12 Intense AB Exercises to Avoid

Intense abdominal exercises are exercises which involve strong contractions of the rectus abdominis muscles and surrounding abdominal muscles. During intense abdominal exercises, such as sit ups, crunches, and planks, the upper abdominal muscles (the six-pack muscles) generate a large amount of pressure within the abdomen. The muscles surrounding the trunk, such as the external and internal obliques, as well as the transversus abdominis, manage the pressure generated by the rectus abdominal muscles.  The pelvic floor muscles withstand the downward pressure generated by the rectus abdominis muscles, which is applied to the pelvic floor.

If the pressure associated with abdominal exercises is too great for the pelvic floor muscles to withstand, then the pelvic floor is forced downwards, causing the pelvic floor muscles to stretch and weaken. 

Abdominal exercises that repeatedly force the pelvic floor downwards, or particularly intense core abdominal exercises that completely overload the pelvic floor should be modified to prevent injury to the pelvic floor in women. 

12 AB EXERCISES TO AVOID (exercises to avoid are written in RED with a safe alternative in GREEN)

The 12 abdominal exercises listed below should be avoided or modified by women to minimise the risk of pelvic floor strain and injury, particularly women who have had children, women who experience light bladder leakage (LBL) or women who have had prolapse surgery. These intense abdominal core exercises have the potential to overload the pelvic floor in women, especially those with pelvic floor dysfunction:

1.  Traditional abdominal curl or sit-up exercises 

Sit-up

Modification: This exercise can not be modified as all other options still require a large amount of downward force on the pelvic floor. Instead I encourage clients to perform mindful pelvic floor contractions whilst performing a reverse bridge or pelvic lift (below).  

Pelvic lift 

2.  Incline sit-ups

Incline sit-up 

Modification: There is not an appropriate way to modify this exercise. I suggest standing knee raises as an alternative exercise to incline sit-ups. Make sure you perform standing knee raises with an activated core (below). Standing knee raises allow you to work on your balance and strengthen your mid-section, providing you maintain core activation. 

Standing knee raises 

3.  Abdominal machines

Abdominal Machine 

Abdominal Machine 

Machines designed to work the abdominal muscles should be avoided, especially if your goal is to strength your core without compromising your pelvic floor muscles. 

Modification: Usually trainers would recommend sit-ups or abdominal crunch exercises, however we know that these exercises are detrimental to your pelvic floor. I recommend trying reptile planks against a wall (below).  TRAINERS TIP: For beginners - do not use a swissball. Place your hands against the wall, similar to the beginning position of a wall push up. For those who are more advanced - perform the reptiles as pictured below, using a swissball. 

Reptiles - advanced option

4.  Oblique sit-ups

Oblique sit-ups

Modification: Try performing this exercise standing, as this will reduce the amount of downward pressure on the pelvic floor. Performing this exercises standing will develop balance and stability. 

Standing oblique crunch

5.  Oblique machine

Oblique machine 

6.  Exercise ball sit-ups

Exercise ball sit-ups

Modification: Instead of performing exercise ball sit-ups, use the exercise ball to perform walk outs. By maintaining an activated core you will be protecting your pelvic floor from intense downward pressure. Be sure to activate your glutes to assist you on the upward motion of the movement. 

Exercise ball walk outs - starting position

Exercise ball walk outs - finish position 

7.  Exercise ball leg raises

Exercise ball leg raises 

8.  Bicycle legs

Bicycle legs 

Modification: To modify this exercise to be pelvic floor safe, perform the exercise with one knee bent and one foot always on the ground. 

9.  Double leg raise

Double leg raise

Modification: Perform this with one leg instead of two. 

Single leg raise

10. Hanging knee raise

Hanging knee raise 

11. Pilates “Table Top” or “The Hundred”

Pilates "Table Top" 

Pilates "Hundreds"

 Modification: Perform the above exercises with your legs supported or feet on the ground (below). 

Modified "table top" (These positions can also be used for "hundreds" - but remember to keep your head down on the floor)

Supported "table top" and "hundreds"

12. Intense core “Plank” or “Hover” exercises.

Intense "Plank" (aka "Hover")

Full Plank or Hover involves full bodyweight bearing through the forearms and the feet. This is an intense abdominal core muscle exercise.

