Posture should be the subject of one out of every four blog posts I write because good posture is one of the cornerstones of successful pelvic floor rehabilitation.  Your posture affects your prolapse and incontinence every waking hour that you are standing or sitting.  Once you realize this, you can begin to understand the profound importance of mastering optimal standing and sitting posture.


There is a position in the physical therapy world called “neutral spine.”  This is a position where you hold a soft, natural “S curve” of your spine.  It is somewhere in between the extreme gymnasts posture that many women find themselves in, where their lower abdominals offer no support around the front side of their pelvis.  Or the other extreme of the flat back, “buns tucked under posture” where their tail bone is so tucked under that their entire pelvis is actually tipped from its natural position to a more vertical position.


To find your neutral spine, first place your hands on your hips and begin to rock your pelvis.  First rotate your pelvis so that you tuck your buns under as far as you can.  This is one extreme.  Now rotate your pelvis back, sticking your buns out like a gymnast.   This is the other extreme.  Now, from this gymnast position, draw your transversus abdominus (TA) muscle tight by pulling your belly button “up and in.”  You will note how activating this muscle rocks your pelvis back ever so slightly, softening the sharp lumbar curve, and pulling you back to neutral spine position.


I recognize that this is not easy.  We all have a tendency to get lazy and allow our bodies to be supported by locked joints.   This may be easiest, but the human body is dynamic and not meant to be in a locked position.  With this in mind, unlock your knees, unlock your pelvis, and open your hands up by rotating the palms of your hands to face forward.  All of these subtle postural changes engage muscles, open neural pathways, and increase blood and oxygen flow throughout our bodies.  This requires effort and constant awareness of your body.  Initially it will have to be a conscious effort to get in front of a mirror and find your own neutral spine.  Then, with consistent effort, neutral spine positioning will become your norm.


Now, let’s go through neutral spine in a sitting position.  To achieve this, you want to be in a position where your knees are slightly lower than your hips if viewed from the side.  This may require you to slide to the front edge of your chair so that your knees drop slightly.  You can also use this measurement in choosing the correct size swiss ball for exercise or for sitting at your work station.   By sitting so that your knees are slightly lower than your hips, you make it easy to roll forward onto your “sitting tripod” made up of your two sit bones and your pubic bone.  Note that your sitting tripod does not include your tail bone!  Your tail bone should be free from all pressure when sitting in neutral spine.  This makes the car and the couch the two toughest places to sit with good posture.  Optimal sitting posture is just that easy…find your tripod!  Once you feel pressure on your pubic bone, you are automatically in neutral spine.  This is simply positioning, not any muscle action at all.


So, now let’s talk about what neutral spine posture does specifically for our pelvic floor function.  We talked about neutral spine posture being a dynamic position, so it requires both our multifidi muscles within our low back as well as our transversus abdominus muscles, which wrap around the front of our pelvis, to be engaged in order to hold this position.  Our pelvic floor naturally co-contracts with these two muscles as our bodies’ deepest core stabilizers.  Also, our pelvic floor is now set at a perfect length, with just the right amount of tension to allow for the strongest contraction it can give.  If we stand with our tail bone tucked under, our pelvic floor is hanging way too loose and relaxed to respond with sufficient support when needed.  Also, if we are standing in a gymnast posture, then our pelvic floor is stretched beyond its functional limits and it, again, cannot provide sufficient support when needed.  However, when we are in neutral spine, with our tail bone in slight extension, then our pelvic floor muscles, stretching from our tail bone to our pubic bone, are at the perfect length/tension to give optimal support.


I hope this is useful information for all of you.  I can’t stress the importance of posture enough.  For many it may be the last missing piece of the puzzle that will lead you to greater improvement of your pelvic floor symptoms!

Published by Tasha


  1. Can you give some tips for holding neutral spine in the car & what you do while relaxing on the couch? I’ve found I can move me car seat to a tilted down position & I think that helps. Thanks!

  2. Can you also help with how to hold neutral spine when exercising? I was doing cardio this morning and was struggling to hold my TA in while breathing heavily. I noticed my prolapse felt worse when I let them go, but it’s a challenge to hold AND work out. Any tips? Or is it just practice makes perfect?

  3. Kristina,
    You have highlighted the two places where holding neutral spine is the hardest. The couch is one that I would tell you to spend as little time there as possible. I love to see people get up and get moving and if you do that, then the little amount of time you may get to put your feet up before bed won’t be detrimental to your pelvic floor health. If you find your self on the couch more than that, then make an effort to place a pillow behind your bad so it rolls you forward a bit on your sit bones. Bottom line the couch is not a posture friendly location!

    As for the car, you can make this work with some effort. You mentioned you have been able to tilt your car seat to get your hips even with or even slightly higher than your knees – that’s a great first step. Then you will have to bring your seat back close to vertical and this will also help you roll forward on your sit bones, so that you are not leaning back on your tail bone. A final step will be to think about drawing your TA in when you are driving. It is a great time to activate your TA and pelvic floor.


  4. Maria,
    Your question on heavy breathing and holding your TA in is an excellent one. It is definitely a practice makes perfect scenario. Also, if you are consistent with the Advanced Program strengthening as you increase the intensity of your cardio, your TA will naturally hold more tone because you will have a better baseline strength.

    Beyond this, as you are working higher intensity cardio, I would predict that your prolapse symptoms are better throughout your normal daily activities after your workout. Do you find this?



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