Pelvic Exercise Programme

Introduction:

We are beginning to understand the role of the musculoskeletal system in endometriosis

pain. By optimising your muscle balance, joint mobility, fitness and posture it seems we can
improve people’s experience of pain, which is also true in other pain conditions. Included in
this leaflet are some basic exercises designed to improve your pelvic health. Advice for
exercising:

• It is really important to ensure whenever you are staring a new exercise to begin
with very small amounts and gradually build things up if and when your body feels
able to.
• Work within your body’s limits (which may change from day to day) and try to not
push your body into discomfort or pain.
• During stretch exercises you would expect to feel a stretch sensation, but again not
pushing into discomfort.
• Allow a recovery day between each session to check your body coped okay and you
haven’t flared.
• Ensure you seek advice if you feel unsure of any particular exercise.

The exercises included help to rebalance some of the muscles we know become
dysfunctional in some patients with endometriosis.

Endometriosis UK would like to thank the Medical Advisory Panel Members for their commitment in
producing this document at an already very busy time.

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Stretching Exercises:

Commonly muscles can become tight and painful because of both posture, which may be in
response to pain generated from endometriosis, and overuse, as other muscles become
weakened requiring these muscles to compensate.

Hip flexor stretch in standing

Stand with one leg in front of the other. Raise your
heel of the back leg and soften your knees. Tuck your
bottom under so that your pelvis tilts under.
You should feel a stretch at the front of your hip/
groin.
Aim to hold for 30 seconds each side.

Piriformis stretch in sitting

Cross one leg over the other as shown. Gently push
your knee towards the floor. If comfortable, lean
forward with your back straight. If the stretch feels
too intense, slouch back slightly into the chair
Aim to hold for 30 seconds each side.

Quadratus lumborum stretch

In standing, raise up one arm up above your head.
Bend to the opposite side, until you feel a stretch on
your side. Then twist your spine slightly towards the
floor keeping your pelvis forward.
Aim to hold for 30 seconds each side.

Childs pose
Bring yourself from seated kneeling into the forward
position as shown. You may feel a stretch into your
back, shoulders and hips.
You can also gently walk arms over to each side,
holding for a short period of time to increase the
stretch into your shoulders.

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Mobility Exercises:

Spinal mobility helps to optimise the function of muscles surrounding our pelvis and relieve
symptoms of lower back pain.

Cat and cow stretch on all fours

On all fours with your knees and ankle hip width apart,
curve back up towards the ceiling, tucking your bottom
under and looking towards your tummy. Then arch back
your spine down, looking forward and tilting your pelvis
up to the ceiling. Aim to work fluidly between the two
within comfort.

Hip Twist
Lying on your back with your knees together and bent.
Slowly relax your knees down towards the floor, keeping
your knees together and your shoulders on the ground.
Repeat the other way.

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Control Exercises:

It is important to gain control in our core muscles for our muscles to be strong. The transverse
abdominis muscle is a deep layer of muscle that acts as the body’s natural corset, supporting the
back and pelvis. It is common that people who experience chronic pelvic pain are weak in this
muscle and therefore over compensate by using their oblique or rectus muscles. The pelvic floor is
also a core muscle. Commonly people who experience pelvic pain have pelvic floor muscles which
are overworked, shortened and painful. Diaphragmatic breathing can help to improve the pelvic
floor muscles ability to work through range and gives people a sense of what these muscles feel like
when they are more relaxed. This will help with reducing pain and increasing strength and control.

Transverse Abdominis Activation:

Lie on your back or on your side or in sitting. Place your hands
just slighly in from you hip bones so they are resting over your
lower tummy. Completely relax your abdomen.
Gently draw your lower abdomen away from your waistband
(approx. 20% of your full squeeze). You should feel a gentle
tension underneath your hands. You should see minimal
movment of the abdomen and your upper abdominal muscles
and back should remain still.
Keep breathing and try to maintain the hold. If you feel it
relax, don’t fight it, fully relax and start again. If you feel your
upper abdominals, pelvic floor or other muscles kicking in,
fully relax and reset.
Start by completing for a few seconds and then build up the
time, ensuring your body isn’t cheating.

Diaphragmatic Breathing:
Lying on your back with your knees bent, place one hand over
your lower abdomen and one over your chest.
Start with 2-3 slow, deep abdominal breaths (breathing in
through your nose and out through your mouth) so that your
tummy passively “swells” out. You should not feel as though
you are “pushing” your tummy out. Try to keep your chest
still. Then go back to breathing normally.
Now, gently tighten around your back passage as if stopping
wind and immediately relax. Try to let these muscles relax as
far as possible. Return to deep abdominal breathing for 2-3
repetitions. Notice the subtle further dropping away of the
muscles.
Continue the cycle up to 10 times.

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Strengthening Exercises:
Muscles can become weakened in response to posture, pain and inactivity. Strengthening the pelvic
muscles helps to rebalance control, reducing the body’s need to compensate using the muscles
identified above.
Pelvic tilts in lying
Lying on your back in your neutral position; engage your deep abdominal
and bottom muscles.
Slowly curl your pelvis backwards and lift slightly. Then curl back down
gently.

Shoulder bridge
Lying on your back in your neutral position; engage your deep abdominal
muscles.
Squeeze your bottom muscles and start to raise your hips off the ground
slowly and segmentally so that your tailbone is the first to lift. The
movement should be as controlled as possible. Make sure that your ribs
are always lower than your hips.
As you come back down to the floor, you should ensure the movement is
segmental and controlled so that your tailbone is the last part to touch
the floor.

Swimming
Lying on your tummy in your neutral position (remember you need to
tuck your bottom under); engage your deep abdominal muscles.
Keeping length in your spine, lift one leg off the floor, feeling a squeeze
in your bottom muscles. Alternate legs.
Keep your arms relaxed and place a pillow under your tummy if required.
Clam
Lying on your side in your neutral position with your legs bent and feet
in-line with your bottom; engage your deep abdominal muscles.
Lift your top leg up, keeping your hip bones facing forwards to avoid
rocking backwards. Slowly lower your leg back to its starting position.
Complete as many repetitions on one side as possible (taking into
consideration pacing) before completing on the other side.

Hundreds
Lying on your back in your neutral position; engage your deep abdominal
muscles.
Raise your arms slightly off the floor and pulse the arms gently from the
shoulders.
Aim for 100, however, you will need to build up to this.

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