Christine mentions under FAQs that certain pilates moves/positions can lead to prolapse. Scary!! I just started doing pilates as a prevenative for pain down the road - the last thing I want to happen is for the exercises to backfire on me and cause a problem. I'd like to know what Christine recommends. What resource of hers would any of you recommend in order to learn more about which exercises/positions I should avoid in pilates?

Thank you!

Hi QuestGirl,

I think you may be the first person to write in specifically about prevention! Pilates can mean many things these days, but the original core mat program places the body in a jack knife position, with head and feet raised off the floor. This sends tremendous pressure to the pelvic diaphragm, and for women whose pelvic organs are either resting on or have fallen through those muscles, these exercises can exacerbate our conditions.

We do exercises that first place the organs out of the way of internal pressures and then work the buttocks and abdominals at the same time.

As for prevention, read through the general premise here: that there is a natural, "neutral" shape to the female spine and pelvis (which differs significantly from the male spine) and try to keep this shape throughout the day as much as possible.


Hi Christine!

Thank you for your input on this! Have you looked into physio-synthesis? I'd love to know your input on that as well. What about the McCall Movement Method? www.mccallbodybalance.com. I got into pilates as a prevention method for pain down the road, but I'm really wanting to know which way of prevention is really the right one! I'd hate to develop prolapse one day because of pilates!

Interesting that I'm the first visiting for prevenative reasons! I have never before heard of this, and I'm guessing that many other young women haven't either. However, now that I know about it, I'd like to prevent it!

Thank you Christine for your website!

QuestGirl - I think its wonderful luck that you found this board and have the opportunity to prevent prolapse. I am 33 and while I had heard of POP I always thought it happened only to older women and that there was nothing you could do to predict or prevent it. Please read through the info here and empower yourself. Please share the knowlege with your friends....prolapse is not inevitable and unfortunately the medical community will not speak to you re: prevention...they don't know (or refuse to believe) that it is preventable or managable without surgery.

I have no experience with either, but the physio synthesis looks very heavily influenced by classic Pilates. I was amazed at the McCall site though!! I knew if my work was right (which I never doubted or I wouldn't have had the guts to put it out here in 2003 in such a radical way) there would be copy-cat sites before long, and it appears she's doing pretty much the same work as Whole Woman!! This is a nice validation, but remember ladies that you heard it here first! :-) Thanks, QuestGirl for sharing the information.


Wow, it's really cool that you think you might agree with the McCall Method. She's teaching a class in my area, and I think I'll sign up! And actually, she's been around for quite a few years and has even worked with Olympic athletes, so I guess you both seperately came to the same smart conclusions! I have her book, and she doesn't put much emphasis on prolapse though, although, she did mention it once. I'd like to ask her opinions on it as well. I love it when I find two different experts that "agree." I want to further understand what actually puts "strain" on the pelvic region, so I'm looking forward to learning more in your books/DVD!

Great! I agree - basic truths are just there to be discovered. Literally though, I've never seen anyone, anywhere talk about "sticking out the butt" but here, and we've even refined our language!! :-) I ordered her DVD to see if she talks about the differences between the male and female spine. If so, she and I are the only two on the planet that I'm aware of.

Christine - I'd love to know what your final thoughts are about the McCall Method! I want to get this prevenative stuff all figured out while I'm still young and healthy! :D So glad you're looking into it! From looking through the book though - I don't think she mentions the differences between men and women's spines. :(

You know, it's interesting about "sticking the butt out," because my pilates studio told me that I have very mild "lordosis" and that I very slightly stick my rear out too much! But, after visiting here and McCall - seems that's a good thing! Also, I'm unable to roll my back down from shoulders to pelvis "vertabrae by vertebrae." I can roll from my shoulders down to my waist inch by inch, but when I get to the pelvis region, it all goes down at once and not "vertebrae by vertebrea." The pilates people told me that's probably because of my mild lordosis and that maybe my spine has been compacted at the pelvis region - but - I'm wondering if maybe the female spine isn't made to be so flexible at the pelvis region, and that the pelvis region touching the floor all at once and not inch by inch mgiht be normal? I'd love to know what you think! I'm so confused about this. I feel so blessed to have found your website! Maybe I can finally get to the real "truth!"

