Levator Muscles: Strengthening the Scapulae and Pelvic Floor (Ani)

How do you strengthen the levator muscle?

Strengthening "the levator muscle" depends critically on which specific levator muscle is being referenced, as the human body contains several muscles with "levator" in their name, each with distinct functions and strengthening protocols. This article will focus on the two most commonly addressed in a fitness and health context: the Levator Scapulae and the Levator Ani.

Understanding "The Levator Muscle": A Clarification

The term "levator muscle" can be ambiguous due to the presence of multiple muscles named "levator" (from Latin levare, meaning "to lift"). For fitness and health purposes, the two most frequently discussed are:

• Levator Scapulae: This muscle is located in the neck and upper back, connecting the cervical spine to the scapula (shoulder blade). Its primary role is to elevate the scapula and assist in neck movements. Dysfunction often contributes to neck and shoulder pain, stiffness, and postural issues.
• Levator Ani: This is a broad, thin muscle group forming a significant part of the pelvic floor. It supports the pelvic organs, plays a crucial role in urinary and fecal continence, and contributes to sexual function. Strengthening the Levator Ani is vital for pelvic health, especially for individuals experiencing or at risk of pelvic floor dysfunction.

Given the common confusion, we will address strengthening strategies for both.

Strengthening the Levator Scapulae Muscle

The Levator Scapulae muscle is often implicated in upper trapezius dominance, poor posture, and chronic neck pain. While direct strengthening is possible, a holistic approach involving balanced development of surrounding muscles and proper movement patterns is key.

Anatomy and Function: The Levator Scapulae originates from the transverse processes of the first four cervical vertebrae (C1-C4) and inserts onto the superior angle and medial border of the scapula. Its primary actions include:

• Elevation of the scapula: Lifting the shoulder blade upwards.
• Downward rotation of the scapula: Rotating the scapula so the inferior angle moves medially.
• Lateral flexion of the neck: Bending the head to the side (ipsilateral).
• Rotation of the neck: Turning the head (ipsilateral rotation).

Why Strengthen/Care for It? While often tight and overactive, direct strengthening of its elevating function can be beneficial if it's genuinely weak in that specific action. More commonly, strengthening involves improving its endurance, coordinating it with other scapular stabilizers, and addressing any associated tightness through mobility work. A well-functioning Levator Scapulae contributes to:

• Improved shoulder stability and posture.
• Reduced neck and upper back tension.
• Enhanced athletic performance in activities requiring shoulder elevation.

Exercises for the Levator Scapulae:

• Dumbbell Shrugs:

  • Execution: Stand tall with a dumbbell in each hand, palms facing your body. Keeping your arms straight, lift your shoulders straight up towards your ears, squeezing the shoulder blades slightly. Lower slowly with control.
  • Focus: Emphasize the vertical elevation. Avoid rolling shoulders forward or backward.
  • Progression: Increase weight or repetitions. Can also be performed with a barbell or resistance bands.

• Farmer's Carry:

  • Execution: Hold heavy dumbbells or kettlebells in each hand, maintaining an upright posture with shoulders back and down. Walk a designated distance.
  • Focus: This exercise challenges the endurance of the Levator Scapulae and other upper back muscles to prevent shoulder depression. Maintain a tall posture throughout.

• Overhead Carries (e.g., Waiter's Carry):

  • Execution: Hold a weight (dumbbell, kettlebell, plate) overhead with one arm, elbow locked, maintaining a stable shoulder. Walk slowly and deliberately.
  • Focus: This requires significant scapular stability and endurance, engaging the Levator Scapulae as part of the shoulder girdle's stabilizing musculature.

• Addressing Overactivity and Antagonist Strength:

  • Often, the Levator Scapulae is overactive due to poor posture or compensation. In such cases, strengthening its antagonists (muscles that pull the scapula down or retract it) and improving its flexibility is crucial.
  • Stretching: Gentle neck side bends with head rotation away from the stretching side can target the Levator Scapulae.
  • Rhomboid and Lower Trapezius Strengthening: Exercises like rows (seated, bent-over), face pulls, and Y-raises help balance the shoulder girdle musculature.

Technique Cues:

• Controlled Movement: Avoid momentum. Focus on slow, deliberate contractions and releases.
• Mind-Muscle Connection: Consciously feel the muscle working.
• Breathing: Maintain consistent, controlled breathing throughout the exercise.

Strengthening the Levator Ani Muscle (Pelvic Floor)

The Levator Ani is a critical component of the pelvic floor, essential for core stability, continence, and pelvic organ support. Strengthening it is a cornerstone of pelvic health, particularly for individuals experiencing or at risk of pelvic floor dysfunction.

Anatomy and Function: The Levator Ani group comprises three main muscles: the Pubococcygeus, Iliococcygeus, and Puborectalis. These muscles form a sling-like structure across the bottom of the pelvis, attaching to the pubic bone, tailbone, and ischial spines. Their functions include:

• Supporting Pelvic Organs: Preventing prolapse of the bladder, uterus, and rectum.
• Maintaining Continence: Controlling the flow of urine and feces by constricting the urethra and anus.
• Assisting in Sexual Function: Contributing to sensation and orgasm.
• Supporting Core Stability: Working synergistically with the deep abdominal muscles and diaphragm.

