Pelvic FloorTherapy & Exercises.

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Do pelvic floor muscles work by themselves? 

Short answer: No — the pelvic floor muscles do not work in isolation.

Here’s the evidence-based pelvic health explanation, especially relevant for female athletes:

The pelvic floor functions as part of an integrated myofascial and neuromuscular system, not as a single, independent muscle group. It works in constant coordination with surrounding muscles to manage load, pressure, stability, and movement.

Key muscle systems that work with the pelvic floor.

• Deep abdominal muscles (especially transversus abdominis)
  These muscles co-activate with the pelvic floor to regulate intra-abdominal pressure and provide lumbopelvic stability. 
• Diaphragm
  The pelvic floor and diaphragm move synchronously during breathing. Inhalation involves pelvic floor descent; exhalation involves recoil and activation. 
• Hip musculature
  Gluteus maximus, gluteus medius, obturator internus, and deep external rotators have strong fascial and functional connections to the pelvic floor and influence pelvic load transfer. 
• Adductors
  Via shared fascial attachments and neuromuscular patterning, the adductors assist pelvic floor activation, particularly during athletic tasks. 
• Thoracolumbar fascia and core system
  Force transmission between the trunk and lower limbs relies on coordinated pelvic floor engagement.
   

Why this matters for female athletes

In sport, the pelvic floor must:

• Respond to impact and ground reaction forces 
• Adapt to load, speed, and direction changes 
• Coordinate with breathing and trunk control 
• Support continence without over-tensioning
   

Dysfunction often occurs not because the pelvic floor is weak, but because of poor coordination, excessive tone, delayed activation, or overload from surrounding structures.

Clinical takeaway

Treating or training the pelvic floor in isolation—without addressing breathing mechanics, hip function, core control, and myofascial load transfer—often limits outcomes. Effective pelvic health care for female athletes requires a whole-system approach.

The pelvic floor muscles do not work in isolation from other muscles within this area. 

They function as part of an integrated lumbopelvic–hip system and influence, and are influenced by, several surrounding muscle groups:

1. Core and Trunk Muscles

• Transversus abdominis – works synergistically with the pelvic floor to support spinal stability and intra-abdominal pressure control. 
• Multifidus – contributes to segmental spinal stability and coordinated movement. 
• Diaphragm – coordinates with the pelvic floor during breathing and pressure regulation.
   

2. Hip and Pelvic Muscles

• Gluteus maximus, medius, and minimus – involved in pelvic stability, hip control, and load transfer. 
• Hip rotators (including obturator internus and externus) – closely linked to pelvic floor tension and function. 
• Adductors – share fascial and functional connections with the pelvic floor.
   

3. Lower Back Muscles

• Erector spinae – affected through postural control and pelvic alignment. 
• Quadratus lumborum – contributes to pelvic stability and lateral control.
   

4. Inner Thigh and Deep Pelvic Muscles

• Levator ani group (pubococcygeus, puborectalis, iliococcygeus) – primary pelvic floor support muscles. 
• Coccygeus – assists in pelvic floor stability
   

Functional Impact

Dysfunction (overactivity or weakness) of the pelvic floor can influence:

• Hip and lower back pain. 
• Core stability and balance. 
• Breathing mechanics. 
• Athletic performance and injury risk.
   

Because of these interconnections, pelvic floor muscle assessment and treatment are often considered within a whole-body functional framework, particularly in women’s health and athletic populations.

 How Abdominal Massage Integrates with Pelvic Floor Therapy

1. The Core Pressure System (Diaphragm–Abdomen–Pelvic Floor)

The pelvic floor does not work in isolation. It is part of a pressure cylinder that includes:

• The diaphragm (top) 
• The deep abdominal wall (front and sides) 
• The pelvic floor muscles (base)
   

Abdominal massage helps:

• Restore normal diaphragmatic movement 
• Reduce abdominal wall tension that pushes excessive pressure downward 
• Allow the pelvic floor to respond and relax appropriately
   

When the abdomen is restricted, the pelvic floor is often forced to overwork.

2. Reducing Pelvic Floor Over-Tension

Many women have overactive (tight) pelvic floor muscles, not weak ones.

Abdominal massage:

• Releases guarding in the rectus abdominis, obliques, and transversus abdominis
  Reduces constant downward pressure on the pelvic floor
  Helps the pelvic floor let go, improving: 
  • Pain 
  • Urgency 
  • Difficulty emptying bladder or bowels
     

This is especially important for women with chronic stress, athletes, or those with pelvic pain.

3. Fascial Continuity Between Abdomen and Pelvic Floor

The fascia of the abdomen blends directly into the pelvic floor tissues.

Manual abdominal work can:

• Free restrictions that pull on the pelvic floor muscles 
• Improve the mobility of pelvic organs 
• Reduce asymmetrical tension patterns affecting the pelvis and hips
   

This makes internal or external pelvic floor techniques more effective and less uncomfortable.

4. Improving Breathing Patterns

Shallow or chest-dominant breathing increases pelvic floor load.

Abdominal massage:

• Encourages full 360° breathing 
• Restores coordination between breath and pelvic floor movement 
• Improves relaxation on inhalation and functional support on exhalation
   

This is essential for continence, lifting, sport, and daily movement.

5. Neurological Down-Regulation

The abdomen is highly sensitive and linked to the nervous system.

Abdominal massage:

• Activates the parasympathetic nervous system 
• Reduces pain sensitivity and protective muscle guarding 
• Helps the pelvic floor respond to therapy rather than resist it
   

A calm nervous system allows deeper, longer-lasting pelvic floor change.

