Kegel Exercises: Get With The Program!
The problem with most D.I.Y. (Do It Yourself) pelvic floor exercise regimens is the same issue with any activity done without proper guidance—compliance—sticking with the plan and seeing it through long enough to reap meaningful results. In order to D.I.Y., you need some real sitzfleisch (my new favorite word)—literally "sit on your flesh"—staying power and perseverance. And if your program ain't working, your sitzfleisch is going to rapidly peter out.
One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs. Being handed a pamphlet suggesting a several-month program of 10 Kegel muscle contractions squeezing against no resistance three times daily during down times—for example while stopped at a red light in your car—simply does not pass muster! These inadequate programs lack guidance, training, direction and the feedback to confirm the engagement of the proper muscles. It is not surprising that if you undertake one of these ineffective pelvic floor muscle exercise regimens, you will more than likely ultimately abandon them.
The bottom line is that you will be unlikely to commit to an ineffective regimen, and any regimen will be ineffective unless it is a well-designed program that adheres to the tenets promoted by Arnold Kegel, the namesake of pelvic floor muscle training. Kegel's principles that are imperative to adhere to are the following: muscle education, biofeedback, progressive intensity and resistance.
Muscle education is an understanding of your pelvic floor muscle anatomy and function and precisely where in your body that these muscles are located. This will permit you to develop muscle memory—the development of the nerve pathway from your brain to your pelvic floor muscles, a.k.a. neuromuscular education in medical lingo.
Feedback is a means of confirming to you that the proper muscles are being exercised, important since studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually squeezing other muscles, typically the rectus (abs), gluteal (butt) and adductor (thigh) muscles. With respect to the male gender, most men have not a clue as to where their pelvic floor muscles are, but also what their pelvic floor muscles do, how to exercise them, and what benefits they confer. In fact, many men don't even know that they have pelvic floor muscles.
Progressive intensity is an escalation of the exercise magnitude and degree of difficulty over time. In a graduated fashion, you increase repetition number, intensity of contraction and duration of contraction. This progression is the key to increasing your pelvic floor muscle strength and endurance. Additionally, it allows you to measure and monitor you progress by witnessing your increased capabilities over time.
Resistance adds a new dimension that further challenges the growth of your pelvic floor muscles. Working your pelvic muscles against resistance rapidly escalates their strength and endurance, since muscle growth occurs in direct proportion to the demands and resistances placed upon them, a basic principle of muscle physiology.
Dr. Kegel recognized that the process of pelvic floor muscle strengthening advances in phases starting with awareness of the pelvic muscles and slowly and progressively proceeding to muscle regeneration and ultimately restoration.
As a physician, I see many female patients who have tried Kegel exercises and report that they did not help the problem they were trying to improve. However, on examining them and testing the strength and integrity of their pelvic floor muscles, they are often found to be contracting the wrong muscles! On questioning them on their regimen they often relate that their gynecologist had at some time given them a single page handout detailing how to perform Kegel exercises.
NO, NO, NO!…this simply will not do. One needs to GET WITH THE PROGRAM and receive the proper training to make these exercises meaningful and purposeful. The vast majority of those who try Kegels do not use a program that provides the precise wherewithal to isolate and exercise the pelvic floor muscles in a progressively more challenging fashion. It's the equivalent of giving someone a set of weights and expecting them to pursue a weight training regimen without giving them the exercise routine and supervision to go along with the hardware, dooming them to failure!
For pelvic floor muscle strengthening to be effective, it is critical to use a well-crafted, progressive instructional routine with the ultimate incorporation of a resistance device. This is now available for men with the release of PelvicRx® Pelvic Exercise Program For Men, and the program for women is in the works. Do it right or don't do it… In order to do it right, you need to get with the program!
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