Alignment and the High Tight Pelvic Floor

Alignment and the high, tight pelvic floor – it sounds like the start of a kids fairy tale. And maybe it is! Can a high, tight pelvic floor have a happily ever after? Could alignment be a knight in shining armor for the pelvic floor? My short answer is: yes! For the long answer keep reading….

A physical therapist specializing in pelvic health sent me a question related to alignment: How does the posture correction you suggest address a ‘shortened’ or high, tight pelvic floor?

My response: Great question! One of the notes I like to hit over and over and over again is the critical role of alignment to the function of the pelvic floor. Studies have shown improved resting activation of the pelvic floor when postural alignment moved more and more toward neutral. In my book, neutral has to do with aligning the rib cage over the pelvis. This ribs over pelvis position optimizes the interaction of the diaphragm and pelvic floor, promoting their pistoning action (down on inhale, up on exhale) which balances the intra-abdominal pressure (IAP) that insures lumbar and pelvic stability. This dynamic quality of rising and lowering with the respiratory cycle is lacking for a high, tight or shortened pelvic floor. Re-establishing the relationship between the diaphragm and pelvic floor helps to restore the ebb and flow movement of the pelvic floor. Getting the rib cage (where the diaphragm lives) over the pelvis (where the pelvic floor lives) helps to optimize this restorative interaction.

In addition, one of the concepts I have learned along the way from my pediatric teaching partner, Shelley Mannell, is the concept of dynamic holding as it relates to spastic muscles.  For some of the kids (with motor challenges) spasticity is both their enemy and their compensation. Their bodies and brains learn how to use the spasticity to stay up against gravity via what is known as dynamic holding. Spasticity has the appearance of shortened muscle and some of it is true length change. However, when they get botox injections, that dynamic holding component is eliminated and you see movement return and a relative improvement in “length”. We have seen dramatic changes in kids with spasticity when they tap into the pistoning relationship between the diaphragm and pelvic floor in alignment. It allows them to reduce their reliance on the spasticity to support upright posture and use properly sequenced muscle activation instead. The dynamic holding component reduces and we see what is left in terms of a true length issue.

This dynamic holding concept has helped explain to me why folks with high tight pelvic floors respond well to re-establishing the relationship between the diaphragm and pelvic floor which is optimized through neutral alignment. Is their shortened state true shortening or is it hyper vigilance against chronic overuse of abs? Is dynamic holding of the pelvic floor the bodies compensation instead of using a more effective strategy for postural support? Is it truly short or is it just functioning in that way?

I have found that I can address all of these clinical questions by linking the diaphragm action to the pelvic floor in optimized alignment to help patients learn to lower and relax the pelvic floor on inhale. If there is any emotional or ANS contributions to the high, tight state, then some focus on deep breathing can help to address that “upstream” contribution as well. Using pelvic floor lowering on inhale as the first cue also helps to avoid feeding into any overuse issues. In addition, the diaphragm and pelvic floor contribute to the IAP postural stability system which reduces the need to substitute the overuse of abs for central stability which can lead to over recruitment of the pelvic floor. Balance can be restored.

Or is it a chicken and egg thing. If they are in a chronically tucked under bum alignment, pulling sacrum toward the front, they may have created true adaptive shortening of the pelvic floor over time. Gradually addressing this alignment of the sacrum and pelvis would be necessary to promote adaptive lengthening of the pelvic floor. However, something to consider when assessing if it is the chicken or the egg – if it is truly shortened due to adaption vs dynamic holding I should not be able to get the sacrum to follow the pelvis as I untuck the bum to promote a more neutral tilt without increasing pain.

My goal is to optimize alignment in order to maximize the powerful relationship between the diaphragm and pelvic floor. If it is a combo of a truly shortened PF (which poor alignment would feed into), and faulty pelvic floor recruitment strategies (which poor alignment also feeds into) or neurologic/ANS strategies (which poor alignment actually feeds into…but that is a whole other blog)…then addressing that holistically with attention to the best alignment you can achieve, I propose is a viable clinical path.

And they all lived happily ever after……

Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil. 2008;89(9):1741-1747

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24 thoughts on “Alignment and the High Tight Pelvic Floor”

  1. Ann Wendel says:

    Wow, Julie – great article!

    1. Julie Wiebe says:

      Thanks Ann! And thanks for sharing it on twitter! Julie

  2. It’s ammazing how the layers of understanding keep unfolding and making the whole picture of ‘inside out’ alignment make more and more sense. Wonderful fun article! Thank you Julie!

    1. Julie Wiebe says:

      Thanks Sherry! I learned ribs over pelvis from you! Thanks to you!! Julie

  3. Grant Headley SPT says:

    Fascinating! Can you provide some more specifics on some common pelvic alignment presentations that you have seen that may contribute to tight pelvic floor?
    It is wonderful that you are offering your experience to the community via the web, thank you.

    1. Julie Wiebe says:

      Thanks for your question. The primary positioning that contributes to a tight pelvic floor is posterior pelvic tilt (bum tucked under). A posterior tilt can be hidden under a posteriorly translated rib cage which gives the impression of a deeper lordosis. This tricks the eye and gives the observer a false impression of anterior or neutral tilt of the pelvis. Flattened upper glutes are a big giveaway, as well as a shallow apex at L4-5 that the pelvis is actually tucked under (posteriorly tilted). As I stated in the blog it is important to tease out if the position is part of their compensation pattern-clinched bum muscles, overused abs and navel to spine can all cause the pelvis to tuck into posterior tilt. And then both habit, and adaptive shortening can contribute to faulty recruitment.

