Pilates Reformer For Pelvic Floor Dysfunction
Pilates can be a wonderful form of exercise if you are interested in strengthening your core. You may already know that your pelvic floor is part of your core, especially if you have read this blog here. However, you may not know that a strong core is not one that is constantly on. Often in Pilates, the cueing is constantly to lift the pelvic floor up and in. If there is no cueing or no awareness how to relax the pelvic floor in between contractions, this can lead to new or consistent pain and dysfunction.
Similarly, if you have been told to always relax your pelvic floor and now you fear returning to class, it is not realistic to expect that you will never turn your pelvic floor on again. It is important to get out of the binary thinking that your pelvic floor either has to be on all the time or off all the time. A healthy pelvic floor is one that is always moving with our breath and is coordinated enough to use its full length tension relationship in order to promote healthy function and blood flow.
Here are 4 key elements on how you can return to a Pilates class without provoking symptoms:
One: Modify Hip External Rotation to Neutral or Internal Rotation
Many exercises in Pilates tend to favor the hips being in external rotation. External rotation is not bad or wrong, and you need to work out hips in this range to engage the gluteus maximus. You also need healthy hip internal rotation to have a healthy pelvic floor. One key muscle, called the obturator internus, stays in an engaged and shortened position with external rotation and it is a muscle that creates the back wall of the pelvic floor. When you add in exercises that bring safe internal rotation to your hips, you are able to length this muscle and create space in the hip joint that contributes to a healthy pelvic floor environment.
Two: Modify the Posterior Pelvic Tuck
Another cue in Pilates that is quite prevalent is the cue to tuck the tailbone or “imprint” the spine. Some Pilates exercises may genuinely need this tucking to create a C-curve to the spine if the exercise is in flexion. However, this cue is often used with the claim that it will “protect the back” and help engage the core and pelvic floor. The biomechanics of the spine tell a different story. Tucking the tail creates an “open pack” position at the sacroiliac joint that creates less support for the spine. Tucking the tail in a posterior pelvic tuck also has been shown in studies to over-recruit the pelvic floor and potentially increase symptoms. Consider staying in a neutral spine when possible and see how that feels for your pelvic floor during your practice.
Three: Modify Constant “Ab Gripping” Patterns
You’ve heard it before- “belly to spine”, “knit the stomach in”, “tighten the abs”. All of these cues are attempting to call your core in to help “protect your spine” or “strengthen your core”. In reality, a tight muscle is not a strong muscle. If these muscles are constantly gripping, they can no longer generate efficient force or be a supple shock absorber (the primary role of the core). In order to have a healthy core, you may want to play with the concept of your core expanding and condensing with your breath. Your true core consists of your respiratory diaphragm, your deep abdominal muscles (transverse abdominus), and your pelvic diaphragm. When you are able to coordinate these muscles together with the breath, you will have achieved a truly strong core. The best part about this coordination is that you have to breathe throughout class, so it is much easier to feel the core in relationship with this dynamic pattern you are engaged with all the time!
Four: Modify Engagement of the Adductors
There seems to be focus on inner thighs (adductors) during Pilates workouts that can also perpetuate pelvic floor symptoms. Adductor muscles are intricately linked to the pelvic floor muscles through fascial chains and often when one is over-recruited, so is the other. Adductors do not have many major functional uses and often will actually compensate in place of other key functional muscles such as the gluteus maximus. When participating in a class, consider modifying cues to squeeze a ball or ring between your legs, and instead see if you can do the same exercise with a band or ring around your thighs and push outwards to engage the abductors. Strong and coordinated abductors have been shown to be correlated with less pelvic pain and dysfunction.
Please keep in mind that these are general suggestions and every exercise is best when tailored to an individual and their experience. Pilates can be very functional and therapeutic with the right cueing and the right environment. Better yet, if you are able to know how to keep the practice safe and healthy for yourself, you will no longer depend on always finding the perfect instructor. You can advocate for yourself and increase agency with improved self awareness and somatic tracking of your experience.
Interested in doing a private session to learn more about these modifications for your body?
Dr. Karah Charette, PT, DPT, RYT is trained in mat and reformer Pilates and can offer private telehealth sessions as well as private reformer sessions in the clinic.
Bodyful is located in Oakland, CA.
