To Kegel or Not to Kegel?

When treating conditions related to the pelvic floor, I’ve come across many patients that have heard about kegels, but many are unclear why they are performing them and or how to correctly perform them. The following statements are very common:

“I heard about kegels online and I tried them, but it didn’t help my pain” or “I started doing kegels, but I don’t feel like I am doing them right.”

The common misconception is that doing kegels or “tightening” your pelvic floor muscles will decrease your pain, but this is not always the case. Pelvic floor muscle dysfunction can be broken down into two categories; overactive or underactive. Studies show that pelvic floor overactivity can cause pelvic pain and refer pain to other parts of the body.1 In this case, performing kegels would not be an appropriate treatment as the muscles are already in a contracted state. With overactive pelvic floor muscles, the focus is often down training and relaxation in order to decrease the tone of the muscles. This is important because the pelvic floor muscles (similar to all of the muscles throughout the body) need to be in an appropriate resting position to function efficiently. This happens to be midway between a contracted and relaxed state.

In the case of pelvic muscle underactivity, symptoms of incontinence and decreased support of the abdominal organs may be experienced.1 Performing kegels is likely appropriate with underactivity in order to improve the strength of the muscles, therefore improving support and function. While these are two classifications of muscle dysfunction, it is best to have a physical therapist specializing in pelvic health complete an internal assessment of the pelvic floor musculature before performing kegels.

1. Bradley MH, Rawlins A, Brinker CA. Physical Therapy treatment of pelvic pain. Physical Medicine Rehabilitation Clinical N Am 2017; 28: 589-601.

Kim Micheletti, DPT


Heat or Ice?

This is often times the first conversation you may have with your health care provider after an injury or when dealing with aches and pains. “Which should I use at home? Is one better than the other? What are the benefits of one vs. the other and how do I use them effectively?”. Pain control can be the first step when starting physical therapy and heat and/or ice is usually the place people start.

Cryotherapy (therapeutic use of cold) has an immediate physiological effect on the body when applied. Cryotherapy is primarily used to control inflammation immediately after an injury, also known as the “acute” stage of healing. Cold applied to the skin causes immediate constriction of blood vessels and decreases blood flow to the area of application. The cold also thickens the blood, which decreases the “rush” of blood to the injured area. Blood flow to an injured area is important and healthy, but too much blood flow can cause excessive swelling. The acute inflammatory phase of healing usually subsides after 48-72 hours. A good way to check whether your injury is in this acute inflammatory stage is to feel the injured area. Is the area warm to the touch? Does the area feel “puffy” or swollen? If so, apply the RICE principal: rest, ice, compression and elevation. The sooner the ice is applied, the more beneficial it will be in reducing inflammation.

Another way cryotherapy can be beneficial is by “tricking” the brain into feeling less pain. When cold is applied, it slows down the conduction of pain fibers to and from the brain and injured area. This can be an effective way to provide temporary pain relief from various aches and pains. Lastly, cryotherapy is great at lessening or even preventing delayed onset muscle soreness (DOMS). DOMS occurs after a workout, where the muscles have undergone breakdown, inflammation and rebuilding. Typically, this soreness lasts for 1-2 days after your workout. Use gentle stretching and ice application to the sore muscles after your gym session, your body will thank you later.

Heat can also be used to manage pain, soreness, and muscle and/or joint stiffness. Heat dilates blood vessels and increases blood flow in the area of application. This increased blood flow, supplies fresh oxygen to the muscles and can help with healing. Heat is effective when used on tight muscles or muscles in “spasm”. Heat, just like cold, can alter nerve conduction which allows muscles to relax and become more flexible. Shoot for 10-15-minute applications of heat, along with stretching to allow for increased range of motion and flexibility.

To review, cold is best used for an acute injury within 48-72 hours to control inflammation and to increase pain threshold by altering nervous system function. Cold is also very effective in preventing DOMS after hard workouts. Heat is best used to increase muscle tissue extensibility (pliability or flexibility) or in treating muscle spasms, especially when combined with stretching.

If you ever have any questions regarding use of these modalities or how to manage your aches and pains, contact your local physical therapist and they will be more than happy to help!

– Travis Jurgens PT, DPT

What Does Breathing Have To Do With It?

Whether we are lifting something heavy around the house or performing exercises at the gym, at some point in time we have been guilty of holding our breath during movement. In order to understand why holding your breath is detrimental to creating stability and coordination throughout your body, it’s necessary to learn what takes place throughout each breath. During inhalation the diaphragm lowers and causes the transverse abdominis (one of our deepest core muscles) and pelvic floor to lower and expand, allowing air to fill our lungs. With exhalation, the diaphragm rises while the transverse abdominis and pelvic floor recoil, creating stability within our system. This process allows for healthy, functional movement.

Our central stability system, also known as the inner core, includes four muscles: the diaphragm, transverse abdominis, multifidus, and pelvic floor muscles. When these muscles are not functioning in a coordinated manner, such as holding our breath during exertion, overtime it can contribute to low back pain and pelvic instability. Research has shown that these muscles including the pelvic floor, are anticipatory muscles, meaning they are the first to activate before completing any other movement.1 Therefore, if our foundation is unstable how is the rest of our movement going to feel or look? This will most likely lead to compensation in other parts of our body, leaving us more susceptible to injury. When we hold our breath during functional activities we are increasing the pressure within our abdomen and shutting off the natural coordination of these four muscles.

Start by becoming conscious of your breathing when resting and then through physical activity. Focus on taking a deep breathe in and exhale through your movement allowing your rib cage to expand and your inner core to engage. This will keep your body stable during exertion. Avoid unnecessary injury; let your breath fuel your life.

  1. Hodges PW, et al. Postural and Respiratory Functions of the Pelvic Floor Muscles. Neurology and Urodynamics. 2007;26(3):362-371.
– Kim Micheletti, PT, DPT