Kegels and Crunches Are Out, Hello Reflexive Core

Understanding the Reflexive Core

The Reflexive Core is comprised of the respiratory diaphragm, deep abdominal muscles and the pelvic muscles. This is a pressurized system among all of these muscles (think of a full balloon). The respiratory diaphragm and pelvic muscles are the exact inverse of each other, so these muscles make up the top and bottom of the balloon. The abdominals start at the front, wrap around your sides and connect in your back so think of them as 360 degrees around the center of the balloon.





How it works:

Some functional anatomy, here it goes! The diaphragm, abs and pelvic muscles are connected. These muscles have to coordinate and communicate with each other in order for the reflexive core system to function appropriately. See this video for what actually happens every time we inhale and exhale.

  • Inhalation:  diaphragm lowers, pelvic muscles yield to the pressure change, abs open and release.

  • Exhalation:  diaphragm elevates (recoils), pelvic muscles recoil from elongated position, abs engage.

  • This is a balanced system and what it should look/feel like in every person when we breath correctly

  • This system should activate ‘reflexively’ (ie pelvic muscles tighten, abs engage) with movement or any time there is increased pressure through our center (think: moving sit to stand, bending to lift weights/children, coughing, sneezing, running, jumping, etc)

Sometimes, there is a fault SOMEWHERE in this system. It could be due to:

  • Diastasis Recti-a separation of the ab muscles. Think about a slit down the center of the balloon

  • C-section or perineal scarring-This can inhibit the elasticity/stretch of parts of the balloon

  • Weak pelvic muscles-not enough support/recruitment at the bottom of balloon to respond to changes in pressure inside the balloon

  • Pelvic muscles that are too tight-what if the bottom of the balloon was so taut that you couldn’t breath into it and get it to open and expand? Due to its decrease in elasticity, It certainly can’t absorb any pressure/force. Tight pelvic muscles= WEAKNESS.

  • Over-gripped abdominals-Think about just squeezing the center of the balloon. Where does the pressure go? This makes for very unhappy and compressed/descended pelvic organs.

  • Decreased awareness of alignment/posture-the ‘lean back & butt tuck’ posture or ‘slumped’ posture make for a balloon that isn’t stacked. These muscles can’t communicate!

  • Poor body mechanics/exercise techniques-breath holding, bending incorrectly, or exercise techniques that isolate only 1 part of the core system. What if only center of the balloon gets exercised?

  • Hormonal changes that occur throughout the lifespan

A fault somewhere in the system leads to SYMPTOMS that may include:

  • urinary incontinence-ANY involuntary loss of urine

  • urinary urgency-intense urge to urinate, with or without urine loss

  • urinary frequency-more than 7x/day, 0-1x/night

  • pelvic organ prolapse-heaviness/pressure into the pelvis or vagina

  • bowel incontinence, urgency, frequency, constipation

  • pain with intercourse, pelvic pain, low back pain, hip pain, perineal pain, c-section pain

What does this mean?

Correct the faults and decrease/eliminate the symptoms.

Note: This is why performing ‘Kegels’ or traditional abdominal exercises may not be effective or allow you to meet your goals. One must consider retraining the entire core system and addressing all faults in order to be most effective for optimizing pelvic health.

So, immediate actions:

  • Watch your standing and sitting alignment. The system has to ‘stack up’

  • Breathe correctly. Breathing with your diaphragm (360 deg rib cage expansion) decreases pressure on the pelvic floor and abs and brings diastasis separation closer together

  • Exhale to activate the reflexive core when lifting, standing up from a squat, etc

  • Be mindful of exercise techniques that could be contributing to faults and symptoms (This could be an entire other blog post!)

  • Seek help from a specialized PT, of course!

How will Physical Therapy help?

We have highly specialized training and we understand the pregnant and highly complex postpartum body in depth. However, we do have training to support women throughout the entire lifespan, even through menopause and beyond!

  • Proper evaluation is key. We will look for any and all faults and customize women’s physical therapy experience

  • Manual therapy. We will used skilled touch to address internal and external soft tissue concerns. Trigger points, fascial restrictions, nerve irritations, poor musculoskeletal alignment

  • Education. This is where we make behavioral, lifestyle, postural, ergonomic, body mechanics changes needed for women to succeed in healing her condition/concern

  • Exercise. No more Kegels or crunches please! I could talk about this forever. We guide women on re-training their entire system in a very functional way (ie how to bend, lift/carry babies, run, weight lift without losing urine, etc)

Who can this approach help? 

  • moms (pregnant or postpartum)

  • female athletes

  • women in menopause

  • any female experiencing pain or inability to wear tampons, pain or inability to undergo a gynecological exam or concerns with sexual health

  • any male experiencing pelvic, hip, lumbar pain or urinary symptoms

The good news...symptoms and conditions are highly treatable, don’t have to be endured, and it’s never too late to seek care!

If you cannot access a Physical Therapist, or need a home program to compliment your physical therapy plan of care, I highly recommend Restore Your Core ( at any point postpartum) and One Strong Mama (prenatal) because they address and incorporate all the important concepts discussed in the blog. Both being a very safe and effective approach to optimizing your core, pelvic, and whole body health! (FYI: I am an affiliate of both programs and I have been through the content extensively prior to becoming an affiliate!) 

All human bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.