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Beyond Kegels: Advanced Pelvic Floor Exercises for Runners and Triathletes

Beyond Kegels: Advanced Pelvic Floor Exercises for Runners and Triathletes Dr Amy Gargin Run Tri Bike

The pelvic floor is gaining popularity in the athletic population with more and more people advocating for themselves, quickly becoming a hot topic. Pelvic floor dysfunction is often associated with the postpartum period but can actually appear at any period of life. This is in part why the pelvic floor is becoming a more widely discussed topic with more athletes returning to sport following childbirth. The most common symptoms of pelvic floor dysfunction include: 

  • Urinary leakage
  • Urinary frequency/urgency
  • Pelvic pain
  • Low back pain/hip pain
  • Constipation
  • Painful intercourse

Along with a discussion about the pelvic floor usually comes a mentioning of the term “kegel”. But what are kegels exactly? Do they help these pelvic floor symptoms? Should we just “do kegels” endlessly for the rest of our lives to prevent pelvic floor dysfunction? How many should we do and how often?

And keep in mind, EVERYONE has a pelvic floor – males included. Therefore, everyone is subject to pelvic floor dysfunction. Although very common in the postpartum period, symptoms also can appear after a traumatic injury to the spine/pelvis/hips, after menopause, or during times of significant stress.

What Are Kegels?

A kegel is a pelvic floor muscle contraction. The pelvic floor muscles lie at the base of your pelvis and are primarily responsible for bladder, bowel, and sexual function. Like all muscles, your pelvic floor muscles should fully lengthen and fully contract. Most people have heard of the term “kegels” and associate them with solving all pelvic floor issues. However, a deeper dive should be done to determine the root cause of pelvic floor dysfunction. The pelvic floor muscles are in danger of becoming too tight, especially for athletes. If the muscles are too tight, a kegel would be strengthening an already tight muscle, which would actually increase irritation and increase symptoms.

As physical therapists, we prescribe exercises like MDs prescribe medication. It would be negligent to recommend only one exercise (or medication) for such a complex group of muscles with multiple possible dysfunctions. There is a time and a place for kegels but the answer is not always and everywhere.


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The Stability You Never Knew You Needed

The pelvic floor muscles also aid in stabilizing our spine and pelvis. These are dynamic muscles that should be able to expand and quickly contract. Think of these muscles as a trampoline – lengthening to absorb force and contracting to spring back and provide support. This action is particularly important in running because triple your body weight has to be absorbed with each step that you take. Performing solely kegels is not a dynamic enough movement to improve the mechanism as the pelvic floor also works as a unit with your core and your hips. This would be equivalent to only performing unweighted leg extension in order to try to improve your cycling. There are multiple exercises and multiple muscle groups that should be addressed if you are experiencing any type of muscle dysfunction. It’s also important to get a thorough assessment in order to diagnose your pelvic floor dysfunction.

As mentioned above, the pelvic floor muscles help to provide stability to your pelvis and spine. If your pelvic floor muscles are not strong and stable, likely something else will be compensating and potentially lead to injury. Think of all the repetitive movements we do as endurance athletes – if something is compensating, you will be allowing that compensation over and over again for miles.

You can view my last article, From Core to Floor: Integrating Pelvic Floor Workouts into Triathlon Training Plans, in the previous newsletter for my favorite stability exercises to keep your pelvic floor in mind.

Addressing Tightness In The Muscles

Again, all muscles should be able to fully lengthen and fully contract. You need to have both in order to prevent dysfunction and prevent compensation. So what if your muscles aren’t fully lengthening? Our pelvic floor muscles need to lengthen in order to urinate and have a bowel movement. However, they also need to fully lengthen in order to have that trampoline effect mentioned above, allowing the muscles to absorb the force. Inability to absorb force adequately could result in stress incontinence – leakage with running for example.

The pelvic floor muscles need that absorption moment to also be able to bounce back up and contract quickly, preventing the leakage. It’s unfortunately very common for the postpartum population to experience leakage with running/jumping. However, it’s not normal and can be addressed with proper treatment. This symptom is common because the pelvic floor muscles were under so much stress during pregnancy and childbirth. This actually puts the muscles through trauma, resulting in a stress response in the muscles.

Below are my top 5 exercises/stretches to help lengthen your pelvic floor muscles and go beyond keels:

  • Diaphragmatic breathing
  • Cat/Cow
  • Happy baby
  • Child’s pose
  • Pigeon stretch

As always, if you’re unsure of the status of your pelvic floor muscles, seek out the help of a pelvic floor physical therapist!

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Dr. Amy Gargin Run Tri Bike Contributor

Dr. Amy Gargin is a doctor of physical therapy and certified running coach. Dr. Amy is board certified in orthopedics and also a pelvic floor specialist. Returning moms to running/exercise after childbirth is her passion as she is a running mom herself!