Is Your Pilates or Yoga Teaching Supporting Pelvic Health? The role of breath, posture & myofascial organisation
Could your Pilates or Yoga classes be exacerbating pelvic health issues such as stress incontinence (SI), pelvic organ prolapse (POP), or other common postpartum and menopause-related symptoms?
How does intra-abdominal pressure (IAP) play a role, and how can breath, posture, and myofascial organisation help address these concerns?
It’s not a pretty picture I’m afraid! Pelvic health issues like stress incontinence (SI), pelvic organ prolapse (POP), and diastasis recti affect a significant number of women—around 25–45% experience SI, while POP impacts nearly 40% of women over 50 – that’s almost half! Childbirth, age, and hormonal changes, particularly during menopause, increase the risk.
As someone navigating these conditions following a medical menopause, over the past few years I’ve explored the interplay between breath, posture, diaphragm function, pelvic floor health, and intra-abdominal pressure (IAP). I’ve been delving into Hypopressive technique and exercises or movements that can either exacerbate or support these all too often demoralising symptoms and I myself am grateful to have tools and methods to manage and drastically improve my symptoms.
However, while Pilates and Yoga are often recommended for their low-impact benefits, I have become increasingly concerned about the number of women attending classes who may be affected by these conditions. Without an understanding of IAP, could we unknowingly be making matters worse for our clients without them or us even realising it?
This blog breaks down key considerations that are crucial when working with pre- and post-natal clients or anyone managing pelvic health concerns. I’ll also be covering the pelvic floor, diaphragm & fascial connections, lateral costal breathing, intra-abdominal pressure, low pressure exercises (hypopressives) and associated class plans in depth during my Pre- & Post-Natal CPD Course (28th–30th March) if you are interested in learning more.
Understanding Intra-Abdominal Pressure (IAP) and Its Impact
IAP refers to the pressure within the abdominal cavity, influenced by various factors including the diaphragm, pelvic floor, and core muscles. Properly regulated, it stabilises the spine and pelvis, supporting pelvic health. Mismanagement, however, can lead to excessive pressure, exacerbating symptoms like incontinence and prolapse.
e.g – When you lift and lengthen from your feet to your crown, your belly naturally draws in and up, which increases intra-abdominal pressure (IAP). This process is crucial for stabilising the spine and pelvis, while also helping to maintain proper posture during movement.
Pilates and Yoga can play a crucial role in IAP management through three key elements: breath, posture, and myofascial organisation:
1. Breath: A Core Foundation
Lateral–posterior breathing in Pilates is particularly important for IAP regulation, and Ujjayi breath in Yoga can also help to maintain control over the abdominal pressure for the following reasons:
- Exhaling through pursed lips enhances this connection, helps to tone the vagal nerve and relax the jaw.
- Encourages a 3D expansion of the rib cage, fostering a biodynamic quality to the breath, dispersing IAP throughout the abdominal cavity and reducing downward pressure.
- The diaphragm and pelvic floor work synergistically, contracting and relaxing, the abdominal contents move up and down massaging the viscera (organs).
- The transverse abdominis (the deep core muscle) is activated naturally, especially when combined with a lengthening of the spine.
2. Posture & Movement: Alignment Matters
Neutral Spine Is Key: Even a 10-degree anterior or posterior tilt can disrupt the relationship between and misalign the diaphragm and pelvic floor, leading to weakness, tension, or excess pressure.
Moreover, because the levator ani attaches to the Gluteus Maximus, individuals with an anterior pelvic tilt are less likely to engage the pelvic floor naturally, leading to weaker tissues and connections. In contrast, those with a posterior pelvic tilt are more likely to over-grip, which can result in hypertonic tissues and associated pelvic health issues. Ensuring that the rib cage is aligned over the pelvic bowl, with both structures being equidistant all the way around, is essential for maintaining pelvic health.
It isn’t enough to cue it – it is vital that we TEACH it, and educate our students on what neutral is for them and how it feels to them through interoception.
