Our Pelvic Floor Physiotherapist’s Favourite (& Most Prescribed) Pelvic Floor Exercises And Release Work

Hello Choice friends! I hope everyone is doing well and taking good care of themselves as we navigate through these difficult times. It is normal to feel a whole wrath of emotions and let’s be honest, a lot has happened, especially here in our home province of Nova Scotia. All that being said, I am not a psychologist, however I have a pretty good understanding of the body. We know one of the ways our bodies hold onto stress is in the form of muscle tension. So I thought it might be a nice time to review some release work and breathing exercises. These four exercises are pelvic health related but apply to all people. They are four of my favourite and most frequently prescribed exercises. If anything, I hope they provide a way for you to take a moment for yourself and some deep restorative breaths in the process. Sending love to all.

Exercise #1: Piriformis Release

You will need an exercise or yoga mat.

  1. Lay on your back with your knees bent and both feet on the floor.
  2. Bring your left ankle to your right thigh to form the figure-4 stretch.
  3. Place the ball under your left buttock as if you were placing it in your back jean pocket.
  4. Gently rock side-to-side until you find a spot that feels tight, stay in this position or continue to move side-to-side gently.
  5. Perform this release for 30-60 seconds then repeat on the right side. Perform 2 times per side.

Exercise #2: Posterior Pelvic Floor Release

You will need a hard surface and a tennis, lacrosse or massage ball.

  1. Sit on a hard chair with a neutral pelvis.
  2. Lift your left butt cheek up and find your sitz bone (the bony prominence in your buttock).
  3. Place the ball in between your sitz bone and your anus.
  4. Lower the butt cheek back down with the ball in place and hold for 30-60
    seconds remember to breath and allow your body to relax into the ball.
  5. Repeat on the other side, performing 2 times on each side.

Exercise #3: Reverse Kegel

Your ability to consciously relax your pelvic floor muscles is a critical part of your pelvic floor function. The feeling of dropping your pelvic floor is similar to the moment of relief when you have reached the bathroom to urinate or have a bowel movement. The key to dropping your pelvic floor is visualization and deep breathing. This is best done on an inhale because the diaphragm lowers to make room for the breath, and naturally the pelvic floor should lower and relax as well.

This exercise can be performed on a mat or in your bed.

  1. Lay on your back, feet together, and allow the knees to fall open (butterfly pose). If this is too intense of a stretch for your inner thighs place a pillow under each knee (see below). Alternatively, you could do this exercise in child’s pose described to follow.
  2. Start by gently contracting/squeezing your pelvic floor to feel what tightening the muscles feels like (image trying to pick a blueberry up with your vagina or anus). Now relax, and let the tension go.
  3. Try to go one step further now, and visualize the muscles between the pubic bone and tailbone lengthening or descending downwards.
  4. Keep the pelvis neutral and still as you do this. Keep your spine still and let the movement occur in your pelvic floor.
  5. Be Patient. This takes some time to feel the letting go or lengthening of these muscles. Do not bear down to make this happen. Just visualize the movement of the pelvic floor like a little hammock dropping down further into the pelvis.
  6. Perform 10-30 breaths in this position morning and night.
  7. Check in with your pelvic floor throughout the day, and let go of any tension that you discover.

Alternative Child’s Pose Position

  1. Sit on your mat with your knees bent and feet under your buttocks (if this hurts your knees try rolling your mat over itself or get a pillow for under them).
  2. Lean your body forward bringing your forehead to the mat and reaching your arms out in front of you.
  3. If your bum does not reach your heels, place a pillow between your bum and your feet.
  4. You can place your hands on your buttocks and feel your sitz bones. Imagine as you breathe in for a count of five that your sitz bones move away from each other. Simultaneously feel your pelvic floor muscles release and relax.

Exercise #4: Core Breath

The core breath is the ultimate foundational exercise. It helps to train your diaphragm, core, and pelvic floor muscles to work in synergy. The core breath is done not only on its own but also while performing other exercises to really bring awareness to the inner core.

This exercise can be performed on a stability ball or chair.

  1. Sit on a stability ball with a neutral pelvis.
  2. Put one hand on the side of your ribs and the other on your belly.
  3. Breathe into your hands. Inhale to expand – feel the rib cage expand, feel the pelvic floor expand (you may feel a fullness in the perineum), and feel the abdomen expand outwards.
  4. Exhale through pursed lips and voluntarily contract your pelvic floor using imagery to engage. For example, imagine picking up a blueberry with your vagina and anus or imagine sucking a milkshake through a straw with your vagina, or imagine lifting your perineum up toward the top of your head.
  5. Inhale to expand again and let the pelvic floor contraction subside (imagine letting go of the blueberry).
  6. Repeat for 10-30 breath cycles. Do the core breath three times/day for 1-2 minutes each time.

Practical Application of Core Breath:

You can use the core breath during any exercise you might be doing. Let’s relate it to a squat and how you should breath for this specific exercise.

  1. Stand up, feet hip-width apart.
  2. As you descend down into the squat inhale, relax the belly and pelvic floor.
  3. Keep the spine long, knees over toes, and push the bum back as if you were going to sit in a chair.
  4. As you rise up from the squat exhale, draw belly button to spine, and pull up the pelvic floor as if you were drawing a blueberry up and inwards.

Remember, you should always be Exhaling and Engaging (core and pelvic floor) on the Effort portion of an exercise – I call it the 3 E’s! If we apply this concept to our squat, we can appreciate that it is easy to get down towards the floor during squat. The effort is hauling our body back up against gravity to a standing position. Most importantly, DO NOT hold your breath when you exercise. Pay attention next time you do a work out. How are you breathing? Is your face red? Are you holding your breath? This way of breathing takes practice, a lot of practice, so be patient with yourself.

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