In my last post, I wrote about Kegel confusion! Many moms have heard that they need to Kegel but they were never correctly shown how to do it. They try to "strengthen their pelvic floor" but end up questionning if it's effective, if they're doing it right, or what it even accomplishes!
I'm a big believer in showing, rather than telling. Research shows that women who are walked through and shown how to do their pelvic floor exercises are 1) much more successful in doing them correctly 2) more likely to stick with their program and 3) more likely to experience success with their treatment goals, whether that's strengthening or something else.
In other words, a hand-out from your OBGyn won't cut it folks.
I wrote briefly about how the term "Kegel" is so widely used but so poorly understood. For the purposes of this post, I'm going to use the term "pelvic floor contraction" (PFC) instead of "Kegel" because I believe it's much more descriptive. In order to correctly do a PFC, you need to know what the pelvic floor is and isn't, and also how to locate it. You need to know how to turn it on and off and be able to feel the action it performs. When people do 'Kegels", they often overdo it. They squeeze a bunch of muscles (abs, gluts, hams, adductors, low back, and yes, pelvic floor muscles) and think they are doing a great PFC. Usually, I have to cue my moms to let go of other muscles and focus on the target muscle group - and to BREATHE!
That brings me to my next point: never do our muscles work in isolation. The problem with "doing kegels" is that we tend to get tunnel vision and forget that our pelvic floor is attached to the rest of our body. The state of the abs, gluts, hams, adductors, viscera, nerves, low back, spine, hips, knees, feet, thorax, neck and brain (pretty much the whole nine yards!) all can have an impact on our pelvic floor! (Imagine that!) I believe that the body is a whole and we need to start treating it that way. If there is dysfunction of some sort occurring in the tissues of the PF, the underlying cause may be found in a place other than the pelvic floor. It is worth exploring to find out the root cause of the dysfunction. Often, PF problems are exacerbated by non-optimal alignment of the body.
Non-optimal alignment of the body can lead to a number of changes in the PF. Alignment can influence the tone and length of any muscle group. When it comes to the PF, many women have muscles which are quite short, hypertonic, and tight. Why does that matter? It's important because every muscle in the body has an ideal resting length where it can generate the greatest force. If its resting state is one that is too long, it will be weak. If a muscle's resting state is too short, it will also be very weak. This is because of the length-tension relationship that exists in muscles.
Weakness of the pelvic floor can therefore occur when the resting state of the muscles are long and stretched and flaccid, OR when they are short and tight and hypertonic. Does it make sense to be squeezing and tightening an already shortened and over-active muscle? If you "kegel" an already short and weak PF, it will only get shorter and weaker.
What causes our PF to get short in the first place? Well, it could be many things. It could be that we subconsciously hold tension in that muscle group. Maybe you sit and drive a vehicle all day with no chance to go pee - so you're constantly holding and tensing the PF muscles. There might have been some sort of trauma to that area. It could be a response to pain or anticipation of pain. It could be as a result of childbirth. Yet it is often our lifestyle and daily postural strategies (most of which are poor) which alter our alignment and leads to shorter hypertonic muscles of the PF and other areas of the body.
The solution is to be aware of the imbalances that exist, and work the PF (like all other muscles) through its entire range of motion. To have a strong and optimally toned and functional PF, it needs to be able to full lengthen and fully contract with fluidity and proper timing. It needs to be able to perform in various positions, and it needs to integrate in with the rest of the body. These are all the things that I take into consideration when creating an exercise program for my mamas.
It's about so much more than just doing Kegels to strengthen. Strengthening is a good goal because strong functional muscles prevent injury and dysfunction. But in order to strengthen, you need to be able to lengthen! And once everything else is sorted out with your body (ie. optimal alignment) you may find that the strength was there all along, but it was masked by one thing or another.
I will write about how to effectively condition and train your PF during pregnancy and post-partum in future posts. In the meantime, it's probably a good idea to stop doing kegels until you know for sure that you're doing them right and that it's the correct exercise for you! Please feel free to make an appointment with me or sign up for the pre or post-partum program. Together we will figure out where you're at, where to go from there, and how to get there.
That's it for now from the Mama's Physio,
Stay beautiful and be your best.
The Mama's Physio
We are a team of experienced physiotherapists with a passion for women's health and well being. We focus on pelvic health in the context of the whole body. We care for pregnant and post-partum mamas and women at all life stages from teens to the young at heart. We are mothers ourselves and we are women. We love what we do and we are here to serve you.