Life beyond Kegels, weak glutes, sciatic pain and Kegels in the car

“When my son was 4 months old I noticed that I had some problems with the frequency and urgency of my toilet habits – I’d not had the most amazing pelvic floor beforehand however it seems to have gotten worse. I’ve been doing my pelvic floor exercises so what has changed?”

This is a question I was recently asked and a common story I hear amongst women who’ve had children.

It’s common knowledge that childbirth and indeed being pregnancy places significant stress on the pelvic floor due to the weight of the uterus and baby as well as any birthing trauma to the structure of the pelvic floor itself. It’s also common knowledge that Kegel exercises make for a stronger pelvic floor... or do they?

When I talk to my clients about doing their pelvic floor exercises/Kegels they often proudly report that they do them every time they feed the baby/sit at a red light or make a cup of tea and that repetitive tasks help remind them to do them.

Often however this means sitting/standing in a less than ideal position with your hips tucked underneath you – unless you are sitting on the edge of your seat bones, your tailbone is tucked under and this means that you cannot fully relax/engage the pelvic floor. It’s also common knowledge that Kegel exercises make for a stronger pelvic floor... or do they?

When I talk to my clients about doing their pelvic floor exercises/Kegels they often proudly report that they do them every time they feed the baby/sit at a red light or make a cup of tea and that repetitive tasks help remind them to do them.

Often however this means sitting/standing in a less than ideal position with your hips tucked underneath you – unless you are sitting on the edge of your seat bones your tailbone is tucked under and this means that you cannot fully relax/engage the pelvic floor even during these exercises.

It’s very common for women (and to be honest most adults) to sit for long periods of time due to tiredness/social habits and demands of a newborn baby/pressures on a pregnant body. This habit leads to over engaging the upper glutes (you have more than 1 glute muscle that should all work together as a team but often don’t) which shortens the pelvic floor also.

WAIT – isn’t glute activation a good thing? In short yes absolutely we all want our glutes to fire but the problems come in when they are OVER engaged in one place and UNDER engaged in another (locked short/tight and locked long/weak). A weak set of glutes can cause someone to clench their bottom at all times, tuck their hips under and encourages again the pelvic floor to shorten. This is bad news because you need the pelvic floor to be firing correctly for the rest of the core to be working fully.

Your hip bones at the front and back need to be completely level for you to be able to use the glutes/core and pelvic floor correctly so try rocking back and forth as if you have a bucket of water inside the abdominals and you are trying not to spill anything out the front or the back of the body. Slowly decrease the rocking and relax any tension in the upper abdominals by the ribs. You should feel immediately more connected through the deep core muscles in a subtle but strong way.

Letting go to strengthen – if you were doing a barbell bicep curl you’d have to let the bicep lengthen in order for the bar to go down. If you don’t then the arms won’t move. The glutes are the same. Imagine picking up your child and holding on with the glutes – these muscles are designed to lengthen and stretch – if they don’t they you would be lifting from just your back and hamstrings – a recipe for disaster.

So we need to both lengthen and strengthen the glute muscles in order for the body to be in neutral alignment and therefore able to contract and release the pelvic floor fully. If you are purely focused on Kegels and nothing else it cannot be expected to change just as you wouldn't improve your push up strength without training your chest muscles but also your shoulders and arms. What you need is a full body movement that trains everything to be stronger and for your muscles to work in perfect harmony with each other

Ok so getting back to those Kegels – under-firing glutes and a short pelvic floor. Now adding Kegels on top – a contraction of a muscle makes it shorten – shorten on top of shorten and now this lady is struggling to have control of her releasing. Struggling to release fully and you’ll be skipping your full control up not to mention potential associated back/hip and pelvic pain.

So should you do Kegels? Absolutely I believe that there is a place for the Kegel exercise when done in full alignment of neutral spine (not sat in your car at the traffic lights or leaning into one hip making a cup of tea and certainly not completely tailbone tucked underneath you whilst sat feeding your baby)

But actually a full body movement has been shown to a 10 fold improvement of contraction of the pelvic floor unconsciously – now that being said it needs to be the RIGHT movement at the RIGHT time for you.

For beginners/weakness I would start with a pelvic floor squat – I often see pelvic floor dysfunction spoken about as if squats would be detrimental (for example for someone with a prolapse) however unless that person is not lying horizontally and not using the toilet, at some stages of the day that client would already be squatting to perform daily tasks (let alone having the tasks of children/work/social life on their hands)

This exercise is less about depth and more about putting the pelvis back into alignment and beginning to lengthen the glutes

You are aiming to keep the knees back and the tailbone long throughout. Keep knees hip distance together and you are the best judge of the depth – if you feel your tailbone tucking underneath you or you feel downward pressure on the pelvic floor you’ve gone too low. Most people only need a little depth here to feel their glutes lengthen and the deep core muscles begin to fire.

For more progressive client I would add a load to their pelvic floor – so you might have done a similar exercise (perhaps a skater or side lunge itself) before but never considered what the core/pelvic floor was doing here. Here the pelvic floor is undergoing a stretch as well as load as you drag the leg back in-towards you. Again you are the best judge of the control you feel – but aim for exactly that – to feel as a controlled core exercise rather than just the legs.

For an advanced exercise I might increase the stretch as shown here and potentially the speed also.

There’s life beyond the Kegel exercise and unless you spend your life lying down chances are you’ll need to progress it from a lying down exercise to standing work. Adds gravity into the picture that shows real life walking/pushing/pulling/lifting.

And if you take nothing else – PLEASE no more Kegels in the car!