Note to Readers: Yesterday we posted a blog summarizing an article titled “Stop Doing Kegels: Real Pelvic Floor Advice for Women (and Men)” written by Nicole Crawford and published on BreakingMuscle.com. There was some confusion that resulted from the post about when kegels are and are not appropriate. The article advises that women (and men) should never do kegels. I do not completely agree with the article. While women and men with tight pelvic floors should never do kegels, they are appropriate for a certain patient population, patients that have weak pelvic floors.
But what about patients who have weak and tight pelvic floors?
This updated edition of the post, will fully explain when kegels are and are not appropriate, including what is appropriate in situations when the pelvic floor muscles are both weak and tight. I apologize for any confusion, but am thankful for the opportunity to add clarity to this issue that I know is super-confusing to so many!
Kegels are no good for a hypertonic or “tight” pelvic floor.
For decades doctors, PTs, trainers, therapists, you name it, have been hammering away at women—and men too—that if they want to strengthen their pelvic floors, they must do their kegels.
Getting folks to stop doing kegels is a bit of an uphill battle because it’s advice that’s seeped into the mainstream consciousness. On an episode of “Sex in the City” Samantha jokes about doing her kegels; Oprah Winfrey had experts on her show dispensing the advice to her zillions of viewers, and if you google “kegels” you’ll come up with about 1.3 million hits.
So you can imagine my delight when I came across an article that went against the party line, and actually delved into the potential harm kegels can do to the pelvic floor. An issue that PTs who treat the pelvic floor are all too familiar with.
The article is titled “Stop Doing Kegels: Real Pelvic Floor Advice for Women (and Men)” is written by Nicole Crawford and published on BreakingMuscle.com.
Ms. Crawford’s article is a Q&A with Katy Bowman—a master’s level Biomechanist whose focus is the mechanical causes of disease. In the past, Ms. Bowman has made waves advising folks against doing kegels.
Ms. Bowman says that at the heart of the problem with doing kegels to strengthen the pelvic floor is a theory in biomechanics called: “Overgeneralized Theory of Strength.” When you do a kegel, she explains, you are doing a muscular contraction, and if you already have a tight pelvic floor, contracting these muscles will only make it tighter, making your pelvic floor problems worse.
Here I agree with Ms. Bowman 100%. If you have a tight pelvic floor, or even a pelvic floor with active trigger points, you should not do kegels. Doing kegels under these circumstances will compound your pelvic floor problems.
Ms. Bowman goes on to say that kegels are never appropriate. In her prior writing on the topic, she’s held that doing kegels can actually cause weakness. As an alternative to kegels for pelvic floor strengthening, Ms. Bowman recommends deep squats. Her reasoning is that deep squats strengthen the glutes, which in turn “pull the sacrum back, stretching the pelvic floor from a hammock to a trampoline” and thus providing for a stronger or more stable pelvic floor.
Here is where I am forced to disagree with Ms. Bowman both on her assertion that kegels are never appropriate and her advice that deep squats are a better way to combat a situation where the pelvic floor is weak.
If you’re not someone who has dealt with the symptoms of a tight pelvic floor, you might wonder why a tight muscle is a bad thing. Often folks equate tight muscle with “toned” muscle. In fact, here’s a comment from a reader on this very point:
“Why is a tight pelvic floor a bad thing? Isn’t it the same as a toned pelvic floor? And a toned muscle is not a bad thing. I understand that if you over-do it, your pelvic floor muscles can become too tight, but isn’t that the same as with any other muscle fatigue in the body when you over do it? The muscle rests and relaxes a bit then it’s fine.
A toned muscle is not a bad thing, the reader is correct. Unfortunately, however, if you “over do it” with your pelvic floor muscles, they do not just rest and relax. Your pelvic floor muscles are the only group of muscles in the body that never get to rest, ever. If they completely relaxed we would be incontinent. So, they are working all the time to maintain continence, to support our pelvic organs, and to contribute to our posture and stability.
Therefore, these muscles are “working out” all the time, and don’t follow the same rules as the other muscle groups in our body. If you do get carried away with kegels and over-strengthen your pelvic floor muscles, they can become too tight, which in turn can cause dysfunction and symptoms, such as pain, urinary urgency and frequency, among others.
When this happens, it often takes the expertise of a pelvic floor PT to return the pelvic floor muscles to a normal tone to eliminate the symptoms.
So, the pelvic floor muscles do not need extra strengthening from doing kegels, unless something has happened that has overstretched them or injured them in some way that has made them truly weak (not weak AND TIGHT, more on that in a bit). Your pelvic floor muscles can become overstretched and weak after childbirth, around menopause, and after some gynecological surgeries. And this overstretching and weakening can lead to organ prolapse.
So kegels are appropriate when the pelvic floor is truly weak and/or overstretched. I prescribe them all the time for this patient demographic. And there are many experts in the field of pelvic floor rehabilitation that will strongly agree that doing kegels are appropriate when pelvic floor muscles are overstretched and/or weak. And in fact, there are many articles in medical journals that support this.
It’s important to note though that many postpartum women can actually have tight pelvic floor muscles so any woman who thinks she needs to do kegels after pregnancy should absolutely get an evaluation by a trained PT to make sure that is indeed what she needs to do. Because if you start a pelvic floor strengthening program when you actually have a tight pelvic floor, you will create problems, I promise you. So, unless you’ve been evaluated by a pelvic PT, and told you have a weak, not tight, pelvic floor, do not continue to do kegels.
So tight muscles = kegels bad. Weak and/or overstretched muscles = kegels okay. Oh, if only we could end things here. But as anyone who has researched the pelvic floor knows, there is no black and white when it comes to this part of our anatomy–only lots of shades of gray, and more than 50, I can tell you that much!
Here’s the clincher: it is possible for a weak pelvic floor to also be tight and/or to contain active trigger points. In this situation, it is NOT okay to do kegels.
So what does someone who has both a tight and a weak pelvic floor do, especially if he or she has a prolapse or other symptoms caused by the weakness. Well, the appropriate course of action in this situation would be to first work to clear up the tightness and trigger points with PT and whatever other treatments are appropriate. And then once the pelvic floor muscles are at a healthy tone–no longer too tight, and all active trigger points gone–do kegel exercises recommended by a trained PT to strengthen your pelvic floor without fear of causing further problems.
So, to summarize: kegels are not appropriate for folks with a tight pelvic floor or active trigger points or folks with a weak AND TIGHT pelvic floor. But, it’s okay to do kegels to strengthen a weak pelvic floor.
I hope this updated post has cleared up all confusion. But, if you still have questions or concerns, please don’t hesitate to send them my way.
All my best,
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836