To kegel or not to kegel
Kegels have become known as an umbrella ‘treatment’ for the pelvic floor and are often handed out as the be all in doctors offices, without true assessment of the state of the muscles. Kegels are voluntary tightening of the pelvic floor muscles.
A recent study showed that 71% of people used at least one inappropriate accessory muscle (rectus abdominus, gluteals, adductors) when asked to perform a kegel. Most of the time, doing something incorrectly is more harm than not doing it at all. Furthermore, another study looked at how often PF PT’s who assessed the pelvic floor and surrounding area were actually prescribing kegels and they were only prescribed about 15% of the time & the program never contained more than 25% kegel exercises.
The pelvic floor muscles have 3 main actions: to support abdominal and pelvic viscera, to maintain continence of urine & feces, and allow voiding, defecation, sexual activity, and child birth. Note I said allow, that will be expanded upon later! In these actions, they have to have a certain level of tone in order to control and support the muscles and bladder. And if you are or have been pregnant, they have increased pressure and weight to support around the clock. They do most of this involuntarily, meaning until you have a problem with it, you are likely not thinking about it.
A tight muscle can be strong. But if shortened and putting undue pressure on surrounding musculature or structures (bladder, urethra, etc.) it could actually cause leaking (incontinence), increase pain, or contribute to weakness in a shortened state. In order for a muscle to work it has to be able to contract and relax. Think of how tired your arm gets when it is holding something for a prolonged period of time, even though the object does not get heavier. Subconsciously you will find you have probably switched positions or arms. This can apply to performing this tightening or kegeling inappropriately.
A PF PT can assess all of this to determine if the muscles are working against, for, or if you are using the right muscles correctly & if you even need kegels at all!
Lasher, B., Thompson, S., Cozean, N., (2017). Use of Kegel Exercises in a Specialized Outpatient Pelvic Floor Physical Therapy Clinic. PelvicSanity Physical Therapy. 1.
Nguyen, M.L.T., Armstrong, A.A., Wieslander, C.K., & Tanay, C.M. (2019). Now Anyone Can Kegel: One-Time Office Teaching of Pelvic Floor Muscle Exercises. Female pelvic medicine & reconstructive surgery, 25(2), 149-153.
