Pelvic Floor Safe Core Exercises | Physio Safe Core Exercises Video


Hi everyone and welcome to Pelvic Exercises,
I’m Michelle Kenway. Today I’m going to teach you how to safely
strengthen your abdominal muscles after pelvic floor surgery. If you’re living with a prolapse
or incontinence issues. This is probably one of the most common issues that I’m asked by
women: what’s safe for an abdominal exercise and what’s not, if you’re living with pelvic
floor dysfunction? Many women need to know that if you place downward pressure (so remember
that your pelvic floor goes in the pelvis from the front bone here, to the back, and
it’s a network of muscles or a hammock. If you’re doing particular exercises such as
really strong intense core work (a lot of sit-up exercises, strong plank, strong hovers,)
those types of exercises actually increase the pressure down on the pelvic floor, mostly
making the pelvic floor move downwards. Studies have shown clearly that when you do those
types of core exercises for women who have had vaginal deliveries in particular, the
pelvic floor is forced downwards. This is definitely not the type of exercise you want
to do if you have a prolapse or following pelvic floor surgery, particularly if your
pelvic floor muscles aren’t working well. Pelvic muscles need to be very strong to withstand
that kind of downward force. So, exercises to avoid? Sit-up exercises,
ball crunches, tabletop exercises, any exercise, essentially, where you’ve got both legs raised
off the ground (that uses my upper abdominal muscles) or my head and shoulders lifting
off the ground. Those exercises will all increase the downward pressure and both at once; even
worse. So they’re the types of things we want to avoid, particularly if you have pelvic
floor dysfunction. So, some safe exercises: First of all we need
to think about how to activate the abdominal muscles properly. What I’ll get you to do
is lie down, or watch me lying down and practice this later on. I’m going to teach you how
to gently activate those deep core muscles. These are the muscles that actually wrap around
and attach to your spine. They’re not your six-pack muscles (the upper abdominal muscles.)
They’re the ones that help you cough, they’re the ones that help you to vomit, and they
increase that pressure downwards. So we’re not trying to train these ones, we’re trying
to train the lower ones and these ones that actually are felt lower, they actually wrap
right around, like a corset onto your spine. To activate them properly, it’s a very very
gentle contraction when lying down so if you stay in these exercises when you have approval
from your gynecologist to start exercises (particularly following surgery,) this is
how you’d start them. Lie down on your back. I like to keep my heels
about fist-width apart and my knees fist-width apart and my head is obviously down so I’m
not using my upper abdominal muscles. You need to have the normal curve in your back.
That means your back’s not flat and slumped. So try to keep that inward curve in your back.
Now, you can use your hands and gently feel, just inside those pelvic bones here (sometimes
you feel these bones and think they’re your hip bones; they’re actually pelvic bones)
You roll over the inside (and use your hands there,) and you can feel that area there.
When you activate these muscles properly it’s a very very gentle in-draw of the area below
your knickers, towards your spine. You’re not going to see a lot when I’m doing these
if you can just imagine that area below where my hands are showing you now. That area is
drawing inwards very very slightly. If I feel this area pulling at the same time I’m pulling
in too hard. It’s a very very gentle in-draw, and hold it. Sometimes when you’re contracting
those muscles, you’ll also feel your pelvic floor muscles contracting as well. So let’s
hold that and contract for ten seconds if you can. So, lying down, inward curve in your back,
heels in line with your bottom bone, knees fist-width apart, hands over that area and
just feel that area very gently activating, just gently drawing in towards your spine,
and holding it for one, two (keep breathing,) three, four (keep holding those muscles on,)
five, six, seven, eight, nine, ten, relax down slowly. If you’re having a lot of trouble
with that, an easy way to find them is by lying on your side. Lying on your side helps
you to identify those muscles I find, if you put your hand (again) over that lower abdominal
area. Let the abdomen bulge, and then very very gently, draw that area in a small amount,
again making sure that you’re not tensing these upper-abdominal muscles too strongly.
