Cueing pelvic floor muscle engagement for men is tough. We've found that with women you can default to cueing a Kegel exercise, but for men it's a trickier, yet more delicate situation... especially for female instructors. Does anyone have advice for helping men find and use their pelvic floor muscles in Pilates work? Do you have any cues or helpful images that you can recommend? Just wondering how instructors out there handle this.

Thanks!

Hi there,

You're right, it's a bit more tricky with men to help them engage their pelvic floor muscles. I have several male clients that I have worked with for many years and one of the cues that I have found works well is to cue them to "lift the boys" when they exhale. Now, it's a little odd at first to use this cue so I usually preface the first time I use it by saying something like "this is going to sound funny but...." It works really well with men; in fact one of my clients had prostate cancer and this is the exact same cue that the physiotherapist used after his surgery.
You'll need to be the judge about how your client will take this, but it does work!

A cue I have found works with my male clients is for them to envisage "walking into very cold/icy water".

I find that "slowing the flow of water whilst peeing" works ok .... and "feel an engagement from pubic bone right through to bottom". Sucking thumb whilst engaging pelvic floor seems to enhance the feeling, but I only use it for beginners. If you know your male client very well, a more intimate (embarrassing!)way of engaging pelvic floor is to use the muscles which are used to attain/maintain an erection.

Personally, I have never found the need to cue pelvic floor muscles. I have found that if the legs are in proper alignment, the pelvic floor muscles will fire automatically upon movement.

Hi,

I am a Pilates instructor, but also a physical therapy graduate student. With all of my time in the clinic and in the studio, I've taught many men how to get to their pelvic floor. I think the best thing to do with male clients is to give them many options. Some people respond to the idea of the pelvic floor like a hammock and you want to lift the hammock. Lifting the boys also works really well. You could also try to incorporate the transversus abdominus as these two muscles are closely linked and it's something you can palpate as it contracts. Once you've got the TA working, it's easier to contract your pelvic floor. Whatever method you choose, to convey the engagement you're looking for, you have to be confident. Talking about the pelvic floor is part of Pilates and your client is more likely to feel uncomfortable if you are uncomfortable. I try tend to shy away from the idea of stopping the flow while you're going. It does engage the pelvic floor, but you can get those "go-getter" types of people who will practice this often and they are at a high risk for giving themselves a urinary tract infection. My opinion is that I don't want to expose my clients to that opportunity.

My cue to get men to access their pelvic floor muscles always gets a laugh and is easily remembered - "nuts to the guts". Cheers, from Australia

Usually, I mention the 'walking into the ocean 2 blocks from here' (c-o-l-d) and then I attended Rebecca Leone's Excel programme last August: testicals to tonsils, my friend ... I want to see you engaged - it's the perfect cue to get the message across and keep things light - usually, the guys laugh and that engages the TVA nicely. Thanks, Rebecca.

Dianne Miller has a wonderful way of explaining the pelvic floor contraction, I have used this cuing imagery for years and it's been really helpful for both men and women.

Cue the bones... 1. Contract to bring the 2 sitz bones closer together (moving the side walls of the floor) 2. Contract to bring the pubic bone and tail bone closer together (engaging the top & bottom of the floor) 3. Connect a drawstring to all 4 bones - sitz, pubic, sitz, tail And close the drawstring to engage the whole pelvic floor.

I normally break this down and practice step 1 as an exercise, step 2 as an exercise, then put it together on step 3 to find the whole pelvic floor. Then I've got a nice image (the word "drawstring") to quickly reference and cue when they need to engage for more support during exercise.

For men, I find that it's easiest to start learning this in a seated position. But I have clients practice lying face up, face down, seated, standing, kneeling....

With this cue, everyone can relate, we've all got the same bones! So I don't have to make jokes or put the 1-2 men in a room full of girls in an awkward or uncomfortable position. Hope this is a useful tidbit for somebody teaching out there:) Let me know!

It is my understanding that the pelvic floor muscles engage autonomically with the engagement of the transverse abdominus and other abdominal muscles. So how does one know whether someone needs to be putting further attention and forceful contraction into this region? Do you all test the function of pelvic floor muscles before giving these cues? What is the effect of over contracting the pelvic floor beyond what it would naturally do for everyday function?

Thanks for any input on this.

These are great replys which I will use in my teacher training as well. Thank you to everyone - except Stacy Redfield - go to as much continuing education as you possibly can and LISTEN to these other posts - for your sake and your clients.

VA,

Any thoughts regarding my questions above? Why is it that we are asking for such dominant engagement of the pelvic floor beyond what is already present? And how do you know that someone's pelvic floor function isn't just fine to begin with? Thanks. And also, just because many continuing ed sources (some very questionable sources to begin with) reiterate this advice, doesn't necessarily mean it's correct or beneficial for everyone.

Agreed Mark. Pelvic Floor is a mysterious group for us Pilates teachers to work with. Yes there are many benefits to pelvic floor contraction. But we have to remember that too much contraction is not what you're looking for either. Unlike Keigel exercises Pilates is focused on contraction of more than just Pelvic floor. Focusing on pelvic floor with transverses contraction will be much more beneficial. Most of the time when someone focuses on pelvic floor alone, they contract to hard and lose the SCOOP that we are truly searching for.

A physiotherapist I know has done tests through ultrasound and has shown that the pelvic floor contraction we practice is actually to hard, and that we do not need as much of a "squeeze" as perhaps we think. The pelvic floor functions on lifting up but also has to release for it's functionality within the pelvis. Just a little tid bit of info.

I've found that my pelvic floor muscles do not engage with the TA without bringing conscious engagement. That said, the kegel, pee muscle analogy has never worked for me. It wasn't until I started 'doming up' from my perineum that I felt the connection of the pelvic floor to the TA. This cue seems to work for most of my clients, male and female alike. Most people seem to know what and where their perineum is, if not, I tell them.

As far as over-engagement goes, I encourage clients to give about 70-80% effort into any exercise, so that there is always room for sensation.

Thanks for the replies.

I guess I was questioning 'too much' pelvic floor contraction in regards to, well, is it already functioning just fine since in fact it co-contracts with TA? And how does the 'teacher' truly know whether one is already contracting here without palpating the region? That's the only way to know for certain and that seems a bit to involved and persoanl for a pilates teacher to be assessing. I've also read that scooping has been shown to degrade or compromise postural and spinal stability, as demonstrated in several studies. Leading experts in the field don't recommend this.??

Hi Mark, you would tend to think if clients are engaging the TVA then all the other local stabilisers should be co-contracting including the pelvic floor....but I suppose we don't really know this is definately happening! The engagement of the TVA is easily palpable and if they are able to engage the pelvic floor only, then the co-contraction of the TVA would be palpable, suggesting the recruitment of these muscles are fine.

I do spend lots of time trying to get client to understand and feel the light co-contraction of the pelvic floor so they are aware if they are engaging or not, but again this requires a great deal of body awareness.

I will at times work with a deeper contraction of the pelvic floor as an exercise in a session, we will do a few just pelvic floor work and then we do our usual contraction of 30%. If clients need to strengthen pelvic floor, the only way I know this if they have been told by a medical professional, if this is the case I will give them specific pelvic floor exercises to do at home.

This is sometimes difficult especially if they have scar tissue and the neural pathway is not functioning! If anybody has any suggestions on how you get clients to 'feel' when they don't know what it is they should be 'feeling' please let me know. I have used many visualisations (don't use stopping the urine flow!).