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When to Strengthen and When to Lengthen
The most common question I get in Tabu Office Hours, in clinic, and even in the comments from the very first post on @hey.dr.heidi is for my #1 pelvic floor tip. This is difficult without an evaluation - or at least more information about an individual’s case - as we don’t know a starting point for treatment.
Sometimes we need to start by lengthening the pelvic floor tissue. If a patient presents with any vaginal or pelvic floor pain, any difficulty with insertion (menstrual products, sex, etc), incontinence, difficulty getting speed or power with kegels I am going to recommend starting with lengthening activities first.
Pelvic floor muscle lengthening is needed for functions of peeing, pooping, vaginal penetration (sex, OBGYN exams, menstrual product insertion, dilator training, etc) as well as rectal penetration (sex, exams, etc). (biceps video clip)
Stretches for the muscles and fascia tied to the pelvic floor, breathwork, dilator training, or use of wands such as the Tabu Nuri or Intimd/Vwell’s Flex are all great places to start.
Please watch the October Tabu Office Hours video for a full run-down of my “how to get started” recommendations for lengthening.
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Pelvic floor strengthening is appropriate when pain isn’t an issue. Strengthening is needed for incontinence management, supporting our core stability and for fall risk reduction and balance.
The method I follow for most patients is to first develop neuromuscular connection (i.e. the brain-body connection), then to put the pelvic floor muscles back into the full muscular system. (video clip “Biceps curl then plates back into the cupboard.”)
I teach kegels in isolation through antigravity (hips elevated), gravity neutral (flat on back), and then gravity loaded positions (sitting and standing). I then teach patients how to put the muscular activation of the “kegel” back into the muscular system with full body exercises and functional movements. I love the Perifit Care+ home biofeedback device for patient’s home exercise programs and is what I use for my own rehab as well.
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Once again, please watch the October Tabu Office Hours video for a full run-down of my “how to get started” recommendations for strengthening.
Questions that have been asked within the safe-space created within the Tabu Office Hours have been one of the biggest inspirations for creating this community. I hope that you enjoy the videos as much as I enjoyed teaching within them.
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