I don’t know really…this sort of sounds like pseudoscience to me. Are our five sacral vertebrae supposed to roll down one by one? Kind of difficult to do given that they are fused into one bone! I believe a lot of yoga and Pilates mistook the natural curvature of the female spine as pathologic.

If you are concerned about hyperlordosis, be sure to keep your abs in top shape, as they oppose the back muscles that allow the lumbar curvature, and also practice the upper body posture.

That is so interesting! Tucking the behind under seems like such an unnatural way to stand, so it's refreshing to hear that for women, it really IS an unnatural way to stand!

I had a breakthrough in class - I can roll down vertebrae by vertebrae now all the way down. I can even roll my pelvis up while still keeping my waist on the floor - I couldn't do that before. However... I'm wondering if maybe this isn't such a good thing!

I'm so happy I found this website and am really looking forward to learning more about the way the female body is supposed to work!

Hi Questgirl,

I have primary cystocele and mild rectocele. Although I think my uterus is in place, I have to believe it is also somewhat further down than it was prior to the birth of my son 8 years ago. Curiously, last December, I had engaged in a vigorous pilates class and suddenly noticed my cystocele appear at the introitus of my vagina. To be fair, I was also working out at my local YMCA, using weight machines at the same time. I did exercises on the machines, whereby I was seated, pushing weights with my legs. I truly feel all of these particular exercises contributed greatly to my proplapse appearing worse. I guess I knew something was different prior to these exercises, but NOTHING like what happened once I engaged in these exercises. SO my advice to you would be to give up the Pilates. Perhaps some careful, gentle Yoga would be a better alternative. PLUS, I for one, don't feel it is natural to be able to curl down the spine as you describe. I remember feeling unnatural doing this in my class, not to mention I wondered "what was the exact point in doing this?" Also, the position you are asked to hold your body in while lying down with your legs extended high in the air above your head also seems a little odd to me. I feel this did send pressures directly to the pelvic region, among some other positions we worked on. It's too bad, because I did enjoy the ballwork class. But, now that this happened to me, I am extremely cautious about what I do. So much so that I have kind of haulted my winter exercise routine. I primarily ride my bike and walk outside, but unfortunately, winter has reared it's ugly head again here in the Northeast! Anyway, short story long, if I were you, I'd give up on Pilates. I don't believe they had prolapse in mind when they created this exercise regimine. I would rather be safe than sorry. :) Take good care, April


Is there a way to tell when pressure is being placed on the pelvic diaphragm? I'd like to continue doing pilates but am kind of at a loss for knowing what exercises are bad or good for women. I'd like to be able to modify the exercises. Does your book go into detail in a way that would give me the knowledge I need to understand which exercises might be dangerous? Also, can I get a workout from the exercises in your book? If so, it might be easier to just replace pilates with your exercises. :) My main issue is that I want to continue doing strenthening exercises, but I want to do them safely. As it is now, I've kind of stopped exercising altogether out of the fear of hurting myself, haha, except for walking.

Thank you Christine!

Hi, I'm posting for maybe the third time (shy, I guess), because I'm also wondering about Pilates. I have 3rd degree rectocele, 2nd degree prolapse, and 2nd degree cystocele. I am often not terribly comfortable, and have stopped doing a lot of my former exercising for fear of doing further damage to my pelvic area. However, there is a woman who teaches Pilates at a local yoga company who has had pelvic floor problems (I know this because one of my good friends has worked with her). I am wondering if she might be a person who already has modified some of the Pilates movements. I thought I would go and audit a class of hers, and also tell her about my situation, and see if she has any thoughts on the exercises. Also, my physical therapists don't want me to do any yoga now, so I just hope that I can do yoga in the future. It seems that I am getting weaker and weaker since I can't ride horses anymore, lift weights anymore, and now yoga and pilates might be suspect, too! At any rate, if I find anything of interest with respect to the Pilates class, I will post here to see what Christine and you all think. I am grateful for this website -- it's about the only voice of sanity and alternatives to surgery that's out there.


