Why Kegels Aren’t the End All Be All
“Kegel” has become a household name since its introduction in women’s health in 1948. Developed by Arnold Kegel, gynecologist, the exercise was originally prescribed for treatment of stress urinary incontinence and is now blasted across the internet and unfortunately in many clinics, as the way to “cure” pelvic floor dysfunction (1).
There may be a time in your life when a kegel is appropriate for you and there may not.
Before anyone does kegels on repeat it is necessary they have an assessment done by a Pelvic Floor Physical Therapist that has been trained extensively through Herman and Wallace and the APTA. An internal manual exam and/or biofeedback assessment determines what is truly happening within the intricate muscle layers of the pelvic floor. Without a thorough understanding of what is actually happening, kegels can, and likely eventually will, do more harm than good and here is why:
Our bodies are extremely intelligent and innately effective, but not always efficient. When your brain senses something wrong in a specific area of the body, surrounding areas are recruited to help support. This means that the support structures are doing work they weren’t specifically designed for, and in the long run you will pay the for this compensation.
Kegels for Leaking Urine
An appropriate example is urinary incontinence due to weakness. When the brain and body sense the inability to hold urine, pelvic floor muscles and surrounding muscles often begin to contract subconsciously to try and reduce incontinence. Over a short period of time this can become habit in most daily activities and before long, the once weak pelvic floor becomes overactive. You may be surprised to learn that overactivity of the pelvic floor can also lead to incontinence! Now, the patient that originally may have needed activating exercises needs soft tissue mobilization and relaxation techniques (2,3).
What is a kegel?
Kegels are a single muscle group exercise and expecting kegels to “cure” pelvic floor dysfunction is the same as expecting bicep curls alone to have you trained for a rope climb. The body is dynamic and needs much more than single muscle group activation to accomplish its tasks: it needs a collaboration and training that allows the pelvic floor to work in coordination with the entire core and whole body movements.
So what are kegels good for?
Under the care of a trained Women’s Health Physical Therapist, kegels may be used for a woman to feel full relaxation. A true kegel is a full contraction of the pelvic floor and in order for the body to recognize full relaxation, full contraction can be used. In addition, if there is a lack in activation, pelvic floor contractions can be guided in office and instructions given for home exercises.
In conjunction with exercises given by the pelvic floor PT, BIRTHFIT recommends a consistent practice of the Functional Progression as it is key in training the pelvic floor to work with the core and be integrated into upright, whole body movements.
What do I do besides kegels?
- As you digest this and look for your next step in healing for yourself or better serving your patients, schedule a Core and Pelvic Floor Consult with a local specialist. They can answer questions and provide recommendations specific to your personal story.
- Find a BIRTHFIT Leader (Professional, or Coach) near you to get in person guidance and support.
- Ask questions of your current healthcare team. If this is all new to you and/or different than what you are currently learning or practicing, please ask more questions.
While kegels were a necessary tool advancing women’s health, we now know much more about the human body and need to expand our practices to meet our bodies’ needs.
Erica Boland, DC@coulee_health www.couleehealth.com
- Bø, K. Int Urogynecol J (1995) 6: 282. https://doi.org/10.1007/BF01901527
- Hartmann D. (2016) An Alternative Physical Therapy Approach to the Overactive Pelvic Floor. In: Padoa A., Rosenbaum T. (eds) The Overactive Pelvic Floor. Springer, Cham
- Laan E., van Lunsen R.H.W. (2016) Overactive Pelvic Floor: Female Sexual Functioning. In: Padoa A., Rosenbaum T. (eds) The Overactive Pelvic Floor. Springer, Cham
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