Diaphragmatic breathing has long been a core element of pelvic floor rehabilitation, thanks to the well-established “piston-like” relationship between the diaphragm and pelvic floor. During exhalation and increased intra-abdominal pressure, the pelvic floor should engage with a coordinated lift and squeeze.
A quasi-experimental, repeated-measures study by Kitani et al. (1) examined whether the force of exhalation influences automatic pelvic floor muscle activation. The study included 26 nulliparous women aged 18–35 with normal pelvic floor function.
Using a breathing device with three levels of expiratory resistance (measured via spirometry), the researchers assessed cranial pelvic floor displacement via ultrasound and squeeze pressure via perineometry.
The key finding: gentle, minimal forced expiration resulted in optimal cranial-ventral pelvic floor displacement—suggesting that less forceful exhalation may promote more effective and protective pelvic floor engagement.
Clinical Application:
This study highlights the importance of how we cue breathing during pelvic floor muscle training. Overly forceful exhalation may reduce the effectiveness of automatic pelvic floor activation.
Effective verbal cues may include:
“Exhale gently, like blowing out birthday candles.”
“Blow softly, as if moving a feather across a table.”
What breathing cues are you using in your practice?
- Kitani L, Apte G, Dedrick G, Sizer P, Brismee J-M.The Effect of Variations in Forced Expiration Effort on Pelvic Floor Activation in Asymptomatic Women. Journal of Women’s Health Physical Therapy. 2014(38)1:19-27.
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