"Most of us could benefit from a personal trainer for our pelvic floor," - Dr. Lauren Streicher, Medical Director of Northwestern University’s Center for Sexual Medicine and Menopause.
The Pelvic Trampoline
The New York Times recently published a great article (Feb. 2023) about the importance of training (and releasing) the pelvic floor, including some good starting exercises you can do at home. It describes clearly where the muscles are and how they work like a trampoline, which is a fantastic image I've been using for years, especially as it sounds buoyant and playful vs. clinical and scary. The exercises described in the article and videos are some variations of basic activities I give in initial private sessions to assess a client's breathing and core function. There are a few subtle differences in how I would teach these (like not distending the belly so far with inhalation and instead sending more expansive movement upward and outward into the ribs). They’re definitely worth a try to begin to gain some awareness of the area. Over time however, I've found that I see more "lightbulbs" go on for people when I explain the pelvic floor's role a little differently through more of a dynamic, full-body approach.
My research started with my own two complicated childbirth recoveries that caused an array of challenges in my pelvic floor and core. I saw several skilled practitioners, including one quoted in the article, and learned some of these foundational exercises. I found there to be a prescribed set of instructions that is fairly consistent across the medical community (for which I have great respect). For me however, even as a lifelong mover with detailed control over my body, I found them confusing. A popular cue to imagine you're "stopping the flow of urine" must work for many, but as observed in my client practice (and in my own body), this instruction could be interpreted in a few ways. It's easy to grip surrounding muscles that can cause further tension, even radiating pain into the low back. The cue of indiscriminately "squeezing" and "holding" these illusive muscles (at least to me), doesn't feel pleasant and doesn't take into account the need for dynamic movement of the pelvic joints, or the possible variables of pelvic positioning in relation to the femurs and spine. Images of lifting "like an elevator" come closer to the vertical trajectory I'm going for but still seem nebulous.
There is a lot to address in every body as we all have our own histories and patterns. So we also have to look at the whole picture. How is that knee pain or your bunions connected to your pelvic movement (or lack thereof)? Are your feet working for you like springs for that pelvic floor trampoline? Or are they disconnected from the kinetic chain and not absorbing shock as they should? How does upper body tension or slouched posture affect the core and pelvic floor, or vice versa?
Working pelvic and deep core muscles in isolation is a great start to find some new sensations, but it's only the first step. You could then benefit from retraining in all sorts of other areas you may have been ignoring. With a positive approach it’s actually exciting to reawaken joints you may not have moved fully in years. And it feels great while you’re doing it, not straining or crunching. The ultimate goal is to get your pelvic floor, deep core, and other surrounding muscles to work as a coordinated team that kick in reflexively during daily life without having to think so much about them. Plus they could help keep you from peeing when you jump with your kids (or grandkids) on an actual trampoline.