Article by Gill Cummings-Bell. BA (Hon’s). MSc. MBA. PGCE. AMSCP
Many Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure. (Lemos et. al 2019 Meta Analysis). Research evidences that you can get more effective pelvic floor work by including a pelvic floor exercise in your Pilates exercises rather than just executing a Pilates exercise on its own. Learn the Kegel exercises first and then whilst you are doing a Pilates exercise do the Kegel exercise at the same time combining a phase of the Kegel exercise with a phase of a Pilates exercise i.e:
The Bridge combined with the Wave
Center into the bridge position. Inhale to prepare: Exhale to articulate up and as you articulate up into the raised bridge contract your pelvic floor in the wave front, middle and back as you articulate up. Inhale at the top and exhale to return the bridge and as you articulate the spine back to the floor gradually release the pelvic floor Kegel wave.
How to do the classical Kegel exercise:
Click on each title orange link to watch the video, learn the exercise first and then follow the chart below to see which Kegel fits with which Pilates exercise:
Stage one is to find the right muscles. To help your class members or clients identify their pelvic floor muscles, ask them to visualise stopping urination in midstream, then squeezing mid passage (i.e. during sex) and drawing up through the back passage. This is conducted in a wave effect from front, middle to back. Hold and breath. If they succeed, they have got the right muscles. Once they have identified their pelvic floor muscles you can teach the exercises in any position, although you might find it easiest to teach them lying down at first.
Practice this several times first to find the muscle rather than just launching into an exercise when your class members can’t necessarily feel if their pelvic floor is contracted.
Stage two is to perfect their technique. To teach your clients how to tighten their pelvic floor muscles (as above in the wave), hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Try this in different exercise positions, i.e. standing, lying supine, lying prone, seated. This is to help them feel the difference between when the pelvic floor is contracted and when it is not. Practice this until they can feel this difference.
Maintain their focus. For best results, ask them to focus on tightening only their pelvic floor muscles. Remind them to be careful not to contract the muscles in their abdomen, thighs or buttocks.
Remind them to avoid holding their breath. Instead, breathe freely during the exercises.
Set this for homework for them to repeat three times a day. Aim for at least three sets of 10 repetitions a day.
When to do their Kegels. Make Kegel exercises part of their daily routine. They can do Kegel exercises discreetly just about any time, whether they are sitting at their desk or relaxing on the couch.
Stage three adding the technique to varied exercises.
While standing, tilt their pelvis forward and backward. As they thrust forward (posterior tilt), ask them to contract their pelvic floor as above in the wave and exhale. Release and inhale as they tilt back (anterior tilt). Do eight slow reps, followed by eight fast reps.
Start with the wave, remain contracted and breathing. Hitch their hips in one direction eight times, and then switch directions for eight repetitions. Make sure their butt muscles and lower abdominals are engaged the entire time. Keep the pelvic floor contracted throughout the exercise and release at the end.
Do the Classic Kegel stage two, but instead of simply releasing their PF muscles when you exhale, forcefully push out.
Lie flat on their back with their knees bent, feet flat on the ground hip-width, and arms straight down at their sides. Little fingers only on the floor. Contract their pelvic floor muscles as in the wave whilst they curl the pelvis off the floor in the up stage of the shoulder bridge. With their PF still engaged, lift and lower their bent legs off the ground, as if you were marching—first the left leg, then the right leg. Once you’ve lifted each foot five times, release their PF before lowering, and lower to the ground. Do three sets.
Lie on their left side, with their left knee slightly bent, and their right leg extended straight out on top of it, heel flexed. Contract their PF muscle as in the wave. Raise their right leg up and down five times, and each time they lift, maintain the contraction of their PF.
Change sides.
Lie on their back with their knees bent and drawn in toward their chest. Open their bent legs out to the sides as far as they will go. Inhale contract their PF muscles as in the wave and tilt their pelvis slightly forward (posterior tilt). Release their PF as you return their legs to centre. Do three sets of five reps.
