Are you always Kegel-ing during exercise? Find out two reasons that may not be the best idea

As a Pelvic Health Physiotherapist I have the privilege of working with and helping so many awesome women, many of whom are struggling with incontinence during activities such as running, weightlifting, or sports.

When I first meet these women, I’ve found that so many employ various strategies in order to reduce their leaking during exercise. Some empty their bladder frequently between sets, some squeeze their legs together, and others try to hold a Kegel while they perform each exercise. Though each of these strategies are not ideal, today I want to speak specifically about the strategy of holding a Kegel during an exercise. Let’s take the squat for example: many women I have met will try to perform and hold a Kegel for the entire duration of their squat in order to reduce the amount of leaking they are experiencing.

Is this an effective strategy?

Squats are an awesome exercise but can be a little less fun if you have to think about your pelvic floor the entire time you do them!

Honestly – the answer is no.

Sure… it may do something. It may help some depending on your level of incontinence, pelvic floor strength, and body awareness. Or it may more help by easing your mind, because you feel you are doing something to help. But the truth is this is almost always an ineffective strategy to both treat and manage your exercise incontinence.

Why?

Because it fails to train two very critical aspects of how our pelvic floor should work during activity: descent and relaxation, and unconscious competence.

1. Descent and Relaxation

Our pelvic floors are meant to both contract and relax. For the most part when these muscles contract they ascend upwards and when they relax they descend downwards. Going through relaxation and contraction throughout the day, or throughout an activity, is very important for how effectively and efficiently our muscles can work, especially when extra stress or load is applied to them.

In order to think about this ascent (contraction) and descent (relaxation) of our muscles, I want you to think about catching a baseball for a minute.

When you go to catch a baseball, you don’t just stop your hand abruptly when you catch the ball, nor do you punch your hand forward in to the ball (aka ascend/contract). No, instead you actually absorb some of the pressure, or cushion some of the force by allowing your hand to move backwards with the ball (aka descent/relax). This allows a much smoother catch, doesn’t lead to pain or discomfort, but most importantly makes catching the ball EASIER! It means we actually exert less effort AND have more success.

Now, let’s go back to the example of incontinence during squatting. If you employ the strategy of performing and holding your pelvic floor throughout the entire squat then you are contracting the muscles the entire time… but remember, we need to allow descent of those muscles to cushion the pressure created during the exercise! So, if you aren’t allowing for this your muscles cannot actually work optimally. And though this may perhaps help to some degree in the immediate moment, it will not allow your muscles to work as effectively and efficiently as they should. What this usually translates to is a ceiling effect where maybe this strategy works “a little”, but will never entirely correct the incontinence.

2. Unconscious Competence

This topic – unconscious competence – is something that is very, very important to me. As a pelvic health physiotherapist I am constantly meeting incredible women who almost never stop thinking about their pelvic floor because they are always trying to manage their symptoms. They do Kegels during exercise, try to manage their abdominal pressure in any way possible, are nervous of doing certain exercises, and are basically always thinking about their pelvic floor.

One of my goals for each and every client I work with is getting to the point where you don’t have to THINK about your pelvic floor AT ALL!!! Constantly thinking about what your pelvic floor is doing during activity or exercise is EXHAUSTING! Not only that, truthfully it is not healthy and can drive pretty much anyone to feel anxious, nervous, scared, or even a bit obsessive.

Now, I’m not saying there isn’t a place to think about your pelvic floor during exercise – there absolutely is, especially in the beginning when you are learning about your pelvic floor, what it does, and how it should work. But, this is not a long term solution! This thinking is more short term and is geared to help you learn about your body!

Depending on your symptoms, pelvic floor coordination and body awareness, we will often go back to the basics at the beginning of your pelvic floor rehabilitation and ask you to consciously think about and control your pelvic floor. This is known as conscious competence, simply meaning that when you consciously think about it, you can contract and relax your pelvic floor as desired. However after conscious competence is achieved we must, must, must transition to training unconscious competence!!

