A question I am often asked by many women. First let’s define what a kegel is. Basically, a kegel is a contraction of the pelvic floor muscle group. Just like a bicep curl is a contraction of the biceps muscle group. It is called a kegel, because back in 1948, Dr. Arnold Kegel coined the term and it stuck. It’s also easier to say “perform a kegel”, then “contract your pelvic floor muscles”. In a time-crunched society we love our abbreviations.
You often see those memes, e-cards, or even articles in fitness magazines, toting: Do your kegels often and regularly to prevent a variety of women’s health issues, such as urinary incontinence, prolapse, or even bad sex. If you follow the general advice, it basically amounts to doing kegels every day, at every spare moment of the day. Do your kegels at every commercial, every red light, when you’re peeing, etc. Basically, there is never a time not to be doing your kegels. It leads women to believe if they are not performing kegels at this high frequency, their vagina will fall out of their body or they will have a lackluster sex life.
This message is inaccurate, and an unnecessary scare tactic for women desperate for any advice to help with these private and personal issues.
The pelvic floor is never at rest, which is why we don’t need to be constantly training it. You would never train any other muscle group that way.
Marathoners don’t run every day.
Cross-fitters don’t dead-lift every day.
These athletes know the risk of overuse injuries when they over train a group of muscles.
So what happens when you over-train the pelvic floor? It can become overactive, and it will develop muscle failure due to fatigue of constantly contracting. As a result, when it is tasked to perform at a high level, like when you sneeze, you will have failure of the pelvic floor to do its job, i.e. maintain continence.
You can have a perfectly strong pelvic floor, but because it is now overactive it functions as if it’s a weak pelvic floor. This is why the recommendation from mainstream media to “just do your kegels” does not help everyone, and can actually make a problem worse. Pelvic rehab is not a one-size-fits all approach.
The pelvic floor can be either weak or overactive, and it is important to identify how it is functioning in each individual person.
Kegels do have their proper time and their place in pelvic floor rehab, but the key is to know when, where, and how often to perform them. A women’s health therapist can give you that answer and help you to design a pelvic floor exercise program that is specific to you and your needs, your individual issues and your long-term goals.
And it likely will not start with kegeling every time a commercial comes on..........
Can we stop calling it mommy tummy?
1. I hate the phrase, kind of like I hate the word moist.
2. It is not just moms that are affected by it.
We don't call an ACL injury, football knee because it mainly affects football players. The technical term is diastasis rectus abdominus or DRA for short.
Ok, so what is it anyways?
Well, DRA is when the abdominals separate in the middle, more specifically when rectus abdominis muscle (6-pack muscle) separates along the linea alba. It is typically diagnosed when the distance is 2 cm. or greater. It DOES typically occurs in pregnancy, but like previously mentioned men can get it too. Some research supports the notion that it happens in 100% of women in pregnancy, but that is not necessarily a bad thing.1 The women's growing uterus needs a place to expand. However, it can become a problem when it doesn't resolve after pregnancy. Women with DRA can develop low back pain, pelvic pain, prolapse or even incontinence. It is not just a cosmetic issue. It is important to identify this condition as it improper exercise can actually increase the size of the DRA.
Many women will ask their trainers, fitness instructors or even ob/gyns......"What can I do to prevent this from happening during pregnancy?" Unfortunately, any advice given is not supported by any current research.
Wait, What ?!?!?! So there's nothing I can do to prevent this from happening to me?
Maybe, maybe not. The point is we don't necessarily know why it happens in some women and not others. It's not due to excess weight gain, it's not due to having multiples, and it's not due to large babies.2 There's not enough research out there on DRA yet to make specific recommendations of what to avoid during pregnancy. Most advice is based on theories or opinions.
So please ladies, don't blame yourself. We got enough that we need to avoid during pregnancy, we don't need to add any more things to our "AVOID list in Pregnancy". We already miss our wine and sushi!
The postpartum period almost needs to be treated like any other injury or trauma to the body. We aren't just magically healed at 6 weeks postpartum. We need to take the time to take care of ourselves.
DRA is treatable condition, even large DRA have been showed to be treated effectively with conservative treatment like physical therapy.3 However, correcting DRA is not a one size fits all approach, so if you tried an online program and it didn't work for you, there's likely a reason for it. One possible explanation is that you are only training the abdominals and not evaluating the function of the pelvic floor. It's like trying to fix a crack in the wall, and not addressing the the huge crack in the foundation of the house. The wall will just develop another crack until the foundation issues are corrected. Same with DRA. If only the abdominal separation is treated, and the pelvic floor is not addressed, it's likely that issues will continue to happen. DRA treatment is most effective when the entire person is evaluated and their treatment is personalized to their own impairments and functional limitations.
How can you do that? The best way is to seek out help from a pelvic health physical therapist.
1. Gilleard, WL & Brown, JL. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postpartum period. Physical Therapy. 1996; 76 (7): 750-762.
2.Mota, PG, Pascoal AG, Carita AI, and Bo, K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbopelvic pain. Manual Therapy. 2015; 20 (1): 200-5.
3. Litos, K. Progressive Therapeutic Exercise Program for Successful Treatment of a Postpartum Woman With a Severe Diastasis Recti Abdominis. Journal of Women's Health Physical Therapy. 2014; 38 (2): 58-73.
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