This area here should be pulling in hardly at all; down here, very gentle contraction.
Try to draw your lower abdominal wall in towards your spine just a little bit, one, two (keep
breathing,) three, four and five, six (can you hold it?), seven, eight, nine, ten and
relax down. Not necessarily as easy as it looks, is it? Let’s make that exercise a little bit more
challenging. These are some nice progressions you’ll actually use for that abdominal area,
and very safe ones as well. All right, so onto your back again, thinking about the exercise
that I just showed you, drawing your lower abdominal muscles in, I’m going to start with
a heel-slide exercise. Now, this is a nice one to do in bed (if you’re lying on a flat
bed, not a soft bed,) on a flat bed or on the floor in your home, even with a sock on
your foot so that it can slide quite readily. It’s called heel-slide so draw-in your abdominal
muscles in the way I just showed you and slow and steady, sliding your heel (one heel at
a time) down, down, down. Maintain that inward curve in your back. Sliding the heel back
up, slide slide slide, and relax down. Okay, let’s try the other side, slow and steady
again, slide that heel down, slide slide slide, keep your toe muscles on just gently as you
go down there, keep your inward curve in your back, slide the heel back, slide and relax.
Once again I can feel my muscles working there and working quite hard too, to control that
area. To progress that exercise, you can take it
into a leg extension with the foot raised off the floor. So you could take it into a
small lift and extend it, again, holding your tummy muscles on just gently. Another nice
abdominal exercise: bringing the leg back, and take it down. That’s not one you’d go into, early days postoperatively.
You can start your heel slides fairly soon post-op (as soon as you’re allowed to, as
soon as your gyne. says you can,) but then the lift and raise is a more advanced exercise,
and you’re probably thinking about starting that five to six weeks after surgery (again,
once you’ve had approval to do exercise your abdominal muscles.) So, you’ve got the advanced leg-extension,
and you’ve got the heel-slide exercise. Another lovely exercise for lower abdominal control
is called bent-knee fallouts. This exercise involves your… (and I’ll do this with my
left leg closest to you so you can see what I’m doing.) I’m imagining I’ve got a glass
of water balanced on my right knee, and my left leg is going to lower down to the side
just gently, without my hips rolling. I’m keeping that glass of water stable on that
right knee, not letting it tip over, bringing the leg back up slow and steady, slow and
steady and relaxing. Try not to tip that glass over, and not rolling my pelvis. You
can see that I can readily roll and move. I’m not doing it. I’m using my lower-abdominal
muscles to control my spine and control my trunk and stop that rolling movement. Let’s go again with the other side. This time
my glass of water is balanced on my left knee (my left knee stays pointing towards the ceiling,)
slowly lowering my right knee out to the side, slow and steady, bringing it back up slow
and steady. I just take it to point before where I feel my pelvis is about to start to
roll and you can repeat that, each side. For all the exercises we’ve done, you can
repeat them up to ten times. Just as you start to feel comfortable with them, working the
number that feels comfortable, and that’s the way to progress those exercises, bringing
back up, and relaxing. So, how did you go with all those exercises? We’ve done a couple
of great abdominal control exercises there. They’re for your T.A.’s, or transverse abdominis,
or deep abdominal control muscles. So, we’ve done our heel-slide exercises. We’ve
done our leg-lift and extend exercise and we’ve also done a very gentle bent-knee fallout
(once again just drawing the abdominal muscles in gently when you’re doing those exercises.)
Try to steer clear of sit-up exercises and intense core exercises. They will actually
place pressure on your pelvic floor. Well that’s it for me, for today. I’ve enjoyed
exercising with you and I hope you’ve enjoyed our exercise session. I look forward to exercising
with you again soon. If you’d like more information on safe exercise with pelvic floor issues,
please visit us at PelvicExercises.com.au I’ll see you again soon. Bye for now.

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