When & How to do "Kegels"
Like all things in life, we tend to function our best when we have balance. There is a time to do work and a time to rest. A time to ramp up activity, and a time to relax and recover. Unfortunately when it comes to exercising our muscles, many people think they need to flex them all the time to make them stronger.
When it comes to pelvic floor health, one of the worst pieces of advice is to "hold a Kegel" throughout an entire activity (walking, jogging, jumping rope, etc).
What would happen if you kept your arm straight out in front of you the entire time you went for a walk? The muscles in your shoulder and neck would start protesting and eventually give up. The same goes for the pelvic floor muscles (continual contraction actually increases risk for pain, incontinence, and prolapse!)
First, a quick anatomy review.
To find a Neutral Pelvis as shown, the ASIS & Pubic Symphysis should align vertically (yellow dash). When sitting, this position is achieved by resting your weight on your Ischial Tuberosities ("sit bones").
Now check out how the Pelvic Floor muscles align from another side-view:
In order to perform a "Kegel", the pelvic floor muscles should lift up (as if you're trying to stop urine or gas passing). Note: this does NOT mean squeezing your glutes and tightening your tush! Keep your glutes relaxed and focus on an "elevator motion" lifting the floor from the ground up.
To break things down even more, we have different functions for different parts of the pelvic floor:
If you find it more difficult to engage the front pelvic floor muscles, then try shifting your weight from the "sit bone" towards the pubic bone (anterior pelvic tilt). Then contract the pelvic floor with a lifting sensation. This should help reduce the risk of incontinence as well as prolapse! (Functional fix: if you leak when you sneeze, try sticking your bottom out a little and attempt to "sneeze up" instead of down.)
If you find it more difficult to engage the back pelvic floor muscles, then try shifting your weight from the "sit bone" towards the tailbone (posterior pelvic tilt). This should help reduce unwanted gas & bowel escape.
If you still have difficulty connecting to these muscles, then you might find it really helpful to start by relaxing them (a "reverse Kegel")... because it's impossible to contract and already contracted muscle!
Think about the tone in the pelvic floor muscles like the levels of a building. At rest, the tone should be pretty relaxed (starting at "ground level"). When we inhale, our pelvic floor should mimic the diaphragm muscle and descend ("lowering to the basement").When we actively exhale and exert ourselves, the pelvic floor should lift back up ("rising to the 1st/2nd/3rd/4th... floor"). If our resting tone already starts on the 3rd floor, then it doesn't have much left to give when we need it to contract more -it will feel weak or even fail!
What contributes to an increased resting tone in the pelvic floor? Check the following and change what you can:
*Alignment and posture (stop slumped sitting and start stacking your ribcage over your pelvis).
*Poor breathing or loading habits (learn to "Exhale with Exertion" and STOP breathe holding, sucking in, or bearing down during activity).
*Trauma (seek a licensed pelvic floor therapist to help treat tearing of tissues that may have resulted in scarring).
*Stress! (Does "chronic clencher" strike a cord? Take time to meditate and practice a deep breathing strategy daily).
Last thoughts and tips (for now):
No muscle works all by itself during functional movement. It's important to begin by isolating a weak muscle individually, but then we must learn to incorporate it with the rest of the team! (Think: deep and oblique abdominals, adductor/groin muscles, and glutes for starters).
Finally, learning to relax AND contract muscles will lead to a better balanced system. Don't underestimate the importance of "letting go" with releasing techniques before charging ahead with your strengthening routine.
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