This weeks question
Should I stretch or strengthen my pelvic floor?
My answer
As with most topics in physical therapy - it depends! Pelvic floor muscles (like any muscle) need a balance of strength and flexibility - too much imbalance can lead to pain and dysfunction. It is important for muscles to be able to move through their full range of motion - too much strengthening without any stretching can lead to tight muscles that cannot fully elongate. However, a muscle with excessive flexibility without the strength to support it can be at greater risk of injury - a classic example is the person with “weak ankles” whose lower leg muscles are not strong enough to resist inward movement of the foot, leading to higher risk of ankle sprains.
A weak pelvic floor will have difficulty supporting pelvic organs, controlling bladder and bowel function, contributing to overall stability, and supporting sexual function. A tight pelvic floor will have difficulty relaxing to allow bowel movements, interfere with sexual function or contribute to pain with intercourse, and potentially contribute to chronic pelvic or low back pain. Focusing on strengthening or stretching without an assessment to identify the cause of pelvic floor dysfunction or pain can worsen symptoms rather than relieving them.
Most pelvic floor physical therapy care plans involve both relaxation of the pelvic floor muscles and strengthening exercises to promote optimal function. A too-tight muscle will be unable to generate the correct amount of force no matter how “strong” it is. A weak muscle may be unable to generate enough force to maintain continence or prevent organ prolapse. And poor coordination of the pelvic floor muscles can contribute to dysfunction even with good strength and flexibility. Pelvic floor physical therapy may also look at the contributions of posture and other body parts to pelvic floor function - everything from foot positioning to neck posture can impact the pelvic floor and affect function.
So how can you know whether you need to lengthen or strengthen? Assessment with a trained pelvic floor physical therapist is the best way to identify your individual needs. Your therapist will then develop a plan specific to you, which may include exercises to strengthen or stretch, manual treatment of pelvic floor muscles, education about the pelvic floor and its connection with the rest of the body, postural retraining to promote pelvic floor health, and coordination of pelvic floor relaxation and contraction integrated into functional and desired activities. The length of your plan of care will vary depending on your individual needs, but many patients start to see improvement of symptoms within 4-6 sessions.
Do you have concerns about your pelvic floor? Give us a call at 973-556-8465and schedule an evaluation to get started!
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