Modification: The pelvic floor loading associated with full Plank or Hover can be reduced with -

• Kneeling rather than supporting body weight through feet
• Breathing normally and avoid holding your breath

Plank on knees and forearm 

Deep Abdominal Muscles - YOUR NEW BEST FRIEND

The pelvic floor muscles work with the deep muscles in your tummy, commonly referred to as the deep abdominal muscles. Understanding this partnership is important in your quest to improve your pelvic floor muscle function, as it is impossible to contract your pelvic floor muscles without contracting your deep abdominal muscles. Engaging the muscles of the abdominal wall facilitates greater pelvic floor contraction, but what is the abdominal wall and what are the deep abdominal muscles? 

The Abdominal Wall Muscles 

The external oblique, the internal oblique, transversus abdominis, and the rectus abdominis are the muscles which create the abdominal wall. The basic functions of these muscles involve providing structural support for the abdominal cavity as well as providing protection for the internal organs within the abdominal walls. The abdominal muscles also assist in the process of respiration. Contraction of the muscles of the abdominal wall usually assists in activities such as protecting and offering the spine extra stability when lifting heavy objects or assisting in the process of defecation.

Fig 1. Abdominal Muscles

The Deep Abdominal Muscles 

The deep abdominal muscles that are intimately involved with pelvic floor muscle contraction are the transversus abdominis. The transverse abdominal muscles (TA muscles) wrap around the torso from front to back and from the ribs to the pelvis. The  TA muscles run horizontally around your body, similar to a corset. 

The fourth layer of the abdominal muscles, the TA muscles, are very important muscles in assisting the pelvic floor muscles with urethral closing pressure. If your TA muscles are weak the probability of stress urinary incontinence (SUI) is highly likely. The TA muscles work with an important back muscle called multifidus, as seen in figure 2, and the co-contraction strengthens pelvic floor contraction. 


By learning how to correctly contract the TA and multifidus muscles, the function of your bladder, bowel and pelvic organ support may be improved, whilst concurrent back pain may be helped also. 

Fig 2. Core Stability Muscles

Contracting the Deep Abdominal Muscles 

In order to engage the entire muscle and to perform a correct contraction, the ribs should be flush with your body and the spine and pelvis should be in a neutral position. A neutral position is achieved when lying on your back and your pubis and pelvic bone are all even. The cue that I like to give is to "use your muscles to pull your belly button back to your spine." I find it helpful to have clients perform the contraction on the exhale phase of the breath.  Make sure to keep the pelvis level during the contraction. 

When performing a lower abdominal exercise, such as table top ( common yoga and pilates exercise), you can tell if you are not using the TA muscles if your rectus abdominis, your six pack muscle, pokes out and looks like a loaf of bread.  Try contracting the TA muscle before you lift the legs (always lifting one leg at a time to avoid unnecessary downward pressure on your pelvic floor muscles) and see if the loaf of bread stays flat and engaged.

Fig 3. At rest 

Fig - 5 With TA muscle 
contraction -
No loaf of bread

Fig 4. Without TA muscle contraction -
the rectus abdominis pops up like a loaf of bread

Exercises to Strengthen the Transversus Abdominal Muscles

These exercises are simple, yet effective movements that work the TA muscles.  

These exercises are all about holding your position in a static pose, in order to strengthen the TA muscles.  These types of exercises, where you hold the static pose, are called isometric exercises and are great for strengthening and toning.

EXERCISE #1 - Plank Pose

TRAINER'S TIP: If you are a beginner to exercise it is recommended that you begin by planking against a wall, before progressing to planking using a chair, and then eventually planking on your knees on the floor.   


How to do the Plank Pose

Fig 6 - Plank Pose - Intermediate option 

Fig 7 - Plank Pose - Advanced option

1. Place your elbows on the floor underneath your shoulders.
2. Now place your knees on the floor with legs hip width apart.
3. With back straight, keep your body lifted off the floor and pull in your belly button towards your spine
4. Hold this position for a count of 5-15 seconds initially with the goal of being able to hold for 30-60 seconds. 
5. Relax, placing your body back on the floor and then repeat for 3 to 5 repetitions.

