Abdominal exercises have the potential to impact upon the pelvic floor, particularly with intense core abdominal exercises and poorly functioning pelvic floor muscles. It can be very confusing to know how to modify some commonly performed intense core abdominal exercises especially when you are participating in a main stream fitness class.
This short Physiotherapist video shows you how to modify some commonly performed abdominal exercises to reduce pelvic floor loading. Scroll down below for written guidelines for how to modify intense abdominal exercises.
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Intense Abdominal Exercises & Pelvic Floor Load
Intense abdominal exercises involve strong contractions of the abdominal muscles. The upper abdominal muscles generate a large amount of pressure within the abdomen. The muscles surrounding the trunk manage the pressure generated by the abdominal muscles- the pelvic floor muscles withstand the pressure generated and applied to the pelvic floor.
If the pressure associated with abdominal exercises is too great for the pelvic floor muscles to withstand, then the pelvic floor is forced downwards, causing the pelvic floor muscles to stretch and weaken. Abdominal exercises that repeatedly force the pelvic floor downwards, or particularly intense core abdominal exercises that completely overload the pelvic floor should be modified in women at risk of pelvic floor injury.
Who is at Risk with Intense Abdominal Exercises?
There is no one single abdominal exercise prescription for everyone. The capacity of your pelvic floor to withstand intense core abdominal exercises is likely to be different to that of the woman next to you in your exercise class. The abdominal exercises that you should match the capacity of your pelvic floor muscles to withstand the associated pressure.
The risk of pelvic floor injury with intense abdominal exercises increases in women with:
- Weak or poorly functioning pelvic floor muscles
- Pelvic organ prolapse
- Bladder or bowel control problems
- Pelvic pain or increased pelvic floor muscle tension.
Specific groups of women at risk with intense abdominal exercises:
- Recent pregnancy and childbirth
- Menopause and beyond
- Overweight and obese women
- Gynaecological surgery (including prolapse, hysterectomy or incontinence surgery).
How to Modify Intense Abdominal Exercises
Abdominal exercises can be modified to reduce pelvic floor loading. This is a matter of reducing the intensity of the abdominal muscle contractions, and reducing the requirement for the pelvic floor muscles to contract for extended periods of time with repeated abdominal exercises or extended abdominal muscle holds.
How to Modify Abdominal Curl Exercises
Abdominal curls or sit up exercises involve head and shoulder forward raises. It is difficult to modify the intensity of this particular exercise which should ideally be avoided in women with pelvic floor dysfunction or very weak pelvic floor muscles.
The pelvic floor loading associated with abdominal curls can be decreased by:
- Doing fewer repetitions
- Breathing out as you sit up
- Minimising resistance on abdominal curl machines.
How to Modify Double Leg Raises
Double leg raises or exercises involving both legs raised simultaneously are commonplace in gyms and women’s fitness classes including Pilates and Yoga.
The pelvic floor loading associated with double leg raises is readily modified by raising one leg and keeping head and shoulders down in contact with the mat throughout. Once again avoid breathe holding and try to breathe normally throughout.
How to Modify Plank or Hover
Full Plank or Hover involves weight bearing through the forearms and the feet. This is an intense abdominal core muscle exercise.
The pelvic floor loading associated with full Plank or Hover can be reduced with:
- Kneeling rather than supporting body weight through feet
- Breathing normally and avoiding breath holding
- Reducing the duration of the abdominal exercise
- Avoiding actively contracting the abdominal muscles or over bracing the abdominal muscles during the exercise.
Intense core abdominal muscles have the potential to overload the vulnerable pelvic floor. Many abdominal exercises can be modified to reduce pelvic floor loading for women at risk of pelvic floor injury. This is a matter of reducing the requirement for the pelvic floor muscles to work to counteract the pressure associated with intense core abdominal exercises.