Why Strengthen It? Strengthening the Levator Ani is vital for:

• Preventing and managing urinary and fecal incontinence.
• Supporting pelvic organs, especially after childbirth or with aging.
• Improving core stability and reducing back pain.
• Enhancing sexual function.
• Postpartum recovery.

Exercises for the Levator Ani (Kegel Exercises):

The primary method for strengthening the Levator Ani is through Kegel exercises, which involve contracting and relaxing these muscles.

• 1. Identifying the Muscles:

  • Urinary Flow Interruption: While urinating, try to stop or slow the flow. The muscles you use are your pelvic floor muscles. Do this only for identification, not as a regular exercise.
  • Anal Contraction: Imagine you are trying to stop passing gas. The muscles you squeeze without tensing your buttocks, legs, or abdomen are your pelvic floor muscles.
  • Vaginal Squeeze (for women): Insert a clean finger into the vagina and try to squeeze it. You should feel pressure around your finger.

• 2. Basic Contraction Technique:

  • Starting Position: Lie down or sit comfortably. As you progress, you can perform them standing or walking.
  • Slow Contractions:
    • Contract your pelvic floor muscles, lifting them upwards and inwards, as if trying to hold back urine and gas simultaneously.
    • Hold the contraction for 3-5 seconds.
    • Slowly relax for 3-5 seconds.
    • Repeat 10-15 times.
  • Fast Contractions:
    • Perform quick, strong contractions, immediately releasing after each squeeze.
    • Repeat 10-15 times. These are useful for sudden urges or coughs/sneezes.

• 3. Progression:

  • Gradually increase the hold time for slow contractions (e.g., up to 10 seconds).
  • Increase the number of repetitions and sets (e.g., 3 sets of 10-15 repetitions, 3 times a day).
  • Integrate Kegels into daily activities: while brushing teeth, waiting in line, or during other exercises like squats or core work (contract on the exhale).

• 4. Breathing Integration:

  • Coordinate contractions with your breath. Often, contracting on the exhale (when intra-abdominal pressure increases) and relaxing on the inhale can be effective.

Important Cautions for Levator Ani Strengthening:

• Avoid Straining: Do not push down or bear down. The movement should be an inward and upward lift.
• Isolate the Muscles: Avoid contracting your glutes, inner thighs, or abdominal muscles. The movement should be subtle and internal.
• Don't Overdo It: Too much pelvic floor strengthening without proper relaxation can lead to hypertonic (overly tight) pelvic floor muscles, which can cause pain and dysfunction.
• Consistency is Key: Regular, consistent practice yields the best results.

Important Considerations for Strengthening Any Levator Muscle

Regardless of which levator muscle you are targeting, a thoughtful and informed approach is essential for effective and safe strengthening.

• Proper Assessment: Before embarking on a strengthening program, especially for the pelvic floor, consider consulting with a qualified professional. A physical therapist, kinesiologist, or a specialized pelvic floor physical therapist can accurately assess your muscle function and identify any underlying issues.
• Mind-Muscle Connection: Consciously focusing on activating the target muscle is paramount. For the Levator Scapulae, visualize the shoulder blade lifting towards the ear. For the Levator Ani, focus on the upward and inward lift of the pelvic floor.
• Progressive Overload: For the Levator Scapulae, this means gradually increasing the weight, repetitions, or time under tension. For the Levator Ani, it involves increasing hold times, repetitions, and integrating the exercises into more challenging positions or activities.
• Consistency: Regular practice is crucial for muscle adaptation and strength gains. Short, frequent sessions are often more effective than infrequent, long ones.
• Listen to Your Body: Pay attention to pain or discomfort. If an exercise causes pain, stop and re-evaluate your technique or consult a professional. Differentiate between muscle fatigue and joint pain.
• Holistic Approach: True strength and function come from balanced development. For the Levator Scapulae, this means also strengthening surrounding shoulder girdle muscles and ensuring adequate mobility. For the Levator Ani, it involves considering overall core strength, breathing mechanics, and posture.

When to Seek Professional Guidance

While self-directed exercises can be beneficial, certain situations warrant professional intervention:

• Persistent Pain: If you experience chronic neck, shoulder, or pelvic pain.
• Dysfunction: If you have ongoing issues like incontinence, pelvic organ prolapse, or difficulty activating your pelvic floor muscles.
• Inability to Feel Activation: If you struggle to identify or feel your Levator Ani muscles contracting.
• Pre- and Post-Natal: Pregnancy and postpartum periods significantly impact the pelvic floor and require specialized guidance.
• Post-Surgery: Following abdominal, pelvic, or spinal surgery.

A qualified exercise professional or physical therapist can provide a personalized program, correct technique, and address any compensatory patterns, ensuring you strengthen the correct muscles effectively and safely.