6. Post-Surgical and Scar Tissue Support

For women with:

• C-section scars 
• Laparoscopic surgery 
• Abdominal trauma
   

Abdominal massage:

• Improves tissue glide and circulation 
• Reduces adhesions that restrict pelvic floor movement 
• Supports better outcomes in pelvic floor rehabilitation
   

7. Who Benefits Most

• Women with pelvic pain or tightness 
• Peri-menopausal and menopausal women 
• Female athletes 
• Women with bladder, bowel, or sexual pain symptoms 
• Postnatal and post-surgical clients
   

Summary

You cannot fully treat the pelvic floor without addressing the abdomen.
Abdominal massage prepares the tissues, balances pressure, and calms the nervous system—allowing pelvic floor therapy to work more effectively and comfortably.

Most spa massage therapists are not trained at a high level of chronic pain management. 

Ray is a highly trained sports massage therapist with advanced expertise in female athlete pelvic health and complex musculoskeletal presentations. This includes the safe, informed treatment of the pelvic floor, deep myofascial structures, tendons, and chronically hypertonic muscle tissue—areas that require specialised training and are often under-addressed in athletic populations. 

Ray applies evidence-based manual therapy principles to identify and treat the primary contributors to pain and dysfunction by addressing both myofascial tissue and tendinous attachments. In female athletes, overload, repetitive strain, and altered load transfer commonly contribute to dysfunction at the muscle–tendon–bone interface; targeted treatment of these structures can reduce neuromuscular guarding, improve tissue capacity, and support optimal pelvic, athletic, and performance outcomes. 

• Relief from long-standing chronic pain often originates from deep or overlooked structures like the pelvic floor, hip rotators, or tendon junctions. Skilled, specific work in these areas can release tension that has persisted for years.

• Treatment of the true root cause. When surface muscles are treated without addressing deep stabilisers or tendon restrictions, pain often returns. A remedial/sports massage therapist trained in pelvic and deep tendon work can identify and release the underlying source rather than just managing symptoms.

• Improved pelvic, hip, and core function. Releasing pelvic floor muscles improves posture, breathing, core stability, and coordination, which can reduce pain in the lower back, hips, groin, and even knees.

• Restoration of healthy muscle–tendon glide. Chronic tightness creates adhesions between tendons and muscles. Deep, precise techniques help restore natural movement between tissues, improving comfort and performance.

• Reduced nerve irritation: tight pelvic and deep muscular structures can compress nerves, contributing to pain, numbness, or referral symptoms. Targeted release can decrease this irritation and calm the nervous system.

• Enhanced mobility and flexibility once deep restrictions are released, surrounding muscles can lengthen properly, increasing the range of motion and ease of movement.

• Better outcomes for athletes and non-athletes alike, these techniques benefit not only athletes but also people with desk-related pain, postural issues, or recovery needs after injury or surgery (when medically appropriate).

• More effective than a generalised massage, therapists trained in these specialised areas apply informed, controlled pressure rather than force, making treatment both safe and effective.

• Personalised, trauma-informed care, qualified therapists emphasise consent, communication, and comfort, especially important when working with sensitive areas like the pelvic floor.

Important note:
Pelvic floor and deep tendon work should only be performed by therapists with specific training, clear consent, and appropriate clinical indications. When done correctly, it can be life-changing for people with chronic pain.

In summary:
A sports massage therapist who is trained to work confidently and ethically in complex areas such as the pelvic floor and deep tendon structures can provide profound relief, restore function, and help resolve chronic pain that standard massage often cannot reach.

Purpose: Strengthen pelvic floor while working legs and glutes. (Never overdo any exercises, no matter what exercises you are doing. If you are doing squats with weights, don't overdo the amount of weight you lift. 

1. Basic Pelvic Floor Squat, which can help with the Pelvic Floor muscles.

How to do it:

1. Stand with feet shoulder-width apart, toes slightly out. 
2. Inhale deeply, letting your belly expand. 
3. As you exhale, gently draw your pelvic floor upward and inward (like a Kegel) and engage your core. 
4. Squat down slowly, keeping your chest up and knees over your toes. 
5. Lower until thighs are parallel to the floor (or as comfortable). 
6. Inhale at the bottom, then exhale and push through your heels to stand, keeping pelvic floor engaged. 
7. Repeat 8–12 reps, 2–3 sets.
    

Tip: Think of your pelvic floor as a “basket” you’re lifting slightly as you squat.

2. Squeeze-and-Squat (Optional Progression)

Purpose: Add dynamic pelvic floor contraction to each movement.

• At the bottom of the squat, squeeze pelvic floor muscles hard for 2–3 seconds before standing up. 
• Repeat 8–10 reps, 2 sets.
   

3. Wall Squat with Pelvic Floor Engagement

Purpose: Supportive version for beginners or if recovering postpartum.

1. Stand with your back against a wall, feet slightly forward.
    
2. Inhale, exhale while engaging the pelvic floor and core. 
3. Slide down the wall into a squat, hfor old 3–5 seconds. 
4. Stand up slowly, maintaining engagement. 
5. Repeat 8–12 reps, 2 sets.
    

4. Tips for Squats with Pelvic Floor

• Do not overstrain: Only squeeze your pelvic floor gently, especially if healing. 
• Coordinate breathing: Inhale going down, exhale coming up while engaging the pelvic floor. 
• Posture matters: Keep chest lifted, shoulders relaxed, knees aligned over toes. 
• Progress slowly: Add hold at the bottom or light resistance when ready.