Pilates pelvic floor safe exercises can minimise the risk of pelvic floor injury.
Some intense core abdominal Pilates exercises have potential to cause or worsen existing pelvic floor problems. Unfortunately some women commence Pilates exercises to strengthen their core muscles only to find that they develop or aggravate existing pelvic floor problems.
Not all Pilates exercises are unsafe for the pelvic floor and many can be performed with confidence despite pre-existing pelvic floor problems. This Pelvic Floor Physiotherapist information discusses Pilates pelvic floor safe exercises to help women continue Pilates exercises, not to alarm.
Read on now to learn:
- Who is at risk with some Pilates exercises;
- How intense core exercises can cause pelvic floor problems;
- 7 Pilates exercises to avoid or modify with pelvic floor dysfunction; and
- How to modify routines for Pilates pelvic floor safe exercises.
1. Who is at Risk?
Some women are more at risk of pelvic floor problems than others with some intense core Pilates exercises including women:
- With pelvic prolapse and after prolapse surgery;
- After a hysterectomy;
- After bladder surgery;
- With increased pelvic floor muscle tension or pelvic floor muscle spasm;
- During and after menopause; and
- During and after pregnancy.
2. Pilates Pelvic Floor Problems and Pilates
There are two ways that intense core Pilates exercises can contribute to pelvic floor problems:
A. Pelvic floor overload caused by strong contraction of the abdominal muscles (particularly the upper abdominal muscles which can generate a large amount of downward pressure onto the pelvic floor). If the pelvic floor is not able to withstand the associated downward pressure, then it is forced downwards. When this type of exercise is repeated over time the pelvic floor can become stretched, strained and pelvic floor problems can become worse.
B. Increased pelvic floor muscle tension or overactive pelvic floor muscles resulting from intense activation of the core muscles including the pelvic floor muscles without learning to relax these muscles. In this way intense Pilates core exercises, particularly those that involve sustained core and pelvic floor contractions have the potential to cause overactive pelvic floor muscles that are unable to relax.
7 Intense Core Abdominal Pilates Exercises
The following Pilates exercises are those that involve intense abdominal exercise. Women with pelvic floor problems may need to modify or avoid these types of Pilates exercises, particularly women with prolapse or after prolapse surgery. If unsure speak with your Pilates instructor about how to modify your Pilates exercises to avoid strain on your pelvic floor.
1. The Hundred
The Hundred exercise (pictured right) is a core strength and stability exercise involving both legs being raised and held in ‘tabletop’ position or the hips and knees raised together above the body at right angles.
The intensity of The Hundred is increased by raising the head and shoulders of the ground while maintaining tabletop position (including ‘Oblique Lifts’) and by extending one or both legs straight at 45 degrees from the ground (known respectively as the Single or Double Leg Stretch). This exercise and its’ variations with both legs raised have potential to contribute to pelvic floor overload and increased pelvic floor muscle tension.
Scissors is also a core stability and strength exercise. From tabletop position the legs are lowered to the floor alternately without changing the angle of the knee. The Scissors also has potential to contribute to pelvic floor overload and overactive pelvic floor muscles.
3. Dead Bugs
Dead bugs are another core stability and core strength using tabletop position. Dead bugs involve lying in tabletop position this time with the arms raised to the ceiling at right angles to the body. From this position the arms are raised above the head to the ground and one leg straightens while the other is held aloft. Dead Bugs activate those muscles having potential for pelvic floor overload and may also promote overactive pelvic floor muscles with insufficient muscle relaxation.
4. Chest Lift Holding (Sit-Up)
Maintained chest lift is a Pilates exercise – it is a sit-up or abdominal curl exercise that involves the head and shoulders being held lifted off the ground and maintained for a series of breaths. This exercise has the potential to force the pelvic floor down and overload it especially when repeated over time.
5. Roll Ups /Rolling Back
This exercise is designed to enhance spinal mobility. Roll ups involve rolling the body back into lying from a seated position on the ground. The legs are extended in front of the body. The body is then raised back up into sitting from the lying down position. The action of rolling down and returning to upright can both increase pelvic floor pressure and pelvic floor tension. Rolling Back involves similar abdominal muscles to the Roll Up but is performed with the knees bent Rolling back involves the strong upper core abdominal muscles contracting strongly when reclining and rolling back and also when returning upright. Both exercises have potential to contribute to overload the pelvic floor and/or inappropriately increase pelvic floor muscle tension. muscle activity.
The Plank Pilates exercise (shown right) is designed as a core and upper limb strength and stability exercise. Plank is performed prone and body weight taken through the forearms or hands and the balls of the feet as the body is raised and held off the ground for a series of breaths. The Plank involves intense sustained contraction of the core muscles.
7. Push Up
Push Up is primarily a strength exercise for the core and a strength/stability exercise for the upper limbs. The Push Up involves the body in prone and weight bearing through the hands and the balls of the feet. From this position the body is lowered to and raised from the floor. This exercise involves intense repeated upper abdominal core muscle activation.
Are Pilates Exercises all Inappropriate for all Women?
No. Your ability to perform Pilates pelvic floor safe exercises is determined by how well your pelvic floor functions. If your pelvic floor is in good condition and you are not at increased risk of pelvic floor problems owing to your life stage or life events, then you may be someone who can perform these exercises unmodified. Unfortunately some women commence core exercise programs such as Pilates with a normally functioning pelvic floor only to find that they develop pelvic floor problems such as incontinence, prolapse or pelvic pain and increased pelvic floor muscle tension result.
4. How to Modify Pilates Floor Exercises
Most of the exercises listed above (aside from the Chest Lift and Rolling exercises) can be modified to reduce the pressure on the pelvic floor. Pilates exercises can be modified by reducing the intensity of upper abdominal muscles involvement, avoiding breath holding and straining with any Pilates exercise. Women also need to be encouraged to relax their pelvic floor and core abdominal muscles having once contracted them. These modifications will be discussed in an upcoming Pilates pelvic floor safe exercises article.
Pilates pelvic floor safe exercises require an understanding of the potential effects of intense core abdominal Pilates exercises upon the pelvic floor. Women with weak pelvic floor muscles and those at increased risk of pelvic floor dysfunction are well advised to avoid intense abdominal core exercises and modify their Pilates exercises.
About the author of Pilates Pelvic Floor Dysfunction: Michelle Kenway is an Australian Pelvic Floor Physiotherapist, women’s exercise instructor and author of Inside Out – Pelvic floor safe exercise for women along with Professor Judith Goh Urogynaecologist.
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