To Kegel or Not To Kegel?

 In Treatment, Women's Health

We have all heard of the use of Kegel exercises for low back pain to help strengthen and stabilize your pelvis.  But what really is a Kegel and do we need to all be doing this exercise?  We have noticed an upward trend of performing Kegels in Pilates and other core exercises, as well as in everyday life and movements.  We are always being told by coaches, personal trainers to ‘pull in’ or tense our abdominals to activate our core.  But is that really necessary or even proper?

Where did Kegels come from?

A gynecologist, Arnold Kegel in 1948 developed this term for the contraction of the pelvic floor muscles.  These exercises were started half a century ago for female stress incontinence after childbirth.  It was thought that stress incontinence was due to the lack of awareness of the function and coordination of the pelvic floor muscles.  Now, research has shown that Kegels are used as the first line of defense for managing stress and urge incontinence, as well as mild to moderate pelvic organ prolapse.  And while people usually associate Kegels with women, men can also benefit from these exercises especially after prostate surgery.

Where do these muscles exist?

Kegel exercises involve contracting and holding the pelvic floor muscles, which are located from the anus to the pubic bone and also attach on the sitting bones. There are three different layers and directions of these muscles.  Their shape is in a hammock or 2 triangles that are facing each other.  They help to support our bladder and our internal organs.  You can feel the superficial layer of muscles with your hand on the outside, but most of the contraction is occurring deeper inside.  There is a strong closing in of these muscles and lift when these muscles are at their strongest.

medically accurate illustration of the pelvic floor muscles

How do we contract our pelvic floor?

To activate these muscles, try thinking about drawing in the sitting bones together or drawing a raisin into the urethra as well as raising a marble from the anus.  It is generally easier to contract these muscles while laying down and also using our diaphragm to help coordinate the core unit.  When we inhale, our diaphragm descends into the abdominal cavity and the pelvic floor also descends.  As we exhale, our diaphragm ascends back to its normal resting position and the pelvic floor recoils.  This is when we can activate our pelvic floor as we exhale to help coordinate these muscles.  If there is a weakness of pelvic floor contraction, then we have to use the diaphragm to help these muscles activate.  Sometimes, even muscle stimulation is used internally to get a stronger contraction of these muscles.

How do we know when it is proper to strengthen our pelvic floor?

The best way to know whether you should be doing Kegel exercises depends on a few things.  Ideally, a health care professional such as a physiotherapist who specializes in pelvic floor would be the best person to consult with.  A nurse, midwife or gynecologist would also have the knowledge and proper training in this area to give advice on the quality of these muscles and whether to strengthen or not.  We know that it is ideal to stretch and release tight pelvic floor muscles first, and make sure that these muscles are able to fully relax before ever trying to contract them.  It is just as important to let go or relax a muscle as it is to fully contact a muscle.  This strategy is applicable for all the muscles of the body.  We need to learn how to develop good breathing strategies in order to prepare our pelvic floor and other core muscles to work together more effectively.  This then will help us be able to perform larger movements such as a lift, or as simple as a sit to stand motion without having to tense from our abdominals first.  Our body needs to have a point of stability in order for it to have good quality mobility with very little compensations.

Breathing Exercises

What can I learn from pelvic floor physiotherapists?

I hope this information has started to get you to re-think how your core and pelvic floor work together and that it might not always be the first type of treatment to strengthen these muscles if there is already a certain tension in these muscles to begin with. Most women and even men will require some type of stretching or releasing type exercises before even trying to perform a Kegel exercise depending on trauma, injuries, and other hip and low back issues that would develop increased tension in this area.  The trend in the past was to always ‘pull in’, but now pelvic floor physiotherapists are bringing awareness to the real issue of these muscles.  A thorough assessment will be the best way to know what type of exercises you would require depending on your anatomy and history.

If you are looking for a physiotherapy centre that treats the above condition, please call our centre at 613-424-7852 to book an assessment with a physiotherapist specially trained in pelvic physiotherapy and rostered with the College of Physiotherapists of Ontario.

 

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