 Whether you’ve never stepped into a gym or are a diehard fitness enthusiast, chances are you’ve attempted a pull-up. That’s a good thing! It’s hard to argue an exercise that is more foundational to upper body strength than the pull-up. That being said, for how much I love this exercise and think it is something everyone should be doing (or at least a type of modification), I treat patients all the time in the clinic with shoulder pain related to the pull-up. Whether it be mobility issues, strength, or poor technique, there are a number of reasons why your shoulder can hurt during or after pull-ups and this article is the first of a two-part series that will teach you how to keep hitting your pull-ups pain-free! Part 1: Mobility First and foremost, let’s take a look at what exactly is happening at the shoulder joint while doing a pull-up. When you raise your arms over your head to get in the starting position for this exercise, your shoulder joint has to do a combination of two movements: flexion and external rotation. If you're limited in any of these two ranges of motion your body will make compensations to get your arm in position, which will eventually set you up for a higher risk of injury. Think of it this way: If your car tires are out of alignment, nothing will happen right away, but eventually there is going to be uneven tread wear and you’ll end up blowing a tire sooner than later. The same can be said for your shoulder if you're lacking requisite mobility with either shoulder flexion or external rotation. The videos below are great ways to test if you have enough shoulder range of motion, as well a favorite drill of ours to improve any range that needs work. 1. Flexion  (Shoulder Flexion Self-Assessment (Performed by Norcal Strength and Conditioning)
(Banded Overhead Opener)
(Thoracic Spine Opener)
2. External Rotation  (Shoulder External Rotation Self-Assessment - Performed by Michael Carroll)
(Chest Opener)
(Front Rack Opener)
To recap, if you have shoulder pain while doing pull-ups, or want to prevent pain from coming, the first place to start is to make sure you have enough shoulder flexion and external rotation to perform the exercise without compensation. Be on the lookout for Part II of this blog post which will dive into the common mechanical flaws and strength imbalances that can lead to shoulder problems with the pull-up. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading,
Dr. Jacob
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 We’ve all seen the outliers: People who are in their 70s, 80s and 90s that just look like they’ve aged better than everyone else. Not only do they seem physically healthier, but they’re mentally very sharp. Early on in my career as a physical therapist, I had the opportunity to work with one such man. His name was Charlie and he owned a mechanic shop in New Braunfels, Texas. When I saw him, he was 85 and was coming in because of some hip pain. I was blown away by how physically active and quick-witted he was. He still worked full time in his mechanic shop with his two sons. The main reason for him coming in was that his hip pain was limiting him when it came to climbing into his deer stand. To make him even more impressive, he was on no medications. He had never had a significant health issue and lived independently. If you’ve been around people in their 80s, being on no medications is incredibly rare in its own right. I ended up working with Charlie for a few months and every time I saw him I picked his brain on life and how he was so healthy and active at his age. Over the course of our time I picked up 4 Key Habits that had contributed to his remarkable physical and mental health at his age. If you want to age like Charlie, stick to these four habits: Habit 1: Move a lot Charlie never did one day of structured exercise in his entire life, except when he was in the Army early in his life. What Charlie did a lot of was move. He started his mechanic shop in his 30s and had been doing that pretty much everyday for 50 years. This is a physical job to say the least, so he had a lot of movement built into his day. He also was a big believer in walking. He would walk 3-5 miles every morning with his dog. You don’t have to exercise much if at all when you move and are active all day long. Habit 2: Have something to wake up for I thought this was a really interesting piece of advice he gave me. He gave me this nugget of advice as he was describing the new computer software they were using for his mechanic shop. In his mid 80s, he was learning a new software program to help his shop run more efficiently. He was so excited about the changes they expected to see with this new change. What I found out was that he loved what he did. He was obsessed with cars and making them run better. He had done what very few people every accomplish. He had matched up his interest in live with how he made his living. He got up early everyday so he could be at his shop to open up and greet the first customer. Constantly trying to improve and having something worth waking up early for really resonated with me. Think about how many people hate their jobs. The internal stress created with hating what you do, yet having to go and do that everyday is significant. Charlie was onto something and it was one of the big reasons for his long term health. Habit 3: Eat like you have Type I Diabetes Charlie’s wife had died about 10 years before