WHAT ARE KEGELS?
“Kegels” are a term coined for pelvic floor muscle contractions. The pelvic floor muscles are the foundation of the ‘core’ muscles. When performing core exercises the pelvic floor muscles should naturally co-contract during these exercises to assist in pelvic support, however, this is not a Kegel. A Kegel is performed when the pelvic floor muscles contract in isolation. It is possible to have a strong core functionally and still have a weak pelvic floor from not performing Kegels correctly and/or in isolation.
HOW TO PERFORM A KEGEL (PELVIC FLOOR MUSCLE CONTRACTION):
The pelvic floor muscles are the muscles designed to stop urine flow, however, it is not recommended (EVER) to Kegel during urination as this will have adverse effects. Use this information to help identify your pelvic floor muscles.
- Lay on your back and gently try to ‘squeeze’ your pelvic floor as if you were stopping urine flow, holding back gas, or ‘closing’ your vagina or anus. A proper pelvic floor contraction should be a ‘squeeze’ and a ‘lift’ as if closing the elevator doors then elevating up towards the belly button.
- The pelvic floor muscles are very small and thin muscles unlike the other skeletal muscles in your body so the exercise should not ‘take your breath away’ and the movement is very subtle. Remember a proper Kegel is performed in isolation so quiet your abdominals, inner thighs, and gluteal muscles. When performing a Kegel, it should not be obvious to anyone observing if performed correctly.
- Once you’ve mastered a quality contraction progress to exercising in sitting to train against gravity.
TWO TYPES OF KEGELS:
Like all skeletal muscles, the pelvic floor muscles are made up of Type 1 and Type 2 muscle fibers (endurance and power respectively). In order to train both types of muscle fibers, pelvic floor muscle contractions should be performed “slowly” and “quickly”. To work on endurance, “slow” Kegels (Type 1 fibers), slowly contract the pelvic floor and hold for 3 seconds progressing to 10 seconds. It is not necessary to hold the contraction longer than 10 seconds. To work on ‘power’ (Type 2 fibers), quickly contract the pelvic floor and immediately relax with no hold. It is important to relax all the way down to normal resting position between each contraction, think “squeeze, relax, repeat”. Remember to breathe during these exercises. Never hold your breath.
HOW MANY KEGELS SHOULD I DO?
Contrary to popular belief Kegels should not be performed hundreds of times a day. In fact doing so may lead to over training of the pelvic floor muscles resulting in hypertonicity (Pelvic Floor Dysfunction!). The general recommendation is one set of 10 slow Kegels repeated 3x a day and one set of 10 quick Kegels repeated 3x a day. That’s right only 60 total with both types combined! Quality is more important than quantity, and don’t do them all at once!
TO KEGEL OR NOT TO KEGEL:
An overactive pelvic floor will not relax or may contract when full relaxation is necessary (paradoxical contraction). When this is the case there will usually be a pain component involved whether it be pain during or after intercourse or daily pelvic (lower abdominal/suprapubic) pain presenting as constant or intermittent (See Pelvic Floor Dysfunction). As a general rule, if pain is present then Kegels are contraindicated. Performing Kegels will ‘up train’ the pelvic floor muscles resulting in increased tension or spasm (overactivity) of the pelvic floor muscles. In this case the focus needs to be on ‘down training’ the pelvic floor muscles which may be accomplished with Physical Therapy interventions such as dilators, diaphragm breathing, manual therapy, and/or biofeedback.
Often my patients will tell me they Kegel at every stop light or while standing in a grocery store line. This allows for the exrercise to become more functional and fit in to your every day life, however, I don’t recommend this for every set of Kegels performed. It is important to sit in neutral and focus on the Kegel exercise with your feet flat on the floor. Any other position is training the pelvic floor muscles asymmetrically (while driving for example, your right leg is more extended resulting in changing your pelvic alignment). While occasionally doing this is fine it should not be the norm. Remember to NEVER Kegel during urination.