According to the Mayo Clinic, “Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. Kegel exercises, also known as pelvic floor muscle training, can be done any time” because basically, a person is simply squeezing their “hoohoo.” This benefits incontinence and other various pelvic floor dysfunctions that require stronger pelvic floor muscles.
While Kegel exercises have a place and provide some benefits, I have come to realize that these exercises alone are a very myopic way of strengthening the pelvic floor muscles. For example, if we look at the anatomy of the pelvic floor, it’s a group of muscles that overlap each other with attachments to our pelvic bone. Kegel exercises only activate a small part of the many pelvic floor muscles. Therefore, other strategies and techniques, such as the following, are needed to also help:
- Recruit other muscles attached to the pelvis and core
- Take advantage of the pelvic bone itself
- Align posture in order to facilitate better pelvic floor function
- Fully support the internal organs
- Prevent floor dysfunctions
While the ability to perform Kegel exercises may give us initial insight to the strength of your pelvic floor, it can play a very small role the functional duties of the pelvic floor and its role in pelvic floor dysfunctions. Therefore, it is critical to look beyond what Kegels can offer in order to provide a more complete treatment strategy.
My Foundational Understanding – The “Traditional” Approach
I was first exposed to physical therapy for women’s health in my last year of graduate school during an internship at the University of Southern California. It was supposed to be the best evidence based practice that was a part of the physical therapy program at USC and it gave me the opportunity to learn about biofeedback, internal weights, how to utilize Kegels, archaic exercises and even some nutritional education.
Surprisingly, I also experienced the heartache of seeing the pain, frustration and hopelessness in the women’s eyes we were helping. Patients with urinary/fecal incontinence, recti-diastasis, prolapse and pelvic pain had to be extra patient with their results because it often took weeks to months before progress was ever reported. As a result, I found an urgency to help these women and address their feelings of helplessness due to the slow progress they were experiencing.
My Lightbulb Moment
Things became even more personal in my approach to physical therapy in women’s health when my mom was diagnosed with breast cancer. After her mastectomy to remove the tumor and lymph nodes, she experienced a lot of shoulder and neck pain, and I saw firsthand all the imbalances that were created after the removal of the various tissues, which quickly led to her developing a frozen shoulder.
Thankfully, at this point, I was already using the Applied Functional Science (AFS) approach with all of my patients and clients. So, I began working with her and focusing on not just cranking on her isolated, symptomatic shoulder joint and pain, but I also focused on helping to restore her posture and to utilize her entire body to completely restore her shoulder.
I specifically began working on areas that didn’t hurt as much but still desperately needed movement, such as her scapulae (shoulder blades), core and hips. This allowed her to improve her posture and to take some of the stress off of her shoulder and lower back, which were also beginning to feel achy from the lack of normal movement and becoming more sedentary. In time, she began to feel improvement in her frozen shoulder, neck and back pain, but she also began to notice an unexpected bonus.
For years, my mom experienced trouble with constipation and urinary leakage when coughing, sneezing and doing any ballistic, jarring motions. This kept her from trying to jog and she would wear a “just in case” pad all the time. She simply assumed that this was a part of aging. However, as we mobilized her shoulder blades, stimulated her core and strengthened and mobilized her hips to improve her posture, her constipation and incontinence also improved. As a result, I needed to think about women’s health differently and remember how everything is connected!
An Internal Organ Perspective
I specifically began to realize that when looking at the connections from an internal organ perspective, there are couple of critical points I needed to keep in mind:
- We all have ligaments that connect from our necks to our diaphragms, to the internal organs, to the stomach and to the bladder.
- It helps to imagine ourselves as a limp puppet with strings and everything hanging because it’s the equivalent of having poor posture, ligaments that go lax and the weight of organs that passively hang and sit on the pelvic floor.
- The excessive internal pressure and wear and tear on the pelvic floor muscles can cause prolapse, leaking or pain.
A Skeletal Perspective
And when looking at the connections from a skeletal perspective, I also realized the importance of keeping these foundational perspectives on my radar:
- Everyone’s posture changes with each stage of their life…sitting during school and work, during pregnancy, while breastfeeding, while taking ballet or Pilates classes and even when trying to tuck in their butt.
- The posture changes contribute to posture tilts that can cause pelvic dysfunctions.
- This tilt also takes away the leverage of using the butt, which, for good reason, is the largest muscle group in the body.
- When the leverage is removed, the glute muscles turn off.
- Therefore, these muscles, which are the largest muscle group in the body to surround the pelvis below the back, no longer act as a shock absorber.
- A person’s glutes also wrap around and support the pelvis when they have ligamentous laxity throughout the different stages of pregnancy and menses. So, when a little jogging or high intensity workout is attempted to lose the unwanted baby weight while still breastfeeding, the perfect recipe for prolapse is created (both in the present or in the future).
