Q: What are your thoughts on the use of pelvic floor weights-Yay or Nay? Would they build load tolerance? Asking for a friend.
A: Short answer: Not a fan, but it can have it’s place in a comprehensive program. Long answer: Keep reading.
A Brief History of Pelvic Floor Weights
The use of pelvic floor weights (aka Kegel or vaginal weights) is a long-held intervention strategy. It is grounded in the presumption that pelvic floor weakness is the sole source of pelvic health considerations, like incontinence. Their use can be dosed as sets and reps or for sustained holds, worn throughout activity. Women have performed legendary feats after the use of pelvic floor weights, like this classic: the surfboard carry. Most women who are considering the use of pelvic floor weights have less lofty goals. No more leaks, better sex, etc., but then again, who wouldn’t want a free hand at the beach.
However, as we continue to press towards understanding pelvic health needs more integratively, a pelvic floor-only intervention strategy falls short. This is particularly true for fit and athletic populations.
If we are talking about holding a pelvic floor weights internally as you go about your day, I am not a fan. This requires a static hold which doesn’t mimic the fluctuating demands of function and fitness. Instead, we want the pelvic floor (PF) to be a part of the movement pattern and activity in a fluid way. It will gain strength and coordination through it’s participation. Thus, building load tolerance as a component of the whole.
In particular, I don’t like pelvic floor weights for a runner or any other kind of dynamic athlete. That is not how muscle groups function, PF included. Leigtner et al. (2018)1, demonstrated the rise and fall of the pelvic floor/vaginal vault during the running cycle. Muscles move. Holding a PF weight during a dynamic activity would be like keeping your quads stiff as you did housework or ran.
We also have to be careful not to continue to perpetuate the idea that restoring 5/5 strength indicates people are now healed or functioning optimally. Suggesting that now they are ready to move, run, etc. because they have achieved 5/5 strength. Seasoned clinicians know, we can make folks strong and they can still have the same symptoms. We have to move beyond our focus on capacity (strength and ROM), and be sure we are looking at the whole picture.
This requires that we also move forward from the notion that the PF is both the source, and therefore the only solution to pelvic health dysfunction. Isolated strength in a fixed position, measured with our 5 point-scale, doesn’t translate to the demands of fitness- power, acceleration/deceleration, change of direction, impact control, pressure management, etc.
However, I do think pelvic floor weights can have a place. If use of them as we do in other forms of weight training (think bicep curl for your pelvic floor), they may have their place as a proprioceptive feedback tool. Meaning a weight might give one a sense of their PF, so they can feel it to engage it. This would also help them use it in a full range of motion, lift and lower. Training the PF through the range might begin to prep for the rise and fall of running noted in the Leightner study. It may give them a chance to practice and implement some control. I can get behind that, it can be a place to begin.
The Middle Ground
This may be the start of restoring baseline strength and load tolerance for day to day challenges. However, pelvic floor weights are not usually heavy enough to build toward the kinds of loads that people lift at the gym. In order to prepare for that level of loading, the pelvic floor needs to be integrated into the motor plan for a heavy lift (with weights on the outside of your body). Learn more here.
In addition to the limitation of isolated work to address fitness demands, it is also unable to comprehensively address multifactorial, whole body issues like diastasis, prolapse, and incontinence or hip and low back pain. Thus, a clinical decision to use PF weights would have to be contextualized in a broader, more functional approach. Let’s coordinate that growing proprioception, control, and strength with the rest of the central and movement systems, ASAP! In other words, it might be an entry point to help women connect to the PF, but it cannot be both the beginning and the end of their treatment program in a return to dynamic activities.
- Leightner, Monika. “Evaluation of Pelvic Floor Kinematics in Continent and Incontinent Women during Running: An Exploratory Study.” Neurology and Urodynamics (2018); 37: 609-818. DOI: 10.1002/nau.23340