Pelvic-Health-Friendly Exercises
✅ Unloaded exercises/positions (e.g., four-point kneeling) instantly reduce downward pressure.
✅ Supine movements (pelvic tilts, bridge variations, legs up the wall, inversions – if in the students’ practice) can alleviate feelings of ‘heaviness’ or ‘dragging’ in POP.
⚠️ Avoid or modify exercises/breath practices that create excessive abdominal pressure (e.g- abdominal doming, straining, baring down, pushing, forcing, uncontrolled rib cage flaring, diaphragmatic compression, gripping in the glutes).
Sit-ups, the full hundred, double leg and/or arm reaches, low boat, or overloading in spinal flexion are likely to do more harm than good unless your student is very well practiced. Even belly breathing can increase downward force on the pelvic floor.
✅ Always consider benefit versus risk. There is SO much you can include without taking unnecessary risks.
3. Myofascial Organisation: The Bigger Picture
Aligning the Body’s Diaphragms
The 5 diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) align best in a neutral posture. The law of ‘opposite forces’ is applied (eg, root down and rise up, spread yourself out in space) helping lift and lengthen through the entire myofascial chain – allevitaing downward pressure, lifting and engaging the pelvic floor naturally.
Integrating Myofascial Awareness & Cuing
Cures to encourage this alignment, are always beneficial, but especially for pelvic health – without them, some exercises like the plank position will be contraindicated. It not just what you teach, but the WAY you teach and how your student embodies it that’s important. Understanding the fascia as a whole-body network and integrating cuing and embodiment can help prevent or improve hypertonic (overly tight) or weak pelvic floor muscles – both are causes of pelvic health issues.
Adding hypopressives (low pressure myofascial engagement exercises)
This is an excellent practice; however, it can be challenging to teach and embody well. In my experience, these techniques are best taught in person (at least initially) with a trained practitioner who understands the mechanics and has strong observational skills, as otherwise, they could potentially worsen symptoms. That said, numerous studies have shown fantastic results, and they are an important part of my ongoing successful management.
Supporting Clients & Deepening Knowledge
In essence, practising Pilates and Yoga with an awareness of breath, posture, and myofascial organisation allows individuals to actively manage their intra-abdominal pressure (IAP), which can reduce strain on the pelvic floor and improve overall pelvic health. By emphasising neutral alignment, lateral breathing, controlled movements, opposing forces, and deep core engagement, these practices help maintain a balanced IAP, lowering the risk of pelvic floor dysfunction or alleviating existing symptoms.
The role of the nervous system is also important, but that’s a topic for another blog! What’s crucial for us as teachers is understanding which exercises or asanas could be exacerbating issues and knowing how, when, and why to adapt them.
So, if you’re keen to explore these topics further, consider joining one of my upcoming workshops:
- Posture Assessments & Working 1:1 (4th March) – Sharpen observational skills to best meet the needs of 1:1 clients.
- Yoga Hands-On Assists (17th March) – Improve cueing and neutral alignment techniques with the help of enhanced observational skills.
- Stretch & Massage Assists for Yoga & Pilates – Bring relaxation and fascia release into the network—unraveling and unwinding to release excess tension and subconscious holding.
- Fascia & Movement (1st April) – Incorporate somatics, neurogenic release, repatterning, psoas release, soft tissue release, and fluid, spiralling movements to enhance energy flow and downregulate the nervous system.
- Fascia & Stability (29th April) – Learn about opposite forces, myofascial lines, and core stabilisation – a full body affair.
+ More courses & Workshops later in the year available to book now:
These concepts are also embedded in our 200hr Yoga & Pilates Teacher Training Courses—as we evolve, so do our courses … and that’s why I love what I do – it’s a never-ending journey !
Let’s keep learning, growing, and refining our teaching to support pelvic health in a way that truly serves our students.
Article by: Clare Francis
