, and connect you to your inner core, allowing healthy movement of your pelvic floor during exercise.