I recently read through two different sites with the bloggers writing about how Kegels are worthless. If I could delete these entries just as quick as I read them, I would so that it didn’t cause any more confusion for all of you searching for answers. Do I agree that pelvic floor strengthening has been over-simplified – YES! But to say that you don’t have to do another Kegel is simply not correct. Our pelvic floor is a muscular area with the ability to tighten on the urethra (the pathway from the bladder to our urethral opening in our pelvic floor) and to support/cradle our pelvic organs. Not to mention the sphincter muscles of our pelvic floor which provide the second line of defense within our pelvic floor to control the passage of solids, liquids, and air from our bodies.
To say that we don’t have to and shouldn’t work this muscle makes no sense. It has a neuromuscular connection to our transverses abdominus and our multifidi, working as our three deepest core stabilizers. These muscles play a huge role in our posture and in maintaining stability of our lumbosacral spine, as well as controlling issues such as incontinence and prolapse. So how do I believe we should work our pelvic floor for optimal benefit?
It starts with the ability to find and contract each of these muscles individually and then progresses to exercises where they all three fire together. Let’s start with our transverses abdominus, then talk about our multifidi, and finish with our pelvic floor and the coordination of our deepest core stabilizers.
Our transverses abdominus (TA) wraps around us like a corset. This muscle is able to stretch lengthwise to accommodate a pregnancy belly and still work to support our low back and pelvic floor. Think of this muscle as the shrink wrap – the deepest abdominal layer that encircles your spine, extending down within your pelvis. To activate this muscle, work to pull your belly button up and in. The best exercise to start with to help find and activate your transverses begins on your hands and knees. In this position, relax your belly, allowing it to hang loose. When you contract your TA by drawing your belly button up and in, you will see your belly draw up from its relaxed position to a tighter position. Keep in mind that you want no rocking of your pelvis when you’re in this position on your hands and knees. If we rock our pelvis in order to hollow out our mid section, we will actually be activating our rectus abdominus which is not our goal. So take care to keep your pelvis and low back in a locked position as your draw your belly up and in.
To find and activate your multifidi muscles of your low back, stand by a mirror so that you have a side view of yourself. In this position, rotate your pelvis, giving a small lift to your tail bone. Your multifidi are small muscles in between each segment of your spine that help to extend each of these joints and can lock you in neutral spine when your pelvic floor needs to pull on a secure anchor that is your tail bone. You should see a slight lift of your buns in the mirror and a slight increase in the arch of your low back, but no other movement of your upper or lower body. Work to isolate these muscles with repetitive, small extensions of your lumbosacral spine.
Our next step is to contract and elevate your pelvic floor muscles. We have talked extensively throughout my blogs on how to activate every fiber of your pelvic floor muscles and we will review it all again now. Your initial contraction is to squeeze your muscles as if to stop the flow of urine or the passing of gas. The next step is to draw your pelvic floor up into your pelvic outlet as if there is a string attached from your belly button down to your pelvic floor and you are attempting to draw it up into a flattened, tighter position. It is during this step that you will feel your belly button draw in, as you co-contract your transverses abdominus with your pelvic floor in order to elevate the muscle fibers. It is these muscle fibers that tighten to elevate our pelvic floor that work as endurance muscles, cradling our pelvic organs and squeezing on the urethra before it reaches our urethral opening. Working longer holds is appropriate for these muscle fibers, so tightening and elevating your pelvic floor, and continuing to pull up on that string attached to your pelvic floor for a full 8-10 count is your goal. Then you can switch your focus to the sphincter muscles of your pelvic floor. Remember, they squeeze the three openings within the pelvic floor tight so we want these muscles to fire quickly if needed. To exercise these quick reacting muscle fibers, we can work them through “quick flicks” of our pelvic floor. Following a long hold with quick flicks that are performed repetitively to a rhythm of “contract, relax, contract, relax, contract, relax, contract, relax”, will work all the fibers of your pelvic floor. This combination of longer holds and quick flicks performed 8 times each day will keep your pelvic floor firing efficiently and effectively.
Finally, we change our focus to the coordination of firing our deepest core stabilizers (TA, pelvic floor, and multifidi) before every lift, every reach, every cheer, etc. We have just reviewed how to contract each of these muscles individually, but now the final step is to coordinate their actions. Contracting our multifidi muscles, giving a slight lift to our tail bone and locking it in this position is important as our pelvic floor attaches to our tail bone and will pull against it. If we don’t activate our multifidi muscles, our tailbone will move when we activate our pelvic floor, leaving us with a weak, ineffective pelvic floor and possible symptoms of incontinence and prolapse. By finding our neutral spine, which requires us to activate our multifidi muscles, we ensure that our pelvic floor is pulling against a solid tail bone or anchor. As we squeeze and elevate our pelvic floor by drawing it up into our pelvic outlet, we automatically activate our transverses abdominus. Our transverses abdominus co-contracts along with our pelvic floor, displacing pressure up under our ribs as it squeezes like a cone within our pelvis. This co-contraction of our TA and pelvic floor creates a stronger contraction of our pelvic floor muscles as it lifts the pressure off of the working muscle fibers.
