Today, let’s talk about our core. This blog is intended to be a helpful guide for those who are pregnant or in the postpartum phase looking to rebuild their core in a safe way, those with pelvic floor dysfunction whether you have prolapse, experience leakage, or are dealing with chronic pelvic pain, those who are athletes or fitness enthusiasts looking to prevent injury and optimize performance, those recovering from surgery or injury needing a gentle, functional approach. We also hope this serves as a helpful intro and guide to core work for trainers, instructors, and healthcare providers who want to guide their clients effectively with a pelvic floor safe approach.
What Does Our Core Do?
The core muscles of the body are those that surround our trunk, pelvis and hips. They provide us with stability so that we can do the everyday tasks of climbing stairs, walking, and running. These muscles also allow us to do more challenging tasks like rock climbing, cartwheeling through the grass and even performing a headstand in yoga class. Our core takes us from things that may seem ordinary to more challenging tasks, and depending on the level of complexity of the task, you may or may not feel your core at work, but likely it’s playing a role in aiding your support through movement. In addition, the core serves to protect and influence our internal organs like our stomach, intestine, and bladder – allowing us to create pressure to have a bowel movement. The deep core stabilizers provide our spine with stability between their segments – think about that time in pilates where your instructor cued you to grow tall through your spine as you gracefully flowed through a movement – they wanted you to keep your core active. The core is essential for overall function, posture, and injury prevention.
How Does Our Core Function?
You can think of the core as a corset, providing stability to your spine, allowing you to have good posture, and relieving superficial muscles from excess strain. The muscles of the core wrap around the trunk and pelvis, enveloping the contents within the rib cage to pelvis making up your midsection. The deep core is not just composed of our “abs”, it includes muscles such as your diaphragm, transverse abdominis, multifidus (small muscles in our back) and the pelvic floor. Together these muscles form the shape of a canister. Together they function to contract and activate to provide stability – this is when the muscles shorten and move inwards. On the other hand, the muscles can relax, decreasing pressure on the spine and internal organs. Lastly, they can bulge or lengthen with changes in pressure. You can create this change in pressure by ballooning our abdomen outwards.
If we fail to properly engage our core muscles, we can accidentally create a bulging/ lengthening pressure outwards. This lengthens the muscles in the area and increases tension in our abdomen. This can increase our risk of getting a hernia, developing pelvic organ prolapse, especially postpartum, experiencing urinary or fecal leakage, pain, or discomfort during exercise. We may also have increased risk of back pain without proper core engagement.
Now that we have discussed a little bit about the influence and role the core has over movement, let’s discuss how we’re going to safely exercise these muscles while supporting our pelvic floor health. It’s important to keep in mind that not all core exercises support pelvic floor health—some can do more harm than good.
Things to consider when thinking about safely exercising our core:
1. Do not hold your breath during core exercise.
2. Avoid doming or bulging the lower abdominal region with exercise.
3. Keep your intention during exercise focused on core engagement.
4. Do not be afraid to modify an exercise to meet your strength level.
5. Take things slow to coordinate core activation with movement.
Let’s break each of these reminders down:
1. Do not hold your breath during core exercise.
Holding your breath during movement creates a closed pressure system. Think of your core system as a canister. If you apply pressure around the can by squeezing it, the can will start to bulge and expand in certain areas. It might bulge from the bottom or top, depending on where you’re squeezing it. If the can is opened and you squeeze it, it will allow the contents to be released from the lid. If you hold your breath and exercise, it’s like the closed can system. With pressure from movement or exercise, the core system will increase in pressure, from the side walls, back, abdomen, pelvic floor, diaphragm. With an open system, created by breathing with movement, you allow for the pressure in the system to flow as you create contraction within the musculature of the core system. The walls of the deep core will be able to contract moving inwards towards midline, stabilizing your spine as you exercise in this open system. Note: a time you may find yourself needing to create a closed pressure system is with lifting max loads. With lifting 1 rep max, weight lifters and coaches may practice and cue breath holding to brace as they lift the load. This strategy is typically only used for lifting very heavy loads
and does not typically apply to body weight exercise or exercises performed using lighter free weights.
2. Avoid doming or bulging the lower abdominal region with exercise.
Avoiding doming or bulging the lower abdominal region during exercise is particularly important for patients postpartum with diastasis recti, thinning of the connective tissue between the rectus abdominis muscle. Doming or bulging of the lower abdominal region can occur if you are trapping pressure in the abdominal region or it may occur if you are not stabilizing the deep core. Losing lower abdominal stability can occur if you lose neutral pelvic position during exercise or if you are having trouble contracting the muscles in a way that engages them correctly to protect your spine. Neutral pelvic position is a position that supports the natural curvature of your spine – the upper back and lower back have natural curvatures that should be maintained with movement. Altering this alignment by moving into excessive curvature of the lower back for example can create more strain in the musculature in the front of the abdomen making it harder for it to engage. You may also be unfamiliar with how to correctly turn on and engage your core muscles, leading to doming or bulging of the abdominal region.
3. Keep your intention during exercise focused on core engagement.
It is important to stay in turn with the muscles you are trying to engage during exercise. Having intention with your movements can help you engage the right areas of your body. Moving without intention can make your workouts less effective and can increase your risk of creating compensatory movement patterns. As a physical therapist, I love educating my patients on the “why” for each exercise. Creating this reasoning helps the patient understand what the goal of each movement we are performing is. It is also a helpful tool for self feedback over time. For example, when I was working on standard squat form with a patient last week, we discussed how my patient was feeling the movement in her quadricep muscles and hip flexors. I helped my patient understand that with this movement, we really want to lead with the gluteal muscles and deep core muscles. Just by telling my patient this, I saw the way she naturally shifted her form to feel the movement in the core and the glutes. This is just one example of how intention can help create great changes to help you properly activate targeted muscles.