This is a critical piece of rehabilitation that I often see skipped: training your pelvic floor to work when and how it should when you are NOT thinking about it!! Holding a Kegel during an exercise, like the squat, does not help you train those muscles to be unconsciously competent.

What to do Instead

I wish I had a cookie-cutter answer for this, but the truth is you need to work with a pelvic health and fitness professional who can guide you, will as we can guide you, give you exercises and techniques to make sure you don’t have to always think about your pelvic floor and can instead start enjoying activities and exercises again!

Once we assess your pelvic floor coordination and general movement we will be well equipped at walking you through the steps to go from conscious incompetence –> conscious competence –> unconscious competence!

Splints and Orthotics of No Benefit for Achilles Tendinopathy

A recent systematic review with meta-analysis (for those non-science folks reading one of the highest quality studies you can have!) looked at a common treatment options for Achilles tendinopathy: exercise, orthotics and splinting.

What they Measured:

Researchers measured function, pain and quality of life for managing Achilles tendinopathy, and analysis 22 studies with over 1100 participants.

What they Found:

Exercise improved pain and function while splinting at night and wearing orthotics provided no benefit to pain, function, or quality of life.

What this Means:

If you’re dealing with Achilles tendinopathy then seek the guidance and assistance of a physiotherapist who can coach you with the best exercises that are appropriate for you and your injury to get you feeling and moving better!

Don’t waste your money or effort on things like orthotics or splints that make no difference in your pain, function, or quality of life !

📖Study Link HERE

The Sex Coach You Didn’t Know You Needed.

We all talk about it. Think about. Dream about it.

What am I talking about?

I’m talking about sex of course.

I think it’s fair to say most of us would be more than okay with a little extra fun and passion in the bedroom. Which brings me to my question for you: are you getting the most out of your sex life, or could it be even more pleasurable?

I want to introduce you to the person out there who can help make your sex life even better. The sex coach you didn’t know you needed. The person who can help make sex with your partner more comfortable, more pleasurable and more intense. The person who has all the resources you need to take your sex life to the next level.

As a Pelvic Health Physical Therapist I can help you have the best sex of your life and I want to tell you how.

1. I teach the best sex positions for you and your partner based on your physicality.

Early in my career one of my favorite moments as a physical therapist happened when one of my clients (who had just had hip surgery) contacted me to find out what positions she could enjoy and which she should avoid while having sex with her partner that evening. Her surgeon informed her as to what day to day activities to be careful of, but never once mentioned sex. Moreover they didn’t have that close of a relationship, so she wasn’t about to ask!

Sex is what we physical therapists like to refer to as an activity of daily living. Sex is an activity everyone should be able enjoy as much as possible, regardless of circumstance, physical limitations or injuries.

While this may be a more extreme example, the truth is we all sometimes have some aches or pains that can make sex sound a little less appealing as it may lead to discomfort during or after the fact. Some of us may also experience pelvic floor dysfunctions such as prolapse or incontinence that can lead to feeling awkward or unsure between the sheets, or just plain less into it.

This is where I come in.

As a pelvic health physical therapist, I know all the tricks. If sex leads to a sore back in the week following foreplay we can show you the best positions. In some cases, it is as simple as using your hands and not your elbows to support yourself while in the throws of passion. For example, if you’re someone who feels discomfort or pain in your back when you sit too long, one of the best sex positions for you is on all fours resting on your hands. Adopting this same position but resting on your elbows? This is actually one of the worst positions for you, along with – believe it or not – the missionary position. In contrast, if you’re someone that doesn’t enjoy lying on your stomach because of discomfort, the missionary position with your knees and hips bent up one of the better positions for you.

Together with my patients who experience discomfort during sex, we find the best sex position so you don’t have to worry about anything other than enjoying yourself.

