Functional Pelvic Floor & Core Fitness

Do you or your clients pee when working out?     Its more common than you think.

Scientific evidence shows women are experiencing pelvic floor dysfunction as a result of inappropriate exercise regimes. ‘The Core’ which the pelvic floor muscles play an important role is not being taught well. Do you really know how to teach “The Core” or Abdominal Cylinder Control or Neutral Spine? Did you know’ The Plank’ does not target these important core muscles. Yes, it is tricky because it’s the deepest lumbar pelvic muscles that contract together to provide core stability.

Contract these muscles correctly and your clients will be

  • Supporting their pelvic organs
  • Not leaking while exercising
  • Keeping their lower back safe –no low back pain from exercise

Here are some interesting stats

  • 43% of women bear down when instructed to squeeze and lift their pelvic floor muscle
  • 1 in 3 women who have had a baby wet themselves

Urinary incontinence is quite common in women who work out in gyms or exercise. Yet only 15.2% of women are screened for pelvic floors issues when they join a gym. And less than half of fitness instructors cue their clients to engage their pelvic floor. Even a quarter of fitness instructors have reported to experience incontinence when working out!  Int Urogynecol J. 2012 Dec;23(12)
A 2012 study showed that women who participate in high impact exercise, like running or aerobics, experience more incontinence symptoms than those who don’t exercise. And that’s regardless of the type of exercise they do. Int Urogynecol J. 2016 Aug;27(8):1175-84.2016
A study involving over 38,000 women has found that disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.  Aust J Physiotherapy. 2006;52(1):11-6


Incontinence, pelvic organ prolapse, low back pain, respiratory issues, pelvic girdle pain in pregnancy and balance problems are fundamentally linked to a deficit in abdominal cylinder control ‘The Core’

 Research suggests education is required to encourage fitness professionals to screen exercise participants and provide pelvic floor friendly exercise regimes contributing to holistic client care.

Core control (abdominal cylinder control) is widely believed to be healthy for female clients as it is supportive to the back, pelvic organs and important for the continence mechanism as well as all stages in pregnancy and beyond... Often referred to as foundation movement in the fitness industry.

The Core muscles are the Pelvic Floor, Transversus Abdominus, Multifidus and Diaphragm. These muscles love working together to provide lumbar pelvic stability.

Every fitness professional should understand and respect the important role these ‘Core Muscles’ play in maintenance of continence, support of pelvic organs, reduce low back pain and critical in all stages of pregnancy – foundation movement pattern for Functional Fitness.

If you could visualise these deep muscles contract on a screen and appreciate how to best cue them would that be helpful?

Using visual biofeedback on the Real-time Ultrasound you can now see these muscles working and no longer rely on guess work. When you know how to recruit these deep muscles on your body you will confidently be able to teach this important foundational movement pattern to your clients.

Advancing your anatomical knowledge enhances your duty of care to prevent harm to your client and assist in mitigating risk. Knowledge gained is fundamental to many Fitness Industry Guidelines.

Your aim as a Fitness Professional is to reduce risk of serious injury or incidents by creating an exercise plan specific to the client constantly referencing information from the Pre- exercise screening.

Being aware that the pelvic floor, multifidus, diaphragm and abdominal cylinder muscles is essential for ideal lumbar pelvic posture (sitting, squatting, standing) –foundational for Functional Fitness and Pelvic Floor Safe exercise

Critical to enhance fitness professionals observational and cueing skills determining whether their clients are correctly recruiting pelvic floor, multifidus, diaphragm and abdominal cylinder muscles ‘The Core’ before attempting any strengthening, cardio exercise workout in the fitness environment

As Fitness Professional you are uniquely positioned to make a difference here! 
You already have a basic understanding of the anatomy and with the visual help of seeing your own deep stability muscles on the screen utilising the Real-time Ultrasound will enhance the correct recruitment of your own pelvic floor and abdominal cylinder muscles – ‘The Core’.  This allows you to confidently teach this foundational movement pattern to your clients.

With a little further education, you can begin to incorporate Functional Pelvic & Core Fitness into your pelvic floor safe fitness regime contributing to your clients’ health and fitness goals…. and, in doing so, help you build a successful and thriving business.


Functional Pelvic Floor & Core Fitness is a two-day, face to face educational workshop (10 CEC’s) promoting awareness, knowledge and practical ‘know how’ to optimise function of the pelvic floor and abdominal cylinder muscles (The Core) in the fitness industry.


Our story

Inspired by Pelvic Floor First  

I attended the launch of the Pelvic Floor First campaign that was presented by the Continence Foundation of Victoria in November 2011.  As a Women’s Health, and Musculoskeletal Physiotherapist I was delighted with the name of Pelvic Floor First.  Inspired with the presentation I woke in the early hours writing a practical educational workshop called PELVIC FLOOR FITNESS  targeting the Fitness Industry on the importance of the functional application of the pelvic floor muscles.