Note:  Remember to breathe while you are holding your position and keep your back straight and parallel to the ground.  For increased challenge, you can also do this as a straight arm plank pose, placing your hands on the floor instead of your elbows.


EXERCISE # 2 - Transversus Abdominal Pull Ins

This TA exercise is very difficult to illustrate, as the movement is so small, it is hard to tell the difference from start to finish position.  Although the move is small, it reaches deep down to the TA muscle.

You can do this exercise either standing up or laying down.  In fact the movement is so small you can do it standing up just about anywhere without anyone knowing your are doing an ab exercise.

How to do the Transversus Pull Ins

Fig 8. Transversus Pull Ins - 

TA muscle not activated 

Fig 9. Transversus Pull Ins -
 Activated TA muscle 

1. Lie on the floor with back flat, knees bent and feet on the floor.
2. Place your hands on your lower abs, about where your bikini bottoms would cover, and place your thumbs touching your naval.
3. Now pretend like you have to zip up a really tight pair of jeans and pull in your belly button towards the back of your spine.
4. Hold for 5-15 seconds initially with the eventual goal of 30 to 60 seconds, then relax and repeat 3-5 times.

Note:  To do this TA exercise in a standing position, just repeat the steps above while standing, being sure to keep the rest of your body relaxed and focus on the TA muscle to do the work.

Prehabilitation

Prehabilitation is essentially preventative training to stop a problem before it occurs. Strength and conditioning coaches and physiotherapists have been employing prehabilitation strategies to help prevent injuries for years. With the increased popularity of HIIT (high intensity interval training) styled workouts and training methods, prehabilitation is now something every 'gym-junkie' needs to know about and understand.

A successful prehabilitation program helps an individual to:

- Achieve normal static and dynamic posture
- Corrects muscle length imbalance, joint alignment and improves flexibility
- Normalise core stability (upper vs lower, right vs left)
- Boost movement pattern efficiency; and
- Enhance proprioception, which is the ability for your mind to sense the position of different joints in relation to the rest of the body

There are three essential phases required when writing a good prehabilitation plan, which are;

1) Analysis - analysis of the individual's posture, joint alignment, flexibility, muscle control, biomechanics of movement, core stability and movement patterns.
2) Risk Assessment - Understanding of the risks involved with the physical activities the individual participates in.
3) Lifestyle - Consideration of other specifics such as lifestyle factors is necessary when developing a prehabilitation program, for example, is the individual a mother of an infant, who requires lifting and needs to be carried?

Following and applying the above 3 steps, enables you to better understand your body and begin to develop a personalised prehabilitation program, developed to prevent future injuries. I will be posting information and basic prehabilitation exercises and movements on FIT.ed, to assist you to build your knowledge, develop your own prehabilitation program, and potentially avoid injury.

* If you are currently suffering from injury or chronic pain FIT.ed recommend that you seek medical advice from a medical professional.

The Embarrassing TRUTH about Sit-ups!

AFTER losing 20kg and competing in a 15km adventure obstacle course in under 2 hours, Sarah Jones* appeared to be a postnatal fitness success story.

About a year after the birth of her first child, Jones had signed up at a gym and engaged a personal trainer to help her lose her post-baby excess weight and regain her former high level of fitness.

Within six months she'd achieved her goal.

"I was so strong, fit and healthy, but then my insides let me down," said Jones, now 36.  “I realise that something wasn’t quite right one morning when I was in the shower and felt a heavy drag between my legs.” After visiting a Women’s Health Physiotherapist, Jones learnt she'd been building her fitness while leaving behind her pelvic floor, the platform of muscles, ligaments, connective tissue and sphincters that combine to support and close the bladder, vagina, uterus and bowel.

"I first started experiencing urinary stress incontinence [leaking urine when under stress, such as coughing, running or sneezing] about three months into my fitness kick. There were some exercises I just couldn't do, because I would wet myself, exercises such as skipping, star jumps, sit ups and crunches. But I pushed on thinking I simply had a weak bladder and ended up being unable to walk or run without having to go to the loo all the time or wear pads to prevent my shorts from getting wet."

Sixteen per cent of the Australian female adult population participate in fitness centre activities, compared with 9.4 per cent of adult male, according to the Australian Bureau of Statistics 2005-06 Multi-Purpose Household Survey. One in three Australian women experience urinary stress incontinence, which can be induced by incorrect exercise methods, as reported by the Continence Foundation of Australia. These are disturbing statistics, especially when many fitness programs and popular training regimes are written by men for men. 

