Core Massage and Bodywork for Men: Pelvis, Hips, Thighs, Low Back and Abdomen
Core Bodywork for Men
♦ The Back and Spinal Musculature
♦ The Abdomen and Respiratory Diaphragm
♦ The Hip and Gluteal Muscles
♦ The Pelvic Floor
Who Can Benefit From Core Bodywork?
Explorers ♦ Sufferers ♦ Optimizers ♦ Survivors ♦ Power Users ♦ Seekers
A Note about Sexual Energy and Erections
Introduction
Comprehensive and effective core bodywork requires a deep knowledge of spinal, abdominal, pelvic, pelvic floor, and hip anatomy and function; awareness of the relationship between these structures and movement, ease, integrity, and vitality; an understanding of the various pain syndromes and dysfunctions caused by, or related to, core systems and structures; and an array of modalities, techniques, and strategies that can be employed to meet the various goals and priorities of each client. It also requires attention to detail in order to fully explore, engage, and address the numerous muscles, connective tissues, and other structures within the core.
By definition, core bodywork usually includes areas that can be sensitive or feel vulnerable, such as the abdomen, buttocks, pelvic floor, inner thigh, inguinal, and pubic areas. As well, the genitals and anus are located within, or are extensions of, the lower core and have highly integrated structural and functional relationships with it. Work in these areas requires a safe space, a non-judgemental attitude, an informed and sensitive touch, and a respect for boundaries.
Many men can affirm how challenging it can be to find a bodyworker who is not only willing to focus on the core, but is also comfortable, knowledgeable, skilled, and experienced in working with this part of the body. As a result, most men find few opportunities to fully explore and address these crucial areas that are too often inadequately engaged or are entirely omitted. As Myers has emphasized, the core is the foundation of our being and the source of our vitality, security, power, sexual expression, and instinct. "Leaving it out of our work because we are scared of its power is as criminal as bulldozing our way through it because we are unaware of its sensitivity" [1].
Bodywork Techniques
Techniques I use to mobilize, stretch, release, relax, and improve the function of the core musculature are drawn from Neuromuscular Therapy, Myofascial Release, Orthopedic Massage, Sports Massage, Soft Tissue Mobilization, Cross-Fiber Manipulation, Positional Release, Deep Tissue Massage, Trigger Point, Swedish, Shiatsu, Trager Bodywork, and other modalities.
When appropriate, I use Active Engagement techniques, which may include contract/relax cycles and/or spinal, pelvic, or leg movements as I apply pressure to various muscles and connective tissues. Similarly, I may employ Pin and Stretch techniques, an approach very similar to Active Release Technique (ART). Adding in active or passive engagement/movements can further enhance tissue release and stretch as well as deepen awareness, connection, and control.
Muscles and Muscle Groups
Any areas of the core described below can be included in a core bodywork session, depending on each client's preferences and goals. See my Who Can Benefit From Core Bodywork? section (or scroll down) for the many ways my work can be applied and experienced, the different reasons men may have for seeking out my work, and the ways that they can benefit. Broadly speaking, my clients range from those who wish to address specific pain or dysfunction issues to those without specific complaints but who wish explore and experience their core in new ways.
→ The Back and Spinal Musculature
The muscles of the back and spine are layered and arranged such that the primary movements of forward bending (flexion), backward bending (extension), side bending (sometimes called lateral flexion) and rotation are made possible—in multiple combinations and to various degrees—while at the same time maintaining spinal integrity.
Many readers will be familiar with the trapezius and the latissimus dorsi muscles, both of which lie just below the skin. Underneath those are multiple muscle groups, including the iliocostalis muscles; the longissimus muscles; the spinalis, semispinalis, and interspinalis muscles; and the multifidus, rotatores, and intertransversarii muscles. On each side of the lumbar vertebrae are the quadratus lumborum muscles, which connect the bottom of the rib cage and lumbar vertebrae to the crest of the pelvis. Several abdominal muscles fully wrap around the sides and connect directly to the spinal vertebrae via the thoracolumbar fascia, which is one of many critical connective tissues interwoven throughout the musculoskeletal structures of the back and spine. And as is true throughout the body, numerous nerves and blood vessels course through, in between, and around all of the muscles and connective tissues of the core.