4. Do not be afraid to modify an exercise to meet your strength level.
This tip is an important one as oftentimes I see patients attempting core exercises that may be too challenging for them. This is evident in cases where a patient knows how to activate their core and they are attempting this during the exercise, but they are not able to adequately stabilize their spine, pelvis and trunk during the movement. In these cases, the load to the system is often too large for them to control. Modifying the movement may be appropriate. Some ways we can do this is by reducing the distance the arm or leg is travelling away from the core – this decreases the weight the core has to support when doing exercises on the back. If you are using weight, decreasing the amount of weight or resistance used can be appropriate. You may also try reducing the repetitions performed before taking a rest break. Knowing how to modify your exercises to challenge you without harm is key.
5. Take things slow to coordinate core activation with movement.
Slowing things down may seem hard and challenging at first, but you may learn to love it! I have multiple examples of the importance of this. When training for my first run as a physical therapist, my trainer taught me how running slowly maintaining a lower heart rate zone will be a lot more challenging than sprinting and letting my heart rate spike. Going slow is hard but it is ultimately what helps you condition your body. Another example is from weight lifting. You may have heard of the concept of “time under tension”. The amount of time your body is under load is key for building strength. Time under tension can only be achieved with slow, controlled movement. Keep these examples in mind during your next core workout. Slow down your marches, sit ups and hip dips and feel the core engage more. You may feel it’s challenging, but over time this will bring more positive results than flying through your core routine.
How to Turn on Your Core
To effectively turn on your core, think about drawing in your abdominal wall. Try moving the belly button towards your spine. While you do this, be cautious of moving the pelvis, low back, or hips. You may also try thinking of drawing in the abdomen, while drawing your low back towards your spine, and knitting the sides of your trunk towards each other. This movement creates compression in the trunk, giving stability to the spine. You can also try thinking of creating a corset in the abdomen to help you facilitate these muscles.
Safe & Effective Core Exercise Tips for Pelvic Floor Health
For Pregnant & Postpartum Individuals:
Start with diaphragmatic breathing to reconnect with the core and pelvic floor. ○ Lay on your back with your knees bent. Place your hands on your rib cage. Inhale for 4 counts into the rib cage, allowing it to expand and widen. Exhale allowing the rib cage to return to the starting position. You should feel the rib cage float back inwards.
Consider beginning with low intensity exercise to create control before progressing to more strenuous exercise
- This can be done laying on your back, side-lying, or on all fours.
- One exercise I like to use to help patients regain core connection is heel slides. Laying on your back with your knees bent, find a neutral pelvic position. This is a position half way between the pelvis tilted all the way forwards and all the way back. Inhale as you slide your leg away from you, exhale as you slide the leg back inwards as you draw your belly button towards your spine, engaging your core. Repeat for 2 sets of 8.
For People with Pelvic Floor Dysfunction:
Start with gentle activation of the transverse abdominis to support the pelvic floor. Avoid over activating the pelvic floor, as this may increase pressure and create more tension on nerves flaring your symptoms.
- Try starting with heel slides mentioned above or marches. Marches can be performed by laying on your back with your knees bent. Starting in the neutral pelvis position, keep your knees bent to 90 degrees and alternate lifting your knee towards your chest on the exhale, as you gently draw the belly button inwards. Inhale as you lower your leg towards the ground and repeat for 2 sets of 8.
Make sure you avoid bulging or straining your lower abdominal region. You can help prevent this by creating more awareness as you exercise your core. Place your hands on your abdomen, spreading your fingers apart to cover more surface area. As you engage your core you should feel the abdominal muscles get sinched inwards. If you keep pressure from the belly towards the hands or if you feel the belly harden, this may be a sign that you are not engaging your core effectively.
For Athletes & Fitness Enthusiasts:
Build breathing into your fitness routine. Let’s consider a kettlebell swing. If you find yourself holding your breath as you swing through this exercise, try slowing it down and pair breathing with the movement. Try inhaling to begin and exhale as you draw your belly button inwards and swing the kettlebell forwards. Inhale as you return to the start position. Repeat as required from your exercise routine following this breath work.
For Post-Surgical Recovery & Injury Prevention:
Consider slow progressions to avoid overloading the pelvic floor. If we try to progress our core exercises too quickly, we may find that we lack the strength or endurance to support the new exercise. Find ways to gradually progress your program to keep safety a priority.
- Some ways to modify exercise are by decreasing the amount of weight you are using. If you are not using weights, try changing the distance your arm or leg moves away from your core. As movement should be initiated from your core, the further away your arm or leg extends away from it, the harder you will have to work to stabilize. You can also try decreasing the number of repetitions you perform before taking rest.
Final Note
With these tips, we hope you feel more prepared for your next workout, more stable and powerful on your next run or even more safe while lifting up your baby. While learning to properly activate your core takes time and learning, its mastery will serve you well day to day. It will allow you to avoid aches and pain stemming from compensatory movement patterns, will help you improve your posture, and will allow you to feel more in tune with your body. For those of you who may still feel in question about safe core activation after reading this, please don’t hesitate to reach out to your local physical therapist or a professional trainer. Getting hands on, in person cueing and guidance can be invaluable. Once you learn how to engage the core safely, you will be able to apply it to everyday movements and those challenging moves at the gym.
