The Overlooked Muscle Group That Will Transform Your Workout—And Your Health

Breathe into your kidneys. Open your third eye. Engage your pelvic floor. These are some of the abstractions masquerading as instructions that I can count on to trigger elaborate daydreams during yoga class.

I have just found out, however, that my lack of engagement isn’t only attention-based. The pelvic floor, or the PF as some neatly call it, is a diamond-shaped sheet of 14 muscles that hammocks from the pelvis to the tailbone and supports our core and organs. A weak PF can lead to everything from slumping and lower back pain to diminished sexual pleasure, not to mention such horrors as incontinence and organ prolapse, where an unsupported organ drops within the body, like a crabapple to the ground.

“The pelvic floor—it’s a really important piece of the puzzle,” Heather Andersen, owner of New York Pilates, tells me. “It makes some people feel uncomfortable to talk about, but you really have to keep it strong. ‘Lift in and up through your pelvic floor’ is a cue I’ll give in most of my classes.” When asked to describe how to do it correctly, Andersen giggles and rattles off a range of different descriptions she’s heard—some instructors suggest engaging the muscles that stop urinary flow, while a more poetic colleague of Andersen’s tells students to imagine a pearl inside the body and contract in order to prevent it from dropping. For her part, Andersen suggests envisioning a tiny X between the female body’s two private-most Os, and focusing on lifting it in and up toward the top of the head. “It’s definitely hard to engage if you don’t already know what to do!” she admits.

Tania Boler, a 39-year-old Londoner, wants to take the mystery out of the equation. She recently created Elvie, a wearable mint green silicone device that turns pelvic floor exercises into a video game of sorts. The slim, curvilinear Elvie (short for, you guessed it, elevate) links up via Bluetooth with your iPhone so an app keeps track of your progress during your training sessions, which involve inserting the apparatus and squeezing it for three to five minutes, three to four times a week. The player follows on-screen prompts to contract and relax, and watches a small symbol rise and fall in tandem with her efforts. The levels range from beginner to total control.

If carving out time to strengthen an elusive muscle group that won’t make you look better in a tank dress seems excessive, think again. “Most women don’t think about it until something goes wrong,” Boler says. “When they have lower back problems, they see a physiotherapist and they’re surprised to hear the problem is the pelvic floor. You can’t just focus on your abs. These muscles are interconnected and complement one another.”

Boler, who has a background in global women’s health, became interested in this field five years ago, when she was pregnant for the first time and her Pilates instructor urged her to take precautions. This was news to her, but her husband, who is French, reminded her of la rééducation périnée, the physiotherapy sessions given to every new mother to help rehabilitate her core—PF and all. In France, therapists hook women up to electrodes in order to measure their muscle activation. “We took this horrible medical equipment and turned it into a lifestyle product,” says Boler. “You can wear it to work and use it while writing email.”

Pregnancy wreaks havoc on the pelvic floor, of course, as a growing baby presses down on the muscles for some 40 increasingly uncomfortable weeks. Another stressor is high-intensity exercise such as running and cardio dance—heavy impact can wear at the muscles if you’re not engaging them properly. (Elvie has a following among the CrossFit and ballet communities.)

For more advanced one-on-one training, I call Lindsey Vestal, a Manhattan-based occupational therapist. Her company, the Functional Pelvis, makes pelvic floor–specific house calls. She shows up at my office toting a life-size anatomical model. “I bring a pelvis with me everywhere,” she says. “This topic is hard to talk about.” It can also be challenging to assess oneself, she explains, since the muscles aren’t visible without the help of an ultrasound or electrodes. Vestal, who has two small children and talks a mile a minute, explains that weak muscles aren’t slack, as I’d imagined. Rather, they tend to be tight. Working to relax and lengthen them will facilitate a greater range of motion and enable my floor to grow stronger with time.

How to achieve this? She proffers a balloon and asks me to blow into it. “You feel it deep in your core, right? You want to breathe deeply, and allow your pelvic floor to expand and contract throughout the day,” she says. During exercise classes, I can make a few simple modifications to prevent tightness: Namely, I’m not to hunch over at spinning or force my belly button against my spine in Pilates. “Don’t drive yourself crazy trying to hold it all in,” she says.

Thankfully, that has never been my problem. The imaginary balloon breathing, I am soon to discover, takes a little more work. I am to be mindful of engaging a heretofore dead zone at all times, especially when performing other activities such as lifting my daughter or standing up from my chair to run to a meeting I’m late for. This mental vigilance doesn’t come naturally to me, but I don’t intend to give up. My core will thank me soon enough.

 

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