Pelvic Health - More than the pelvic floor

23 April 2021

Since qualifying as an Osteopath in 2009, and as a Pilates instructor in 2019 I have heard from patients and clients that they feel they are at the mercy of their pelvic floor.

Many women avoid higher impact sports due to stress incontinence, or feel they need to wear pads, dark leggings, or not run with friends / clubs.

I have found that with combining Osteopathy and Pilates, women’s pelvic health can improve, which can in turn improve their quality of life and their confidence when doing exercise.

When approaching pelvic floor issues with women both from the perspective as an Osteopath and a Pilates instructor the same issues arise. In this blog I hope to provide some top tips for starting to improve pelvic floor health.

Before we go any further, let us learn more about the pelvic floor. We often think of the pelvic floor in isolation. However, the pelvic floor is a part of the pelvic bowl that has a lid - and this is how you should think of it!

The base of the pelvic bowl is the pelvic floor. At the front of the pelvic bowl are the abdominal muscles – these are a group of muscles (in layers from deep to superficial) all of which need to be considered. The sides of the bowl are the oblique muscles, the back of the bowl is the lower back (lumbar spine) alongside the big powerful gluteal (bottom) muscles. The roof of the pelvic bowl is the diaphragm – the main muscle we use for breathing.

The whole pelvic bowl needs to be trained with consideration of all of the muscles of the ‘pelvic bowl’ as they work together as a team, as well as in isolation. Training involves both strengthening as well as stretching. We must also consider that overtraining this region is just as much of a problem as not training it at all.

Stress Incontinence and the pelvic floor

When people think of pelvic floor issues, we mainly think of stress incontinence. But what is this? Stress incontinence is the leaking of urine (mainly in women) involuntarily when there is a sudden increase in abdominal pressure – for example coughing, jumping, running.

Statistics suggest that over the course of their lifetime, over half of women will experience stress incontinence, but this does not mean it is normal or ok. In fact, it can be embarrassing and stop people from doing things like running, or even watching a funny film with others.

Stress incontinence is not only due to childbirth - although this is one of the most common reasons for it to begin. The menopause can contribute to stress incontinence as oestrogen levels drop, which causes a natural decrease in muscle tone (globally), however, if the pelvic floor was already weak, this natural hormonal change can then cause further issues. Women who partake in a lot of impact sport, or who are extremely athletic can also suffer from stress incontinence, as can women who have conditions where they are repeatedly coughing/sneezing, as the pelvic floor has been subject to repeat explosive pressure – which can cause the muscles to weaken over time.

So what can be done to help?

Training the pelvic floor in isolation (also known as Kegal exercises) is a great start to improving pelvic health. These exercises are what is usually prescribed / advised to help strengthen the pelvic floor. However, if your pelvic floor is misaligned or already too tight, the pelvic floor can be trained into further dysfunction.

I take a broad approach to the pelvic floor and pelvic health – after all our body does not work as individual components in isolation, our body works as a system, linking all the components together.

What are my top recommendations to help pelvic health?

This is where Osteopathy has met Pilates for me; and become a great team!

1. Find Neutral Spine and 30% core engagement

Neutral spine simply means that your pelvis and spine are held in neutral alignment. A large number of people tuck their bottoms under – which can cause the pelvic floor to become short (and then people do their pelvic floor exercises and can shorten the muscles even further!) This posture can be made worse if people sit in a slouched position.

Watch a video here on how to find a neutral spine.

This position may be new to you, but this is the best pelvis position to do your pelvic floor strengthening exercises from.

30% core engagement is the next part of training our pelvic bowl – this is a gentle way of stabilising the pelvis as well as strengthening the core muscles. Pilates exercises start from 30% core engagement.

Watch this video to learn how to do this.

2. Get your breathing right

Not many people breathe ‘correctly’ – a lot of people do something called ‘upper rib breathing’ where they take shorter, shallower breaths which mean the lower ribs and diaphragm are hardly being used/activated. This style of breathing tends to be accompanied by elevated shoulders, and the abdomen being drawn in. Occasionally individuals breathe exclusively from their tummy – they tend to have a rounded back and their abdomen protruding out in front of them. Both of these breathing patterns exert a downwards pressure on the pelvic floor.

As we spoke about above I think of the pelvic floor as the base of the pelvic bowl, and the diaphragm as the lid. Therefore getting your breathing right is helpful for your pelvic floor, because when we breathe in (inhale) the pelvic floor relaxes, and as we breathe out (exhale) the pelvic floor contracts and lifts up a little – these movements actually mimic the diaphragm.

It is important that we use our lower ribs to breathe – please see the video on how I teach people to do this.

3. Strengthen your gluteals

The gluteals are the muscles in the bottom – they are big, powerful and love to be used and kept strong. They help a lot with the pelvic floor, and one common thing I see with pelvic floor dysfunction is weak glutes. Please watch this video for one way of strengthening the gluteals.

Another really good way of keeping your gluteals strong – especially the slow twitch muscle fibres is to walk! Walking is predominately powered by the gluteals. Remember if you take the time to strengthen a muscle group, you should also stretch – watch this video for one way of stretching the gluteals.

4. Do your pelvic floor exercies - once you're happy with your breathing, finding neutral spine plus 30% core engagement and you're using your gluteals!

Like all muscles the pelvic floor is made up of fast twitch and slow twitch fibres. Fast twitch muscle fibres help to control the explosive pressures placed through the pelvic floor for example sneezing / coughing. Slow twitch muscle fibres help us when there is prolonged use of a muscle, so when thinking about the pelvic floor – this could be when you really need a wee and you're 5 minutes from home. It is important that both muscle fibres are trained.

The NHS Squeezy app is really good – you can download this from the Apple App Store or the Google Play Store.

See this video on how I train the pelvic floor in designated classes.

What REALLY makes the difference is making these exercises a DAILY HABIT - the app really helps with this!

My last comment on this is do not put up with a dysfunctional pelvic floor. There is so much that can be done to help, and there is a lot you can do to take back control of your pelvic bowl.

If you would like any further information, please contact the surgery at

Disclaimer Alert!

These videos represent the honest opinions of Kibworth Osteopaths, and it is not a treatment plan or medical advice. Please do not self diagnose using this video, or use it to treat any health / medical / physical condition.

Do not do these exercises to avoid seeing a medical health care practitioner, or use them to replace any advice given to you by a qualified medical professional. Ask your health care practitioner to check you are safe to do these exercises, and you do them at your own risk.

You agree to indemnify and hold harmless Kibworth Osteopaths for any / all loses / injuries / damages resulting from any and all claims that arise from your use or misuse of the content of this video.

Kibworth Osteopaths makes no representations about the accuracy or suitability of this content.

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