I met him. She was born with Type I Diabetes and had lived an incredibly long life for someone born in the early 1900s with Type I Diabetes. Charlie credited the way his wife had the family eat to much of his health. Because his wife had to be very strict about what she ate, the entire family just ate the way she did. There were two big nutrition components to how he ate. First, he ate minimal to no sugar besides fruit. Black coffee instead of with creamer, banana on his oatmeal instead of brown sugar and he never ate desserts. Second, eat nothing white. Charlie explained that his wife would have big insulin spikes when she would eat white bread, rice, or even drink milk. Recent studies have shown that a cup of milk causes the same insulin response in the body that eating a piece of white bread does. He and his wife just figured this out by tracking her insulin response to food. Other than that he ate pretty much whatever he wanted. He was a big fan of the brisket from Rudy’s BBQ which was right down the road from our clinic. He was also an avid hunter and would eat a lot of venison as well. Habit 4: Go to sleep early Charlie swore that going to sleep early was important. To put this in context, he usually got to his shop around 7am and they didn’t open for business until 8am. He would get up around 5am every morning to take his dog on a walk before going into his shop. He would usually go to be by 8:30/9:00pm. That meant he usually was getting about 8 hours of sleep per night. We all know sleep is important. Often one of the most difficult parts of sleep for people is actually getting to sleep at a decent time. Follow Charlie’s advice and start waking up earlier. You do that for a week or two and I’m sure you’ll be ready to go to be once it’s 9:00 or 10:00pm. I know these 4 habits seem simple, and they are. Your health doesn’t have to be complex. There’s also no magic supplement you can take that will give you longevity like Charlie. In an age of Bird Scooters, Amazon delivering your groceries, and having an app for everything, don’t forget the basics. Move often, have something you're excited to wake up for, sleep and eat well. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Remember: If you have a body, you’re an athlete! Thanks for reading, Danny  In the past two weeks, we defined concussions and the signs and symptoms to help identify one. In the final part of this series, we will cover my favorite part: Management and Return to Sport. A study in 2014 showed that in 43.5% of concussion cases, the patient returned to sport too soon and in 44.7% of concussion cases, the patient returned to school too soon. That’s almost every other concussion. Come on, we can do better. Management Let’s build on my previous example about Billy Bob – It’s Saturday, the day after the playoff football game, where he had to sit out after receiving a concussion. He didn’t sleep much. He has a headache, some trouble concentrating, and light sensitivity. What should Billy Bob do next?  Be like J.Beebs and wear sunglasses inside? [twitter.com] In the past, medical professionals would advise staying in a dark room and resting till all symptoms go away. But with more recent research, we see that being in these dark caves and shut off from the world can actually hinder your recovery. For the first 24-48 hours, I do think rest is an important component. But what I would recommend is to try to go about your normal day within your capacity and don’t exceed your symptom threshold. What does this mean in English? Try to work with what you currently have and don’t make it worse. The goal here is to get back into your normal routine as fast, but safely, as possible. Below is a slide from a recent presentation I gave in June at one of our National Physical Therapy Conferences regarding concussion management.  What this basically shows is that there’s a “sweet spot.” Too much rest and/or too much activity can make a concussion worse. We call this graded exposure. This is why understanding your threshold is important and using your symptoms to help guide the process. To better understand graded exposure, I always like to give patients the pool analogy. You don’t want to be in the shallow end and you don’t want to be in the deep end. You want to be somewhere in the middle where you can start causing some stress on your body in order to create positive adaptations. Now, there are many different routes that concussion management and treatment can go. This all depends on the clinical exam and the signs and symptoms the patient is experiencing. I’m going to keep this general in order to provide a 360 degree view of these different options:
These are all areas that Physical Therapists can address and help treat. Return to Play The Concussion in Sport Group (CISG) creates consensus statements for physicians and healthcare providers involved in athlete care every 4 years. Below outlines our most current model from their meeting in 2016 for the concussion return-to-play process.  I also like this integrated model by Complete Concussions below where they combine school and play together to give you a better overall picture of this process.  And, I would be remiss if I also didn’t mention 3 other aspects of health that are very important in this recovery process:  Our best recovery weapons are sleep and nutrition. We have to approach this from a holistic perspective if we expect to have the best outcomes.
