by Jeanna Viramontes, PT, PRC
The pelvis is an amazing part of the human body—when the pelvis is in balance, we can move easily through our world, eliminate waste from our system, engage in sexual intimacy and create new life.
As a pelvic health physical therapist, I help people to restore these aspects of pelvic function that may be lost or diminished. Clients and I work together to restore fluid movement of the body and improve the function of the bones, muscles, connective tissue and nervous system to improve pelvic health.
An important component of pelvic health physical therapy is education about the pelvic anatomy—both physical and energetic.
An anatomy lesson—Getting to know your pelvis
Physical pelvic anatomy can best be understood by a description in layers. At the deepest layer is the bony pelvis, comprised of the triangular-shaped sacrum at the base of the spine, two ilia—the wing-shaped bones on either side—and the coccyx, or tailbone. There are three joints found within the pelvic ring, two sacro-iliac joints in the back and the pubic symphysis, the junction where the tailbone and sacrum meet.
To find the perimeter of your pelvis, rest your hands on the bones just under your natural waistline. Here is the top of the ilia. The bottom of the ilia are the “sit bones,” where you feel pressure under your buttocks when sitting on a hard chair. The front of the pelvic ring, the pubic symphysis, is just under the mound of soft tissue and hair between your legs. The sacrum, or back of the pelvic ring is the bony area above your tailbone.
The bony pelvis serves as the attachment point for the muscles that cross the spine, pelvis, and ball-and-socket hip joints. It also houses and protects the pelvic organs: the bladder, reproductive organs and the rectum. Ligaments help to support the bony pelvis and organs, and a network of fascia (connective tissue) also helps suspend and support the organs.
The next layer is comprised of muscles, blood vessels, nerves and the lymphatic system. The nerves that are found in the organs and soft tissue of the pelvis send messages to and from the central nervous system (brain and spinal cord). They play a role in automatic regulation of the structures in the pelvis, conscious control over the sphincters and pelvic muscles, and sending information to and from the central nervous system about the state of the pelvis’ health. Blood vessels carry oxygen-rich blood to the tissue and carry away carbon dioxide; the lymphatic system carries waste away from the cells.
The muscles of the pelvis include the buttock and hip muscles, abdominals and the pelvic floor muscles (PFM). The pelvic floor muscles provide support to the pelvic organs and bony pelvis, keep urine and fecal matter inside the body, and subsequently allow release of this waste. They also aid in sexual function.
The pelvic floor muscles are unique. They are a group of muscles found at the base of the pelvis. This diaphragm of muscles extends from the pubic bone to the tailbone and between the two “sit bones.” A contraction of these muscles is known as a “Kegel.”
How to do a Kegel (and do it right)
Kegels increase support of the pelvic organs, aid in sexual function and improve sphincter control. Most of us have heard of or learned how to do Kegels, but in my clinic, I see many people performing them incorrectly and in some cases actually doing more damage than good. Here’s a quick primer:
To identify the pelvic floor muscles, I suggest using a hand mirror to look at your bottom. Locate the area between each “sit bone,” the pubic bone and the tailbone. This is the region where the PFM is located. Look at the area between the vaginal and anal opening (for women) or the area just above the anal opening (for men). This is known as the perineal body. To contract the PFM, imagine the sensation of pulling a tampon up inside of the vagina, holding back urine or gas, or for men, deflecting the penis.
If you’re doing a Kegel correctly, the perineal body will lift up and in, the anal opening will tighten and the area over the clitoris will pull downward. Men will see deflection of the penis and contraction around the anal opening. To isolate the muscle, the buttocks, inner thighs or abdomen do not contract.
If you’re still unsure about performing a Kegel correctly, insert a finger or thumb about two inches into the vaginal opening, press to the side and slightly back toward your sit bone to feel the muscles contract. Another option is to ask a partner to do the same or to give feedback during vaginal intercourse to help isolate and contract the PFM.
Breathing evenly while performing a Kegel is very important. Often, people hold their breath during a contraction, but the body needs the PFM to be able to contract during both exhalation and inhalation.
Creating an exercise program
Kegels can be done on a daily basis to maintain and improve pelvic health.1 It’s beneficial to establish a baseline of strength and coordination using the strategies listed above for self-assessment, and then create an individualized exercise program.
Establish how long you need to hold a contraction. For a regular program, challenge the muscle by using a slightly longer hold time; for example, if the pelvic muscles contract strongly for five seconds before the contraction diminishes, you may want to hold the contraction for six seconds. Over a period of time, increase to ten-second holds. If there is difficulty contracting these muscles at all or for more than a few seconds, you can try performing Kegels while lying on your side or on your back until the muscles are stronger. This eliminates the effect of gravity and unweights the pelvic organs off of the muscle. Remember to breathe!
Another option is to strengthen the fibers involved in sphincter control. These fibers work in short bursts to keep the sphincters closed, particularly with coughing, sneezing or a sudden increase in pressure in the abdominal cavity. By performing a gradual contraction and then slowly releasing (without holding) to the resting position, you engage these fibers.
Establish a baseline. While performing the self-assessment, try a few Kegels in a row (three to six) and then rest. Repeat sets of three to six. Count how many quality contractions are possible before the muscles fatigue. This will determine repetitions for a regular program. In order to improve strength, some muscle fatigue is necessary, but when the quality diminishes it is a good idea to stop and allow the muscles to recover.
No one program is effective for everybody; use these techniques to establish an individualized program that’s right for you. For assistance, it may be beneficial to find a local physical therapist who specializes in pelvic muscle rehabilitation. If you have a history of pelvic pain, urinary incontinence or another known pelvic health condition, I recommend a visit with a healthcare provider to discuss treatment options. Many states allow direct access to physical therapy for treatment of musculoskeletal conditions. The American Physical Therapy Association Section on Women’s Health is a resource for finding a PT who has training in this type of rehabilitation.
