Pilates for the pelvic floor

You’ve heard that Pilates builds your core. But did you hear it can also strengthen your pelvic floor?

Pilates is one of the few exercise genres that includes cues for the pelvic floor as part of the core. The fundamentals of Pilates are breath, concentration, control, precision, and flow. The pelvic floor muscles do not activate themselves, it doesn’t just happen, you have to put it there! Similar to activating the abdominals during Pilates, it’s intentional, it doesn’t just do itself!

Let’s dig deeper into the Pilates fundamental of breath. With restful breathing the diaphragm muscle pulls downward on an inhale bringing air into the lungs, and an exhale is passive recoil of the lungs. With a forceful exhale, however, THAT is an action of the abdominals. Every movement in Pilates that is connected to breath is an opportunity to activate the abdominals, so why not the pelvic floor too?! The pelvic floor muscles, the levator ani, have fascial connections that brace against the abdominals. If you place your hands just inside your hipbones, you can feel your abdominals tension when you do an isolated pelvic floor muscle contraction or with a cough. This is a timely opportunity to activate your pelvic floor along with your abdominals during Pilates practice, with that forceful exhale. The air is leaving your body, so there is less resistance to the squeeze and lift of your pelvic floor compared to an inhale when your lungs are bringing in incoming pounds of pressure downward. Blow like you are blowing a balloon up with air to get the most of the forceful exhale and abdominal activation. If you’ve been doing Pilates for a while, you know Pilates breathing can be heard! Make some noise!

The other fundamentals of Pilates also have pelvic floor considerations. With concentration the activation is intentional and quality, with control and precision the effort, power and coordination of the muscles is specific, and with flow there is the opportunity for concentric and eccentric activation with the rhythm of the movement and breath so that there need not be excessive tension and creation of unnecessary overactivity.

You like evidence based practice? Me too. 12 weeks of 2x/week pilates mat class decreased urine leakage in participants with continued improvement at 6 month follow up (Hein et al 2020). Overall whole-body strength is not associated with stronger pelvic floor muscles in powerlifters (Skaug et al 2023). See? Even heavy powerlifters don’t just get a stronger pelivc floor just because they lift heavy. You have to put there!

The caveat here is can you correctly activate your pelvic floor? If you are not sure, I suggest you see a Pelvic Specialist and confirm you are doing it right.

Peace, Love, Pilates & Pelvic Floor,

Amanda Fitzgerald, Physical Therapist, Pelvic Rehab Practioner Specialist, and Certified Pilates Instructor