Can you lift your testicles? Training the pelvic floor for injury prevention, back pain resolution and sports performance.

As a physiotherapist I use that first sentence surprisingly frequently.

Most women know they have a pelvic floor, men not so much. Women who have been pregnant will definitely know they have a pelvic floor and should have trained the muscles ante and post natally, with or without the help of a physiotherapist. What most people don’t know is how important the pelvic floor muscles are for preventing back pain, hip and groin pain, shoulder pain and, to be honest any injury to the body from top to toe.

The reason is that the pelvic floor provides stability to the back and pelvis and therefore helps to reduces unnecessary movement and forces going through the joints in the back and pelvis. By reducing these excess movements the leg and arm movements are more efficient thereby reducing stresses and strains through the whole body. This improved efficiency of movement has a significant positive effect on sports performance.

Fantastic all round. So what are my top physio tips on how you should train them?

Because you are aiming to use them as a stabiliser you need to learn to activate them so that they work continuously for you. Therefore you should aim to contract them at about 20% of the maximum contraction. Unlike a movement muscle that you might train at about 70-80% max and unlike when training the pelvic floor ante-natally when training them to switch on and off is the key. At first, if the muscles are weak or damaged or if you have a history of back pain, pelvic pain, hip or groin pain, this might be very difficult and I would strongly recommend that you see a physiotherapist to help you.

Don’t do these exercises when you have a full bladder or you can increase your risk of a urinary tract infection. Apart from that you can do them anytime anywhere (just be careful of your facial expressions!)

MEN AND WOMEN: Imagine that you are going to stop yourself from going to the loo. You want to be gently contract your muscles imagining that you are pulling them up towards your head. You want to use the muscles at the front and the back in one simultaneous contraction. It should be the complete opposite of the kind of pushing that you would do if you are constipated.

Because the muscle is innervated by the same nerve as the muscle deep in your lower abdomen called the transverse abdominus you can feel if you are doing it right by feeling this muscle. Put your fingers on the bony bits at the front of your pelvis. Move your fingers inwards towards you belly button slightly. When you contract the pelvic floor you should feel the muscles under your fingers increase in tension slightly. They should not bulge. If they bulge you need to do less of a contraction and go and see a physiotherapist.

Once you have the contraction you want to aim to hold it for as long as possible. You need to practice doing it 3-4 times a day and eventually you will notice that it is a lot easier to switch it on and that it is even switched on without you having to think about it. Then you will just need to make sure it is switched on before you exert yourself like lifting something heavy, going for a run or during an intense training session.

Now for the gender specific stuff…

WOMEN: This description is not for the faint hearted… Imagine you are going to pull a tampon up towards your head. Makes sense though doesn’t it?!

Your pelvic floor is responsible for holding up your pelvic organs (bladder, bowel etc) as you get older because the ligaments get longer and longer so it is extra important for you to this to avoid prolapses etc.

MEN: This has worked every time I have used it… Imagine you are walking into a cold lake and you are going to try and lift your testicles away from the water without moving your buttocks.

Another advantage of training your pelvic floor and the associated muscles is that you will flatten the lower part of your abdomen which so many people struggle to target… But perhaps that deserves another blog.

In the meantime I would love to know how you get on and if you find any of this difficult or have any pain in the region please go and see a women’s and men’s health Physiotherapist

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