I want this article and the rest of this concussion series to serve you as a resource. If you suspect you or someone you know has had a concussion, it’s important to make sure it gets addressed. Concussions are incredibly complex and it takes a team approach to make sure each person gets the best care. At Athletes’ Potential, we have Doctors of Physical Therapy who are able to appropriately screen and assess for concussions as well as offer treatment for the management of this condition. If you have any questions, please call us at 470-355-2106. Cheers, Dr. Ravi  cdc.com Last week, we dove head first into concussions (sorry, I can’t help it), looking at what exactly defines a concussion and what sports populations are most at risk. If you missed it, check out Concussions, Part 1. The interesting part about concussions is that you may not see some signs or symptoms present until minutes, hours, or even days later, which is why I want to equip you with the knowledge to know what to look for in part 2 of this Concussion series. The easiest way to do this is to break it down into acute (sudden/very recent concussion) and chronic (prolonged period of time after concussion) phases. Acute: But first, a story about Billy Bob. So say it’s 3rd and goal with 10 seconds left in the 4th quarter. Your high school team is losing 22-27. This game decides whether your team goes to the state championship. The ball snaps and Billy Bob, the running back, runs towards the goal. He is instantly met by the middle linebacker with a head-to-head collision. Now, it’s 4th down. Billy Bob lays there and struggles to get up. The team Athletic Trainer (AT) runs on the field and finds that he is able to now stand up, but definitely notices something is off. Billy Bob repeatedly assures the AT that he is okay and can play the final play. What do you do as the AT? As the head coach? As the parent? – do you sit Billy Bob out? What about the game? This seems like a no-brainer (again, sorry), but can be a very controversial call, especially when there’s a game on the line. I always go by the rule: “When in doubt, sit it out.” Now, you’re probably saying, “Ravi, quit being a softy and suck it up. There’s a game to win!” But as someone who has personally experienced a concussion, I would say the risk is not worth the reward. Let me explain why… Introducing Second Impact Syndrome (SIS) – This happens when an initial concussion has occurred or not fully resolved and the individual receives another concussion, this time resulting in more severe complications including excessive swelling in the brain. That’s no bueno. If I have you freaked out, don’t worry. This is a rare occurrence, but it can happen. As long as everyone is doing their job, there should be nothing to worry about. And, statistically speaking, most concussions resolve within a matter of 7-10 days. “Can imaging diagnose a concussion?” No. This is a HUGE misconception. Currently, there is no imaging that can effectively diagnose a concussion. Typically, most concussions present as a functional issue, rather than a true structural issue (Think more of how a computer program runs rather than the wires connecting it) which is why imaging is rarely helpful. Signs and Symptoms of a Concussion:   Each concussion can present with different signs and symptoms based on numerous factors (i.e. where the impact was, number of concussions, severity, etc.), which is why every concussion must be evaluated and treated on a case-by-case basis. As you can see above, headache takes the cake for most common symptom. Recognizing these signs and symptoms can be very helpful to make sure no concussion goes undiagnosed. Chronic: Introducing Post-Concussion Syndrome (PCS) – this is categorized as a complex disorder in which symptoms – such as headaches and dizziness – continue to persist for more than 21-28 days after the initial injury. A variety of factors can play into why there are prolonged symptoms:
A team approach is most effective to tackle these acute and chronic concussion cases by utilizing a variety of treatment approaches. Next week, we’ll discuss the final part of this series where we’ll cover management and return to play for concussions. In the meantime, if you have any questions, please feel free to reach out by giving us a call at 470-355-2106 or clicking the button below! Cheers, Dr. Ravi It’s August, which means summer break is over, school is starting back up, and sports are around the corner. This also means the overly-compulsive dads, moms and coaches are on high alert. But come on, everyone loves seeing kids run around the field like little drunk adults.  academy.com As a Physical Therapist and Performance Coach, I always get the question – “do you think my son or daughter should play ‘insert any contact sport’?” This is a loaded question, but 11/10 times I will recommend kids to be active in any way they can. Research has repeatedly shown that physical activity and organized sports contribute to better performance in the classroom, improved growth and development, greater social interactions, and positive long-term health habits. By allowing your son or daughter to take part in sports, there is always an inherent risk of injury. And with contact sports, concussions are always on our radar. You as a parent or coach may have some questions: What exactly is a concussion? How do I know if my son or daughter has had one? Should I keep them locked up in a dark room forever? When is it safe to let them go back to sports? My goal is to answer these questions for you. This article will be 1 of a 3-part series related to concussions and how to get ahead (get it?) of these injuries. Each year, 1.6 to 3.8 million concussions result from sports/recreation injuries in the United States. Sports concussion can affect athletes of any age, gender, or type or level of sport played. While most concussions result in full recovery, some can lead to more severe injuries if not identified early and treated properly. Concussion Rates Per Sport The below numbers indicate the amount of sports concussions taking place per 100,000 athletic exposures. An athletic exposure is defined as one athlete participating in one organized high school athletic practice or competition, regardless of the amount of time played.
 expressnews.com Now, does this mean we need to throw in the towel and keep our loved ones from playing sports? I don’t think so. But context is king, and every individual and situation is different. Is this their first concussion? Did they make a full recovery? These factors and many more go into whether we should let them play. Concussions can be complex and tricky. It’s not like a broken bone or cut, where these injuries can be seen with our eyes. Concussions are internal injuries, which is we must be educated on what they are and the appropriate steps to handle them. So, What's A Concussion?
What Causes A Concussion?
Approximately 90 percent of diagnosed concussions do not involve a loss of consciousness, so it is important to look for signs and symptoms of concussion, which is something we will discuss in Part 2 of this series. Stay tuned! Thanks for reading, Dr. Ravi  Ok, so now that you’ve stepped up to the bar and have set yourself in a good position by following the “3 B’s” (if you don’t know what I’m talking about, see Part 1 of this series), it’s time to safely pick some weight off the floor. There are a number of different nuances you can get into when teaching someone how to deadlift, but for this sake of this post we are going to break the lift into two main parts: First Pull and Second Pull. 1. First Pull: This is where you lift the bar from the ground to your knees. During this part of the lift you should be keeping your spine in a neutral position by having your hips and shoulders rise at the same time until the bar reaches your knees. If you let your hips rise faster than your shoulders then you’ll end up rounding your lumbar spine, and if you let your shoulders rise faster than your hips then you’ll end up over-extending your lumbar spine. Both of those approaches increase the shear forces at your vertebra, which our spines are not designed to handle.  2. Second Pull: Once you get the weight past your knees you are entering the second pull of the deadlift. At this point in the movement your main focus needs to be “bringing your hips to the bar”, meaning your shoulders continue to move upwards as your hips move forward towards the barbell.  So the big takeaway here is that, when you initially starting lifting the weight off the floor, you need to keep your hips and shoulders moving in the same direction, at the same rate, until you get to knee height, and at that point you start to shoot your hips forward as your shoulders continue to rise. Sounds simple enough; right? Well, there are techniques you need to also remember in order to not just perform the lift correctly, but to also keep your back out of harm’s ways.
