Why Kegal Exercises Don’t Work

Why Kegals don't help

If you are not familiar with Kegal Exercises, chances are you’re a man, this will pertain to you none the less. Women tend to be more familiar, as childbirth and pregnancy can damage the pelvic floor musculature and leave women with what is called stress incontinence, small amounts of urine leakage with increased intra-abdominal pressure; coughing, sneezing, lifting tasks, or for our cross-fitters, Double-unders (more like double undies amirite)..   This is considered mild pelvic floor dysfunction, with urinary urge (large amounts) and fecal incontinence being more severe.  We will limit our discussion to the more common stress incontinence.

Read on…or just scroll down to the video 🙂

Kegal exercises are a CONCENTRIC contraction of the pelvic floor musculature (PF). Usually described as a pulling up of the pelvic floor. The PF is a group of muscles that for a net inside of our pelvic girdle, they hold up our abdominal viscera and have openings for ‘excretion.’  Depending on who you are learning a kegal from, they vary.  I’m here to set the record straight on this exercise (which I rarely think is beneficial) in that there are two ways to learn the feeling of a concentric contraction of the PF.

  1. Learn to stop urine flow mid stream, first with a light bladder load, then with heavier streams. (Deep Transverse Perineal)
  2. Imagine your anus is suction cupped to the chair, then try to pull the chair up. (Levator Ani Puborectus part but possibly only External Anal Sphincter).

These are both a “pulling up” of the PF meant to strengthen them with a concentric contraction.  A concentric contraction means the muscle is shortening.  Think of a bench press, with the weight on my chest the act of pressing it up is a concentric contraction of the pecs.  The act of lowering it from the top position to my chest is eccentric, with the muscles lengthening under tension.

This eccentric vs concentric discussion is extremely important.  By any explanation of stress incontinence, the PF fails to hold pressure eccentrically. In a sneeze, cough or lifting task there is increased intra-abdominal pressure. This is where the diaphragm is pressing downward, and the abdominal cavity is pressurized, with that pressure caught by an eccentric contraction of the abdominal wall (including the PF). Try it, cough, feel your belly kind of on the side or front but at least as wide as your hip socket.  Stick your thumb in somewhat deep (don’t try to feel your kidney but press in a few centimeters).  Then clear your throat, it doesn’t take much.  That is intra-abdominal pressure, and it’s always with us, fluctuating and is TASK DEPENDENT.  As in you don’t need much intra-abdominal pressure (IAP) to pick up a pencil, and when you cough or sneeze there is a spike of high pressure for a short time, but if you’re doing a max deadlift or jumping and landing hard, yes you do create a lot of IAP. In jumping and landing there is high IAP plus the entire abdominal viscera ‘wants’ to keep going downwards.  The PF has to act as a trampoline catching that pressure via an eccentric contraction.  Now, why focus training on the ‘concentric’ portion when it is its ability to lengthen under pressure with control that matters?

Because it’s better than nothing is actually a decent answer, but I’d also say that it’s kind of easy to coach, theres gimmicky gagets that can be sold, its easy to do anywhere and women might feel that its ‘tightening’ and I know people like that concept.

We have to view the Pelvic Floor as part of something bigger:  The abdominal cylinder. Therefore training of it should also represent this bigger piece, as opposed to the concentric pulling up of the pelvic floor.  The pelvic floor has rolls in respiration, spinal stabilization, holding up the abdominal viscera and of course sphincter rolls in excretion.

I feel the best way to retrain the PF is to approach it the same way you did when you first learned it as a baby.  Dynamic Neuromuscular Stabilization (DNS) offers an excellent view point and strategy on PF training in regards to developmental kinesiology (DK), the normal movement milestones of developing baby.

The role of the Pelvic Floor evolves as the baby goes through verticalization. In all cases some regression should occur, some more than others, but training it in a less than vertical posture initially. I’m going to start the discussion on our back in a supine and work our way to verticalization, with increasing IAP and PF requirements in each position

  1. 5/6 month supine posture.
  2. DNS Low kneeling
  3. 12 month bear
  4. 7/8 month side lying
  5. 11 month lunge
  6. Squat

Supine 5/6 month position: From your back, hold the legs up in a 90/90 position, hands resting on your knee/shins like shown here. Shoulders must be ‘dialed down’ and into to the body, not shrugged up. Focus on where the breath goes, send it low.  Try to feel your breath in your sit bones (and that is true for all of these positions)

DNS Low kneeling: Basically, the same position, just flipped.  Your kneeling, knees wider than your hips, and feet spun inwards touching or nearly touching, hips back a bit behind the knees, on your elbows/forearms.  Lift the head, elongate the spine. Here we can increase IAP by ‘pulling the floor’ with the arms.  Allow no spine motion.  Again, feel the breath sent low into the PF.

Bear position:  From a quadruped position, maintain a neutral spine and lift off your knees and onto your toes.  You hips should go backwards (towards your feet) about as much as they go upwards.  Your spine should stay neutral, not flexing. The knees stay somewhat bent in an athletic position, with knees outside the hips. This is not downwards facing dog. The shoulder should be engaged, pushing the floor away, with the head and spine neutral.

7/8 month Side Lying: Now we are getting more vertical.  Side lying, supporting on elbow, hips in an oblique position. Same neutral spine position, focused on the ribs connected to the pelvis, no “J” ing of the spine. Here we can increase load on the hips and PF by transitioning off the hip and onto the knee. In the eight month variation we have a more vertical pelvis and spine, by using hand support instead of elbow. Feel the PF expand as your breath low.

11 month Lunge: from the lunge stance, have the down knee (lets say right) leg slightly rotated inwards, toes pointed away. The lead leg (left) also slightly opened, and use the right hand on a bench or box for support. Your motion should be slightly forwards and left (towards lead foot), but mostly vertical.  Go up a few inches and hover there.  Again, breath low into the PF.  This is the first position where the baby experiences full loading of the pelvic floor under IAP and gravity of abdominal viscera.

Squat:  Ideally a kettlebell works great for this.  In a KB goblet squat position, sit low, pry then knees outwards with your elbows holding the weight in the bottom position.  Breath low.  Then rise up, just high enough to not be elbows on your knees and be fully engaged, breath low into the PF.

Stress incontinence is a failure of the pelvic floor musculature to control forces placed on them from IAP and gravity, an eccentric contraction lengthening of the muscle under tension.  Kegal exercises may create a concentric contraction, a pulling up of the pelvic floor, but even then its a fraction of the whole pelvic floor contracting.  Coordinated co-contraction of the pelvic floor and entire abdominal wall is the best way to train against stress incontinence.

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