The Inner Core 

Deep to our superficial muscles are a group of muscles that are frequently referred to as the deep core or “inner unit”. This unit can be thought of as a can deep within us. It is made of the diaphragm at the top, the pelvic floor at the bottom, the transversus abdominus at the sides and front and the lumbar multifidus at the back. These muscles have been shown in some studies to have a feed forward activation. In other words they contract before the muscles that create our spinal movements and regardless of how we move when functioning normally. When they are not functioning properly, they may contract too late resulting in  low back pain with light tasks.


Is Inner Core Training Right For Me?

Several clues will let your health practitioner know if inner unit training is right for you. Your provider should be taking a detailed history including the location of your pain, its nature and what brings it on and improves it. A detailed physical examination should include active movements as well as range of motion of neighbouring regions. If you are able to contract the muscles, you may be cued to contract them during limited or painful movements. If you are unable to contract them, your physiotherapist may apply pressure to certain regions to mimic the action of these muscles. 

If active or passive cueing of your muscles improves your symptoms of stiffness or pain then inner unit training may be appropriate for you. The exercises are not painful to do and the emphasis is on low level activation and building up endurance of the muscles in neutral positions.

As you improve the exercises should be progressed to functional positions and movements with the goal of maintaining a neutral spine while performing other exercises. Poor progression of these exercises is one of the reasons that you may have experienced a recurrence of your symptoms or didn’t feel like you returned back to full function.


Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today






How can pelvic floor problems develop?

The pelvic floor muscles can be weakened by childbirth, surgery, heavy lifting, being overweight, menopause or constipation. For other patients, the pelvic floor muscles may be overactive.  Over activity in your pelvic floor muscles can cause difficulty with intercourse, emptying your bladder or bowel, and using a tampon. Patients with overactive pelvic floor muscles won’t benefit from strengthening the pelvic floor because they need to be taught how to relax the muscles.




5 signs that you need Pelvic Floor Therapy

  • Urinary issues, such as frequent urge to urinate, incontinence or painful urination
  • Constipation or bowel strains
  • Pain or pressure or muscle spasms in the low back, pelvic region genitals or rectum
  • Discomfort during sexual intercourse
  • A bulge at the opening of the vagina or feeling that something is falling out from the vagina


What does a pelvic floor therapist do?

Physiotherapists that have undergone special postgraduate training are authorized to assess the pelvic floor. During a detailed examination, your physiotherapist will determine the reason for your pelvic symptoms. It is important to determine this, as your pelvic floor muscles can be either weak or overactive. The pelvic floor therapists at Family Physiotherapy are also trained manual therapists. This training allows them to focus on the big picture, assessing not just your pelvic floor, but also your back, pelvis and hips, in order to develop a comprehensive treatment plan. We have previously discussed the anatomy of the pelvic floor the evidence for pelvic therapy.


Image result for emoticon phone

Image result for emoticon email


Pelvic Physiotherapy at Family Physiotherapy in Thornhill

The pelvic therapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. We want you to know that whether you suffer from incontinence or other problems with urination, pelvic pain, pain during sex, constipation or lasting pain and muscle weakness after childbirth, help is on the way. We want to educate you and help you understand the nature of the problem that you may be experiencing and tell you about treatment options to help you get your pain-free life back. Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track!


Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today






How to know when you’re ready for safe exercise after having a baby?

By Tanya Kestenberg, PT


  • Gentle exercise, such as walking, stretching and pelvic floor exercises can be started as soon as comfortable after uncomplicated delivery
  • If your baby was delivered by C-Section, wait 6-8 weeks to resume exercises, and do so only after your post-partum check-up by a physician
  • Practically speaking, walking is a great exercise to do with your baby, even a few weeks after C-Section since the baby is easily transportable in a stroller and will most likely enjoy being gently rocked as you push the stroller during your walk


What about more complicated exercises, such as weight lifting, Pilates and Yoga?

