Tag: groin pain

Are Kegels Making Your Symptoms Worse?

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By Jenna Jarvis 

Over the last decade, the term “Kegels” has become the standard recommendation and almost promoted as a “cure all” for women dealing with pelvic pain or dysfunction; the assumption being that the pelvic muscles are weak and need to be strengthened. We know that miracle cures rarely exist and as a Women’s Health Specialist, I often cringe when I hear patients tell me they were told to do Kegel exercises by a friend, website, or even a medical provider, without first undergoing an individualized examination to determine whether pelvic floor weakness is the true underlying problem. To be clear, Kegels can be helpful for pelvic floor dysfunctions related to weakness; however, Kegels are not a one-size-fits-all exercise for all women with pelvic floor dysfunction.  

Similar to any other muscle in the body, the pelvic floor can and often has too much tone and recommending generic Kegel exercises for someone who already has too much tone will be like adding fuel to a fire, the symptoms will often worsen! You ready for the tricky part?

Even for women with too much tone, they often STILL have weak pelvic floors, which can lead to signs such as urinary or fecal incontinence, often confusing the patient as to what is the cause. To reiterate, patients can have too much tone in a muscle that is still weak. All muscles have an ideal length-tension relationship. To produce optimal strength and function, they need to maintain a proper length-tension relationship.

So if Kegel exercises are not always the right solution, what is?

Pelvic floor physical therapists have the understanding and training to interpret symptoms, and then examine the pelvic floor, lumbar spine, pelvis, and hips to determine what treatment is appropriate for the patient. If the pelvic floor has too much tone, we must first address this issue via combination of deep breathing exercises, down-training of the pelvic floor, manual therapy of the pelvic floor, biofeedback exercises, etc. If pelvic floor weakness is also an issue, we will prescribe specific pelvic floor exercises based on the patient’s weakness and symptoms. Ultimately, a thorough assessment of the pelvic floor is necessary to target the underlying cause of the patients and create a detailed, individualized treatment plan.

What is Women’s Health/Pelvic Floor Physical Therapy?

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Today’s blog post is from our Women’s Health Specialist and OSSPT physical therapist, Jenna Jarvis. We hope you enjoy and share with your friends.

When I started physical therapy school, I suspected I would likely work in an orthopedic and sports setting; however, I never suspected I would become a Women’s Health Specialist and treat pelvic floor dysfunctions.  In fact, prior to physical therapy school, I did not even know women’s health or pelvic floor therapy existed. People often ask me what led me down this path and why I chose this specialty.  In reality, I didn’t choose to become a Women’s Health Specialist as much as it chose me.

Beginning in my first year of physical therapy school, I started developing a constant, aching pain in the back of my right hip and thigh when sitting for long periods of time while studying or riding in the car while commuting to school.  Not long after, I began experiencing pain with running, my main outlet from the stress of school.  After a few weeks of continued pain, with no help from any of the exercises I “Googled” online and knew from PT school already, I decided to schedule an appointment with a physical therapist for further evaluation.  After a few weeks of treatment, I still noticed only a minimal difference in my symptoms and became quite frustrated with my situation.  I continued consulting with other physical therapists and an orthopedic surgeon, but never found any answers or treatment that relieved my pain.  I started to feel a little crazy, and question whether it was all in my head.  My pain was so intense, I could hardly sit in the car without a cushion and I had to stand in the back of the classroom during lectures.  Most frustratingly, I could no longer run due to the pain being so severe.

Nine months of continued, unrelenting pain later, we had a guest lecturer present about women’s health physical therapy. As I stood in the back of the room (remember the pain was too intense to sit), she presented a case study of a 20 year old female who had pain with running and sitting. As she continued discussing the case, all the symptoms matched mine entirely.  I knew I needed to explore this treatment more.  After class, I talked with the Women’s Health Specialist and she confirmed that, in fact, a lot of my symptoms were common with pelvic floor dysfunctions and that she felt confident she could help me.  To this day, I can still not explain the amount of relief I felt to know that my symptoms, not only made sense, but that a solution was also available as well.  Within the first few weeks of treatment, I already noticed a reduction in pain, returned to some light running, and I could finally sit in class again. Within a few months of treatment, I was at least 95% better and ran my first marathon, qualifying for the Boston Marathon. I finally had my normal life back!

