When relaxing is harder than strengthening…
Understanding a High-Tone Pelvic Floor and Why "More Kegels" Aren't Always the Answer
One of the biggest surprises for many women who come into my clinic is hearing me say:
"Your pelvic floor isn't weak... it's actually working too hard."
That often comes as a shock.
Many women have spent months—or even years—trying to strengthen their pelvic floor with more exercises, more squeezing and more determination, believing that stronger muscles must be the answer.
But like every muscle in the body, the pelvic floor needs to be able to do two equally important jobs:
Contract.
Relax.
If a muscle can't relax properly, it can never function at its best.
Imagine Walking Around Shrugging Your Shoulders All Day
One of the analogies I often use in the clinic is this.
Imagine someone asked you to walk around all day with your shoulders pulled up towards your ears.
For the first few minutes you could probably do it.
After an hour your neck would begin to ache.
By the end of the day you would have tension headaches, sore shoulders and tight muscles that no longer knew how to switch off.
Your pelvic floor behaves in exactly the same way.
For some women, those muscles remain partially contracted all day without them even realising it.
Over time, they become tired, painful and less efficient.
Ironically, muscles that are too tight are often too weak when they actually need to work.
Strong Doesn't Always Mean Functional
People often assume muscle strength is everything.
As physiotherapists, we know that isn't true.
Think about someone recovering from a knee replacement.
Immediately after surgery the physiotherapist asks them to bend the knee.
Most people don't want to.
It hurts.
The natural instinct is to protect it.
If they avoid bending it for weeks or months, the knee becomes stiff.
Eventually they can still walk—but they struggle to climb stairs, get into a car or squat down because they never regained their full movement.
The pelvic floor is no different.
If pain causes the muscles to tighten and protect themselves, they gradually lose their ability to lengthen.
That loss of movement can become just as limiting as muscle weakness.
Why Does the Pelvic Floor Become Tight?
There isn't usually one single cause.
Common contributors include:
Painful intercourse
Endometriosis
Pelvic surgery
Vaginal birth trauma
Radiation therapy
Vaginal dilator therapy
Chronic constipation
Repeated urinary tract infections
Anxiety or chronic stress
Years of "holding on"
High-level athletes who constantly brace their core
Previous trauma
Sometimes the muscles become protective after a painful event.
Sometimes they've simply spent years working harder than they need to.
The Pelvic Floor Doesn't Work Alone
Another thing I explain regularly is that we don't have an isolated "pelvic floor muscle."
The pelvic floor is part of an entire movement system.
It works together with:
your diaphragm
your abdominal muscles
your hips
your gluteal muscles
your spine
your nervous system
If your hips are extremely tight, your pelvic floor often works harder.
If your breathing is shallow, your pelvic floor moves less.
If you're constantly stressed, your nervous system may keep these muscles switched on all day.
This is why treatment is rarely just an internal examination.
We're treating the whole person.
Why Breathing Is One of the Best Pelvic Floor Exercises
This surprises almost everyone.
Every time you take a relaxed breath in, your diaphragm moves downward.
As it does, your pelvic floor gently lengthens.
When you breathe out, both structures recoil together.
This means every slow breath becomes a gentle movement exercise for your pelvic floor.
It's one of the reasons I often encourage women to combine breathing with stretching, pelvic floor relaxation or vaginal dilator therapy.
Instead of forcing tissues to stretch, we allow the body's own breathing mechanics to assist the process.
Sometimes the biggest improvement comes from learning to breathe—not from pushing harder.
Tissue Learns Through Time, Not Force
One of the biggest misconceptions about stretching is that more pain equals better results.
In reality, connective tissue adapts remarkably well to gentle, sustained loading.
Whether we're stretching a calf muscle, recovering from a knee replacement or using vaginal dilators, the principle is similar.
The body responds best when it feels safe.
Gentle pressure.
Steady breathing.
Time.
Consistency.
Rather than forcing your way through pain, we aim for a tolerable stretch that gradually becomes easier as the muscles learn they no longer need to guard.
Progress often comes from doing a little, regularly, rather than a lot, occasionally.
It's Like Looking After Your Teeth
Sometimes women ask me,
"Will I have to keep doing these exercises forever?"
I usually smile and ask another question.
"Will you keep brushing your teeth?"
Most of the things we do for our health aren't one-off treatments.
We keep walking because it keeps us fit.
We keep strength training because muscles naturally lose capacity over time.
We brush our teeth because daily maintenance prevents bigger problems later.
Pelvic floor health is much the same.
For some women, especially those living with congenital conditions, pelvic pain, previous surgery or pelvic radiation, a small amount of regular maintenance helps preserve the gains they've worked so hard to achieve.
Maintenance doesn't mean something is wrong.
It means you're looking after your body.
Management Is About Building a Toolkit
There is no single treatment that works for every woman.
Instead, we build an individualised plan that may include:
Pelvic floor physiotherapy
Assessment of muscle tone, coordination and movement patterns with hands-on treatment where appropriate.
Breathing and nervous system regulation
Diaphragmatic breathing, relaxation techniques and strategies to reduce muscle guarding.
Vaginal dilator therapy
A gradual programme designed to improve tissue flexibility, comfort and confidence using gentle progression rather than force.
Manual therapy
Release of tight muscles through the pelvic floor, hips, abdomen and lower back to improve mobility and reduce pain.
Hip and pelvic mobility exercises
Improving movement through the hips, pelvis and spine often reduces unnecessary tension throughout the pelvic floor.
Foam rolling and stretching
Targeting the gluteal muscles, deep hip rotators and connective tissues surrounding the pelvis can complement internal treatment.
Lifestyle and bladder or bowel management
Addressing constipation, bladder habits, exercise, lifting strategies and pressure management to reduce ongoing strain.
Multidisciplinary care
Some women also benefit from input from gynaecologists, pain specialists, psychologists, sex therapists or continence nurses, particularly when symptoms are complex or longstanding.
There Is No Medal for Pushing Through Pain
One of the most important things I hope women take away from pelvic floor rehabilitation is this:
Recovery is not about tolerating more pain.
It is about helping your body feel safe enough to let go.
Sometimes progress looks dramatic.
More often it happens quietly.
A little less pain.
A little more movement.
A little more confidence.
Over weeks and months, those small changes add up to something much bigger.
You Are Not Broken
If you've been told your pelvic floor is "too tight," it can feel confusing.
Please remember that your body is trying to protect you.
Our job isn't to fight those muscles.
It's to understand why they're working so hard, gently teach them that they're safe to relax and help them become strong, flexible and functional again.
Because the healthiest pelvic floor isn't the strongest one.
It's the one that knows when to hold on—and when to let go.
Melinda Sandon
Principal Physiotherapist
Matremaga Physiotherapy
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