Sit in a comfortable cross-legged position, with their spine straight and their hands on their knees. Close their eyes, contract their PF as in the wave, remain contracted, and take a series of 15 short, fast inhales and exhales through their nose. Then relax and breathe normally.
Lie on the floor, bend their knees out to either side, and touch their heels together. Then grab their feet and pull them toward their chest, heels still touching, knees still wide. Contract their PF as in the wave and hold for a count of 20. A great inner thigh stretch as well.
Finally, get into a child’s pose (like you do in yoga) but with legs like a frog with their knees wide apart and their heels together. Rotate their pelvis forward (anterior pelvic tilt), contract their PF. Hold for 20 seconds. Then release. Breathe normally throughout.
| The Classical Pilates Mat Exercises adapted with Pelvic Floor exercises | |
| 1. Hundred |
1. Start by identification exercises with the classic Kegel 2. The Push 3. Tabletop – dorsi flexion – Classic Kegel |
| 2. Roll Up |
1. Classic Kegel |
| 3. Roll Over |
1. With lying clam legs and Kegel 2. TT pointer with Classic Kegel/Pelvic Tilt |
| 4. One Leg Circle |
1. Classic Kegel halfway relax on inhale other half contract on exhale 2. Lying Clam combo using Classic Kegel |
| 5. Rolling Back (rolling like a ball) |
1. Combine with the breath Oscillator |
| 6. One Leg Stretch |
1. Classic Kegel, contract your pelvic floor – remain contracted – breath oscillator as you switch legs |
| 7. Double Leg Stretch |
1. As above with contraction on the out and release on the in 2. Try adding the birth mother legs |
| 8. Spine Stretch |
1. Add the hip hitch |
| 9. Rocker with Open Legs |
1. Add birth mother legs and hold for 20 seconds |
| 10. Corkscrew |
1. Semi supine/supine hip rolls |
| 11. Saw |
1. Classic Kegel 2. The Push 3. The Breath Oscillator |
| 12. Swan-Dive |
1. Elegant Swan Dive with Classic Kegel – inhale and contract to prepare and rock forward release on return 2. Scorpion with Classic Kegel |
| 13. One Leg Kick |
1. Breath Oscillator for 15 2. Wild Child with leg lift |
| 14. Double Leg Kick |
1. Classic Kegel 2. The Push |
| 15. Neck Pull |
1. See roll up above |
| 16. Scissors |
1. Adapted scissors supine imprint or semi-supine 2. Classic Kegel 3. Pelvic Tilt |
| 17. Bicycle |
1. As with Scissors above |
| 18. Shoulder Bridge |
1. As Kegel Shoulder Bridge |
| 19. Spine Twist |
1. Hip Roll 2. Hip Hitch 3. Classic Kegel |
| 20. Jack Knife |
1. As roll over scissors or bicycle above |
| 21. Side Kick |
2. Lying clam into Teaser |
| 22. Teaser |
3. Seated tall with lifted long spine, tabletop leg lift and hold, leg extensions |
| 23. Hip Twist |
1. Modified hip roll on elbows, with posture ball support, long neutral spine lift with Kegel hip roll |
| 24. Swimming |
1. Normal no spinal hinging, limited range 2. Reverse Kegel Clam Legs 3. Breath Oscillator |
| 25. Leg Pull – Front |
1. Same Kegel as in the bridge 2. Pelvic Tilt |
| 26. Leg Pull – Prone |
1. The Pelvic Tilt 2. Classic Kegel mix with 2/3 Oscillator – contract lift – push oscillate – release lower |
| 27. Side Kick Kneeling |
1. As side kick |
| 28. Side Bend |
1. Classic Kegel |
| 29. Boomerang |
1. See Rollover |
| 30. Seal |
2. The lying Clam into seal release on up |
| 31. Crab |
1. As above for Seal, use leg variations for peroneal stretch and leg switch |
| 32. Rocking |
1. Wild Child into Push Release 2. Scorpion with Classic Kegel |
| 33. Control Balance |
1. Birth Mother – then into Control Balance |
| 34. Push Up |
1. Classic Kegel 2. The Push |