Musculoskeletal health is important in maintaining pelvic function; evaluation of muscles, nerves, connective tissue and the skeleton can indicate areas of imbalance in the system. Evaluation of the energetic aspect2 of the system is also important for pelvic health, as imbalances on this level can affect musculoskeletal health.
The energetic anatomy—Getting to know your chakras
From the perspective of the chakra system, the body consists of more than simply the dense, slowly vibrating physical matter discussed above. There exists an invisible part of the physical body that serves as a framework or blueprint for visible matter. This is known as the etheric body; it connects dense matter to our thoughts, emotions, consciousness and to the streams of energy that give us life.
There exist points of connection within the energetic body known as chakras (or centers), a Sanskrit word meaning “wheels.” Seven major chakras are anchored at different points along the spine and may be seen as spinning wheels, or vortices of energy that extend from the spine. Each chakra is associated with the etheric aspect of dense physical structures and aspects of emotions, thoughts, beliefs and consciousness.
When evaluating an energetic center with my hands, I perceive a balanced chakra as a lightweight, full cloud of energy that is simultaneously defined and fluid. There is a sense of joy and light in a balanced chakra, and each of the seven have a different kinesthetic vibrational quality. The chakras that anchor at the bottom of the spine feel weighty and spin more slowly. The higher chakras feel lighter, quicker in vibratory frequency with finer edges. A chakra in need of greater balance feels either overcharged with energy or undercharged, overwhelmed or sluggish.
The two chakras most relevant to pelvic health are those found at the base of the spine: the root chakra (basic center) and sacral chakra (sacral center). The basic center is associated with the basic needs for existence in a physical plane: shelter, food, water, safety. Fear of loss of the basic elements of life and beliefs about scarcity or abundance are found here, as well as our ability (or inability) to “ground” in the world of form and to the earth. This center anchors at the tailbone and includes the pelvic floor muscles, the urinary system and adrenals. Clinically, I perceive the openings of the body, particularly the vaginal and anal openings, as tissue strongly associated with unresolved traumas and fears.
The second chakra, the sacral center, is associated with the reproductive organs, gonads, sacro-iliac joints and low back. On an emotional level, our self-esteem, self-worth and ability to tend to our own needs are found in this center. The health of inter-generational relationships and partner relationships manifest here as well as beliefs about sex, sexuality and sensuality. This is a powerful creative center, for production and nurturing of offspring in the form of children or other creations that manifest in physical form. Since the life force found in this center can be directed to energize creative pursuits in the outer world, I believe it is especially important to become aware of our limiting beliefs about sexuality. Our Western culture in particular is faced with many challenges (and opportunities) related to beliefs about sexuality. Expansion of consciousness related to the sacral center increases the availability of our creative energies, and allows them to flow into collective awareness so that we can continue to evolve and create.
Clinically, I see that imbalances in the first two chakras can manifest through the etheric body and into dense physical matter (tissue). For example, someone who has a history of trauma may hold certain faulty beliefs about safety and security that result in a corresponding physical tension pattern or condition. Particularly in some cases of physical and sexual abuse, I see pelvic floor over-activity and difficulty “letting go” of the muscles in and around the pelvis to allow for fluid movement in the lower half of the body.
In treatment, we can retrain and bring greater awareness to this movement, allowing healing to occur in both the energetic and physical bodies. This, combined with chakra balancing and/or body-mind techniques, brings awareness to imbalances and allows the innate wisdom of the body to heal itself. In my practice, I regularly see the correlation between greater awareness of limiting beliefs, fears, emotions and thoughts, and a reduction in musculoskeletal imbalances, thereby improving function and reducing pain.
I believe that acknowledging the interrelationship of the physical and energetic aspects of the human system is essential to see the full spectrum of pelvic health. The beauty of a healthy pelvis is in its gifts: the ability to move fluidly in relation to the earth and gravity, to be intimate with others, to eliminate waste from the body and to fully express our creative potential.
 Consult your healthcare provider before starting any exercise program.
 The belief in the existence of the energetic body originates in ancient texts and is the basis of many healing modalities, including Traditional Chinese Medicine and Ayurvedic medicine. The “maps” to navigate the energetic body differ; the chakra system is specifically described in the Vedic texts, which are included in the Ancient Wisdom texts. The Vedas are a main source of Hindu tradition, and the texts influenced Buddhism, Jainism and Sikhism. Recent research in modern quantum physics theory also supports healing practices based on treatment of the energetic body.
Esoteric Healing, Part 2: “Integrated Living” Manual by the International Network of Esoteric Healing. Canadian Intellectual Property Office.
The Chakras by CW Leadbeater. Theosophical Publishing House.
Clinically Oriented Anatomy Fourth Edition by Keith Moore, L PhD, FIAC, FRSM and Arthur F Dalley, PhD. Lippincott, Williams & Wilkens.
BodyTalk Fundamentals by John Veltheim, DC and Sylvia Muiznieks. International BodyTalk Association.
The Gynecological Manual by Elaine Wilder, MA, PT. American Physical Therapy Association.
Jeanna Viramontes, PT, PRC is a licensed physical therapist who practices in Hudson, WI. She is an expert in pelvic floor rehabilitation, specializing in treatment of pelvic health conditions since 2003. She has been a mentor and teacher to other professionals during the course of her career, and learns from her own clients every day. She believes in expansion of consciousness through movement and the gift of the body as a vehicle for self-transformation.