You can have a pelvic floor that’s doing too much and glutes or abdominal muscles that aren’t doing enough. Those findings aren’t contradictory. In fact, they can be part of the same movement strategy.
The pelvic floor isn’t only involved in bladder, bowel, and sexual function. It also participates in stability and responds to movement throughout the day. If your body has learned to rely heavily on the pelvic floor for support, those muscles may begin contributing more often or more intensely than the task actually requires.
Meanwhile, another muscle group may be perfectly strong but consistently under recruited. This combination of muscles doing too much, too little, or contributing at the wrong time is one of the ways muscle coordination can influence pelvic pain.
And it changes the question from:
“How do we make this muscle stronger?” to “Why is this muscle working so hard in the first place?”
An Overactive Pelvic Floor Isn’t Necessarily a Strong Pelvic Floor
“Overactive” and “strong” aren’t interchangeable.
An overactive muscle is one that has difficulty appropriately reducing its activity or relaxing when the task no longer requires it. That doesn’t tell us how much force the muscle can generate or how well it performs its job. A pelvic floor can have increased resting tension and still be weak. It can also have good strength but poor endurance. Or it may generate plenty of force but have difficulty coordinating contraction and relaxation.
This distinction matters because adding more strengthening to a muscle that’s already doing too much may not address the actual problem. For someone with hypertonic pelvic floor dysfunction, the first priority may be understanding why the muscles remain active rather than assuming they need to become stronger.
Sometimes Overactivity Is the Compensation
Imagine standing on one leg. Your body has to control the position of your pelvis while your weight shifts onto a much smaller base of support. Your glutes, hip muscles, trunk, and pelvic floor all adjust their activity to accomplish that task.
Now imagine one part of that strategy isn’t contributing efficiently. Your brain has a goal: accomplish the movement and keep your body stable while doing it.
It doesn’t consciously choose which muscles should do each job. Instead, your nervous system organizes a movement strategy using the muscles available to accomplish the task. If one part of that strategy isn’t contributing efficiently, your brain doesn’t simply stop the movement. It finds another way.
One option is to increase muscle activity somewhere else. For some people, the pelvic floor becomes part of that solution. This doesn’t mean the pelvic floor consciously “takes over” for one specific muscle. Movement is more complex than a one for one trade. Instead, the overall recruitment strategy changes. The result may be a pelvic floor that’s being asked to provide stability more frequently than necessary, particularly during activities that challenge the hips and pelvis.
Under Recruitment and Overactivity Can Exist at the Same Time
This is where pelvic floor dysfunction can become confusing.
- You may have under recruited glutes and an overactive pelvic floor.
- You may have difficulty recruiting part of your abdominal wall while simultaneously gripping through other abdominal muscles.
- Your hamstrings may be doing far more than necessary while another hip muscle contributes very little.
The body doesn’t distribute muscle activity evenly simply because that would be biomechanically ideal. It uses the movement strategy it has learned.
For example, someone who can’t feel her glutes during exercise or after pregnancy may rely heavily on the hamstrings, lumbar muscles, or pelvic floor to help control the pelvis. That’s why identifying the tightest or weakest muscle doesn’t always tell us what needs to change. Sometimes the more useful question is which muscles are contributing, how much they’re contributing, and when.
Why Would the Pelvic Floor Keep Working When It Doesn’t Need To?
Because movement patterns become automatic, you don’t consciously decide how much glute, abdominal, or pelvic floor activity you need every time you take a step. Your nervous system handles that for you. Once a particular recruitment strategy becomes familiar, the body can continue using it even when the original reason for the compensation is no longer present.
Pregnancy is a good example. As the body changes throughout pregnancy, the muscles surrounding the pelvis continually adapt to different loads, positions, and movement demands. After delivery, the physical circumstances change dramatically again. But movement strategies don’t necessarily reset at six weeks postpartum. A woman may continue bracing through her abdomen, gripping with her pelvic floor, relying heavily on her back, or under recruiting her glutes long after the tissues themselves have healed.
Pain, surgery, injury, prolonged inactivity, and repetitive movement can produce similar changes in motor patterns. The body learned a strategy that worked. Now it may need help learning another one.
What Happens When the Pelvic Floor Doesn’t Fully Let Go?
A muscle needs more than the ability to contract. It also needs the ability to reduce its activity.
The pelvic floor needs to lengthen and relax for bowel movements, comfortable penetration, and efficient urination. It also needs to move through different levels of activity as your physical demands change. When the muscles remain more active than necessary, that flexibility can decrease. For some people, a pelvic floor that has difficulty relaxing may contribute to symptoms such as:
- Pelvic or vaginal pain
- Pain with intercourse
- Urinary urgency or frequency
- Difficulty initiating urination
- Constipation or difficulty emptying
- A feeling of incomplete bowel or bladder emptying
- Pain or discomfort with sitting
- Symptoms that increase with exercise or prolonged activity
Not everyone with these symptoms has an overactive pelvic floor, and not every overactive pelvic floor develops because of altered muscle recruitment. That’s why symptoms alone don’t tell us which muscles need strengthening and which need to do less.