Had Jones been screened before starting her initial fitness training it would have been obvious that she was at high risk. Jones recalls: "I'd experienced a difficult birth [one long forceps delivery] and, after inquiring, I discovered I had a family history of pelvic floor weakness. I often wonder if my story would have been different if my initial trainer had required me to complete a pelvic floor screening tool."

Jones, like many women, was looking to take care of herself and her body but didn’t realise that fitness starts from the inside and although the pelvic floor is a group of muscles which are hidden from view, they are a very important  to every woman. As Jones explains, "I'm an educated health promotion professional, but I simply didn't know about what I needed to know about my pelvic floor."

The pelvic floor muscles attach to the pubic bone in front and run underneath the body like a muscular hammock, inserting into the tailbone and stretching from the sit bones on either side of the body. Heavy lifting, excessive abdominal training (sit ups and crunches) and classes such as combat, balance, pump and step, can cause serious damage to this structure.

Lifting a heavy weight increases pressure inside the abdomen, which in turn pushes down on to the pelvic floor. Sit-ups, crunches and double leg lifts, traditionally recommended as abdominal strengthening exercises, also raise internal abdominal pressure. If the pelvic floor isn't strong and co-ordinated enough to quickly lift and hold to counter this internal pressure during exercise, then pelvic organ prolapse, or misalignment, is promoted.

Leaking when running, lifting or jumping in high-impact classes indicates the pelvic floor isn't coping with the effect of the feet hitting the ground, and persisting is likely to weaken the pelvic floor even more.

While certain exercises can cause or aggravate pelvic floor problems, others can cure them. Pelvic floor muscle training is effective in treating stress incontinence, with cure rates of up to about 85 per cent, according to Pauline Chiarelli, a women’s health physiotherapist and associate professor at the University of Newcastle.

Chiarelli says tailored pelvic floor exercises and tailored exercise programs or fitness regimes that are pelvic floor friendly, work best.  

"Initially, my pelvic floor muscles were so weak that I couldn't isolate or contract them at all," Jones recalls. "It took me two to three months to build up enough strength to be able to activate the correct muscles. I'd been compensating for my weakness by using my stomach, back and thigh muscles instead. I had to unlearn those strategies so they wouldn't be the first to kick in."

Poor instruction also doesn't help. Chiarelli said: "There are some very highly regarded Pilates instructors teaching pelvic floor exercises on the in-breath, but you need to do them on the out-breath as when you cough or sneeze.”

After about several months of dedicated pelvic floor strengthening exercises three times a day, Jones can now run 5km and stay dry. "I've changed my gym routine completely: no high risk ab work, meaning no sit ups, crunches or exercises with double leg lifts, no wide leg squats or side lunges and low impact classes only. It's about gradually bringing my pelvic floor strength up to my body's fitness level," says Jones. “I also changed personal trainers and now train with Krysia Child. Krysia’s understanding of the female body allows her to ensure that all of my sessions are pelvic-floor safe.” 

The best way to prevent urinary stress incontinence and prolapse is to find out that you are not at risk by taking 5 minutes to complete a Pelvic Floor Screening before you commence any form of exercise. Attached is the Pelvic Floor Screening Tool that all DASH Spot on Fitness Trainers require our female clients to complete before commencing training. If you answer yes to any of the questions we recommend that you make an appointment to see a Women’s Health Physiotherapist to prevent any injury to your pelvic floor muscles. 

For more information on Pelvic Floor safe exercise visit the Pelvic Floor First website: http://www.pelvicfloorfirst.org.au

• Name has been changed to maintain client confidentiality. 

DASH Spot on Fitness - Pelvic Floor Screening

Women are at higher risk of bladder and bowel control problems because of pregnancy, childbirth and menopause. Certain exercises can cause or worsen these problems. 

This survey has been designed to see if you are at risk of pelvic floor problems, and if so, to make sure your exercise program is pelvic floor safe. The survey will take 5 minutes to complete and your answers will be confidential.

