tightness = weakness, kegels

[popburner]

In talking with my new PT (Maryland), she reminded me of something I've known to be true form my years as a personal trainer. Often, when there is muscle tightness, it is due to the "overworking" of the muscle because it is weak, and is being used too much for what it can handle. She did something very interesting with me, she had me do a Kegel and she (and I after she held up a mirror) could tell that my right pelvic floor is strong, and my left pelvic floor BARELY moves when I contract. Interestingly enough, 90% of my tightness is on my left side! She explained to me that over and over again she hears that people with pelvic pain are scared to do kegels because they will exacerbate pain...yet her point is it is more complex than that. Releasing is one thing, but to keep it released the muscle must be strong enough to avoid having to strain (and TIGHTEN) to keep up. She is suggesting kegels with a mirror for me to try to even out the left and right side. That is combined with RELEASE and STRETCHING, as we want them strong, but through the FULL range of motion, not a shortened part....

This is an interesting detail to the Kegel or no Kegel argument, as well as an insight into other ways to approach releasing those tight muscles.

ALL THE BEST!

[boulder]

Can you really see the movement of your pelvic floor from the outside though? I know kegels, and personally stay the heck away from them (I was doing them when my chronic prostatitis / chronic pelvic pain syndrome came on/got worse), but I'm curious. Could you explain more about what you're doing? My tightness is also asymmetrical, I think.

[ramana]

This is the same that one PT told me. But not in so many words. Basically the muscle has to go through FULL range of motion.
I did not understand how you can do Kegel and detect the movement of the pelvic floor using a mirror. I have the same asymmetry - left is painful and does not go through the full range of motion as the right. I became better after exercising (insert a finger then squeeze / release / push) but it is not easy to tell if that affected the pain directly.

[popburner]

If you do a Kegel you will see your testicles pull up slightly - my right testicle jumps up, while my left one just hangs there (unless I concentrate on pulling it up two - even then it doesn't do much!). Also, you can watch the perineal body and see if it dimples in slightly - the left and right side should move together. Again on me my right side moves in and my left just sits there. I'm going to try this for a week or two and see how it goes - I'm worried about creating extra tightness, though she said as long as I keep releasing it, it should be fine. She said the goal is to get it back to the balance it is supposed to have, not just to a weak and loose state, because then upon any major use it will jump back to tight...Interesting stuff :)

[boulder]

Hmm... I'm still scared of kegels, but let us know how it works for you. I guess the trick is how do you do a one-sided Kegel that doesn't strengthen the already-too-strong side? The way the PC/pelvic floor is put together, it would seem really difficult to isolate and contract just one side (I think the testicle movement you're seeing could be an example of that- couldn't that be the cremaster muscle getting involved?)- Maybe if one side were immobilized by Botox or something...

I would strongly advise people not to do kegels unless they and a highly qualified PT are closely monitoring the situation, but, of course, I'm not a PT or a doctor or anything. Good luck, and be careful!

Edit: On second thought, I guess movement of the testicles wouldn't have to be the cremaster, but it does kind of illustrate how difficult it can be to tell which muscle or muscle group is doing what...

[popburner]

I think her pov is that I shouldn't be worried about strengthening the right side (strong side) more (all of my tightness is in the left), but instead the focus is on training it to contract as a unit instead of only on the right - leaving the left side to make up for it's weakness by TIGHTENING up. I'm going to email tim sawyer and see what his thoughts are on this :)

[popburner]

Emailed with Tim and he said that Kegels are fine and potentially useful as long as they are done with biofeedback (mirror/finger) and only moderately (he said the problem is a lot of people do 100s a day and that tightens things up). He also said it is key that trigger points have been eliminated first and that Kegels are followed by stretching of tightened area.

[superuse]

It always seems that the left side is worse than the right 3:1 or more. I forget if Dr. Wise or another source had an explanation. Perhaps if you are right handed, the left is worse, and if left handed, the right is worse.

. Interestingly enough, 90% of my tightness is on my left side! She explained to me that over and over again she hears that people with pelvic pain are scared to do kegels because they will exacerbate pain...yet her point is it is more complex than that.
This is an interesting detail to the Kegel or no Kegel argument, as well as an insight into other ways to approach releasing those tight muscles.

ALL THE BEST!

[popburner]

oh, but I'm left handed :)

[boulder]

a lot of people do 100s a day

Oh boy, was that ever me in summer 2005, when I first started getting a hint of dribbling after urination and convinced myself I was becoming incontinent (catastrophic thinking, anyone?): Threw myself into a regimen of several hundred kegels and crunches a day (this, from someone with- at the time- a very sedentary lifestyle)! If I'd known then what I know now... ah, but that's the way the cookie crumbles. It's quite ironic to think that kegels- under correct supervision, for the correct patient, at the correct time- could be a part of of the healing process! But it makes sense and I'm happy to hear it. You Kegel-ers out there, make sure you've got a good PT monitoring you, and keep us posted on your progress!

[neue01]

This is a pretty interesting idea and I'm very interested to know if it pans out.