A common misconception seen frequently in the pelvic floor world is, “my doctor told me my pelvic floor muscles are really tight, so why do I need to do strengthening or kegels?”
The purpose of the pelvic floor is to stabilize the base of the core as well as provide support for the bladder and internal organs to hold them suspended in place. When the pelvic floor is not operating as it should, this can result in decreased ability to support the bladder particularly when doing activities that increase pressure on the pelvic floor (like squatting, coughing, jumping, and laughing). This can result in symptoms such as bladder leakage or prolapse.
When any muscle (including pelvic floor musculature) is stuck in a too tight (shortened) or overstretched (overlengthened) state, it is not able to generate as much muscle strength and power as it does in its optimal state. This optimal state lies in the middle between too tight and overstretched, and the relationship between muscle length and strength is called the muscle length-tension relationship. The alignment of the pelvis also influences this relationship because any asymmetries in the pelvis can contributed to the pelvic floor muscles being too stretched or too tight based on where they attach to the pelvic bones. Our goal is to get the pelvis back into symmetrical or neutral alignment before training the muscles to be stronger, because having them at the proper length will make kegel exercises more effective. Proper alignment will give the muscles the best chance of achieving their maximal strength, while also retraining the pelvis to maintain this neutral alignment rather than continue to revert back to its previous asymmetric position.
In addition to impaired strength, many patients also experience pain or irritation within the pelvic floor muscles when they are too tight. This may cause trigger points or knots that may translate to painful intercourse and even a sensation of feeling like “hitting a wall” when penetrating the vaginal opening with an object as small as a tampon. Often for these patients, an important piece of therapy in addition to strengthening is training to decrease the resting tone or tension of the pelvic floor muscles. This may involve breathing techniques, use of biofeedback or internal myofascial release, or use of pelvic floor dilators to facilitate the muscles’ ability to fully relax at rest and only contract when we want (or need) them to. This also allows kegels to be more effective, because the patient can feel the pelvic floor lifting through its full range of motion rather than contracting and releasing within its smaller, tighter, range of motion. By training the muscles to fully relax and fully contract on command, this improves patients’ ability to control their bladder and pelvic alignment as well as limit potential for back pain and injury with any activity, whether it be as strenuous as weight lifting or seemingly simply as squatting to lift a laundry basket.
Here at Synergy, we can help you determine whether you may benefit from pelvic floor rehab. Set up an appointment today to help us get you a strong and healthy as you can be.