ABOUT YOU…	YES	NO
Are you currently pregnant?
Have you recently (or ever) had a baby? Did you have a diastasis of the Rectus Abdominis?
Are you going through or have been through menopause?
Have you ever undergone gynecological surgery (e.g. a hysterectomy)?
Are you an elite athlete (e.g. a runner, gymnast or trampolinist)?
Do you have a history of lower back pain?
Have you ever injured your pelvic region (e.g. through a fall or pelvic radiotherapy)?
Do you suffer from constipation or regularly strain on the toilet?
Do you have a chronic cough or sneeze (e.g. because of asthma, smoking or hayfever)?
Are you overweight, obese or have a BMI over 25?
Do you frequently lift heavy weights (e.g. at work or at the gym)?

DO YOU…	YES	NO
Accidentally leak urine when you exercise, play sport, laugh, cough or sneeze?
Need to get to the toilet in a hurry – or not make it there in time?
Constantly need to go to the toilet?
Find it difficult to empty your bladder or bowel?
Accidentally lose control of your bowel – or accidentally pass wind?
Have a prolapse (e.g. a bulge or feeling of heaviness, discomfort, pulling, dragging or dropping in the vagina)?
Suffer from pelvic pain or experience pain during or after intercourse?

NOTES/ COMMENTS
If you have answered YES to any of the above questions please provide a brief explanation of your current condition in relation to the identified issue/s.

• If you have answered YES to any of the above questions it is recommended that you visit a Women’s Health Physiotherapist. 

IS YOUR EXERCISE ROUTINE DAMAGING YOUR PELVIC FLOOR?

Protect yourself from that warm, damp and embarrassing feeling between your legs when you’re at the gym. Learn how to modify your training programs to make sure that they are pelvic floor friendly, keeping you dry and happy.

By Krysia Child 

B.ed.(Hons), AdDip (S&R) and Cert. III & IV in Fitness

Millions of women needlessly suffer from damaged pelvic floor muscles even though their suffering is both preventable and curable through appropriate exercise. One in three women wet themselves when they laugh, cough, sneeze, lift or exercise (The National Continence Program, Australian Government. 2011.). 

There are many causes of pelvic floor muscle damage, including exercises which compromise the structure of the pelvic floor, pregnancy and childbirth, heavy lifting, being overweight, post surgery recovery, or even hormonal changes around menopause.  


The Pelvic Floor muscles are the group of muscles that are responsible for holding your bladder, uterus and bowel in their proper place. The pelvic floor muscles also help to close off the bladder, the vagina and the back passage. 

One of the more common and embarrassing issues from pelvic floor muscle damage is ladies leak urine when in the gym, in exercise classes, or playing sport. In more serious cases women can suffer organ prolapse, when one or more pelvic organs (bladder, uterus, bowel) sag down into the vagina. 

Unfortunately such occurrences lead to many women avoiding exercising and group activities. In reality, with a little help and guidance, appropriate exercise can often not only provide the solution but also prevent the issues arising in the first place, allowing many women to lead the healthy, active and enjoyable lifestyle they seek. 


As an exercise professional working with women who suffer organ prolapse or simply discomfort from a weakened pelvic floor, the shift from functional training to aesthetic training (focused on sculpting the perfect bikini abs) is extremely worrying. 


While childbirth is one of the most common causes, years of grueling and inappropriate or poorly executed exercise regimes are also major and growing contributors. 


About 3 years ago my own mother (a wonderfully fit 59-year-old) suffered organ prolapse as a result of deep overhead squats in a supervised fitness class. Since then, I have been dedicated to researching and educating women on how to protect themselves from a similar fate. 


Trying to be kind to their bodies many women attend yoga, pilates, aerobics and complete weights programs but whatever exercise method they use, whenever downward pressure is placed on the pelvic floor they risk damaging this vital group of muscles.  


Over the coming blogs, I will be outlining a range of pelvic floor safe exercise options. In my blogs I will show you how to modify your favourite exercise methods to ensure they are pelvic floor friendly, allowing you to enjoy an active and fit lifestyle while protecting and strengthening your pelvic floor.


If you already experience symptoms of pelvic floor muscle damage (leaking when you laugh, cough, sneeze, run, skip or jump) I highly recommend you seek advice from a medical professional before you engage in any physical activity. Medical clearance is recommended before you embark on any fitness regime.