Following my personal experience and success with pelvic floor therapy, I knew I wanted to offer these same services to my future patients.  Knowing that these advanced women’s health treatments were not taught in PT school, I found and attended some of the most advanced and respected pelvic floor and women’s health courses and completed a long term clinical rotation with one of the premiere women’s health specialists in the country treatments women with pelvic floor dysfunctions on a daily basis.  Additionally, I am constantly learning more about this specialty every day.  In my experiences, I am always astonished with how many of patients have lived through years of pelvic and low back pain with no answers before they discovered pelvic floor therapy. Pelvic floor physical therapy is truly my passion and my professional mission is to educate the medical field and the public about pelvic floor therapy and its benefits.

What is Pelvic Therapy/Women’s Health Physical Therapy?

Pelvic floor physical therapy is a common term for a thorough examination, assessment, and treatment of the thoracic, lumbar, and sacral spine, pelvis, and lower extremities and various related physiological systems that could be causing pain or dysfunction. Pelvic floor therapy is also known as women’s health physical therapy, pelvic floor physical therapy, pelvic rehab, or urogynecological physical therapy.  In addition to the pelvic realm, women’s health therapy can also be beneficial for women following breast cancer and radiation treatment to address pain, decreased upper extremity mobility, and other dysfunction related to treatment of cancer.

Who can benefit from Pelvic Therapy/Women’s Health Therapy?

Pelvic and women’s health therapy can be beneficial for patients experiencing the following:

  • Urinary incontinence
  • Pelvic pain
  • Pregnancy and post-partum
  • Bowel incontinence
  • Constipation
  • Fibromyalgia
  • Pelvic organ prolapse
  • Scarring from abdominal surgeries
  • Post-partum- Cesarean section or vaginal delivery
  • Diastasis recti (separation of the abdominal muscles)
What are common signs and symptoms of a Pelvic Floor Dysfunction?
  • Urinary leakage with coughing, sneezing, or laughing (although urinary incontinence is common, it is not normal in any situation)
  • The urge to urinate frequently or a sudden, uncontrollable urge to urinate immediately
  • Waking up multiple times throughout the night to urinate
  • Pelvic, lumbar, thoracic, or lower extremity pain
  • Pain with sitting
  • Pain with sexual intercourse
  • Chronic urinary tract infections
Where does Pelvic Floor Dysfunction Pain Refer to?

Pelvic Floor referral pattern

What can I expect with pelvic floor therapy?

In your first visit, you can expect a thorough examination of your past medical history, eating, drinking, voiding, and sexual habits and how they may relate to your pain or dysfunction. In addition, an examination of the thoracic and lumbar spine, pelvic, and lower extremities will be done to assess any orthopedic dysfunction that could be contributing. Finally, an examination of strength and control of the surrounding musculature will be assessed, which will include an external and possibly an internal examination.  Patient comfort and safety is always my top priority.  I understand that every patient will have differing levels of comfort and we can always modify the examination and treatment to the patient’s preference.

What treatments are used for physical therapy?

Treatment for pelvic floor therapy may include, but is not limited to the following:

  • Pelvic floor, core, and lower extremity exercises and re-training
  • Soft tissue mobilization
  • Joint and spinal mobilization and manipulation
  • Creating a bladder diary to track progress
  • Diet education
  • Behavioral techniques and education
  • Postural and functional retraining

Kegel exercises are specific exercises that focus on strengthening the pelvic floor.  Although these exercises can be beneficial in the right situation, Kegel exercises do not fix all pelvic floor dysfunctions.  In fact, often times Kegel exercises magnify a patient’s symptoms.  Pelvic floor dysfunctions are not caused purely by weakness; they are due to an inability to properly engage the pelvic floor musculature, which can be either over-active or under-active musculature.  This is one of the biggest reasons why a patient cannot simply “Google” their problem and why they need to be individually evaluated by a specialist to determine the true cause of their pelvic floor dysfunction and to create an individualized plan to properly retrain the pelvic floor musculature.

When a patient is experiencing a significant pelvic floor dysfunction it can be debilitating and life altering.  To make matters worse, resources to address these issues are often limited; patients are often initially misdiagnosed and improperly treated.  If you are someone who has been suffering from a possible pelvic floor dysfunction, please do not give up.  I have been in your shoes and I can help.  If you have any additional questions or would like to schedule an evaluation, please call us at (405) 735-8777.