If you’re recovering from birth, no doubt, you’ve encountered kegels.
And if you’re trying to return to higher level fitness or sport, perhaps you’ve realized this:
There’s a miles-wide gap between kegel exercises and the stuff you WANT to be doing.
While we talk about progressing exercises that build strength in any other muscle group, somehow, we leave the pelvic floor out of the conversation.
But the pelvic floor is a muscle like any other, and so we can use familiar principles of progressive overload and specificity to ensure that your pelvic floor continues to keep up with the strength gains the rest of your body is making.
Advanced pelvic floor exercises isn’t a topic that’s being addressed in a lot of places- so before I get too far, I want to acknowledge one of my mentors, Katie St. Clair, and her community, the Empowered Performance Academy. She introduced me to this idea, which informs the way I approach my own pelvic floor training and the way I coach my postpartum clients.
If you’re interested in these ideas, I recommend you give her a follow on Instagram at @katie.stclair.fitness.
What Does It Mean To Have A Strong Pelvic Floor?
Before we can talk about “advancing” pelvic floor exercises, we have to want to define what it means to have “strong” pelvic floor muscles. We have to know what we’re working towards.
A “strong” pelvic floor can respond to the demands of your life and your activities. It can generate tension, create power, manage load while lengthened and relax appropriately.
It keeps your panties dry.
A strong pelvic floor isn’t a tight pelvic floor. It’s not a pelvic floor that can hold the tightest or longest kegel.
Pelvic Floor Foundations: The Connection Breath
In traditional pelvic floor muscle exercises- kegels, the emphasis tends to be all on the contraction.
I prefer to teach a more holistic pelvic floor exercise, the Connection Breath.
In the Connection Breath, you relax your pelvic floor as you inhale with your diaphragm, and you contract your pelvic floor on exhale.
Another way to think about it: you’re inhaling down to the pelvic floor and exhaling from the bottom up.
The Connection Breath is an essential foundation.
It builds awareness of the pelvic floor and starts to re-establish reflexive function of the deep core muscles (the pelvic floor, deep abdominal muscles and respiratory diaphragm).
In the early stages of pelvic floor rehab, I teach the Connection Breath and then I teach you to apply it to movement.
➡️ Exhale on exertion.
➡️ Contract the pelvic floor on exhale to help create a stable core.
➡️ RELAX in between efforts.
But this is only the beginning- because in real life, in dynamic exercise (running, for example), we aren’t always thinking of our breath.
We can’t carefully consider and cue our breath and pelvic floor to match our effort at all times.
So once we master this foundation, we have to build on it so that your pelvic floor doesn’t fail you when you lift something heavy on an inhale.
Or while your heel strikes the ground multiple times per step while you’re running.
Or when you unexpectedly trip over your kids’ toys.
6 Ways To Advance Your Pelvic Floor Exercises
There are endless ways to up the ante on your pelvic floor exercises, but here are a few simple ideas that can get you started as you progress from a simple “exhale on exertion” strategy to a more dynamic, responsive and stronger pelvic floor:
1) Breathe in different positions.
If you’ve been doing your breathing exercises lying on your back with your knees bent, vary your positions. Practice the Connection Breath on your hands and knees, in half-kneeling, and standing up. Challenge your breath with gravity and see how it changes your pelvic floor response.
Practice breathing in a hands and knees hip shift or standing hip shift and see if you can feel differences in your pelvic floor right to left.
2) Inhale on exertion
Once you are able to contract or lift your pelvic floor during the hard part of an exercise, practice inhaling and RELAXING your pelvic floor during an exercise. For example, exhale DOWN into the squat and inhale UP out of the squat.
4) Inhale on impact
As you become comfortable exhaling on impact, practice the same exercises while inhaling and relaxing your pelvic floor on impact.
5) Practice breathing through dynamic exercise
If you’re able to exhale AND inhale on impact with no symptoms (pelvic floor heaviness, pain or leaking), move on to dynamic exercises.
These are exercises in which your breath is asynchronous from your exertion. For example, try pogo jumps or toe taps or wall knee drives. You’ll hit the floor several times during each inhale and during each exhale.
6) Incorporate Movement Variability
Vary your breathing strategy (exhale on impact, inhale on impact) during bilateral exercises like squats, drop landings and box jumps.
But also experiment with them during unilateral exercises (single-leg stuff) or exercises that better mimic gait. On the continuum from static to dynamic exercise, try hip shifts, split squats, kickstand deadlifts, single leg jump downs and single leg hops.
The Role Of Pelvic Floor Physical Therapy
If you are taking the time to carefully process your pelvic floor exercise, maximize your pelvic health outcomes by booking a session with a pelvic floor PT.
A pelvic floor physical therapist is the only medical provider that is qualified to evaluate your pelvic muscles’ readiness for impact and intensity.
And if you’re prone to any type of pelvic floor dysfunction (hypertonic pelvic floor muscles. pelvic organ prolapse or any kind of pelvic pain), they can help you ensure your pelvic floor strategy matches the specific needs of your body.
Bridging The Gap Between Pelvic Floor Rehab And Performance
As I mentioned, the possibilities are endless just as they are when we’re training any other muscle.
For some folks, pelvic floor rehab is really simple and they CAN jump from the Connection Breath and the exhale on exertions back into more dynamic exercises without issue.
But if you’ve found it difficult to transition back into higher impact, higher intensity, higher demand activities without leaking or feeling pelvic pressure, consider taking a progressive approach to your pelvic floor.
Fill in the gaps between “contract and relax” and truly reflexive function.
It might just be the missing piece in your pelvic floor puzzle.
If you have questions about how this applies to YOU, hit reply. Let’s build a strategy that allows you to confidently return to the activities you love.
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Laura Jawad holds a PhD and a personal training certification (NASM). She’s a Certified Prenatal & Postnatal Coach, Pregnancy & Postpartum Athleticism Coach, and Pregnancy and Postpartum Corrective Exercise Specialist. You can check out the rest of her alphabet soup here.