Why Kegels Aren’t Always the Answer
Kegels have become almost synonymous with pelvic floor health.
- Leak urine? Do Kegels.
- Had a baby? Do Kegels.
- Feel weak? More Kegels.
But urinary leakage, postpartum symptoms, or pelvic instability don’t automatically mean the pelvic floor needs more strengthening. If the pelvic floor is already maintaining excessive activity, repeatedly asking it to contract may reinforce the strategy you’re trying to change.
For some people, the more important skill is learning how to reduce unnecessary pelvic floor activity and then coordinate an appropriate contraction when the task actually requires one. For others, strengthening absolutely is appropriate.
The point isn’t that Kegels are bad. It’s that the exercise needs to match the problem.
You May Not Know Your Pelvic Floor Is Overactive
Unlike a tight hamstring or sore shoulder, pelvic floor tension isn’t always something you can easily identify.
Many people have very little awareness of what their pelvic floor is doing. You may not feel the muscles tightening throughout the day. Instead, you notice the symptoms associated with that pattern.
- You may experience urinary urgency.
- Sex may become painful.
- You may have trouble emptying your bowels.
- Your pelvis may ache after exercise.
- Or you may repeatedly try to “relax” your pelvic floor without being quite sure what relaxing it is supposed to feel like.
Reduced awareness of pelvic floor contraction and relaxation is one reason simply telling someone to “relax your pelvic floor” often isn’t enough. First, you have to understand what the muscles are actually doing.
What Pelvic Floor Physical Therapy Looks At
An evaluation isn’t simply a search for a tight pelvic floor. You need to understand the pattern around it. That includes assessing pelvic floor muscle tone, strength, endurance, coordination, and the ability to relax, while also looking at the muscles and movements that influence the pelvis.
- Can you recruit your glutes without immediately using your hamstrings or low back?
- Can your abdominal wall contribute without excessive gripping?
- What happens at the pelvis when you stand on one leg, squat, walk, lift, or perform the activity that triggers your symptoms?
- Can the pelvic floor increase its activity when needed and then reduce it again?
These findings help distinguish a muscle that needs strengthening from one that needs better coordination, improved awareness, reduced resting activity, or some combination of the above. At Femina Physical Therapy in Atlanta, this is why movement assessment is part of pelvic floor rehabilitation rather than treating the pelvic floor as an isolated group of muscles.
Improving Coordination Doesn’t Mean Making Every Muscle Work Equally
The goal isn’t perfect muscle activation. And it isn’t trying to consciously control every muscle during every movement.
That would be exhausting.
Treatment is about giving the nervous system better options. Depending on the individual findings, that may include improving awareness of pelvic floor contraction and relaxation, reducing unnecessary muscle activity, retraining under recruited muscles, changing the timing of muscle recruitment, strengthening where appropriate, and then integrating those changes into functional movement. Manual therapy may also be useful when pain, tissue restriction, or persistent muscle tension is limiting movement or making it difficult to access a different strategy.
Ultimately, we want the body to become adaptable again. Some tasks require more stability. Some require less. A healthy movement system needs be able to do both.
Frequently Asked Questions
Can a pelvic floor be tight and weak at the same time?
Yes. Muscle tension and muscle strength describe different characteristics. A pelvic floor can have increased resting tension while also having poor strength, endurance, coordination, or the ability to generate an effective contraction.
Can weak glutes cause a tight pelvic floor?
Not directly. Pelvic floor dysfunction rarely has a single cause. However, if the glutes are under recruited during movement, other muscles may increase their contribution to stability. In some people, the pelvic floor may become part of that compensation strategy.
How do I know if my pelvic floor is overactive?
Symptoms can include pelvic pain, pain with intercourse, urinary urgency or frequency, constipation, difficulty emptying the bowel or bladder, and discomfort with sitting or exercise. However, symptoms alone cannot determine pelvic floor muscle tone. A pelvic floor assessment can evaluate resting tension, contraction, relaxation, and coordination.
Should I do Kegels if my pelvic floor is tight?
Not automatically. If the pelvic floor is already overactive or has difficulty relaxing, additional strengthening may not be the first priority. Whether Kegels are appropriate depends on your individual muscle function and symptoms.
Why can’t I relax my pelvic floor even when I try?
Pelvic floor activity is largely automatic, and long standing recruitment patterns can become difficult to change voluntarily. Pain, guarding, reduced proprioception, altered movement strategies, and other factors may all contribute.
Can pelvic floor physical therapy retrain muscle coordination?
Yes. Depending on the findings, pelvic floor physical therapy may address muscle awareness, relaxation, recruitment, timing, strength, mobility, and functional movement to improve how the pelvic floor coordinates with the rest of the body.
References
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Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of Physical Medicine and Rehabilitation.
Bø K, Sherburn M. Evaluation of female pelvic floor muscle function and strength. Physical Therapy.
Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurourology and Urodynamics.
van Dieën JH, Reeves NP, Kawchuk G, van Dillen LR, Hodges PW. Motor control changes in low back pain: divergence in presentations and mechanisms. Journal of Orthopaedic & Sports Physical Therapy.
Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. Elsevier.