      Hope that adds to the clinical picture. Let me know if you have any more questions.


  4. Susan says:

    So nice to see another Pelvic Health PT looking at at whole body alignment and integration. Thanks for sharing.

  5. Julie Wiebe says:

    Thanks Susan! It is a big piece of a big puzzle! Integration is my favorite word.


  6. Carla Cupido says:

    Nice article Julie… thanks for the share:)

    1. Julie Wiebe says:

      Thanks for stopping by Carla!


  7. Vanea says:

    Thanks Julie ,great Infomation.
    I love your contributions on linkedin too.

    1. Julie Wiebe says:

      Thanks for stopping by and commenting, Vanea!
      Take care! Julie

  8. Amy F says:

    My biggest issue is getting someone to be able to evaluate this on myself or a visual for correct allignment. My PT in town (the only one who handles pelvic foor issues) has never addressed this with me and I honestly feel does not have a good understanding of this. Would you suggest seeing a chiro. to help look at someone’s allignment???? Any visuals or advice on how to get the best neutral pelvis would be appreciated..

    1. Julie Wiebe says:

      Hi Amy,

      Thanks so much for your note. I have known both good PT and good Chiro alignment evaluators, and some not so hot…so I am not sure the professional designation is the issue. This is not something we understand well, or are taught well in school. In fact, somewhere along the way in my teaching career, I realized there weren’t any mirrors in the labs at my PT school. Using a mirror clinically is my number one way of giving alignment feedback to my current patients, can’t practice or teach without them now!

      I have some videos that you might find helpful and and a blog with a few tips Feel free to share them, this post and this post with your provider to ask her for her feedback. I also have a webinar for pro’s available on my site, that discusses the role of alignment in activating the system if you think she might be interested or open to it. .

      I also love to refer folks to the practitioners that have taken my courses. They might be able to provide some complementary info to what you are already receiving from your current provider. You can email me direct at to see if I know someone in your area.

      Hope that helps! Julie

  9. Torill Mjelde says:

    Hi. I have been told that some people have a high pelvic floor to start with. Which will result in a short range of motion. But how can you tell the difference between this, and a tight pelvic floor that can be improved?

    1. Julie Wiebe says:

      Hi there,

      First I think it is important to hear that both can be improved, although I honestly haven’t heard of someone born with a high pelvic floor. That is tough messaging to overcome, that you are born into pelvic pain, I don’t agree, and I want a different message out there. As I noted in the blog, if someone is truly shortened (lost muscle cells) I shouldn’t be able to untuck their bums and get the sacrum to follow the pelvis. If you can without significantly increasing pain then I think that muscle has length available to it. This is a new way of thinking about this….are we using muscles in a shortened way all the time (due in part to our habitual alignment), this may give us the perception of “tight”. But when we learn to use the pelvic floor in a different way (I love to have it team up with its friend the diaphragm for 14x/min opportunities to lengthen), then that ‘tightness’ lifts without what we would think of as lengthening techniques. I would argue this about any muscle that often gets tight-hamstrings, calves, low backs. Is it tight (short) or is it a motor program that is faulty that needs to be addressed?

      I hope that helps. Try the bum untucking test to see what the pelvic floor is capable of and allow a new message in that changing this is possible. Take care- Julie

  10. Torill Mjelde says:

    Thanks a lot for your answer. Makes sense to me 🙂 will ask further what she actually meant.

    1. Julie Wiebe says:

      Sounds good! Julie

  11. Lori F says:

    Hello Julie!
    I have a high resting pelvic floor with no pain at all however, it causes severe constipation. (Sorry if this is too much info). I am unable to decipher once a bowel movement is completed or if I even have to use the bathroom at times and I drink prune juice every night to help me go in the mornings. I’ve had biofeedback therapy and my muscle still seems to be short and tight no matter how much I do relaxation exercises I do. Do you have any other suggestions?

    1. Julie Wiebe says:

      Hello Lori,

      Not TMI at all! It is good for others to understand that constipation is one consequence of an overactive pelvic floor. My suggestion would be to look at your breathing pattern. The Diaphragm is a big player in GI motility, when it goes down on an inhale and then back up on exhale it literally massages the colon. Anxiety and stress surrounding trying to have a BM can ramp up muscular tone, regular deep breath using the full excursion of the diaphragm can improve parasympathetic tone and help relax your bowels and your pelvic floor. The pelvic floor also follows the rhythm of the diaphragm. The PF lowers (or should) when the diaphragm descends on inhale, and it gently rises on exhale. Finding/identifying that pattern, and allowing breath to help you relax the PF and let it open on inhale 14x/min can translate to learning to relax it on the toilet. I am sure your PT has discussed potty posture: feet up on a stool, so you hips are higher than your knees to rock your pelvis under while trying to have a BM. Relaxing the tongue to the bottom of your mouth can also relax the pelvic floor while you are attempting to eliminate. Saying ‘mmm’ and ‘ahhh’ as you relax on the potty can help to relax the pelvic floor as well. Try it! The pelvic floor doesn’t activate in isolation, it also doesn’t relax as an isolated entity! There are lots of players on the team to help it chill out, too! If you are interested, I show folks how to learn to synch that up and DOWN pelvic floor and diaphragm rhythm in my DVD (also available in an online version), you can find it here: . I hope that gives you some new ideas! Let me know if you have any other questions. Take care! Julie

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