When someone presents with pelvic floor dysfunction, the most common advice they receive is to start doing Kegels. The assumption is that weakness is the problem, and strengthening is the solution. But for many women—especially those who are active, stressed, or hypermobile—that advice could be doing more harm than good.
In reality, pelvic floor dysfunction is not always caused by weakness. It’s often a coordination issue. Sometimes, the pelvic floor is actually overactive—constantly switched on and unable to relax. And unless a full pelvic health assessment has been done, it’s impossible to know whether the problem is underactivity, overactivity, or a mix of both.
What’s often missing from the conversation is how the feet are contributing to the dysfunction.
Not All Pelvic Floor Issues Are Due to Weakness
The pelvic floor muscles, like any other muscle group, can be underactive (hypotonic) or overactive (hypertonic). Both can result in similar symptoms:
- Leaking with effort, coughing, or sneezing
- Urgency or frequent urination
- Pelvic heaviness or pressure
- Pain during intercourse or physical activity
- Ongoing lower back discomfort
With an underactive pelvic floor, these symptoms stem from lack of support. But with an overactive pelvic floor, the muscles are already holding too much tension. They can’t lengthen, relax, or contract effectively when needed.
A tight pelvic floor can also interfere with diaphragmatic breathing, core control, and spinal mechanics. This dysfunction often gets missed—especially in women who appear strong, flexible, and fit. That includes many with undiagnosed hypermobility.
What About Underactive Pelvic Floors?
Some individuals do have true pelvic floor weakness. A hypotonic pelvic floor may lack strength, tone, and endurance, which affects its ability to control continence or support pressure through the core.
In these cases, strengthening work—such as correctly performed Kegels—may be helpful. But it’s essential that they’re done as part of a broader strategy that includes:
- Coordinated breathing
- Proper posture
- Whole-body movement patterns
Even when the pelvic floor is weak, the rest of the body plays a role. If the feet are unstable and the glutes are under-recruited, the pelvic floor may still end up compensating—just in a different way. That’s why a feet-up approach is relevant regardless of whether the pelvic floor is too tight or too weak. It's about restoring proper sequencing and shared load throughout the kinetic chain.
The Hypermobility Connection
In hypermobile individuals, the ligaments that provide joint stability are more elastic. This creates a reliance on muscular control to maintain alignment and balance. As a result, deep stabilising muscles like the pelvic floor can become overactive. The body uses gripping and bracing strategies to try and create stability where passive support is lacking.
Over time, this leads to tension-based dysfunction. The pelvic floor doesn’t get a chance to switch off, and symptoms persist—even with targeted strengthening.
This is why blanket advice like “just do Kegels” can backfire. Without knowing whether the muscles need to release or recruit, you could be reinforcing poor mechanics rather than improving them.
The Role of Foot Function in Pelvic Stability
The body works as a kinetic chain. When one link is unstable, others compensate. The feet are the body’s first point of contact with the ground. If they’re not functioning well, everything above—ankles, knees, hips, pelvis, spine—adjusts to cope.
Common foot dysfunctions include:
- Collapsed or rigid arches
- Limited big toe extension
- Overpronation or supination
- Poor proprioception and balance
These dysfunctions affect gait, stance, and joint alignment. When foot mechanics are off, glutes often underactivate, and the pelvis lacks efficient support. The pelvic floor may then step in as a stabiliser, leading to clenching and overuse—or strain in the case of underactivity.
In short, if the feet aren’t doing their job, the pelvic floor may be forced to take on roles it was never designed for.
Why Pilates Can Help—When It Starts from the Feet
Pilates is often recommended for core control and pelvic floor rehabilitation. But not all Pilates is equal. Traditional cueing can sometimes encourage more bracing than release, especially if foot mechanics and breath patterns aren’t addressed.
When Pilates is taught from the ground up—with a focus on foot function, alignment, and proprioception—it can be a highly effective approach. It helps to:
- Restore sensory feedback through the feet
- Improve glute engagement via the foot-to-hip connection
- Re-establish diaphragm and pelvic floor coordination
- Release overactive muscles while strengthening underactive ones
The result is a more responsive, functional pelvic floor—not one that’s constantly gripping or collapsing.
What to Do if This Sounds Familiar
If you’ve been doing pelvic floor exercises and your symptoms aren’t improving—or they’re getting worse—it’s worth reassessing the approach. Start with the following:
- Seek a pelvic health physiotherapy assessment if possible
- Pay attention to your feet—how you stand, walk, and load through each foot
- Start incorporating foot drills and barefoot movement where appropriate
- Avoid excessive clenching during core or glute exercises
- Focus on breath-led movement and releasing strategies alongside strengthening
If you’re hypermobile, these considerations are even more important. Your body may be relying on the pelvic floor for stability it can’t find elsewhere.
Conclusion: Reconnect Before You Reinforce
Pelvic floor dysfunction doesn’t exist in isolation. It’s part of a whole-body system that relies on efficient load transfer, alignment, and coordination.
Strengthening is important—but only when it's targeted correctly. If your feet aren’t functioning well, and your glutes aren’t engaging efficiently, your pelvic floor may continue to compensate. Over time, this leads to dysfunction, not resolution.
A foot-first, Pilates-based approach can help you retrain your system—starting from the feet up.
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