A Pelvic Floor PT On The Anti-Kegel Trend

“Never do Kegels” might be the most shareable pelvic floor advice online and it can also be one of the most misleading. We’re digging into the anti-Kegel trend and why it frustrates us as clinicians who care about evidence-based pelvic floor physical therapy, especially for pregnant athletes, postpartum moms, and anyone dealing with stress urinary incontinence.

We walk through how pelvic floor rehabilitation got so “squeeze” focused in the first place, and why the backlash makes sense emotionally. Then we get specific about what the research actually supports: pelvic floor muscle training has some of the strongest and most consistent data in rehab, and blanket statements like “nobody needs Kegels” erase the reality that many people do improve when training is prescribed well.

We also unpack the viral EMG argument. Yes, planks and bracing can light up the pelvic floor as part of the core canister, but activation is not the same thing as an intervention that reliably stops leaking with coughing, sneezing, or jumping. That’s where specificity matters: sometimes you need the pelvic floor to work as part of the whole system, and sometimes you need to be able to contract and coordinate it in isolation, on demand, in real life.

If you’re tired of clickbait rehab and want practical, nuanced pelvic floor guidance you can trust, listen through and join the conversation. Subscribe, share this with a training partner, and leave a review so more people can find evidence-based postpartum and pelvic floor health info.

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Transcript

Welcome And Medical Disclaimer

SPEAKER_00 0:28

We want to talk about the lovely company among the loved access. Whether you are a creational access monitor or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're going to talk about fertility, creativity, and post-partism topics that are relevant to the active individual. While I am a public floor physical therapist, I am not your public floor physical therapist, and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together at a kid. Hello everyone, and welcome to the Barbell Mamas podcast.

Why Anti-Kegel Posts Spread

SPEAKER_00 1:13

Christina Brevit here. And today I'm going to be talking about the down with Kegels, anti-Kegel, do these exercises instead of Kegel's crowd and why I believe these posts are actually harmful. Before we do that, a little bit of a history lesson and why, even though I'm going to criticize this movement, I understand why it is so wildly popular. When we look at our research, and I totally agree with this, and I am on the research side trying to change this narrative. And we look at what pelvic rehabilitation has traditionally looked at or been focused or centered around.

How Pelvic Floor Rehab Got Here

SPEAKER_00 2:03

It has been around pelvic floor muscle training. And in the concept context of pelvic floor muscle training, specifically on the squeeze, right? On learning the contraction and growing the strength of the contraction of your pelvic floor muscles in an attempt to strengthen the pelvic floor and as a consequence, see a reduction in pelvic floor dysfunction symptoms, right? That was very much a driver of what pelvic floor rehabilitation was in the clinical space at first. And it is still predominant in the research space. As more and more clinicians have jumped into this space, as we have moved pelvic floor rehabilitation from not only being done in hospitals under medical directive, but being able to be done by community providers. We now have so many more people who are engaging in these conversations, who are looking at this role of rehab in pelv floor dysfunction. And we've started to add a lot more nuance, right? We see that it isn't always a weakness problem. And it might be a coordination or a tension problem. There is a nervous system, stress regulation, tension problem, that tension and tightness are not always the same. There's all of this extra layer that is being leveraged to say you never have to do Kegels. There is also a paper that was released that looked at EMG activation of other exercises like the plank, like I think it was like a sit-up and some other activities that showed a kick on of the pelvic floor muscles greater than a isolated pelvic floor contraction. And so this combination of things, our history, where we have gone, and sometimes the frustration that our research has only focused on the squeeze has created this brilliant marketing tactic, and that's what it is. It is marketing that is saying I am the anti-Kegel clinician. I will never prescribe Kegels, right? So this is kind of where we're at in 2026. And honestly, I kind of just think it has gone too far for several reasons. Okay. So

Evidence Still Supports Kegels

SPEAKER_00 4:45

I'm gonna go through four reasons why I think this is really important to call out for what it is and that it can be harmful. So number one, when we look at pelvic floor muscle training, right, and we look at the strength of our evidence, pelvic floor muscle training is one of the areas in all of rehab, not just pelvic health, that has the strongest and most consistent data to support its utilization. So to say you never need to be prescribed Kegels or Kegels are never the answer is actually medical misinformation because we have a Cochrane review, grade A level evidence that is saying that for many scenarios, doing or initiating pelvic floor muscle training can improve your symptoms. To say that we never need them is going against a very large body of evidence. That

The EMG Study Misread Online

SPEAKER_00 5:54

EMG study that people are saying kicked on the pelvic floor, that was not an intervention study. That study was just looking at activation of the core canister during a variety of different exercises. Of course, when you are activating your pelvic floor or activating your abdominal wall, the rest of the sides of your core canister are going to kick on, right? We know that when we are doing effortful movement of the abdominal wall, there is a coordinated co-contraction of the core canister in order to produce force, increase spinal stiffness, and allow for effortful movement. And so when we are bracing, there is chest wall, abdominal wall, and pelvic floor, sometimes lumbar erectors, if we are with gravity or without, those muscles are going to kick on. And the strength of their contraction is relative to the effort of the movement. What this crowd is missing a lot in their messaging is the specificity piece. When we are thinking about specificity of muscle training, we can think about it as a muscle group and or we can think about it as a movement pattern specific, right? For example, I am going to deadlift to get my body, including my core canister, stronger in deadlifting. When I'm doing a strong deadlift, that doesn't always mean that my hamstring curl is going to get stronger. Okay. Why I make this comparison is that when we are thinking about pelvic floor muscle training for incontinence, we need the pelvic floor to be able to work with the system, the core canister system. And I need it to work in isolation as well. I am not going to get a person who has to sneeze to drop and give me a plank or a glute bridge, right? If that is the only way that we have trained the muscle to activate, then we do not have intervention studies that say if you get stronger in your pelvic floor muscles with these activities, it's going to translate into no incontinence with sneezing and coughing, which is such a huge part of the pressure management mismatch symptom burden for many of our general population, including some of our pregnant and postpartum moms. So, yes, I'm going to add these planks and I'm going to add glute bridges and I'm going to add hip strengthening into my program. And I'm going to be doing some isolated pelvic floor strengthening or coordination work if it is needed, so that you can isolate the pelvic floor when you are calling on it only to close your holes.