→ The Abdomen and Respiratory Diaphragm
The superficial muscles of the abdomen are the rectus abdominis, the external and internal obliques, the transversus abdominis, and the pyramidalis. Knitting the left and right halves of the superficial abdominal muscles together is the linea alba—a connective tissue structure that also connects the sternum to the pubic bone. The psoas major and minor muscles are located deep within the abdomen, attaching to the front of the lumbar spine. The bulk of the psoas major and all of the minor are accessed through the superficial abdominal muscles and the abdominal contents. Many of the abdominal connective tissues are continuous with those of the back, pelvis, pelvic floor, genitals, and thigh—one of many examples of the strong interrelationships between the abdomen and these nearby structures.
The respiratory diaphragm is located under the rib cage and forms the top of the core. It is the principal muscle of respiration and is a critical component of core function. Though largely inaccessible to direct manual contact, there are a number of bodywork techniques and strategies to improve diaphragmatic function.
→ The Hip and Gluteal Muscles
The hip is a ball–and–socket joint where the femur (thigh bone) meets the pelvis. The hip and gluteal muscles, many of which are very large and powerful, are movers and stabilizers of the femur, the pelvis, and in the case of the psoas major, the low back. Numerous muscles are arranged in layers around this joint, which enables multiple directions of movement: flexion, extension, adduction (bringing the thigh toward the midline, as in squeezing your legs together), abduction (moving the thigh away from the midline, as in opening your legs widely), and rotation—while also maintaining the integrity and stability of the joint itself.
The gluteals are comprised of the gluteus maximus—which largely determines the external appearance of our buttocks or butt—the gluteus medius, and the gluteus minimus. The lower fibers of the maximus insert into the femur and are hip extensors, while the upper fibers of the maximus, together with the tensor fascia lata, insert into the iliotibial tract (the so-called "IT band") and are hip abductors. The medius and minimus are also primarily abductors of the hip, and all four of these muscles contribute to hip rotation.
Underneath the gluteus maximus are several smaller muscles which are collectively called the deep lateral rotators of the hip (though they contribute to other movements as well): the piriformis, the obturator internus and externus, the gemelli superior and inferior, and the quadratus femoris.
The adductors are a massive group of muscles on the inside of the thigh, which attach to the pubic bone and sit bones (ischial tuberosities). Here we have the adductor magnus, the adductor longus, the adductor brevis, the pectineus, and the gracilis. Though these are primarily powerful adductors of the hip, they also contribute to flexion, extension, and rotation.
The most powerful hip flexors are the paired iliopsoas muscles—the psoas major, psoas minor, and iliacus muscles which join together to form a common tendon that inserts into the femur on the inside of the upper thigh. Additional contributors to hip flexion are the rectus femoris and the sartorius muscles, with smaller contributions from some of the adductor group of muscles.
What about the quadriceps and hamstrings? Of the four muscles commonly known as the quads, only one—the above-mentioned rectus femoris—spans the hip joint and contributes to hip flexion. The other three (vastus lateralis, vastus medialis, and vastus intermedius) act only on the knee joint. Three of the four hamstrings, however, act on both the hip and knee joints. These include the semitendinosus, the semimembranosus, and the long head of the biceps femoris—all of which function as hip extensors.
→ The Pelvic Floor
The male pelvic floor is more complex than the female pelvic floor and has strong structural and functional relationships with all other parts of the core—pelvis, hips, abdomen, low back and spine, and respiratory diaphragm. It is capable of generating pain and dysfunction anywhere within the pelvic, pubic, or inguinal regions and/or in the genitals; on the other hand it can equally be a source of comfort, ease, vitality, and pleasure. In addition, the pelvic floor houses the urinary and anal sphincters, making it highly relevant to voiding function and dysfunction as well as anal health. Sexual function and genital health greatly depend on a functional pelvic floor.
Numerous highly integrated muscles and connective tissues, in 3 layers and multiple orientations, form the male pelvic floor (the perineum being perhaps the most well known part of the pelvic floor). These include: the bulbospongiosus muscle, ischiovavernosus muscles, superficial transverse perineal muscles, deep transverse perineal muscle, external urethral sphincter, perineal body, puborectalis, pubococcygeus, and iliococcygeus muscles (these three are known collectively as the levator ani group), coccygeus muscle, external anal sphincter, internal anal sphincter, and the ano-coccygeal ligament.
For a more detailed description of the above pelvic floor muscles and connective tissues including their relevance to various conditions, dysfunctions, and pain syndromes, plus information on additional structures such as the cremaster muscles, suspensory ligaments of the penis, the erectile muscles of the penis, the tunica albuginea, the foreskin, and the prostate gland—see my Massage and Bodywork page on my malepelvicfloor.com website.
See also the information on this website's Pelvic Floor page (or click on the pelvic floor tab at the top), as well as The Sexual Core and Genitals section within The Body's Core page.
