Kegel Exercises: Finding the Best Position for Your Pelvic Floor Training

What is the best position for Kegel exercises?

There isn't one single "best" position for Kegel exercises; rather, different positions offer unique advantages for isolating, engaging, and progressively challenging the pelvic floor muscles. The optimal position depends on an individual's current strength, body awareness, and the specific goals of their training.

Understanding Kegel Exercises

Kegel exercises, also known as pelvic floor muscle training (PFMT), involve consciously contracting and relaxing the muscles that form the floor of the pelvis. These muscles support the bladder, bowel, and uterus (in women), playing a crucial role in urinary and fecal continence, sexual function, and core stability. The effectiveness of Kegel exercises hinges not just on performing them, but on performing them correctly, which includes proper muscle identification and technique, often facilitated by specific body positions.

The Principle of Progressive Overload in Pelvic Floor Training

Just like any other muscle group, the pelvic floor responds to the principle of progressive overload. This means gradually increasing the challenge over time to stimulate adaptation and strength gains. Different body positions alter the influence of gravity on the pelvic floor, thereby changing the demand placed on the muscles.

• Gravity-Assisted Positions: Reduce the load on the pelvic floor, making it easier to isolate and feel the contraction. Ideal for beginners.
• Gravity-Neutral Positions: Offer a moderate challenge, suitable as strength improves.
• Anti-Gravity Positions: Increase the load, requiring more strength and control. Essential for functional integration of pelvic floor strength into daily activities.

Optimal Positions for Beginners

For individuals new to Kegel exercises or those struggling to identify their pelvic floor muscles, positions that minimize the effect of gravity are highly beneficial.

• Supine (Lying on Your Back)

  • How to do it: Lie on your back with knees bent, feet flat on the floor, hip-width apart. Your spine should be in a neutral position, not pressed flat into the floor. Place your hands gently on your lower abdomen to ensure it remains relaxed.
  • Benefits: This position allows gravity to assist in supporting the pelvic organs, reducing the demand on the pelvic floor muscles. It promotes relaxation of surrounding muscles (glutes, thighs, abdomen) making it easier to isolate the pelvic floor for contraction and relaxation. It's an excellent starting point for learning proper muscle identification.

• Side-Lying

  • How to do it: Lie on your side with knees bent and a pillow between your knees for comfort and spinal alignment. Ensure your head is supported.
  • Benefits: Similar to supine, side-lying positions reduce gravitational load, aiding in muscle isolation and relaxation. It can be more comfortable for some individuals, especially those with back pain or during pregnancy.

Intermediate Positions for Enhanced Engagement

Once comfortable identifying and contracting the pelvic floor muscles in gravity-assisted positions, progressing to more challenging positions can further strengthen and functionalize the muscles.

• Sitting

  • How to do it: Sit upright on a firm chair, feet flat on the floor, hips and knees at 90-degree angles. Ensure your back is supported, maintaining a neutral spine. You can also try sitting cross-legged on the floor.
  • Benefits: Sitting introduces a moderate gravitational challenge, requiring the pelvic floor to work harder against gravity to maintain support. It's a practical position, allowing for discreet practice throughout the day, integrating the exercises into daily life.

• Standing

  • How to do it: Stand tall with feet hip-width apart, knees slightly soft, and a neutral spine. Avoid locking your knees or tilting your pelvis excessively.
  • Benefits: Standing is an anti-gravity position, significantly increasing the challenge on the pelvic floor muscles. This position closely mimics the demands placed on the pelvic floor during daily activities like walking, lifting, or coughing, making it crucial for functional strength and continence.

Advanced and Functional Positions

For those with established pelvic floor strength and control, incorporating Kegels into more dynamic and functional movements can further enhance their utility and integration.

• Squatting/Deep Squat

  • How to do it: Perform a bodyweight squat, lowering your hips towards the floor as if sitting in a chair. Contract your pelvic floor as you descend or ascend, or hold the contraction at the bottom of the squat.
  • Benefits: This position integrates pelvic floor activation with major lower body movements. The deep squat also helps to stretch and lengthen the pelvic floor muscles, which is important for flexibility and release, in addition to strength. It is highly functional for activities like lifting and transferring.

• Quadruped (Hands and Knees)

  • How to do it: Start on your hands and knees, hands directly under shoulders, knees under hips. Maintain a neutral spine.
  • Benefits: This position can be useful for individuals with specific pelvic floor dysfunctions, as it allows for a different gravitational vector and can facilitate core engagement. It can be particularly effective for targeting different aspects of pelvic floor activation.

Key Considerations for Effective Kegel Execution

Regardless of the position chosen, several core principles remain paramount for maximizing the effectiveness of Kegel exercises:

• Proper Muscle Identification: Ensure you are contracting the correct muscles. Imagine stopping the flow of urine or preventing the passage of gas. You should feel a lift and squeeze inside.
• Isolated Contraction: Avoid engaging the glutes, abdominal muscles, or inner thighs. These accessory muscles should remain relaxed.
• Breathing: Breathe naturally throughout the exercise. Do not hold your breath, as this increases intra-abdominal pressure and can be counterproductive.
• Relaxation Phase: The relaxation phase is as crucial as the contraction. Fully release the muscles between repetitions to prevent fatigue and promote blood flow.
• Consistency: Regular practice is key. Aim for multiple sets of contractions and relaxations daily.
• Progressive Challenge: As your strength improves, increase the duration of contractions, the number of repetitions, or the difficulty by performing them in more challenging positions (e.g., from lying to sitting to standing).

When to Seek Professional Guidance

While Kegel exercises are generally safe, incorrect technique can be ineffective or even harmful. If you are unsure about proper technique, experience pain, or have persistent symptoms related to your pelvic floor, consult with a healthcare professional. A pelvic floor physical therapist is specially trained to assess pelvic floor function, provide personalized guidance, and ensure you are performing the exercises correctly and effectively for your specific needs. They can also use biofeedback to help you visualize and understand your muscle contractions.