top of page


Pelvic Floor Muscle Strengthening

Pelvic floor Muscle strengthening is important to help prevent pain from recurring once the skeleton is in alignment.  Having a strong pelvic floor can also reduce and prevent incontinence.  The pelvic floor muscle group attaches to the skeleton and is therefore under voluntary control.  This muscle group will not fire automatically, you have to think about it and give the nerve the signal to command the muscle to contract.  


Firing the pelvic floor muscle can be difficult because it can be hard to locate.  I think of pulling the two sit bones (ischial tuberosities) toward each other, or pulling inward and upward on the pelvic floor muscle group as if holding back gas or urine.  The most difficult part of locating the pelvic floor muscle group is isolating it away from other muscles such as the gluteus maximus or buttocks muscles.


Probably the easiest way to locate the pelvic floor muscle is to practice trying to turn off the floor of urine while using the restroom.  If you can stop or slow the stream of urine even slightly, this indicates you are firing the right muscle group.  This is a good time to practice working to isolate this muscle away from other muscle groups.  The buttocks or thigh muscles do not help to stop the flow of urine.  


Start by trying this four times a day, once at each mealtime and once at bedtime.  Shut off the flow of urine four times and then relax and let all of the urine leave the body.  If you cannot stop the flow wait until the end of the flow and try stopping it at that point. It is difficult to hold back Niagra Falls for anyone.


Once you are able to isolate the pelvic floor muscle group away from other muscles while urinating, stop doing it when using the bathroom.  The pelvic floor muscles need to relax in order to let the urine out.  I think firing the pelvic floor during urination confuses the body.  But if you do not do this for very long or very often it is fine.  After you have confidence you are firing the pelvic floor muscle group away from other groups then practice it four times a day holding it for 4 seconds each time.  Initially, do this while holding the body still.

Pelvic Floor Muscle Overuse

If your body is prepared to fire the pelvic floor muscle group 10 times a day but you do so 15 times a day this will pop a few of the muscle fibers.  When you rest and don’t fire this muscle it will repair.  However, there is a point at which so many fibers pop away from the muscle that the repair will take even longer.  I have never seen a rupture of the pelvic floor muscle group but imagine it can occur in severe trauma.  


When the pelvic floor has been overused you might feel pain in the pelvic floor muscle group or a burning sensation during urination.  You may have to use the bathroom more frequently or notice other signs of incontinence.   Many times people think they have a urinary tract infection.  Another site of pain can be the deep muscles of the stomach.  The transversus abdominis contracts at the same time as the pelvic floor.

The first photo shows intact pelvic floor muscles and the second photo shows fibers being pulled away from the bone.

Pelvic floor from bottom looking up

Pelvic floor torn fibers

Preventing overuse of the pelvic floor muscles

During pelvic floor muscle strengthening, it is important to build slowly and gradually to prevent overuse.  If you have enough energy tokens in the pelvic floor muscle group you can fire it 10 times a day.  I am using this as an example, as no one knows how many energy tokens you start with so starting with four times a day is perfect.  At least once a week add 1-2 more times a day.  


If at any point you notice discomfort, then you must rest the pelvic floor and not fire it until the problem is resolved.  For some people, this only takes one week but others may take longer to rest.  The discomfort I referred to can be in the pelvic floor or the deep abdominal region.  Some people notice overuse symptoms such as burning during urination, thinking they have a urinary tract infection (UTI) or even greater frequency of using the bathroom causing worsening incontinence.

Greater challenges

Start pelvic floor muscle strengthening initially while holding the body still.  Next, begin practicing to hold the pelvic floor muscle group while keeping the body still and moving the arms and legs.  Eventually, I recommend firing the pelvic floor muscles every time you change positions such as getting in and out of bed or a car.  Holding the pelvic floor muscles while moving the body is the most difficult challenge.   However, the payoff when holding the pelvic floor tight during position changes is huge.  


While moving the body with the rib cage out of line with the pelvis, this increases the risk of the skeleton sliding out of place causing poor alignment and pain.   Holding the pelvic floor during movement keeps the pelvis and spine stable and prevents loss of neutral alignment and pain.

Movements that combine bending, tilting, and twisting are the most likely to cause the spine to go out of neutral alignment and therefore, the most important time to stabilize the pelvis and spine.  Such movements including, bending over to care for pets, gardening, picking up toys or children, chopping or hauling wood, lifting anything, vacuuming, mopping, sweeping, and reaching, for example.  Walking and climbing stairs make the spine rotate but not bend, tilt, or twist, so you do not need to hold the pelvic floor while doing those activities.  If you do hold the pelvic floor while walking or climbing stairs, you will likely cause overuse.


Often when I tell patients that the only thing I have to do to remain pain-free for more than 20 years is to hold my pelvic floor, they immediately start overusing the pelvic floor muscle group.  Please learn from my example and my cautionary tales and do not overuse the pelvic floor muscle group. Incontinence, or losing your urine, is not fun.  You can prevent and even resolve incontinence by building slowly and gradually and watching for any signs of overuse while working to build the pelvic floor.


Strengthening the inner core to sleep through the night and prevent pain.

bottom of page