What if I told you that kegels alone aren’t always the answer for all your postpartum woes? I know, I know.  Your obstetrician said it would fix your leaking, pelvic pain, back pain, eliminate wrinkles and ward off gingivitis.  Yes, I am being snide, but the truth is the kegel has long been hailed by doctors, and even mainstream media outlets targeting women, as the catchall fix to keep our lady parts fine-tuned.

With more than half of postnatal women experiencing long-lasting side effects from child-bearing, a one-size-fits-all approach would be convenient, but the body is much more complicated and requires a comprehensive approach.  

Cosmopolitan Magazine

“We need to be looking at the system as a whole.  The body is a machine, and just like a machine, all parts need to work in unison for it to be functioning,” said Julie Wiebe, a physical therapist who specializes in sports medicine and women’s health.  “If one part of our system isn’t doing its job, another part of the system will pick up the workload—working overtime—and this compensation presents itself as dysfunction within the body.”

Dysfunction can appear in a variety of forms with common postpartum issues presenting as stress urinary incontinence (leaking urine with running, jumping, sneezing, etc.), pelvic organ prolapse, diastasis recti, back pain, vaginal pain, fecal incontinence, and a variety of other issues.  These “breaks in our system” commonly come to light postpartum, as the body has been taxed throughout pregnancy and childbirth, and then given the added demands of motherhood before core connection is restored.

Here is a prime example.  You recently had a baby and as a result you lost the connection with your deepest abdominal muscles and glutes (common occurrence after pregnancy).  You still need to lift the stroller, carry the baby, bring in the groceries, and do all the things moms need to do in a day.  Your body compensates for this weak core support, still seeking to get the task at hand done.  Compensation often looks like gripping or bearing down, creating intra-abdominal pressure that places strain on the pelvic floor.  This compensatory movement becomes the body’s new norm. The result?  Well, you may experience any of the aforementioned postpartum woes, or even discomfort or pain in other unassuming areas of the body.

(Watch this video to understand more about how this intra-abdominal pressure puts strain on the pelvic floor)

Julie wasn’t always an authority on women’s health, but she saw the same scenario time and time again in her sports medicine practice.  A mother would come in complaining of shoulder pain, knee pain, back pain, you name it…and more often than not, the true root of the problem was a disconnect with the core and pelvic floor.

“I kept seeing it in my clinic.  I would treat a woman for her shoulder, but really what it came back to was that she never recaptured the connection with her core postpartum. It was the missing component in so many of my female patients,” Julie said.  “I was trained in sports medicine, but realized when treating patients that a lot of their injuries are coming from not restoring their central foundation after pregnancy.  That’s the true culprit.  Women were coming to me and wanting to be fit again…to do what they love.  They didn’t want to have to stop. It became my job to equip them with strategies so they could function better and continue to do what made them happy.”

Strategizing is precisely the overarching philosophy behind Julie’s work and teaching.

“It takes strategies versus a set equation.  You can’t simply say X + Y= Z and your problem is fixed.  Don’t we all wish it were that easy,” Julie said.  “But one-size-fits all doesn’t exist in women’s health.”

A 2007 study by Michelle D. Smith, Michel W. Coppieters, and Paul W. Hodges, entitled Postural Response of the Pelvic Floor and Abdominal Muscles in Women With and Without Incontinence, demonstrates the need for an integrative approach to women’s health—not simply the one-fix kegel solution so many physicians prescribe.

Using pelvic floor electromyography (EMG), researchers monitored the pelvic floor response when a woman caught a weight that was dropped into a bucket they were holding.  Groups were split amongst severely incontinent, mildly incontinent, and continent women.  Contrary to the researcher’s prediction, pelvic floor EMG was greater in women with incontinence compared to continent women. Similarly, external oblique activation was greater in women with incontinence.  Simply put—women with the most severe incontinence activated their pelvic floor muscles and external obliques (side abs) the most. It can be seen that strengthening the pelvic floor alone, as is the task of the kegel, would do little to help these women with their stress incontinence.

The data from this study lends itself to what Julie has long been teaching. The body needs to work in unison to have proper function.  This means learning to use the diaphragmatic breathing, core activation and pelvic floor muscles in unison, and this is best accomplished by reestablishing neuromuscular connection.

“Strengthening our pelvic floor only gets us so far. We have to retrain the the brain.  It is neuromuscular,” Julie said. “We need neuro-based strategies instead of telling women they simply need to get their pelvic floor stronger.  If we can get the neuromuscular response stronger, then we can look at strengthening the muscles next. ”

As the study highlights, “the findings challenges the clinical assumption that incontinence is associated with reduced pelvic floor muscle activity, and suggests that training control and coordination of abdominal muscle activity may be important in treatment of this condition.”

Overtime, this neuromuscular connection becomes second nature.

“The comment I get most is that women report feeling more grounded or centered [after treatment]. Women know something is off after they’ve had a baby, but they just don’t know what.  There is help. It all starts in the brain. Early results are in the brain.  Strength comes after the strategy,” Julie said.

Julie has some excellent online courses.  Check out her website, and if you purchase a program before December 8, she is offering 20% off using the code STRATEGY.  It is a super affordable foundation to learning to move better, breathe better, and live better!


Julie Wiebe, PT