The Inner Pelvic Core

by Christina Christie, PT on Oct 24, 2008


Try simple three-dimensional moves to help participants effectively train their pelvic-floor muscles.

The “core” by its simplest definition includes the muscles of the abdominals and back. However, the core is actually an integrated system that includes many parts. The “roof” is the respiratory diaphragm; the abdominals support the front wall; the back and hip muscles make up the back wall; and the pelvic-floor muscles make up the bottom. Together, these parts can also be referred to as the Pelvic Core Neuromuscular System (PCNS).

The fascial system provides a network of functional feedback through the nervous system, linking the musculoskeletal system to the “common core.” This balanced or synergistic activity should happen automatically—without conscious effort. If it doesn’t, the PCNS must be trained in an integrated and three-dimensional fashion.

Addressing Pelvic-Floor Issues

One in three women has some form of pelvic-floor dysfunction (e.g., incontinence, pelvic pain or pelvic-organ prolapse) (Christie & Colosi 2008). Pregnancy is commonly associated with the start of pelvic core muscle weakness (Viktrup, Rortveit & Lose 2006). Many women also have low-back pain and diastasis recti (splitting of the abdominal muscles at the linea alba), which can lead to the lower abdominal protrusion or “pooch” that so many women develop after childbirth or significant weight loss. The pelvic core muscles may also lose their reflexive capability to “turn on” automatically, providing support to the entire core from the bottom up. When this happens, a potential solution is three-dimensional core training that integrates the pelvic-floor muscles and PCNS (Moen et al. 2007).

A valuable connection to understand is the fascial connection of the pelvic-floor muscles (levator ani) to an important hip muscle (obturator internus) via the arcuate tendon. The pelvic-floor muscles are also fascially connected to the adductors, which provide a balanced, equal and opposite reaction to the obturator internus. All of these interconnections produce chain-reaction activation of the pelvic-floor muscles when hip rotation moves are added to a core-training exercise.

The exercises below produce subconscious activation of the PCNS. This is very different from the conscious pelvic-floor contraction known as the Kegel (Kibler, Press & Sciascia 2006). Ninety-nine percent of everyday function is subconscious. The PCNS must be trained to turn on automatically so that it supports the core and allows for optimal biomechanical health.

Introduce the following three moves in a class that has a functional or postnatal theme, or simply add them to an existing core-training class (men need three- dimensional core training, too!). Cue participants to exhale upon exertion. For additional strengthening, add a Pelvicore™ Pro exercise tool, a small round “sponge” ball or a Pilates ring. Perform all exercises in sets of 10 repetitions.

Bridging With Hip Rotation

  • Begin supine with knees bent.

  • Lift hips and rotate knees toward each other.

  • Return to start, then lift hips and rotate knees away from each other.

  • Perform with toes turned inward and with toes turned outward.

Squat With Hip Mobility

  • Stand with feet neutral (shoulder width apart, both feet facing forward).

  • Perform a mini squat and roll knees inward, then rotate your hips in clockwise and counterclockwise directions.

  • Perform with toes turned inward and with toes turned outward.

  • Repeat whole series with knees rolled outward.

Mini Squat With Cross Punch

  • Stand with feet neutral (shoulder width apart, feet facing forward).

  • Perform a mini squat and roll knees inward.

  • Cross punch in the air (alternate arms) at various levels (up, down, to the side, back, diagonal, etc.).

  • Perform with toes turned inward and with toes turned outward.

  • Repeat whole series with knees rolled outward. n


Christie, C., & Colosi, R. 2008. Continuing education course: The female chain reaction. The Gray Institute.

Kibler, B.W., Press, J., & Sciascia, A. 2006. The role of core stability in athletic function. Sports Medicine, 36 (3), 189–98.

Moen, M., et al. 2007. Knowledge and performance of pelvic muscle exercises in women. Pelvic Medicine Surgery, 13 (3), 113–17.

Viktrup, L., Rortveit, G., & Lose, G. 2006. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstetrics Gynecology, 108, 248–54.

IDEA Fitness Journal, Volume 5, Issue 11

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About the Author

Christina Christie, PT

Christina Christie, PT IDEA Author/Presenter

Christina Christie, PT, is the president of Pelvic Solutions, LLC and inventor of the Pelvicore™. She is a senior physical therapist at the outpatient rehabilitation department of Advocate Luther...