The PGM Method - Activating the Core, Targeted Strengthening and Stretching for the Pelvic Girdle

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Original Editor - Deborah Riczo

Top Contributors - Wanda van Niekerk, Tarina van der Stockt, Kim Jackson, Jess Bell, Vidya Acharya and Lucinda hampton  

Core Activation

The deep or inner core muscles are:

• Transversus abdominis
• Pelvic Floor
• Diaphragm
• Multifidus

These are the targeted muscles when the core is being activated. It is recommended to start with core activation exercises in a static and safe position and from there on one can progress. The progression of core stability exercises can be as follow:

• Starting of in a stable and symmetric position (static position)
• Progressing to asymmetrical positions (still in a static position and adding movement of the extremities)
• Mobility (adding a roller or ball under the trunk)
• Agility (moving the trunk in space, balancing activities, lunges and dynamic balancing activities)

Activation of deep core

• Start of with diaphragmatic breathing
  • Belly muscles should soften within the inhale
  • Rib cage expanding with inhale
  • Exhale through pursed lips

• Engaging pelvic floor and transversus abdominis
  • On the exhale of the diaphragmatic breathing, engage the pelvic floor and transversus abdominis
  • Various connect cues that may help the patient with this are:
  • Transversus abdominis
    • imagine a line that connects the inside of the two pelvic bones (front of the hips). Think about connecting, or drawing the muscle along this line as if closing two book covers
    • imagine that you are pulling on a pair of tight jeans and flattening the lower abdomen to be able to pull up the zipper
  • Pelvic floor
    • visualize squeezing/closing of the urethra - as if to stop the flow of urine
    • visualize or squeeze/close the anus - as if to stop flatulence

• 
  Blowing out through pursed lips or making a "hissing" sound improves pelvic floor contraction
• If the patient’s pain is increasing with pelvic floor contraction, this may indicate possible hypertonic pelvic floor muscles, leave this part out then
• Aim to repeat this core activation pattern 10 times in a position and do it in various positions, such as supine, prone, standing, 4 point kneeling
• The amount of repetitions and in which positions you would start your patient of will be based on clinical reasoning and decision-making, keeping in mind that the muscles need to be worked to fatigue in order to strengthen
• The inner core muscles should be working automatically, but it has been shown that with pelvic girdle dysfunction and other injuries that these muscles do become inhibited

Examples of core activation in different positions:

Targeted Stretching

Part of the assessment in patients with pelvic girdle pain and dysfunction is to include investigations to assess for any specific muscle tightness or shortening. Some of the structures that may be tight or shortened include:

• Hip extensors
• Hip flexors
• Hip rotators
• Hip adductors
• Hip abductors
• Quadriceps
• Hamstrings
• Lumbar rotators
• Latissimus Dorsi

For a quick recap of the anatomy of the pelvic girdle have a look at this page: Anatomy of the Pelvic Girdle

Patients are often tighter on the side of pain and it may be valuable to provide them with specific unilateral stretches. It is also recommended that you ask if the patient perceives one side to be tighter than the other.

Examples of Stretches of Pelvic Girdle Muscles

Hip Extensors

Hip Rotators

Hip Flexors

Hip Adductors

Hip Abductors

Quadriceps

Hamstrings

Glute medius

Glut maximus

Hip rotators

Sit to stand

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