Do a simple self-assessment to see if you’re ready:

  1. Curl up test: lie on your back with your knees bent and feet planted. Slowly try to do a crunch up (lift your head and shoulders, as you keep your chin tucked in).
  1. Leg lift test: lie on your back with both legs straight, then lift one leg slowly about 2 inches off the ground


Diastasis recti
Diastasis recti, a split in the abdominal muscle at the front near the belly button often is diagnosed in the last trimester or after delivery.  It does not resolve spontaneously but often is corrected with specific exercises


During either of the tests, you must assess for the following:

  • Do you have back pain or pubic area pain?
  • Do you feel a “soft” gap in your stomach (rectus abdominus) muscles?
  • Do you see any bulging (like a hernia) in the centre of your stomach?
  • Feel your pelvic floor (a space between your legs), do you have a bulging out at your vaginal opening?


If any of the above mentioned 4 symptoms occur, then see your family doctor, obstetrician and/or a physiotherapist for a complete assessment prior to beginning the exercises.




muscles of the pelvic floor0-8 weeks postpartum:

  • You may experience pain in the back, hips or pelvis
  • You may have difficulty controlling urine, gas or stool
  • Your neck, arms, backs and hips may be sore, as you’re recovering and getting used to new positions and demands as you’re caring for your baby

During this stage of healing allow yourself the time to heal, relax and rest


8+ weeks postpartum:


  • Your bleeding should have stopped, and incisions or tears should have healed
  • You should no longer feel pain in any of the above mentioned areas
  • You should have control over your bowel and bladder
  • You may be considering returning to your pre-baby activity level


What can I do to ensure healing goes as expected?


  • Use good posture as you care for your baby. Don’t slouch when you nurse your baby, but use pillows to lift the baby up to your breast instead of slouching yourself over towards the baby. When carrying your baby, engage stomach muscles and don’t lean back or arch your back.
  • Begin training your pelvic floor and deep abdominal muscles. You should not feel pain as you do these exercises. See a physiotherapist to make sure you’re doing them correctly or if you have any concerns.
  • Stretch or massage (with a tennis ball or Pilates roller) your neck, back, shoulders and legs to help relieve soreness.
  • Remember to rest and look after yourself, as you’re doing the most important job of caring for your baby.


How would I know if healing is not progressing as it should?

Here is a list of symptoms you should NOT feel:

  • Ongoing back, pelvis, groin or abdominal pain
  • Leaking urine, gas or stool with laughing, jumping, coughing, sneezing, walking, running and/or lifting
  • Being unable to control stool or urine when you feel an urge to go to the washroom
  • Pressure or bulging in your vagina or rectum
  • Bulging in your abdomen after 8 weeks postpartum during any exercise
  • Difficulty doing any of your daily activities due to pain or other symptoms 8 weeks post partum

A few final notes on Returning to Exercise after Pregnancy

  • Avoid stretching exercises to the area that has stitches, until the incision/tear has healed (6-10 weeks)
  • Start exercising gently and be patient. Remember, everyone is different and will recovery differently, so don’t compare and rush yourself. Exercising should feel good, listen to your body
  • Remember to maintain proper rest, nutrition and hydration
  • If you’re breastfeeding, you most likely would require extra fluid during the exercise and throughout your day
  • If breastfeeding, try to exercise after baby is fed and breasts are empty. At least wear a good supportive bra and not a sport bra (as it would compress the breasts too much, which is undesirable)

Your ligaments are going to be lax for some time after delivery, and even longer if you’re breastfeeding (for the entire duration of lactation and even sometime after). This means you may be more prone to injury caused by ligamentous laxity (i.e. twisting your ankle, seemingly unexplained joint sprains, back, pelvic and hips pain).


Related Posts:


Not sure where to start?

If you are having trouble returning back to your activities post partum, our team of physiotherapists, massage therapists and naturopathic doctors would be happy to consult with you.  An individualized plan addressing some of the pre pregnancy compensations can get you back to feeling your best and achieving your fitness goals.  Contact us for a consultation today!