Discharging the Kegal

When you hear the words pelvic floor, who thinks of doing kegals?

If you raised your hand, you’re not alone.

I’ve definitely seen a surge in information on social media regarding doing more than just kegals for pelvic floor rehab which is awesome! However, I still feel it’s important to explain why just doing kegals isn’t always the answer.

First, let’s just briefly review what the pelvic floor is. The pelvic floor refers to a group of muscles that attach to the bottom of the pelvis and spine in a bowl like fashion. The muscles have the following functions:

· Acting as sphincters to help us keep poop and pee in, but also let it out at the appropriate time

· Help pump blood and lymphatic fluid back into the circulatory system

· Involved in sexual function

· Help provide stability to the pelvis

· Support our internal organs

· Play a roll in posture

· Work with our diaphragm and abdominals during breathing

WOW! That’s a lot of functions! No wonder these muscles are important.

I want to note though that the pelvic floor muscles do not work in isolation. They automatically engage during walking, running, lifting, standing, ect. This is why just doing isolated kegals isn’t always the best approach.

To better illustrate this, let’s take a look at how the quadriceps muscle is rehabbed after a surgical ACL repair.

If you’ve ever had this surgery you probably unwrapped the ace bandage to find your thigh had shrunk. The quadriceps losing strength very quickly following surgery and getting the quad stronger and functioning again is vital for long term recovery.

In order to wake the quad back up and start getting it stronger the first exercise prescribed is doing a quad set, simply squeezing and relaxing the quad in an isolated fashion. This is 100% necessary to do during the first few weeks, however once a patient can achieve a good strong contraction, the exercise is progressed. Over the next few weeks to months progressing quad strengthening usually look likes squeezing the quad and raising the leg, adding an ankle weight to the straight leg raise, starting to walk without crutches, standing on one leg, performing mini squats, starting to leg press, full body weight squats and lunges, squats with weight, then return to running and jumping.

Something you may notice is that initially we are working the quad in a very isolated way and slowly progress to more complex, full body movements that still utilize the quad.

I don’t think anyone would argue that there is no reason someone 3 months out from an ACL repair should still only be doing isolated quad sets.

So why do we think mammas who are 3 months postpartum should still be doing isolated kegals?

The pelvic floor muscles are no different than the quads!

Right after a trauma, like child birth, it may be totally necessary to work the pelvic floor in isolation to essentially “wake up” those muscles and re-establish the brain body connection.

Once that connection is restored though we need to move on from isolation work. If we want to continue strengthening the pelvic floor, we need to incorporate more complex, full body movements that will naturally engage these muscles. This means working on things like bridges, squats, lunges, rows, carries, core work, walking, running, and really any movement you can think of!

Since our pelvic floor muscles also naturally engage when we exhale, by incorporating intentional breathing with our exercises it can further help our pelvic floor function.

The other problem with doing too many kegals is that it can cause pelvic floor tightness and tension. By only working on squeezing the pelvic floor muscles without also working on length and relaxation it can lead to more issues.

So, if you’ve been doing kegals daily but feel you’ve hit a plateau, it may be time to reassess and start incorporating more full body strengthening. If you aren’t sure where to start or are experiencing symptoms such as leaking, pressure, or pain, find a knowledgeable health care professional who can help guide you and prescribe appropriate exercises.

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