Engaging ourselves from within and utilizing our bodies' most important support structure
You have probably heard your Physical Therapist or doctor say to you that your core is weak and that's why it's causing your back pain or other issues, but what does that mean?
It's important to define what the core is. The core is made up of a couple of important structures that wrap around our entire torso. Think of the core as a tube, with the top of the tube being our diaphragm and the bottom of the tube our pelvic floor. The front of the tube is the abdominal muscles, and the back is our lower back musculature.
These structures all work together to provide support for the spine and organs as well as have the important function of regulating intraabdominal pressure during our daily activities and breathing. When one or more of the structures are weak or moving dysfunctionally, it can lead to pain or other issues.
Pelvic floor and Transverse Abdominis Weakness:
If you have core weakness, the usual suspects that are most oftentimes affected are the transverse abdominis muscle (the front of the tube) and the pelvic floor (the bottom of the tube). When these areas are weak, they can lead to a myriad of issues for all genders. These issues can include but are not limited to:
Chronic Low back pain
Pain in the pelvic region, genitals, perineum, or rectum
Urinary incontinence
Sexual dysfunction
Pregnancy-related pain and/or dysfunction post-partum
Pelvic organ prolapse; oftentimes felt as a bulge or even see a bulge or a feeling of heaviness, discomfort, pulling, dragging, or dropping in the pelvic region
The pelvic floor is a vital part of our support structure and has many different responsibilities. It's important to note that pelvic floor functions are also non-gender specific, so no matter what gender you identify as you can have pelvic floor dysfunction.
In terms of the Transverse Abdominis muscle (TA), if this area of the core is weak, it can lead to more orthopedic issues like chronic lower back pain and lower crossed syndrome. Lower crossed syndrome happens when our hips start to anteriorly rotate due to TA weakness and can lead to improper alignment of our spine, causing more pain and dysfunction. As Physical therapists, we are primed for treating this syndrome and can intervene with small core activation techniques that can then progress to higher strength training to address impairments.
Interventions for treating Pelvic floor and Core dysfunction:
One of the most important functions of our core is to assist in breathing. Oftentimes, many of us are breathing incorrectly by engaging our neck muscles and upper chest, which can then cause a decrease in movement of our diaphragm and therefore, our pelvic floor. Going back to the tube example, we want both the top and bottom of the core to be moving in sync and getting the proper activation. Below is an image of what should be happening with our core when we breathe properly:
A great place to start learning how to engage our core correctly is with breathing, or Pranayama. Pranayama is a yoga breathing technique where you cultivate energy (oxygen) and allow it to flow through the body. We can utilize this technique to properly connect the pelvic floor and diaphragm and allow for a good flow of energy. Follow along with the video below using these steps:
Find a comfortable position with your back supported, either lying down or seated
Place both hands on the torso, with one on the chest and the other on your lower stomach
First, notice your natural breathing pattern. Is the hand on your chest moving, or your stomach?
From here, we want to start our pranayama. When you inhale, you want the hand placed on your stomach to move up and out, with the chest hand unmoving
It's important not to force movement and stay relaxed during this breathing. It's not so much about breathing "deeper" but rather "smoother and softer". Some may start by "sipping" on the breath so as not to force or rush through it.
This activity is the start of being able to properly engage your core and pelvic floor. From here we can build upon this activity by incorporating some movement.
An activity that is commonly prescribed by Physical therapists is a Posterior Pelvic Tilt. What this activity does is engage the Transverse Abdominis muscle by bringing the top of the pelvis down and in. This exercise is often a precursor movement for many activities, and proper pelvic/core engagement is essential to building proper strength in other areas of the body
With this activity, it can be challenging to know if you are performing it correctly. Refer to the video below and follow these steps:
Start by coming into a comfortable position laying down and starting with some breathing. With most movement, you want to sync any activity with moving on the exhale
On an exhale, rock your pelvis towards your face and bring your naval to your spine, you should feel your core engage and your back flattens into the floor.
Hold for about 3-5 seconds, then release
To progress from here, you can perform a Glute Bridge. This exercise is also a foundational activity but is a progression from the posterior pelvic tilt as it utilizes the lower extremities as well as the core to complete.
You should start this activity by initiating a pelvic tilt, and then performing the bridge and maintaining the tilt to get the maximum benefit and not to put extra pressure on the lower back. Using a yoga block, ball or small pillow between the legs will help aid in the contraction of the pelvic floor and core while also activating smaller inner thigh muscles. Refer to the video below for the proper sequencing!
There are a myriad of different impairments that can originate from core weakness and pelvic floor dysfunction. At RTC, we utilize a well-rounded approach to core
and pelvic floor strength, but if you are suffering from more serious pelvic floor dysfunction like prolapse or post-partum trauma, a certified pelvic floor physical therapist will be able to fully address your impairments. Should you need pelvic floor-specific services, we recommend Her Health Therapy Center. Inquires about their services can be emailed to info@herhealththerapycenter.com or by calling (757)-340-0361
If you have any of the conditions above or know someone who would benefit from our approach, call 757-578-2958 or visit our website today! Thank you for reading and feel free to share.
Contributed by Frances Rogers, PT, DPT
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