Kegels: Is it Time to Move On?Jan 25, 2023
Author: Dr. Blair Green PT, DPT, OCS, PHC
The headline read: “Movement is in, Kegels are out.” I had been seeing similar things all over social media. The anti-Kegel campaign was out in full force. As someone who for YEARS has championed the phrase “move it and move on” when it comes to pelvic floor retraining, I couldn’t believe what I was reading. You would think that I would be in favor of this, but actually it’s just the opposite.
I am in favor of advancing the profession, of learning and evolving but at the same time, there is value in basics. Or maybe it’s a matter of semantics? Let me explain.
Let’s start with the term Kegel. This is often used to describe the contraction of the pelvic floor muscles. It is named for the doctor who invented the exercise. Initially, this was done in the doctor’s office where the physician could palpate the muscles as the patient contracted. Given Kegels were shown to be effective in helping manage urinary leakage, people began to do them everywhere and anywhere. Have you been told to squeeze as hard as you can for 50-100 times when you stop at a red light? All be told, Kegels are not a bad thing - when done correctly. Studies have shown that up to 80% of women, when prompted, cannot perform the exercise correctly. So, for me, this is the best place to start.
We also know after many years of research and clinical practice, that the pelvic floor muscles work in conjunction with the abdominals, low back muscles and even the diaphragm. This is important because addressing one muscle group may beneficially affect the others. Maybe you’ve been told to exhale as you contract your pelvic floor? This is why! So then the question arises: if you are breathing and contracting the pelvic floor, or incorporating it with abdominal exercises, does that mean you are no longer doing Kegels? Where do we draw the line? This is where semantics comes into play. For me, and the people I work with, the term Kegel refers to any isolated contraction of the pelvic floor. Alone, with breathing, while contracting the abs, fast or slow… it is a fundamental part of muscle retraining. I teach patients how to both contract AND relax the pelvic floor muscles. I also teach them how to hold, lengthen, quickly turn on and off and more. All of these are important as they address awareness, strength, endurance, timing and coordination. So no matter what you call it, this is a great starting point for pelvic floor muscle retraining.
So as for whether we should throw out Kegels with last week’s garbage, my answer would be no. However, as I mentioned before, this is merely a starting point to rehab and muscle retraining. Awareness comes first, but once that is achieved, it’s necessary to move on to integration and functional training. This is what I like to think of as the fun part of PT. Each person is different, and has different needs when it comes to strength and functional training. Some women need to be able to lift babies and push a stroller. Others are more concerned about strength training at the gym. And if you have a job like mine, well there are a lot of physical challenges. However, regardless of which exercises you are doing, at this point in rehab, the goal is to help the pelvic floor muscles work automatically to control the changes in intra-abdominal pressure. Moving from isolated “Kegels” to more integrated movement.
You can see that appropriate, effective pelvic floor muscle retraining is not as simple as “do Kegels” or “ban Kegels.” It’s an interplay of all of this, highly personalized and designed to be progressive in nature. So while I would argue that Kegels are not the miracle cure to things like urinary leakage, pelvic pressure or prolapse, I would say with the right instruction and plan to advance care, they can and do provide a good starting point for anyone looking to improve pelvic floor muscle function. Perhaps the better thing to say is not “just do Kegels,” but “just find yourself a great physical therapist” who can help you achieve these goals and more.
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