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Why Kegels Aren’t the Only Answer…

We all know the term Kegel exercises.  I hear them all the time from friends and family, especially because I do what I do each day.  As a pelvic floor physical therapist, one of the most aggravating things I hear is “but I do my Kegels everyday” despite complaints that they still leak, so why would coming in to see one of the amazing PT’s at my clinic do anything for them?  Well, because just doing Kegels wont fix pelvic floor dysfunction.  Why, you ask?  Because our bodies are made up of intricate relationships of muscles, bones and joints and tissues that work together to provide movement, support and function.  I went to grad school for three years to understand this intricacy, not to learn how to teach Kegels!

Let’s take running as an example. Lots of mamas leak with running after baby, right?  Of course the pelvic floor is weakened by childbirth, so improving strength is important. But rather than think of this as a muscle that needs to contract at 200% to allow you to run without peeing, think of it as a supportive base, with just the right amount of tension to support organs but also absorb shock.  Every muscle has an antagonist and the PFM are no different, too much tension will pull the sacrum and tuck your tail between your legs. You need strong hip musculature to counter balance this, namely the gluteals.  You also need to consider the muscles in the front of the trunk and hip, are they tight, pulling the pelvis into poor posture with running?  If you want to stop peeing when you run, you need a therapist who can look at your body head to toe to determine the best way to balance out the system to allow ALL muscles to function optimally.

That brings us to the beloved Core.  While there is not really a solid definition, we can all agree core stability is imperative for daily function, especially exercise like running.  The beauty of the core is its simplicity. It takes very little to produce a great deal of stability. Clinically it has been shown that only a very small increase in a lower abdominal contraction, about 5% max voluntary contraction, will stiffen spinal segments to provide core stability (Cholewiki, J. 1998).  Adn amazingly enough, when this coordinates with your diaphragm for breathing, and your deep spinal muscles, you create a solid foundation that allows your extremities to function well. When this happens, larger muscle groups can function at their optimal length!

Yes I get very excited writing and talking about this, because it is AMAZING.  Our bodies are truly a work of art.  Now that we have optimal length of larger muscle groups, we have a good antagonistic pull against the pelvic floor, and guess what?!  It is placed in a good tensioned position to provide that support to your organs and absorb the shock with running or other exercises and activities.  And where do you think that leaves you?  DRY!!!  When you look at the whole body, and take the time to tease out biomechanics and functional strength and find what is truly the root cause of your symptom (peeing your pants) it can be fixed.  And Kegels don’t get all the credit!

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