Should I strengthen or stretch my pelvic floor?

                                            Should I strengthen or should I lengthen my pelvic floor?

Great question: 

The pendulum in the pelvic floor world has swung... and its confusing... 

It used to be that anyone and everyone who would need pelvic floor rehabilitation needed "kegels" to learn how to activate pelvic floor muscles in isolation. 

This really helped a lot of people with pelvic floor problems. Having a greater awareness of how our muscles contract, and then strengthening  said muscles after assessing is something as a physical therapist, I can get behind.  

This tidal wave of blanket  kegels kegels kegels, “do your kegels so your vagina stays tight” do your kegels so your organs don’t fall out. Keep your core tight so you don’t have a mommy tummy in combination with all the OTHER stressors of being a parent, or care taker in our world has created some very tightly wound pelvic floors and really  was not considerate of individual differences that exist.

Our profession started to realize that we need pelvic floors to also relax and stretch- move through its full ROM and this was another triumph! Many people helped! Many that were not helped with strengthening alone, could get back life! Amazing! Incredible.

But it shouldn’t end here.

Long before I got into pelvic health I worked in sports medicine.

I helped a lot of people recover and return to sport following various orthopedic surgeries, but mainly knee surgeries and more specifically ACL repairs.  

99% of the time, we started their rehabilitation with the ability to activate their quadriceps (front of legs) , in isolation. The “kegel” of the leg if you will.

Sometimes with electrical stimulation or biofeedback and often not through a full ROM, because they did not have it yet. 

This is not unlike traditional pelvic floor rehab. Using electrical stimulation or biofeedback units to help people learn to contract and relax pelvic floor appropriately through whatever ROM they had available. 

In “ortho world” we would also be encouraging that knee (and hip) to restore it’s full ROM. Lots of stretching and  releasing- and sometimes, those muscles (and the joint)  were freaking tight.

But what if we left it there? At that? A knee that can bend, and a quad that can contract? Good to go? Ready for return to athletics?

I think anyone who’s actually had a knee surgery would agree, that that’s a big no.

Restoring pelvic mobility, hip mobility, gait mechanics, looking at the neuromuscular control of the hip, knee ankle and core in system during functional tasks, managing coordination, length and progressive strength of muscles in the whole body, breathing and core coordination are all essential aspects of an effective rehabilitative program. 

This is not new. We have known this in the rehab world for a long, long time now.  Oddly its getting better, but still seems to be lacking in the pelvic floor world. 

I hope I can continue to be a driving force in our profession inform and educate both individuals and professionals that our bodies deserve comprehensive informed wholistic care EVEN when dealing with issues that involve seem a little taboo , like peeing, pooping, sex, gas, queefs, pregnancy birth, gender affirming surgeries ect

So… to get back to answer the initial question should I strengthen or lengthen my pelvic floor?

 The answer is …. YES... which may not be what you were looking for, but if you are TRULY lost, 

…. You might just need some guidance from a pelvic floor professional to figure out the where the what the why and the how :)