Everyone has probably heard about the famous Kegel exercise. Traditionally thought as a series of “clench and release” exercises, the Kegel helps strengthen the pelvic floor – a series of muscles, ligaments and other tissues that form a hammock in between your pelvic bones. Done correctly, the Kegel exercise can help decrease bowel and bladder dysfunction like incontinence. It can also help with pain with sex (dyspareunia) or other pelvic floor issues AFTER you have completed the appropriate down regulation portion of the plan of care. You should be assessed for what exercises you should start on… which spoiler alert, is almost never Kegels.
So what are Kegels?
Kegel exercises are a great tool for a lot of men and women to help strengthen the pelvic floor – but they are not for everyone. Many care providers will tell you to do Kegel exercises for everything having to do with *issues down there.* Depending on what type of pelvic floor issue you have, they may actually do more harm than good.
So who are they good for?
Generally, people who need a little bit more support and stability for their pelvic floor. We’ve talked before about how your pelvic floor muscles can be too loose and weak OR too tight (tonic) and weak. Those with an overactive pelvic floor have muscles that are “on” all the time and therefore too tight. When a signal from the nervous system is sent to an overly contracted muscle, it is difficult for that muscle to respond to what you want it to do. Furthermore, the shortened fibers make it difficult or impossible for the muscle to contract any further – which chronically fatigues the muscle. As with any contractile tissue (muscle) in the body, your pelvic floor muscles need to be at an optimal length to function their best. Think about trying to carry a heavy bag of groceries with your elbow almost – but not quite – straight. That is certainly tiring compared to being able to bend your elbow closer to your body.
It is hard to know whether your pelvic floor is weak from being overactive or underactive without consulting a pelvic floor physical therapist. They will determine if Kegels are right for you and teach you how to properly relax and coordinate your pelvic floor.
So how is a Kegel actually done?
If you can identify and tighten the muscles that help stop the flow of urine, you’ve got yourself a Kegel (If you have difficulty with this contraction, a pelvic floor PT can also help!). Where many people make a mistake is thing that the Kegel exercise is this giant *clench and hold* maneuver. If you do one huge squeeze, you may feel other muscles being recruited – like your glutes or abdominals. Some handy cues to do a Kegel include:
You can think about squeezing the walls of your vagina together and lifting up toward your nose
You can pretend that you are trying to quickly stop a toot from escaping (no one wants to fart in a meeting at work!)
Try to gently hold a blueberry between your labial folds near your clitoris
Try to imagine the front of your pelvic floor sucking air through a straw
You may notice that the Kegel you do with these cues is more subtle than what you normally feel- you should be able to feel muscle squeezing at the front and the back of your pelvis. It is also very important to not hold your breath during a Kegel exercise. Holding your breath increases the intra-abdominal pressure in your abdomen – and puts further strain on an already fatigued pelvic floor. So think about a soft contraction as you breathe out – and relaxing as you breathe in. When you perform diaphragmatic breathing correctly, your pelvic floor acts like an elevator – going down with the inhale and elevating with the exhale.
So how many should you do?
BEFORE we get to that, we do want you to know that 95% of the people in our care are not provided with Kegels until the middle or the end of their plan of care because their muscles are too tight. So if you haven’t been assessed yet- don’t do Kegels. This exercise could do nothing for you or make your issues worse.
Your pelvic floor PT (hopefully it’s us) will also help you determine the best place for you to start but, as with any other exercise, you should perform as many as you can with good form and without too much fatigue. A good baseline is 6-8 reps with a hold of 3 seconds – relaxing for 5 seconds between each repetition. This works the slow twitch muscle fibers that people often have more difficulty recruiting. However, it is also important to strengthen the fast twitch fibers – following your *slow holds* with 6-10 repetitions with a hold of 1-2 seconds and no rest in between. This can be done 1-2 times per day.
You can also change the position in which you perform your Kegel exercises. Starting in a gravity-eliminated position (such as on your belly, side lying or laying on your back) and eventually progressing to against-gravity (like on hands and knees, tall kneeling, sitting and standing) is a great way to progress your pelvic floor strength for all types of functional activities.
There is a reason that Kegels are considered the classic pelvic floor exercise. They are very effective for a lot of pelvic floor issues — when done correctly for the right type of dysfunction. So before you start doing them, make sure they are the right exercises for you by chatting with a pelvic floor PT first.
<3 the Recharged Performance Therapy Team
(321) 802-1630
Paige@RechargedPerformanceTherapy.com
https://www.rechargedperformancetherapy.com
References
https://www.healthline.com/health/kegel-exercises#purpose
https://www.health.harvard.edu/bladder-and-bowel/step-by-step-guide-to-performing-kegel-exercises
https://nafc.org/kegel-exercises/