“Do your kegels!”
What does that even mean?
If you’re pregnant or have had a baby, you’ve likely been told to do your kegels. But, how are you supposed to actually do your kegels? It can be a bit tough to wrap your brain, and your body, around what a kegel is and what it should feel like when you’re doing one.
A lot of women who try to do kegels, end up "bearing down" on their pelvic floor instead (think: valsalva) or aggressively squeezing of what they think to be the right muscles. In these instances, they don't quite have the correct action and could be doing more harm than good.
The pelvic floor is a network of muscles and other connective tissues in the base of the pelvis that provides structure and stability for the pelvis itself and for the organs within it.
One of the best explanations I’ve heard to describe the pelvic floor is from Lisa Gimenez-Codd (who wrote this article on the pelvic floor) comparing the pelvic floor to a wicker basket.
Think about the base and outer structure of the basket as your hip bones (your pelvis) and the all the interlocking strands of the basket as the muscles and connective tissues of the pelvic floor. They provide the extremely important internal support to hold things in your basket, or in your pelvis. The diagram on the right shows a typical female pelvic floor. Everyone, including males, has a pelvic floor.
Lisa goes on to explain how you can imagine carrying your wicker basket while grocery shopping. You know the feeling of putting items in your basket and you feel that weight dropping down and pulling at your arm? This is a brilliant way to describe the cumulative effects of pregnancy with the increasing weight of your baby, the placenta, and, not to mention, the normal weight of your pelvic organs. Kegels can be effective for those who have a pelvic floor that needs strengthening and re-toning, which is typically the case later in pregnancy and early postpartum. Check with your pelvic floor or women’s health physiotherapist to be sure.
Disclaimer: Kegels are not effective for everyone. If you have a tight pelvic floor, focus more on relaxing and releasing the muscles first, not on contracting them.
To get the body ready for kegels you first need to master your alignment. You can think of alignment as posture, but just know that this goes beyond your mom telling you to “stand up straight” or “pull your shoulders back” when you were a kid.
I think of alignment as the way the joints and bones stack up to create your posture. I’ve used this analogy before, but this is a tale of Goldilocks and the Three Bears to get the body set up in good alignment. For example, your pelvis should not be rocked too far forward (anteriorly tilted), or too far backwards (posteriorly tilted). The picture on the right shows what non-optimal alignment looks like with a posterior pelvic tilt. The bum is tucked under and the low back is flattened.
Rather, it should be stacked right in the middle, with your ribcage sitting over top of your pelvis. This is a great article from Julie Wiebe, women’s health physical therapist, speaking about what happens when our ribs are not over our hips, leading to a ‘junkless trunk’.
How to get into good alignment:
In good alignment, with the ribs over the hips, you have the diaphragm stacked over the pelvic floor, which sets you up for Step 2. The picture on the right shows what more optimal alignment looks like (it takes some practice to master).
When you're ready with your alignment you are set to breathe properly. You need to really focus on your breathing patterns to ensure you're recruiting the core all together as a team. The core starts from the diaphragm, goes all the way down to the pelvic floor muscles, and is surrounded by the abdominal muscles and spinal muscles. Your alignment from Step 1 sets you up for the breath to flow easily and therefore, helps you gain core stability.
Set up for breathing:
Recap: Inhale to inflate the trunk and the floor. Exhale to feel a deflation of the trunk and the floor.
Now that you’re ready in your alignment and set with the basic breathing pattern, you’re ready to go on to the core and floor connection. Here’s how to do your Core and Floor Connection:
*Tip: Practice two sets of 10 breaths daily focusing on both the relaxation and the contraction. If the relaxation bit seems trickier to sense, and it often is, it’s best to forgo the contraction and keep working on the relaxation.
*These are cues I’ve learned from various resources, physiotherapist, yoga and pilates instructors, and ones that my client’s and I have come up with together to better help them best connect with their core and floor. There’s no "best" cue—it’s truly just a matter of whatever makes the most sense to you in your brain and body.
Daily is best, especially when starting out. Eventually this will become automatic and you won’t have to think so hard. Train your core and floor connection purposefully so that it becomes automatic and happens on cue when you lift, sneeze, sprint, laugh, etc.
Remember:
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