2. You shouldn’t have pain or discomfort with penetrative sex.

Want a crazy stat? Nearly 1 in 10 women experience pain with penetrative sex (known as dyspareunia) with a quarter of these women experiencing this pain often. Women between the ages of 16-24 are the second largest group of women to experience this type of pain. Though some women assume it is because they partner is “too big” the truth is that that is rarely, if ever the case.

There are a number of reasons that penetrative sex might hurt you, but a common one comes down to the muscles of the pelvic floor being overactive, tight, or in spasm. The muscles of the pelvic floor, like all muscles, are meant to contract and relax throughout the day. For a lot of women who have pain with sex, those muscles cannot fully relax and instead are in a constant state of contraction. This leads to difficulty and pain for these muscles during penetration. This also leads to a more complex psychological pain cycle where after penetration has been painful our brain recalls this feeling and then resists it in the future because of the painful memory.

The good news is there is so much we can do to both relax overactive pelvic floor muscles and change this pain cycle! Our goal is not only to make your sex life pain-free, but to also make it as enjoyable as possible!

3. You can experience more intense and longer lasting orgasms (yes it IS possible).

I love my job. How many other health professionals can say that their female clients come to them so happy (sometimes with tears of joy) because their orgasms are getting more pleasurable and intense because of the right treatment, coaching and advice?

Yes – you heard that right. Part of my job includes helping women have more powerful orgasms. I’m confident that I’m correct in assuming that most women would be “ok” with experiencing more powerful orgasms. Research shows that working with a professional coupled with a pelvic floor exercise plan, improves the support function of the pelvic floor, increases blood flow, and stimulates the awareness (or proprioception) of our pelvic floor. Better functioning, stronger, pelvic floor muscles, contribute to increased sexual desire, performance, and both achievement and intensity of orgasm.

Plus, the improved proprioception and awareness of our pelvic does more than just improve our physical experience during sex. It also, quite simply makes us feel sexier. Trust me, when you feel your pelvic floor muscles functioning better and feeling sexy, you are more likely to experience mind blowing sex compared to if you’re feeling less confident in your pelvic floor.

4. I have all of the best resources and want to share them with you.

There is one more way I can help you spice up your sex life. I know where all of the coolest resources are regarding sex.

Strange but true fact: I am on a first name basis with the adult stores in town, know some amazing therapists (who can also play a huge role in improving your sex life), and I can guide you on additional strategies to up your sex game even more.

As an example, have you heard of OMGyes yet? This is an game-changing resource I direct many of my clients to. An easy, self-directed platform that teaches you how to find even more pleasure in your life – whether you are going solo or with a partner.

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My mission as a pelvic health physiotherapist is to help people alleviate their pain and feel amazing so they could experience the best in life. And yes, that includes helping you have a great sex life solo or with your partner!

Should you exercise during pregnancy? Yes!

Pregnancy is an incredibly exciting time of life, but it can also be a time where you feel unsure about all of the things you should and should not do. A lot of women who have always been active wonder if they can continue to train the way they have previously, while others who have been more sedentary feel they cannot start anything new as their changing body isn’t yet used to it.

It’s time to clear some things up for you!!

Unless you have a high-risk pregnancy exercise is not only a good idea, it is actually so incredibly important for both your health and the health of your baby!!

Due to all of the misconceptions out there on exercising during and after pregnancy, an Expert Committee from the IOC was formed to specifically look at exercise and pregnancy in both recreational and elite athletes. Their recommendations are as follows:

In absences of maternal or fetal contraindications, exercise prescription in pregnancy includes the same principles and elements used for the non-pregnant population.

BUT it is important or remember and work with someone who understands the changes associated with pregnancy, which the IOC committee list as “significant anatomical, hormonal, metabolic, cardiovascular and pulmonary changes/adaptions.”

What does this mean?

That pregnant women should continue to incorporate exercise (or start to exercise)! In fact, the article continues on to state that there is very strong evidence that strength training both in general and of the pelvic floor muscles during this time can both prevent and treat urinary incontinence during pregnancy and after birth. It is also associated with a shorter first stage of labour.