Athletes Postpartum And Lost Nuance

SPEAKER_00 8:55

This actually really drives me crazy because it goes into number two, which is that this lacks so much nuance. And the reason why I get frustrated with the nuance loss is coming up. So much of this has been driven, is being driven by our highly active population. What we see in some of the work, for example, coming out of Mara DeSantos' lab, right, is that our female athletes, and this is actually gonna come into my point one too, but our female athletes tend to have higher maximal voluntary contractions and higher squeeze pressures than our in our non-incontinent athletes when we compare them, right? And so a lot of people are saying, well, your pelvic floor muscles are already strong, you don't need kegels, but then here's actually exercises that are gonna make your pelvic floor muscles even stronger when they don't have a strength deficit. And so this nuance is getting lost. Do I think that everybody needs kegels or that kegels are the end-all be-all, and that's the only thing that I'm offering a person in a session? No. But I would never go so far as to say that nobody needs them, right? My early postpartum crowd is probably going to be getting some amount of kegling or pelvic floor muscle contractions, maybe not even for a strength effect, but for a motor reprogramming effect after a very strong contraction or very strong uh stretch to the pelvic floor after a vaginal delivery, resulting in an injury to those muscles and retraining that is required in the postpartum period. And so we really have to um to think about these conversations a lot. And

Isolation Versus System Training

SPEAKER_00 10:51

so this kind of comes into my number three is that it is really important to know that the pelvic floor needs to be able to contract in isolation and it needs to be able to be optaken as part of the system. Those are both unique challenges and they have their own unique goals, right? If we are trying to challenge the system and get the pelvic floor core system stronger, then things like planks, glute bridges, and stuff may be um sufficient and I don't need to be doing pelvic floor muscle training. But in the rehabilitation space, these reels that are saying don't do Kegels, do these other exercises, are missing the isolation training component. And the thing is, like, I don't want to be hating on these provide these um these creators because I understand again where the frustrations are coming from. And if you talk to them and you say, Well, what about this? They're gonna say, Well, of course. But the problem is the damage is already

Confused Clients And Better Language

SPEAKER_00 11:52

done. And this goes to my number four, which is the person that ends up getting the most confused is the consumer, right? I have people come into my clinic room and they say, I got told that I don't need to do Kegels. Well now we have to have this like really in-depth conversation about when we use them and when we don't. And when we have our own profession who is confusing the consumer about what we are doing, right? And and you know, sometimes there are gonna be like differences of opinion and things like that. But in this scenario, like some people may be biasing a bit more between like Mackenzie versus manual theory, whatever. Like there are different approaches, but the underlying construct around like, do we do pelvic floor muscle strengthening should never be an area that is up for debate. It has to be the information that has to be applied in a meaningful and client-centered way, right? So it's not that everybody needs Kegels, right? And that's where we were. It's just as damaging to the consumer on the information spot side to say that nobody needs Kegels, right? Like the answer is always somewhere in the middle. And this is another example where we now are pendulum swinging so severely from one side to the other that one, we're missing nuance, two, we're actually medically misinforming, and three, we're going against what the evidence has told us over and over and over again for the last 50 years, right? And so to me, it is just very frustrating to be in a space where the nuance seems to always be being lost. And the clickbait content and the this is saveable and all that kind of stuff. Like those are marketing initiatives. And of course, like you want people to understand and see you, right? Like that's the goal of being on social media, but it always has to be done in a balanced way from what is true. And this is an area that I've been like, I'm like sweating as I'm recording this because it does frustrate me so significantly, is that we want to make sure that the person who like who like our clients just need to be getting the best quality information. And so here's an example. So instead of the the real saying, do these exercises instead of Kegels, or these exercises are better than Kegels, it could be something like these exercises also train our pelvic floor muscles, or add these to your rehab program for added benefit to the pelvic floor. Maybe the hook's not as strong, right? Um, but it gets out of this binary language of yes or no, Kegel's yes or no, um, and goes a little bit more into like kind of the support language, the systems-based language, the specificity language, this clinical context and client nuance language that if you've listened to this podcast for any length of time, you know that I'm always gonna lean into that language over something that is a blanket statement or is some sort of black and white narrative.

Final Thoughts And Your Take

SPEAKER_00 15:26

What do you guys think? Shorter episode, a little bit on the ranty soapbox. Um, apologies for that if you guys are hearing me getting all fired up in your headphones on your walk. Um, but I think it's really important to have these conversations. I I think for me, the misinterpretation of that EMG study and this insinuation that it is an interventional study and showed that planks and um other exercises because EMG is as strong that it's it's gonna alleviate stress incontinence to the same degree, to the same amount, and with the same um consistent result as a Kegel is um untrue. Um, maybe in the future I'm gonna change my mind and all of a sudden I'm gonna say, hey, we don't need to do Kegels, but where we are right now in 2026, um that just isn't the case. So let me know what your thoughts are. Uh I think I'm gonna try and see if I can uh maybe put up a couple more like posts to try and get um this conversation going online because I think it's really fun to have these kind of nuances and and uh have these conversations out. But until then, um have a wonderful week, everyone, and we will see you all next time.