- Finally, when a person tucks their tailbone under, it also shifts their anterior pubic bone up. This takes away from the bony support that is supposed to be present for the pelvic floor.
As a result, I was reminded that not only is a person putting too much internal pressure on the pelvic floor, but they are also taking away the outside skeletal support at the same time.
Some Happy Guinea Pigs
With my new perspective I immediately began making changes with my clients!
First, I started to ask intentional questions about the pelvic floor to those who experienced low back pain and sciatica. I found that they also had incidences of incontinence and pelvic prolapse. Most also thought it was a natural part of the aging process and didn’t think there was anything that could be done, especially since commercials were telling them that everyone starts and ends life in diapers.
I also began to observe a higher incidence of incontinence or pelvic prolapse in women with poor posture, vegetarians and women who ran throughout their pregnancy or right after the birth. (Please note, this was not scientifically substantiated. It was simply my clinical observation.)
Needless to say, I began to collect data on what exercises and movement would decrease symptoms and I was thrilled to now have a whole body approach that was largely movement based to help treat these potentially embarrassing conditions that most thought were untreatable. Plus, these treatments could easily be done at home once the strategies and techniques were learned, thus eliminating internal weights, no more difficult biofeedback and very little uncomfortable internal exams.
It Got Really Real!
But, my journey didn’t stop there. After the traumatic birth of my own child, my understanding of physical therapy and women’s health took on an entirely different meaning.
I had the typical nausea in the first trimester and interestingly, I found that it went away while exercising. At five months, I even felt well enough to spend the entire weekend filming a mommy and baby exercise DVD. Like every woman, I also had cravings, but nothing more than oranges and gummy candy. And with the help of my favorite little wedge that I used to support the extra weight and to remove the stress off of my back, I slept relatively well. Basically, it was pretty much a dream pregnancy.
Two weeks prior to my due date, my water broke in the middle of the night and I found myself in the hospital pushing and pushing. When the “time” finally arrived, Mike, my husband, was ready with scissors in hand to cut the cord. However, in one small second, something happened. The hospital room was suddenly filled with extra nurses and doctors, the OBGYN pushed Mike aside, and after one quick snip-snip, my silent baby was placed in the hands of a cardiologist.
After what felt like hours had passed, I thankfully heard a little cry moments later. Come to find out, the cord was wrapped around our baby’s neck, and when our incredible OBGYN realized this, he signaled the cavalry to assist the birth. I am incredibly thankful to say that our sweet baby was perfectly healthy and the only casualty was my hoohoo.
To give you a bit of a perspective, when someone gives birth, they may “tear” in one of two ways (not everyone tears):
- Natural Tear, which creates a zigzag appearance and heals with more integrity and elasticity.
- Episiotomy, which is a clean slice/cut that actually weakens the pelvic floor because the straight edge has less integrity and decreases the elasticity.
When I had an episiotomy, along with being prone to scarring due to my Asian skin, I ended up with not only a very painful recovery, but was also set up for some future pelvic dysfunctions.
With my professional experience, I understood the need to give my body time to heal and I recognized the importance of taking notice to see if my posture, pelvic floor and hormones were ready for a successful return to higher impact activities. However, I didn’t fully “get it.” I didn’t have the depth of empathy towards the entire birthing process that I do now and I didn’t recognize the amount of time needed to truly heal.
In fact, 3 months after my delivery I thought enough time had passed and I began running again. Yes, I was still breastfeeding. Yes, I was not stretching to restore my posture. And yes, I was not strengthening because I was too sleep deprived. All I wanted was to take 30 minutes to go for a run and I completely forgot all of the important things I regularly teach other women to apply. My need to feel “normal” overshadowed my listening to my body. And as a result, I not only began to set myself up for a pelvic floor prolapse and leakage but also potential permanent damage.
Once my hormones started to balance and I got my head on straight, I started to get back on track and began practicing what I preached. I was able to quickly reverse most of my symptoms, but to this day, I still have permanent damage. Once the pelvic floor has been overly stretched and weakened, a prolapse can occur. It is similar to a hernia where once there is a thin or weak spot, the organs can literally fall through. So even though I have learned how to manage things and have even successfully returned to running, I wish I had connected the dots sooner and been more careful.
The blessing of my personal pain and journey of learning is that it has given me an enormous passion for educating others on how to take care of their bodies! It doesn’t require fancy machines or isolated Kegels, but it does involve a full understanding of the female body and how posture, muscles and movement can change everything. Women also don’t have to experience pelvic pain, rib pain or calf cramps during pregnancy. It is entirely possible to improve leakage that results from sneezing or jumping. And ultimately, this has left me with the deepest desire to empower women through all stages of their life so they will feel comfortable chasing their kids and grandkids, so they can experience the freedom of playing soccer or pickleball and so they are able to grow older feeling stronger with functional freedom.