Beyond Kegels - A Comprehensive Look at Pelvic Floor Exercises

This topic has been hotly debated in the pelvic PT world for a while now. And it’s trickling into social media, especially on fitness professional platforms, so I wanted to address it.

Let’s start at the beginning, Kegels had been the primary exercise prescribed to strengthen the pelvic floor. It was introduced by a Dr. Arnold Kegel in 1948 to help his patients with incontinence after he noticed if he had them tighten the muscles that stop pee the symptoms improved.

Fast forward to today, we know that the pelvic floor doesn’t work in isolation on a functional level. So the debate is why should your exercises be isolated?

So in 2014 a study of 100 women revealed that certain exercises actually increase pelvic floor strength more than kegels. Great, but what does that actually mean.

Since we know the pelvic floor muscles are part of a core system that coordinates with your breathing and abdominal muscles to provide trunk and organ stability and pressure management during activity or increased intraabdominal pressure like sneezing or coughing. It seems reasonable that doing “core” exercises should increase pelvic floor muscle strength. However, the exercises they tested were not all core exercises, so how do these other exercises help strengthen the pelvic floor?

Through neurological overflow from the surrounding muscles to move the pelvis and hips. This style of training the pelvic floor is not new. I have been using it for almost 15 years and I know others who have used it longer.

But, I do have some reservations around jumping straight to all the exercises from the study. By now you’re probably wondering what they are.

In the study they found that cat/cow, bear crawl, side plank with a clam, bridges, squats and lunges all strengthened the pelvic floor more than kegels at varying degrees.

Now if you heard this, you may be excited. Because let’s face it kegels are boring. However, you may also be thinking, but I’ve been doing these exercises and I still have symptoms. So what’s the deal.

The way these exercises are most effective is how you use them and your intention behind the movement. Even though these exercises showed that for the women who performed them they strengthened more than kegels, that doesn’t mean you are ready for them all. Yes, cat/cow is one that most people will be ready for, however it may not be enough to treat your symptoms.

This is what I wish people knew before starting these exercises:

1. Do you have any awareness of your pelvic floor?

2. Can you feel movement in your pelvic floor when you inhale deeply and exhale forcefully?

3. Do you breath primarily into your chest or belly?

4. Do you leak pee or have perineum pressure when you squat or lunge during functional tasks or as an exercise?

5. Do you know you have a tight pelvic floor?

All of these factors play a role in how these exercises are going to work for you or not.

If you have no awareness of the pelvic floor, meaning if you tried to do a kegel you couldn’t or feel no movement during big breathes, you either have a tight pelvic floor, no or minimal strength or your neurological control to the pelvic floor may be compromised.

If you chest or belly breath this can be a sign of reversed breathing pattern that lifts the pelvic floor while inhaling and pushes down on the pelvic floor while exhaling. Not an ideal situation for pressure management or pelvic floor function during exercise.

If you have symptoms during the exercises, then it may be a coordination or breathing issue. Or you may be overloading the whole system beyond it’s capacity.

And if you have a tight pelvic floor, you don’t want to do exercises that are intended to strengthen the muscles. You want to figure out first why you have a tight pelvic floor, if it’s because of weak surrounding muscles then go for it, but it still requires deeper understanding of breathing and coordination around how to intentionally let go of the pelvic floor.

In some of these cases doing more isolated “kegel” style or “reverse-kegel” style exercises may be necessary to improve your pelvic floor connection prior to doing the more “advanced” exercises. Where as some of you may find that movement is actually needed to improve the connection by using the overflow effect from the other muscles.

What I’m getting at is sometimes you need to problem solve if certain exercises that are touted as what to do are right for you. This is especially important during pregnancy and postpartum when your pelvic floor is more vulnerable.

If you want to learn more and see some visuals of the exercises click here to watch my Youtube video where I demonstrate the exercises and discuss more of what you can look out for during each exercise.