So there you have it. By utilizing appropriate muscle activation, spinal position, breathing mechanics, and biomechanics, you’ll be able to successfully deadlift with less pain and more weight. At Athletes’ Potential we work daily with barbell and strength athletes, so if you’re struggling with pain while you deadlift and live in the Atlanta area, give us a call or fill out the contact request form below! Thanks for reading,
Dr. Jake  On average 80% of Americans will experience low back pain at some point in their lives and more than a quarter of the population currently deals with low back pain on any given day. Not only do most people have some form of back pain, but it many cases it is the result of poor movement patterns that have been abused for years causing the root of their problem to be both incredibly complex and multifactorial. An exercise once thought to be dangerous (something that has been debunked by a multitude of recent studies), there is arguably no other lift that is more functional than the deadlift. The deadlift is a hinge type movement pattern, which is used every single time you bend over to pick something up off the floor, so you better be efficient with this movement. This article is Part I of a two-part series covering the common mistakes I see in the clinic and will teach you how to prevent low back pain while deadlifting. This exercise can be moderately complex to perform correctly and the number one mistake that I see most in the clinic is a poor set up. There is a lot that goes on to get into this position but by bringing your shoelaces to the bar and remembering the “3 B’s” (Bow, Bend, Blades), most people will be able to get into a solid starting position.
 So in review, to be in a good set-up position you need to “bring your shoelaces under the bar," bow until you feel tension in your posterior chain, bend your knees until you can grip the bar, and engage your shoulder blades. Doing this will get you into a good set-up position, which will protect your low back and allow you to lift bigger weight. Thanks for reading, Dr. Jacob  Strength and flexibility training along with skill practice are usual as we train for marathons, weightlifting competitions, tennis matches and golf tournaments. But have you ever thought about training your diaphragm? What about your pelvic floor? What if I told you there is one major key to training that many folks skip right over? Would you try it? Here is your chance. The diaphragm is a large muscle in the body with direct connections to the lumbar and thoracic spine and ribs. The pelvic floor mirrors the diaphragm- like the younger sibling that mimics the older- and has connections to the pelvis, sacrum and hip rotator musculature. What are the most common injuries and dysfunctions that WE see? Low back, SI joint and hip! “Core strength” is definitely a buzz word in the fitness industry these days. And if you ask 5 people what it means, you are likely to get 5 different answers. So first, let’s talk about the “core.” What is the core? Your core, or the “soda can," is made up of your deep abdominals in the front, back muscles in the back, pelvic floor on the bottom of diaphragm on the top. These muscles work on concert to create pressure on your midline- think a full can of soda that has not been opened. If there is weakness or dysfunction in one of these muscles, then the midline is depressurized- the can has been opened.  So as you run, lift weights, swing a tennis racket or play with your kids, this pressurized can is helping you create torque and move through space with both dynamic stability and mobility. To learn more about this system, check out my blog about pelvic floor anatomy and leaking with exercise. How can I train it? DIAPHRAGM No doubt your diaphragm works; you’re sitting here breathing right? But you can train it to be strong and more effective with your training. A great place to start is the diaphragmatic breath. Not only does this help us work towards full excursion of the diaphragm with a deep breath but it also help relax the pelvic floor. Relaxation of the pelvic floor is just as important and being able to contract it! Try the 90/90 breathing drill and see if you are able to focus on the moving the ribs cage out and up rather than shallow chest breathing. This is essential for control. To add more strength work, try blowing up a balloon in the same position and breathing pattern!  PELVIC FLOOR As far as the pelvic floor goes, I am definitely a proponent of seeking assistance from a women’s health PT before starting specific strengthening programs. They can give you a better idea of what YOUR body needs- strength, endurance, relaxation. But a great place to start is imaging creating controlled amounts of tension through your pelvic floor. This can be cued for most folks as avoiding passing gas or gently stopping a stream of urine. (Don’t ever actually stop your stream of urine, this is just a cue for a gentle contraction.) So this contraction should be as intense as the activity that you are performing. Lifting a pencil would be perhaps a 2% contraction, where lifting a heavy couch might be closer to 100%. This sliding scale applies to both pelvic floor and abdominal contractions. Only as much tension as needed for the task! How does posture relate? Going back to the soda can analogy- can you picture how bad posture is equivalent to having dented and bent my soda can? Not idea for keeping that pressurized cylinder! An easy example for this is running. If you have the “grandma lean” from the hips rather than the ankles, your can is bent. These folks tend to have back issues with running, perhaps some leaking and dysfunctional breathing. Straighten up the can and breaths are less challenged and your back feels better!  Summary:
If you are dealing with back, hip, pelvic pain with activity try some of these strategies. This can also improve your breathing and postures/form with fitness. This merely scratches the surface but may stimulate some ideas about what is holding your training back. After you try these, if you are still having issues or questions, come see us! We love to help people like you get back to doing what they love and living a high functioning, pain-free life. Thanks for reading, Dr. Jackie  Youth sport participation is growing around the globe, and the increasing trend is to have youth athletes specialize in one just one sport. With the goal obviously being to maximize a kid’s potential to play in college/pros/olympics, parents are having their kids spend 20+ hours working on very specific skill sets, going to countless camps, and squeezing out every last opportunity by playing on multiple teams in a single season. On the surface, it's easy to see why parents would think this… ”to get better at basketball, play more basketball." However, let's take a deeper look as to why this may not be not be the best (nor safest) route to making your kid the next Michael Jordan. Playing multiple sports makes you more competitive Weather your goals are set on college or the pros, top recruiters are looking for the most competitive athletes they can find...regardless of sport. Want to play baseball? Check in to what Scott Upp, the leader of a baseball program that has been ranked as high as number one in the country and has more than 35 IHSAA sectional baseball championships, has to say. “If there are coaches out there that are telling kids to play one sport, I think they’re crazy,” Upp said. “Because while you’re working on drills and everything else like that, he’s out competing...running from 6’2”, 280-pound linemen. He’s trying to get away and make plays. So he’s competing, and you can’t really substitute that. And basketball, with time winding down, he’s got the ball in his hands, he’s learning how to compete. And all those things that happen in other sports just make him that much better in baseball.” What about soccer? Abby Wambach, a member of the 2015 US Women’s World Cup team, is known is the best header in sport history, and guess what she attributes her success to...basketball. “Playing basketball had a significant impact on the way I play the game of soccer," Wambach said. "I am a taller player in soccer, in basketball I was a power forward and I would go up and rebound the ball. So learning the timing of your jump, learning the trajectory of the ball coming off the rim, all those things play a massive role." In fact, when the 2015 Women’s World Cup Champions were surveyed, they had collectively competed in more than 14 different sports growing up in addition to soccer. Dreams of playing in a College Football National Championship Game? Clemson’s Head football coach, Dabo Swinney, who continuously has his team in playoff contention and won a national championship in 2016 famously recruites multisport athletes and had this to say about them. “I just think that the cross-training, the different types of coaching, the different types of locker rooms, the different environments that you practice in, the different challenges — I think it develops a much more competitive, well-rounded type person” Playing multiple sports makes you more athletic  This one gets a little touchy...your kid has the best hands on his middle school football team, so naturally he needs to go to every SEC camp available and work year-round to improve his route running; right? Or, your daughter is the tallest on her 7th grade volleyball team so of course she's going to play year-round club volleyball to perfect her swing; right? Sure...practicing a skill is important, but the data doesn’t lie and improving overall athletic ability trumps all. Demarco Murray, one of the most decorated running backs in Oklahoma who also led the NFL in rushing yards in 2014, didn’t seal his fate with Oklahoma until the coach watched him dunk a basketball during a game. Sam Bradford played basketball, football, golf, and hockey all throughout his high school and then went on to be a heisman trophy winner and number 1 overall NFL draft pick. In fact, 91% of the athletes drafted in the 2018 first round of the NFL played multiple sports in high school and 96% of the players who played in last years superbowl