PT In-Service: Alignment and Core Exercises

By Amy Stein

Our famous Dania Kafka, who is an amazing physical therapist and Pilates instructor, recently discussed alignment, posture and core exercises correctly at our latest PT In-Service. She helped us with proper cueing because we don’t want pelvic pain patients to utilize the pelvic floor muscles, or limit their use, with any core stabilization exercises. We went over how to gently engage the transverse abdominus, which is one of the core muscles and helps with pelvic and trunk stability. If this muscle is weak and the patient is overusing their pelvic floor, they can end up with pelvic pain. Core and trunk muscle imbalances can be one of many reasons a patient ends up with pelvic pain and/or pelvic weakness. Therefore, it is important to have a strong and balanced core. Dania proceeded to lead us through a series of transverse abdominus exercises that were adapted by Shirley Sahrmann, PT, and we incorporated diaphragmatic breathing with each exercise. We practiced neutral spine versus posterior pelvic tilt to compare the difference, and discussed with which populations we would use which position.

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With any pain condition, if there are active trigger points, tightened and/or shortened tissue, you need to address these impairments prior to strengthening these muscles. Otherwise you can exacerbate trigger points and continue to shorten tissues. It is essential to make sure these conditions are resolved prior to starting a core exercise to that specific area.

With regard to pelvic floor weakness, including incontinence and post surgical weakness (prostatectomy, prolapse, etc.), it is important to strengthen the pelvic floor muscles correctly and the transverse abdominus correctly, as well as the rest of the core muscles.

Monitoring each patient with each exercise, is essential for their recovery, in order not to worsen any condition. Starting slow and in a controlled environment is key.

If you have any questions with regard to Pilates and core exercises and when to introduce them for pelvic pain, or pelvic weakness, feel free to call us and ask for any of our PTs. Or, attend our upcoming Pelvic Health 101 this spring!

4 thoughts on “PT In-Service: Alignment and Core Exercises

  1. Wow! I wish you guys had a similar clinic in NZ! I have endometriosis and would love to learn more about how to look after myself and strengthen my muscles gently after 3 Surgeries.

  2. Dennis Durost

    Very interesting. I actually aggravated (again!) the perineal branch of the prudendal nerve by doing a palates movement. It’s the one where you lay on your back with a ball under the small of your back and your legs up. Doing either side leg splits for forward/backward splits in too aggressive a manner really enflamed my perenium to the point I couldn’t sit without a burning sensation and could hardly tolerate any tight clothing in that area. I’ve had an off and on pelvic floor pain issue for 20 years and only found out what it was recently. I need to find a practitioner in Las Vegas who can help me. Hopefully, your book will be of benefit.

    Dennis
    St George, Utah

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