We have all heard it said how important it is to strengthen our core yet few people really know what this means. Core muscle strength is important to maintain correct posture and stabilise the spine to allow ease of movement, to help protect the pelvic organs from prolapse, to maintain sexual function, and to prevent lower back pain. Core muscle training is often neglected in preference for working larger muscles since our core muscles are deep and invisible to the eye and the benefits are not often seen.
So what exactly are we referring to when we talk about our core and how can we go about safely exercising it?
So What Exactly is Your Core?
Our core muscles include our pelvic floor as well as our deep back and abdominal muscles. These work with our diaphragm to support our spine and control the pressure within our abdomen.
During exercise, lifting, bending, and twisting, the internal pressure in the abdomen changes. For example, when lifting something heavy the internal pressure increases, when we put that object down the internal pressure returns to normal.
Ideally the regulation of pressure within the abdomen happens automatically. For example, when lifting up an object, the muscles of the ‘core’ work together well – the pelvic floor muscles lift, the abdominal and back muscles draw in to support the spine, and breathing is easy. In this scenario, the pelvic floor muscles respond appropriately to the increase in abdominal pressure.
If any of the muscles of the ‘core’, including the pelvic floor, are weakened or damaged, this coordinated automatic action may be altered. In this situation, during activities that increase the internal abdominal pressure, there is potential to overload the pelvic floor and/or cause lower back strain. Further to this, a weakened core can lead to other injuries due to the fact that it simply does not have the strength to maintain correct posture and muscle positioning during movements and activities.
How to Strengthen Your Core
The key to successfully strengthening your core is to start slowly with simple exercises, build up repetitions as your strength improves, and to listen to your fatigue levels. If you are becoming tired or feel a little worn out before exercising be kind to your body and listen to these cues. Pushing past this point may lead to injury.
Some examples of pelvic-floor-safe core-strengthening exercises include:
- Knees side to side with feet on ball
- Modified plank on hands or knees with a slight bend at the hips
- Wall push-ups
- Ball bridge (feet on ball or back on ball, +/- single leg lift)
- Opposite arm and leg lift on all fours
- Leg lift sitting on the ball
- shoulder rotations with back on the ball
- Standing balance work on a bosu or balance disc
Core exercises to avoid if you have pelvic floor weakness or lower back pain:
- Sit-ups, curl-ups, or crunches
- Abdominal exercises with a medicine ball
- Deep squats or lunges
- Double leg lowers
- Plank position on hands and feet (e.g. ‘hovers’)
Along with the above exercises, other exercises to include regularly in your daily routine are simple pelvic floor exercises. These can be done whilst driving in the car, sitting at your desk, standing in line at the supermarket, or whilst you are lying down watching television at night. Done frequently enough these exercises will help to keep the pelvic floor muscles toned.
Before starting a pelvic floor muscle training program it is important that you can identify your pelvic floor muscles correctly.
Identifying Your Pelvic Floor
The first step in performing pelvic floor muscle exercises is to identify the correct muscles. There are a couple of ways to do this:
Method 1: Stopping the flow – try to stop or slow the flow of urine midway through emptying the bladder. Stopping the flow of urine repeatedly on the toilet is not an exercise, but a way of identifying your pelvic floor muscles. This should only be done to identify which muscles are needed for bladder control.
If you can, stop the flow of urine over the toilet for a second or two, then relax and finish emptying without straining. This ‘stop-test’ may help you identify the muscles around the front passage, which control the flow of urine. It is not recommended as a regular exercise as it can lead to bladder urgency.
Method 2: Visualisation – imagine stopping the flow of urine and holding in wind at the same time. This can be done lying down, sitting or standing with legs about shoulder width apart.
- Relax the muscles of your thighs, bottom and tummy.
- Squeeze in the muscles around the front passage as if trying to stop the flow of urine.
- Squeeze in the muscles around the vagina or scrotum and suck upwards inside the pelvis.
- Squeeze in the muscles around the back passage as if trying to stop passing wind.
- The muscles around the front and back passages should squeeze up and inside the pelvis.
- Identify the muscles that contract when you do all these things together. Then relax and loosen them.
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Dr Cris Beer
Holistic Medical Doctor