Are there any signs you should slow down?

The IOC Committee explains that women without contraindications should exercise regularly during pregnancy while being regularly assessed. They indicate the following signs to indicate it may be time to stop exercising:

  • Vaginal bleeding
  • Regular painful contractions
  • Amniotic fluid leakage
  • Dyspnoea (shortness of breath) prior to exertion
  • Dizziness/syncope (fainting)
  • Headache
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling

What about Post-Partum?

The birth of your child is a wonderful moment, but it also can very much impact Mom’s musculoskeletal system, with delivery being likened to an acute sports injury. Therefore, deciding when and how to return to exercise can sometimes be more complex and multifactorial. This is why it is important to seek the help of a pelvic health physiotherapist who can guide you based on your needs and your rehabilitation goals.

The IOC committee encourage exercise in the post-partum period should start gradually with a pelvic floor muscle first focus.

Key Take-Aways:

– Exercise before, during and after pregnancy is so important for both the health of you but also for your baby

– In the absence of high-risk pregnancies, exercise is safe and beneficial as long as the anatomical and physiological changes that mom undergoes are considered

– Monitor your body during exercise and be followed/assessed regularly by a skilled coach or practitioner who is experienced in working with pre and post-natal clients.

– Begin exercise post-partum slowly and under the guidance of a professional who can help you take a pelvic floor first approach to strength training

Find this awesome research article, here.

And to find out more about exercise during pregnancy, follow the amazing @coach_vanessagiguere on instagram (she is the one above in the photo, rocking the prowler while in her third trimester!)

Remember, it’s OK to Walk Before You Run.

Today I just wanted to remind you that its okay – in fact not just okay, but necessary – to walk before you run. To slow things down and master the basics before trying to get to the advanced stuff. To recognize that just because you aren’t achieving your end goal at this moment in time, it doesn’t mean you won’t get there. And most importantly to appreciate that its your habits over time that make the biggest impact on your results.

I once had a goal of doing a pull-up. So, in an effort to achieve my goal I would jump on the pull-up bar and try with all my might to do a pull-up. My legs kicked everywhere, my neck got all tense, and I pretty much just shrugged my shoulders instead of using any sort of useful strategy to lift my body upwards. Oh, and then I would always have to let go of the bar because I didn’t actually have the grip, back or core strength to hold on to it for long.

I was trying to run before I walked.

I was trying to perform my end goal before developing the strength and movement patterns needed to successfully execute this goal. And in my effort I ended up just creating a number of compensations that were harder to break later when I focused instead on learning the fundamentals.

Fast forward to today: I still can’t do a pull-up, but I can hang on the bar with all the right muscles engaged and hold myself there in a solid position. If I have a coach around, with their assistance I can pull-up without those wonky strategies I once used – no flailing legs, sore neck or shoulder shrugs. And I know that this puts me at a much better trajectory towards the end goal of a pull-up than if I had just kept trying to “do a pull-up”.

I think we are all guilty of this sometimes. Of wanting to reach our end goal so badly that we skip steps along the way. But most always the process of learning the skill is so important and doing so properly under the guidance of a coach will help you achieve your goal at a much faster rate AND avoid a lot of frustration along the way.

What This Means in Relation to Our Pelvic Health

When it comes to our pelvic health I find a lot of times women start running before they walk. And to be clear, I don’t mean literal running and walking. I mean trying to do advanced versions of their pelvic floor exercises or advanced exercises (with little to no coaching) that they may not yet be ready for.