were multi-sports athletes! However, the impact on athletic development goes well beyond the NFL and football. For example, a study in the American Journal of Sports Medicine looked at first found draft picks from 2008-2015 and found that athletes who played multiple sports in high school played in more NBA games, had a lower significant injury rate, and had more longevity in the spoty. The exposure to different athletic and movement demands, especially as an adolescent has been well documented in countless studies to have a strong carry over effect into your primary sport. The reason is simple, when you limit yourself to a single sport at a young age, the lack of diversified activity may stunt neuromuscular control development, leading decreased overall athletic ability. Playing multiple sports decreases your risk of injury.  I’m a doctor of physical therapy, so I may be a little biased, but I’ve saved the best for last as a reason for playing multiple sports as a youth athlete. I don’t care how skilled your kid is, how physically gifted they are, they will never reach their full athletic potential if they can’t stay healthy and on the field and specializing into one sport has been shown time and time again to increase your risk of injury. Think about this, only 65% of athletes report returning to their previous level of play 1 year after an injury and up to 20% of elite athletes say an injury is what caused them to stop playing their sports. When you specialize into a single sport at an early age you’re risking increased exposure to repetitive technical skills and high risk mechanics, Over-scheduling leads to decreased time to recover from competition and early psychological burnout, all of which have demonstrated to statistically increase your risk of injury. So in review, let kids be kids. Don’t force their hands by specializing at an early age. Let them become a more competitive, athletic, and healthy athlete by playing in multiple sports. Thanks for reading, Dr. Jake First things first, let’s clear up the pronunciation of the name. It’s kegel- as in “bagel” with a K. Kegels were named after Dr. Arnold Kegel who performed research on the pelvic floor after child birth. Just a fun fact—Thanks, Tracy Sher! Kegels are contractions and relaxations of your pelvic floor with the goal of strengthening those muscles. Ok, now that we cleared that up, the true debate is: To Kegel or Not To Kegel? Many post-partum patients have told me that after the birth of their child, they are never given instruction or care past “perform kegels daily” to address their pelvic floor. They are never taught or checked to be sure they are performing them correctly! You can only imagine the frustration when they learn there is more to the puzzle. Especially after years of leaking with exercise, painful sex or other related symptoms. Others, who may or may not have given birth, read in magazines that the best way to “stay healthy down there” and “please your partner” is by performing kegels daily.  The full spectrum of pelvic floor movement is contraction, relaxation, and bulging. It is important that we maintain all of these functions for optimal strength, control, and length of the pelvic floor. The popularity around kegels emphasizes the contraction and strength part. It seems that women think they tighter and harder they can squeeze, the better. This is true for certain situations- think sneezing. But it is also important to be able to relax the pelvic floor fully. Re-lengthen before we strengthen For much of the active population, pelvic floor over-tension is a problem. For these women, we want to focus less on the contraction and more on the relaxation and lengthening. Once full relaxation and length is achieved, THEN kegels are needed to strengthen in the new range of motion achieved. Strength comes in many forms- quick bursts, endurance, holds, etc. These are exercises specific to YOUR needs and deficits that a pelvic floor PT will prescribe to you. There is also a piece to the puzzle of timing of the pelvic floor contraction. Look back to a blog I wrote about 7 Habits That May Be Stressing Your Pelvic Floor to start addressing these issues now. How are you performing a kegel? Remember how we said a kegel is a pelvic floor contraction? Well, all of these muscles are deep so if I can SEE you performing a pelvic floor contraction, you’re doing too much. Sometimes it is hard to know what you are squeezing in the nether regions. Is it pelvic floor? Is it my glutes? Am I just squishing my legs together?  The easiest way to know if you are performing a kegel correctly—see a women’s health PT and learn!
So, to kegel or not to kegel? It depends! The best place to start - regardless of age, sexual activity, pre or post-partum - is to see a women’s health (aka pelvic floor) physical therapist. We can help you with a plan to decrease pain, improve function, and stay active without you having to guess what is right for you and if you are performing contractions correctly. Thanks for reading, Dr. Jackie |
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