How Physical Therapy Can Help Pelvic Muscle Weakness

Pelvic muscle weakness is a condition that many women experience. A common treatment involves pelvic floor exercises.  Kegels are the most well known, but by no means the only option. Doing these exercises can improve symptoms like pain and pressure, as well as bowel and bladder control.

WomensHealth.com talked with physical therapist Tina M. Christie, PT, CCE, FAFS, FMR, 3DMAPS, Women’s and Men’s Health Program Manager at Athletico Physical Therapy, about this topic. Bonus: She describes some exercises you can do at home.

WomensHealth.com: What are some pelvic strengthening exercises beyond Kegels?

Tina Christie: Kegels, also known as pelvic floor contraction exercises, are only part of the story. An example that is easy to correlate would be as follows: If a patient required shoulder rehab and all I gave them as an exercise was biceps curls, do you think that shoulder would improve? This is the same with Kegels (Dr. Arnold Kegel brought awareness to the female pelvic floor muscles, but this is only the beginning of the story.). In order to fully stimulate the pelvic floor muscles, complete core and lower girdle exercise must be incorporated to a female’s exercise program. Our brains do not know individual muscles, our brains know movement patterns, which means we need to train by incorporation movement patterns that bring in the muscles that assist the pelvic floor. At Athletico, we provide a program that looks at the body as a whole and determines appropriate exercise prescription based on the findings in the evaluation. In some cases, doing Kegels can actually make the situation worse.

WH: How do you figure out which exercises to employ? Are there specific exercises depending on the cause?

TC: The exercises are determined based on an individual’s needs and the symptoms they are experiencing. Different diagnoses will be given different exercises. However, we do know that “every body” has 11 major joint complexes which go through 66 joint motions three-dimensionally. So, the exercises will be determined based on an individual’s success through six Vital Transformational Zones. This type of screening is called a 3DMAPS (Three-Dimensional Movement Analysis and Performance System) screening, which was developed by The Gray Institute.

WH: Does a woman’s age affect which exercises are done?

TC: Yes, a young female athlete may receive exercises that are different from a post-menopausal female. There are common exercises that will benefit everybody, but when we can be specific to an individual’s needs/goals, our exercise prescription is more successful.

WH: Can these exercises be done safely at home? When should they be done under guidance of a PT?

TC: Some of the common exercises can be done safely at home, but to really receive an individualized program, the guidance from a PT who specializes in Women’s Health will be even more effective.

WH: How long should the exercises be done? What’s the typical duration? If stopped, will the issue reoccur, and what should you do if this happens?

TC: Length of time is determined by an individual’s needs and goals. But, in general if movement patterns are given, an individual can notice improvement rather quickly. Even correct breathing and management of intra-abdominal pressure can make a world of difference. For the most part, strengthening will usually take place within a 6-12 week period depending on symptoms/severity. PTs have noticed that once improvement has been achieved, [clients] need to continue with the exercise program 2-3 times a week to maintain improvement.

WH: Can these exercises help with other issues, and if so, which ones?

TC: Yes, because the pelvic floor muscles are part of the Pelvic Core Neuromuscular System, patients usually notice improvement in back pain, core stability and balance.

WH: What are some exercises you recommend?

TC: 

• Bridge with three-dimensional hip movements: Go into a bridge and move the hips up and down, then shift the hips side to side, then rotate the hips in circles (CW/CCW) and twist the hips (R hip up, then L hip up). A ball/band combination or PelvicorePro can be used for added resistance. If used, you would perform this with a light squeeze to the ball and then an expansion of the band.

Photo Credit: Tina M. Christie

• Squat: Either with feet and knees narrow or with feet and knees wide. A ball/band combination or PelvicorePro can be used for added resistance. If used you would perform this with a light squeeze to the ball and then an expansion of the band.

• Standing hip mobility: Keep feet narrow, then move your hips forward and backward, side to side, circles CW/CCW and twisting right/left.

Please remember that these are beginning exercises. If you are experiencing any symptoms associated with incontinence, pelvic pain, pelvic organ prolapse, or pregnancy/postpartum related symptoms, please seek the guidance of a women’s Health Physical Therapist to achieve the best results for your individual needs.