The progression of what we work on will differ, of course, depending on the individual, the presence of any pelvic floor dysfunction and the activities they are doing. But to give you a few examples of the most common cases of running before walking I see are as follows:

  • Practicing Pelvic Floor Muscle Contractions (PFMC aka Kegels) when you are not ready to do so (either due to incorrect technique or oversight pelvic floor muscles
  • Holding the contractions longer than you are capable of, leading to compensations
  • Doing other exercises with poor form (holding breath, increasing intra abdominal pressure unnecessarily)
  • Doing exercises your pelvic floor is not yet able to tolerate

Sometimes doing these things can lead to further dysfunction (aka worsening symptoms, which no one wants!), or simply putting forth a substantial effort with little to no results from all the hard work. Either way, it can be incredibly frustrating to work towards something without seeing the results you want.

When this happens, we just need to re-adjust and focus on finding out what it is we need to be doing to see continued progress! And I am here to help you do just that

How Do You Know What is Too Much?

Quite simply, you will know by working with a Pelvic Health Physiotherapist who will assess your body (including your pelvic floor) and determine what is best for you.

You see, during an assessment we look at the whole body (posture, alignment, movement, range of motion, coordination, strength, tissue health) including a detailed assessment of the pelvic floor. When speaking of the pelvic floor we assess your ability to voluntarily contract and relax those muscles (in other words, can you do a Kegel properly? Can you relax those same Kegel muscles?), the strength and endurance of the muscles, the coordination of your pelvic floor (does it contract and relax when it is supposed to? Is the timing right?), and how supportive it is to the organs above/is there a prolapse present.

Based on this assessment we will guide you and coach you on how to train the muscles of your pelvic floor to work on any one or combination of the following: strength, endurance, power, and/or coordination. We will coach you on how to move and exercise effectively to both improve your overall fitness and health, but also to both protect and improve your pelvic health.

When your body starts making compensations, or symptoms start occurring (incontinence, pain) we know that we have to adjust what we are doing. Common compensations related to the pelvic floor include holding your breath (which can sometimes lead to more pressure on the pelvic floor) and recruiting other, bigger, muscles or strategies, such as using the abdominal muscles, glute muscles, squeezing your thighs together and tensing your upper body.

What this Blog is NOT Telling You

I want to be clear: I am here to work with to ensure you experience success when it comes to your pelvic floor muscle training and training in general. I will help guide and coach you on how to progress your pelvic floor muscle training, chat with you about all the lifestyle and behavioural strategies we can use, and work with strength coaches to ensure you are incorporating physical fitness.

When I say you have to walk before you run, what I am NOT telling you is this:

  • You can only walk for fitness
  • Running is bad for you
  • You can’t workout and train
  • You can’t do most exercises
  • You are not doing as well as you should be or you are not good enough
  • Something is “wrong” with you
  • You won’t get better
  • You are alone in this

No. All of these are NOT true.

You can workout. You might be able to run. You can do most exercises, though some may just need to be modified slightly.

You see, it isn’t so much about what exercise you do, but how you do it. And luckily I work with some amazing strength coaches who are highly educated and skilled so they can ensure you can have a great workout doing things you love that will not only not negatively affect your pelvic floor, but that will help!

You are good enough. Nothing is wrong with you. You will get better. You are not alone.

So many people think that whatever they are dealing with – be it incontinence, pelvic pain, prolapse, weakness – is just going to be their new normal. That they just have to get “used to it”. This is absolutely not the case! Regardless of what symptoms or things you are experiencing know this: it is common, but there is SO much we can do and you will see change. Because you are not alone in this. So many other women experience these same symptoms, and they, along with us are here with you. We will guide and coach you and ensure that you can be your best you.

Remember: it’s not only okay, but it is also necessary to walk before you run. Allow yourself to go through the process instead of rushing to the finish line. I promise, it will be worth it in the end.

Wearing High Heels Could Make Your Incontinence Worse

Wearing High Heels Could Make Your Incontinence Worse

Our pelvic health is so incredibly important to our overall health and thankfully this fact is starting to get more and more recognition with more resources and research focusing on improving this aspect of women’s health.

Pelvic floor dysfunctions such as incontinence, pelvic organ prolapse, pelvic pain and low back pain are incredibly common among women (both who have had children and who have not), but they are NOT normal. In other words, there is SO much we can do to prevent and treat these dysfunctions so you can feel and move your best!