Who can Benefit from Core Bodywork?
Core bodywork can be equally rewarding for those men who wish to gain more awareness and insight into their bodies as well as those men who are experiencing specific issues, concerns, discomfort, pain, or other dysfunction within, or relevant to, their core. While this work is most often practiced and experienced on a physical and sensory level, many men may also be open to, and appreciate, concurrent energetic, emotional, psychological, or spiritual shifts that may occur. We humans are multidimensional, and it is useful to keep this in mind.
There are as many potential benefits to receiving core bodywork as there are motivations to seek it out. Men with differing priorities, concerns, issues, and goals can be loosely and broadly divided into several groups, though most men will fall into a combination of these:
Explorers
Men who want to explore and learn more about their core in a physical and sensory context, including those areas that are rarely given any attention.
These men are typically open to exploring the vast array of sensation and response that skilled bodywork can elicit, and are interested in experiencing their bodies in new ways. Engaging and interacting with muscles, connective tissues, and sensory nerves via core bodywork is an excellent way to explore these tissues in a spirit of curious discovery, enhance and fine tune internal awareness (interoception), appreciate the relationships and connections within the body and between body and mind, inhabit your body more fully, and shift your experience.
A playful yet accurate term to describe men in this group is somanaut, coined by the anatomist Gil Hedley (soma is from the Greek word meaning body). Similar to an astronaut who explores outer space, a somanaut is eager to sense, explore, and interact with the inner landscape of his body.
Sufferers
Men who are seeking an understanding of, and treatment for, their discomfort, pain, dysfunction, or other limitations in the low back, abdomen, pelvis, hips, groin, pelvic floor / perineum, tail bone, or genitals.
The core is susceptible to misuse, overuse, disuse, and abuse, with consequent negative effects that can significantly affect quality of life and daily functioning.
Manual therapy can often provide the missing link in cases where medical evaluations have been inconclusive or negative (i.e., nothing was found), diagnoses have been missed or are inaccurate, or treatments have been insufficient or ineffective. Low back pain, abdominal pain, pelvic pain, 'prostatitis', and genital pain are just a few examples of symptoms and conditions that can be difficult to accurately diagnose or may not respond to standard medical care. As well, accidents, injuries, and invasive procedures such as surgery can frequently result in chronic pain and dysfunction due to tissue trauma, muscular tension, and restrictive scar tissue formation.
Many manifestations of back pain, abdominal pain, hip pain, pelvic pain, pubic pain, inguinal pain, groin pain, tailbone pain, perineal or pelvic floor pain, anal or rectal pain, prostate pain, and genital pain can be caused, exacerbated, and/or maintained by local or regional myofascial tissues. Skilled and informed manual therapy can go a long way toward alleviating such conditions. Muscles and connective tissues are, after all, the biggest generators of pain in the body and can thus be key to improved pain management and pain resolution.
The core can also be susceptible to the effects of stress—physical, mental, or emotional. Muscular tension, stiffness, restriction, holding, bracing, retraction, and guarding are all terms that describe how stress can adversely affect the body. Core bodywork can be surprisingly relaxing even on a global scale, meaning that all areas of the body—even those not directly included—commonly feel significant benefit. This can be especially true for pelvic floor work, whether it is the main focus or incorporated into core work.
Optimizers
Men who are having no specific concerns or issues with their core, but want to maintain a high level of, or improve, its comfort, vitality, power, and efficiency.
We often take our bodies for granted, and assume that they will continue functioning as they always have. Yet there are a number of things we can do to maintain the good health we may currently be experiencing or to further support and improve it. Core bodywork is one of them. Some men get bodywork regularly as a tune up or periodically as a treat, and the core can benefit from these approaches just as much as other parts of our bodies can.
While abdominal, back, and pelvic exercises are the focus of most core training programs, the pelvic floor and respiratory diaphragm typically get far less attention—or none at all. Men can learn how to sense, recruit, coordinate, and strengthen these critical core components, which can improve the overall function of the core and their general health.
In addition, exercising and strengthening the pelvic floor component of the core can improve erectile quality and endurance, increase the propulsive force of ejaculations, enhance pleasurable sensations and excitement, and intensify the orgasmic experience.
Survivors
Men who are suffering the consequences of trauma or abuse of any kind: physical, mental, emotional, or sexual.
Pain, physical guarding, bracing, protecting, retracting, or numbing—especially in the abdomen, pelvic floor, anal sphincters, and genitals — can be a consequence of traumatic experiences and last for many years after the abusive or traumatic events. Sensitive and gentle core bodywork can be an excellent way to safely get in touch with, explore, release, integrate, and improve function in parts of ourselves that may have become frozen, deadened, or painful in response to past experience.