Hi QuestGirl,

I took that old post down that you copied because it did not transfer/read well to the new forum – I’m sure there are many like that as the smiley faces and certain punctuation did not translate.

I think we’re getting a little carried away with exercise-phobia.

Pilates can mean anything these days and I’m sure there are many programs out there that promote natural, protective movement. The only movements I feel to be deleterious to women WHO ARE ALREADY COMPROMISED IN THESE WAYS (and that certainly includes post-partum moms) are those that send a lot of pressure out the back – such as sit-ups, boat poses, and the classic mat program of Pilates. A young girl with no pf issues should be able to do any sort of exercise she wants provided she is in all-around good condition. Think of gymnasts and circus performers. The human body is incredible in its flexibility and ability to defy gravity.

I’ve developed this new way of considering the female body, not as an exercise physiologist, but simply from a mother-dancer-clothingmaker-female perspective. My theories remain unproven and there are still details to be discovered. I think the biggest hint that we are on the right track, however, is that it just “makes sense” to women, not to mention how many are seeing improvement.

Use your own best judgment, explore other methods, and always do what you feel is right.


I guess I am a little phobic,haha, but with good reason. I hear that many professional gymnasts have urinary incontinence because of what they put their bodies through (you can confirm this by googling it)... it just goes with the territory, and they consider it normal. This stands to reason that exercise can indeed cause these problems to develop. I'm really, really surprised that I'm the only poster at these boards here for "prevenative" reasons! I think women of all ages should be aware of your theory - it would probably prevent many problems for a lot of women!

I mainly wanted to know, Christine, if by reading your book, I would be equipped with the knowledge needed to know what types of exercisies/positions to avoid. I know to avoid sit-ups, even though I don't really understand why, and I have no idea how to safely exercise the abs. I just want to be educated as to how to safely exercise. Right now, I'm just totally confused.

The post you took down, the one that talks about the "degrees" of positioning for the body, I found to be very helpful. I at least know to avoid exercise positions that put the body in a degree greater than 90 degrees. So I have part of the puzzle so far... but I want to know more! :) I'm very fascinated with your theory.

Thanks Christine. :)

As the more senior members of this board know, I was just coming to the postural work when I wrote STWW. I was letting my body teach me, but I really didn’t have the languaging yet, nor a complete understanding of the anatomy for the first edition. That is why I have posted the article “re-thinking the concept of pelvic floor” for free here on the site. It is the replacement anatomy chapter for the new edition of the book, which I hope to have available by the end of March. It will also contain a new movement chapter outlining all the concerns you raise. The first edition of STWW is still the only resource on the planet describing pelvic reconstruction operations in detail as well as their aftermath. Thank you so much for your interest and validation, QuestGirl. Of course I’ve known for a long time that ALL women need this work – it’s just a huge project to deliver and I’m working as hard and as fast as I can.

P.S. I had researched the literature for years, but the reason it took so long to understand what's really going on with female anatomy is because the science doesn't exist in any one place. I was very lucky to find and gather insights from a few brilliant doctors of the past who wrote articles (one guy had to deliver his in Paris) that were published, but then never spoken about again.


I'm SO happy to hear of the new edition and what it contains! I will be ordering a copy for sure. Any ideas when it will be out? Sorry if your website says somewhere - I looked and didn't find it. I downloaded the article you mentioned and found it helpful.

Thanks so much for all you do to get this information out there. This should be basic information that all women are aware of. :)