And I’m not just talking about doing Kegels. In fact, did you know that there is so many more factors to consider when it comes to our pelvic health than just training the muscles of the pelvic floor?

One of these factors is what I want to talk about today – a particular habit that can affect how your pelvic floor functions: wearing high heels.

A recent study just published earlier this year looked at the effect of certain ankle positions on the resting and maximal contraction of the pelvic floor muscles. In other words, they looked to see if there was a difference in pelvic floor muscle activity when someone was in a neutral ankle position (ie flat foot), in a plantar flexed ankle position (ie in high heels) or in a dorsi flexed ankle position (ankle flexed up).

So, let’s dive in to the study and see what the effects of wearing high heels are on your pelvic floor!

The rationale for the study:

When looking at urinary continence it is important to understand that the pelvic floor muscles form a major component of what’s called the uretrhal support system. They provide this urethral support by maintaining the constant muscle tone necessary to support the bladder neck and keep the urethral closure closed both at rest and during episodes of increased pressure (such as during a sneeze).

The Pelvic Floor muscles maintain a constant muscle tone that is necessary to keep you continent.

Previous studies have shown us that the activity of the pelvic floor muscles will change based on different body positions or postures, such as sitting, standing, or in varying degrees of pelvic tilts.

Other studies have shown that wearing high-heels will significantly change your biomechanics, posture and the way you walk, and armed with this information this study sought to determine if there would be a difference in muscle activity wearing high heels (ie plantar flexed ankle position) vs in a neutral or dorsi flexed ankle.

The Results

Authors of the study determined that there is significantly more muscle activity in the pelvic floor at rest when the ankle is in a neutral or dorsi flexed position as compared to a plantar flexed position.

This means that your pelvic floor muscles have a better ability to work and support your bladder and to keep you continent when in these positions, versus when you are wearing high heels.

Authors also determined that women had a maximal pelvic floor contraction (aka Kegel) that was much stronger when they were in the neutral or dorsi flexed positions vs in the plantar (high heel) flexed position. In other words, they were able to better consciously contract their pelvic floor when they weren’t wearing high heels.

Why this is important

The results of this study show us that women who experience pelvic floor symptoms such as stress incontinence could experience worse symptoms when wearing high heels due to the decreased support of the pelvic floor muscles in the urethral support system.

This means that women who experience leaking throughout the day could potentially improve their symptoms by opting for flatter shoe choices.

Just another reason to limit the amount of time you spend in high heels and to visit a pelvic health physiotherapist who can help you to ensure that your pelvic floor muscles are functioning as optimally as possible!

Wearing high heels leads to less activity of the pelvic floor which could mean more leaking.

Check out the study, here.

Prolonged Sitting and Low Physical Activity can Increase Urinary Tract Symptoms

At this point most of us have heard multiple messages talking about the importance of daily physical activity and the importance of avoiding prolonged sitting for our health, but more and more studies are coming out showing us just HOW critical these things are in ALL aspects of our health!

A recent study published just four days ago decided to look at the association of sitting time and physical activity level on the incidence of lower urinary tract symptoms.

Results? 

Both prolonged sitting time AND low physical activity level were independently associated with lower urinary tract symptoms. In other words, individuals who sat for long periods of time (even if they were physically active otherwise) had increased symptoms, as did individuals who participated in low physical activity (even if they did not sit for long periods of time).

This is just yet ANOTHER reason to ensure you are including movement and exercise in your daily lifestyle!

How do you do this?

If you are someone who works at a desk all day, find a reason to get up frequently! Use a very small water bottle so you have to get up frequently to go fill it. Take every phone call walking around your office instead of sitting in your chair. Change positions frequently throughout the day. Find what works for you, but get up and move to avoid those periods of prolonged sitting.

And otherwise, work with a coach who can help guide you on how to best incorporate physical activity in to your day!

For link to the study, click here!