So putting all of this together is the challenge that will lead you to optimal pelvic floor control. Working to find neutral spine and performing a pelvic floor strengthening sequence while lying down, while sitting, and while standing as instructed on our Hab It: Pelvic Floor DVD is functional training of the deepest core stabilizers. A progression of exercises as included on the DVD will train this firing pattern that will allow you to remain continent and in control throughout all of your daily activities!
I’m a little horrified you came away from my post thinking that I, or Katy Bowman, think Kegels are useless. The point of the post (and my takeaway because this was new information for me) was a paradigm shift in the way we think about kegels being ONLY a contraction. What I learned is that the release and lengthening step is just as important. And, the importance of engaging our glutes (something you recommend too!) is not incorporated enough. Did you read the recommendation to do gentle kegels while squatting? I think new information and additional positions/techniques to try should always be welcome. It’s a little like triathlon training. You know what works, but whenever you can tweak your training to squeeze any more benefit from it, you try it out! I have been a kegel devotee since the birth of my twins and have become somewhat of a pelvic floor strengthening fanatic. I’ve seen PTs, chiropractors, taken Pilates–I’ve done it ALL, and it all is working fairly well. But if I can do something to improve on where I’m at? I’d be a fool not to consider it.
Kara, I am in total agreement that a little tweaking can go a long way. Certainly, the field of physcial therapy is constantly changing and we all have to be open to new ideas. But you have to admit that your title and the response of many of your subscribers was excitement in doing away with the kegel. Maybe to clarify a bit more, the message should be to do away with the simple tightening “as if to stop the flow of urine” for 100 reps a day. A purposeful 8-10 contractions per day with the second step of elevating the floor for a longer hold will achieve far more than squeezing over and over.
In the end, it was a healthy discussion. Katy and I agree on many things…probably more than what came across in our comments. I applaud you for your post and bringing attention to the issue, as there are many women searching for answers.
Most of the important structures in the pelvic region are held in place by LIGAMENTS, not muscles.
If the ligaments have stretched or torn, *NO* amount of muscle training will improve the situation. Ligaments simply do not behave as muscles do. The cannot be tightened via exercise.
If the pelvic organs have prolapsed due to damaged ligaments, NO amount of Kegels are going to fix the situation. Yet thousands of women suffer silently with doctors who give stock answers like “do kegels” instead of providing any kind of meaningful help or support.
Its not that Kegels do not have their place, however, they are so over-emphasized that many women are left feeling helpless and alone, forced to suffer through problems that could be treatable if only anyone would listen.
The harm that comes from recommending them far outweighs the good that is done in the cases that are appropriate.
Your dialogue is welcome, although I do respectfully disagree. As you can gather from the comments above, I do not tout Kegels as “The Cure” for pelvic floor disorders, however, they are a piece of the puzzle. To throw your hands up and say – that’s it for me – it’s surgery, medication, pessary, or live with it…well this is simply not something that I and many women of my mindset are willing to do. So I have worked, initially with a very selfish goal of resolving/reducing the “lime sized bulge” I had protruding outside my vaginal opening. Once I experienced success and returned to all of my prior recreational activities without symptoms, I decided I wanted to give women another option and took my program to the public. I want women to know they have an option of exercise, posture, and increased body awareness that could help their own bodies remodel. Better yet, there is no side effect. At the very least, women who learn from the Hab It dvd and follow the exercise plan, will have better posture and improved body awareness…but most often, women are reporting a significant improvement if not resolution of symptoms.
You are right in stating that ligaments do not heal or tighten up, however, the human body has the ability to adapt through many different injuries and the pelvic floor with the support of the entire pelvic basket is no different. The Kegel exercises in the Hab It program are no more important than strengthening exercises for the transversus abdominus, multifidi, inner thighs, deep hip rotators, and neutral spine posture. You can read through another blog http://hab-it.com/blog/?p=244 to see my thoughts on our bodies ability to remodel with consistent attention to posture and strengthening.
[…] All of these muscles are an integral part of the pelvic floor “basket” and without learning to activate them, it is impossible to strengthen the pelvic floor optimally. You can find a great description of all the muscles and how they should work together HERE. […]