In clinical practice using the Real Time Ultrasound for biofeedback I became aware that women’s pelvic floor muscles were not being acknowledged and  recruited with exercise.  Observations using the real time ultrasound revealed that women were not recruiting the pelvic floor muscles instead were pushing down upon the pelvic floor risking pelvic organ prolapse.

Women were trying hard to improve their physical fitness, placing great trust in their personal trainers and fitness instructors.  However, were saddened to hear they were not being properly guided on how to best recruit their pelvic floor muscles for exercise.   I became aware of the gap in knowledge regarding the correct recruitment of the “core” of which the pelvic floor muscles are an essential  component.

Pelvic Floor First was a brilliant choice to encourage the pelvic floor muscles to be well elevated in the pelvic cavity to counteract the inevitable increase in intra-abdominal pressure in fitness based exercise.
This repetition of intra-abdominal pressure and constant loading of an unrecruited pelvic floor has the negative consequence of pelvic organ prolapse and/or stress urinary incontinence.

Mandy’s Story 

Mandy (fictitious name) returned to her local gym 8 months after the birth of her third child.  After 3 months of enjoying  multi weekly gym visits Mandy presented frustrated that she still looked 6 months pregnant.  Mandy experienced mild stress urinary incontinence and abdominal discomfort with exercise.

Mandy’s typical abdominal routine included sit ups which she enjoyed doing.  Mandy performed these sit ups with her abdomen swelling outwards and on real time ultrasound observation  her bladder descended downwards into her vagina.
Mandy was horrified that she had been working out for the past 3 months potentially developing a prolapse and worsening her stress urinary incontinence.  She was upset that the fitness instructors had not corrected her poor technique and wondered why her pelvic floor muscles were not discussed considering she was recovering from the birth of her third child.   

Mandy was then taught, in physiotherapy, how to correctly recruit her pelvic floor muscles and perform an appropriate and safe partial sit-up.  When viewing on real time ultrasound, whilst doing this exercise, Mandy maintained an elevated pelvic floor with no downward movement of her bladder.

Mandy left with the motto “Pelvic Floor First” before exercise.


Real Time Ultrasound is a wonderful biofeedback tool where you get to see your deep core muscles work on the screen.
It is vital for all fitness professionals to see and feel how their core muscles are recruited so they are able to teach this to their clients. 
Abdominal muscle cylinder (core) includes the transversus abdominus, pelvic floor muscles, deep lower back muscles (multifidis) and diaphragm. The four parts of the abdominal cylinder work synergistically together to best support the spine. This is referred to lumber pelvic stability in the literature and often spoken of as “neutral” spine.
The deep abdominal muscle transversus abdominus, surrounds the trunk and acts like a natural back brace. The pelvic floor works to regulate bladder and bowel control, support the pelvic organs and is important in sexual function. These muscles work in unison with the diaphragm and other spinal stabilising muscles to provide core stability.
Scientific research has shown that during an episode of low back pain these important deep stabilising muscles, the multifidis, can switch off and waste away long after the pain has settled. They do not automatically return to ideal function on resolution of pain. This is why it is vital after an episode of low back pain that your deep stabilising muscles are assessed. This information should empower fitness professionals that if they are able to teach neutral spine and cue clients correctly recruiting their pelvic floor muscles before exercise they may be reducing recurring episodes of low back pain, stress urinary incontinence and prolapse symptoms.

This information below about Pelvic floor muscle strength training should EMPOWER all Fitness professionals to be comfortable about discussing with clients the pelvic floor muscles and possible associated pelvic floor dysfunctions such as incontinence and prolapse symptoms.

Did you know that

  • 65%  of women sitting in a GP’s waiting room have some type of incontinence – less than a third will seek your help
  • 1 in 3 Australian women suffer from urinary incontinence
  • 43% of subjects with incontinence and prolapse depressed their pelvic floor on ultrasound when instructed to lift (straining strategy)

There is :

  • Level 1A evidence, Grade A recommendation, Fourth International Consultation on Incontinence  (Abrams et al, 2009)

 “Pelvic floor muscle training should be offered as first-line therapy to all women with stress, urge or mixed urinary incontinence”

Morphological changes after pelvic floor muscle strength training (RCT):

  • Increased muscle thickness, 1.9mm
  • Decreased hiatal area by 1.8cm squared
  • Shortened muscle length by 6.1mm
  • Elevated the position of the bladder by 4.3mm
  • Rectum elevated by 6.7mm
  • Increase maximal urethra closure by 11.1 mm2.
  • Reduced hiatal area and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness
  • Inhibition of detrusor contraction

Obstetrics & Gynaecology (2010), Hoff Braekken


As a fitness professional be EMPOWERED and PASSIONATE about including Pelvic Floor Fitness into your exercise programs.  Your clients will love that you are respecting and interested in their deep postural muscles.

" Empowering women, dancers and athletes on their physical journey."