Connecting to, increasing awareness of, waking up, and bringing vitality to areas that have been a source of sometimes overwhelming pain and suffering can do wonders for those men who are ready to take this step in a safe and supportive environment—one in which they set the boundaries and are in full control of what happens to their bodies. Beyond specific bodywork techniques, the mere act of giving caring attention to long-neglected areas can be powerful therapy and help break the cycle of non-feeling, dysfunction, or dissociation.
Power Users
Physically active men, including athletes, performers, men with physically-demanding jobs, and those who enjoy recreational activities that require substantial physical effort.
The core is the central engine that drives all physical activity, and thus is relevant for all physically active men—that is, anyone for whom the physical body is critical to their work, play, or sport. Weight lifters, personal trainers, runners, swimmers, cyclists, yoga practitioners, hikers, climbers, wrestlers, martial artists, dancers, singers, and construction/trades/delivery workers are just a few of many examples. Ensuring that the core is functioning in support of athletic, recreational, and occupational demands can improve performance, speed recovery, and reduce the likelihood of injury. Should injuries occur, core bodywork can accelerate healing and improve tissue integrity.
I was in the first group of bodyworkers to attain national certification in Sportsmassage and have worked with athletes at all levels—including Olympic athletes — in my private practice and at local, national, and international competitions.
Seekers
Men who are interested in, practice, or teach any of the mental, physical, philosophical, or spiritual systems or disciplines from the East or the West.
Among these are yoga, meditation, martial arts, breathwork, multiple esoteric practices, or any of the hundreds of other self-improvement, personal growth, awakening, contemplative, or transformative practices. Seekers from all disciplines and traditions can benefit from a deep appreciation and felt sense of the structures and energies that are located in the core. The pelvic floor, the pelvic bowl, the abdomen, and the low back are structures that not only generate physical power but also generate, coordinate, and distribute vital energy via energy centers (chakras are but one example of these phenomena) and pathways that lie within or course through the core. Tuning into, expanding, shifting, and circulating these energies can have major physical, mental, and spiritual benefits, which in turn can deepen one's practice. Core bodywork can facilitate and enhance this process.
Men for whom this category resonates may also be interested in the information in my section titled The Energetic Core on The Body's Core page.
A Note about Sexual Energy and Erections
Many of the core muscles and sensory nerves—especially those of the lower abdomen, groin, and pelvic floor—are associated with sexual arousal and response. Thus, working in these areas can give rise to sexual energy in response to physical contact and engagement. This can be a source of anxiety for some men who may wonder: "What if I get an erection?"—which can lead to another question and perhaps bigger fear: "What if I happen to ejaculate?" The physiology of erection and ejaculation is complex and both responses are frequently not within our voluntary control—and can occur regardless of intention. Some men never get erect during a bodywork session, some have intermittent erections, and some are erect for the majority of the time. If and when erections occur, I regard them as a normal response and a non-issue. If a client happens to ejaculate during a session, I do my best to allay any feelings of discomfort, embarrassment or shame that may arise, and reassure the client that they did nothing wrong. Communication, dialogue, and maintaining an open, non-judgemental attitude are essential.
Consider the following two points:
- Worrying about getting an erection or ejaculating will detract from your experience, create tension throughout your body, and make your session less effective and less enjoyable. Core bodywork is about letting go, opening up, releasing tension, exploring, paying attention to sensations, and allowing the free flow of energy. Worry, anxiety, stress, and fear make it more difficult to experience and embrace these things.
- Sexual energy can be channeled and directed in various ways and used for various purposes. It does not always have to be used for sex. When energy arises (of any sort), it provides an opportunity to work with that energy to unlock tissues, shift awareness, repattern sensory response, enhance vitality, and even heal. Dean Ornish, MD, founder of the Preventive Medicine Research Institute associated with the University of California–San Francisco, for example, states that healing energy and erotic energy are two different forms of the very same thing [2].
My suggestion to clients is to allow all sensations and responses to happen without worry or censure.
References
1. Myers T. The Abdominal Balloon, Part 2: Gut-Level Strategies. Massage Magazine. July / August 1998, p. 102-113.
2. Ventegodt, S. The Nobel Prize in Medicine Should Go To Dean Ornish. BMJ, 2010;341:c5715
© 2010 – 2023. Revisions in 2019 and 2023. ♦ Jeff Gibson
Muscle anatomy images courtesy of MassageNerd.com. Thanks Ryan!