Strong from the Floor Up: A Fitness Professional’s Guide to Pelvic Floor Health

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Strong from the Floor Up: A Fitness Professional’s Guide to Pelvic Floor Health

By: CarolAnn, MS, NPCT

As fitness professionals, we recognize the importance of having strong glutes, a stable core, and effective breathing mechanics. Yet one area often overlooked in the conversation is the pelvic floor — the hidden powerhouse at the base of the core that supports posture, breathing, continence, and even athletic performance.

Whether you’re training postpartum women, aging adults, athletes, or clients with chronic pain, pelvic floor awareness should be part of your coaching toolkit. Learn how this hidden powerhouse supports movement, how to recognize signs of dysfunction, and how to integrate pelvic floor–friendly strategies into every program.

What Is the Pelvic Floor, and Why Does It Matter?

The pelvic floor is a network of muscles and connective tissues that form a hammock-like, foundational support at the bottom of the pelvis. It works in tandem with the diaphragm, transverse abdominis, and multifidus to form what’s often called the "inner core unit."

Key Functions:

  • Voluntary control: Some pelvic floor muscles are skeletal muscles, meaning we can strengthen and control them through training (like glutes or biceps).

  • Involuntary function: They also respond to reflexes (e.g., sneeze, jump), requiring coordination—not just strength.

These muscles have several important roles:

  • Support: Holds up pelvic organs such as the bladder, uterus (in women), and rectum.

  • Continence: Controls bladder and bowel function.

  • Core stability: Works with other deep core muscles for posture and balance.

  • Sexual health: Plays a role in arousal, sensation, and function.

When the pelvic floor is functioning well, movement feels more supported and efficient. When it’s not, issues like urinary leakage, pelvic pain, low back pain, or even hernias can develop—issues we may observe in our clients but not always recognize as pelvic floor-related.

Signs of Pelvic Floor Dysfunction (PFD)

You don’t have to be a medical professional to notice red flags. Your role isn’t to diagnose, but to observe, educate, and refer when appropriate. Here are some signs that your client may be dealing with PFD:

  • Leaking urine when jumping, running, coughing, or sneezing

  • "Doming" or bulging of the abdominal wall during core exercises

  • Chronic low back or pelvic pain

  • Sensation of heaviness or pressure in the pelvis

  • Breath-holding or bracing during movement

  • Difficulty with deep squats or core activation

Fitness Professionals Play a Key Role

While pelvic health specialists provide medical assessment and treatment, fitness pros are essential in prevention, maintenance, and recovery. Our role is to:

  • Teach breath-to-core coordination

  • Support postural alignment

  • Modify exercises for safety and effectiveness

  • Promote awareness without shame or embarrassment

  • Collaborate with pelvic floor physical therapists

Four Exercises to Support Pelvic Floor Health

These exercises can be introduced in warm-ups, mobility sessions, or integrated into strength work. They promote core integration, pelvic floor activation, and functional movement patterns.

1. Diaphragmatic Breathing with Pelvic Floor Awareness

Goal: Connect breath with pelvic floor movement.
How to Do It:

  • Lie on your back, knees bent, feet flat. Place one hand on your chest, the other on your belly.

  • Inhale through the nose, allowing the belly (and pelvic floor) to expand.

  • Exhale slowly through the mouth, gently lifting the pelvic floor (imagine picking up a blueberry with your vaginal or anal sphincter).

  • Repeat for 6–8 breaths, ensuring relaxation on the inhale and gentle lift on the exhale.

Pro Tip: This is not a "Kegel." Cue gentle engagement, not forceful contraction.

2. Glute Bridge with Exhale

Goal: Engage glutes and coordinate breath with core and pelvic floor.
How to Do It:

  • Lie on your back with knees bent and feet hip-width apart.

  • Inhale at the bottom.

  • Exhale and press through your heels to lift your hips, gently lifting the pelvic floor as you rise.

  • Hold for 2 seconds, then lower with control.

  • Perform 10–12 reps.

Modify: Add a small Pilates ball between the knees for inner thigh engagement.

3. Modified Dead Bug

Goal: Stabilize the deep core while coordinating with pelvic floor engagement.
How to Do It:

  • Lie on your back with knees bent, arms extended toward the ceiling.

  • Inhale to prepare.

  • As you exhale, extend the right leg and left arm toward the floor while drawing the pelvic floor up and in.

  • Inhale to return to start.

  • Alternate sides for 8–10 reps per side.

Watch For: Rib flaring or back arching—keep core gently engaged throughout.

4. Supported Squat with Breath Focus

Goal: Integrate functional lower body movement with breath and pelvic floor support.
How to Do It:

  • Stand with feet shoulder-width apart, holding a light kettlebell or TRX for support if needed.

  • Inhale as you lower into a squat, allowing the pelvic floor to relax.

  • Exhale as you rise, gently engaging the pelvic floor.

  • Perform 10–15 controlled reps.

Cue: “Let go on the way down, lift gently as you stand.”

What to Avoid in Clients with Suspected PFD

  • High-impact exercises that cause leaking or pressure

  • Heavy bracing or breath-holding (Valsalva maneuver)

  • Excessive crunches, double leg lifts, or exercises that create bulging in the abdomen

  • Kegels without professional guidance, especially if the pelvic floor is already hypertonic (too tight)

When to Refer Out

If a client consistently experiences leaking, pelvic heaviness, pain, or difficulty with core engagement, it’s time to refer to a pelvic floor physical therapist. Build a referral network and communicate openly about collaborative care—it enhances client outcomes and professional trust.

Final Thoughts: Elevating the Core Conversation

Pelvic floor health isn’t just for postpartum moms or older adults—it’s a fundamental piece of movement integrity for everyone. As fitness professionals, we have a powerful opportunity to change the narrative from silence and shame to strength and support.

When we include the pelvic floor in our programming, we’re not just helping clients move better—we’re helping them live better.

Expand your teaching expertise with the FiTOUR® Primary, Advanced, Reformer Pilates, and Core & Functional Fitness courses that provide the tools necessary to create safe and effective programming for the pelvic floor. 

CarolAnn is a certified fitness professional with a master’s degree in Exercise Science and Health Promotion and over 30 years of experience. A FiTOUR® ProTrainer for 25+ years and author of 18 FiTOUR® courses, she also serves as a Club Pilates Corporate Master Trainer and Lead Instructor in Athens, GA, specializing in movement for everyBODY.