Are squats better than pelvic floor exercises?
The idea of squats (or other functional exercises) being better than pelvic floor exercises is one that is often promoted on social media and as part of a prolapse or pelvic floor rehab programme.
And the idea that you can heal your prolapse or leaking without doing pelvic floor exercises is very potent. Many women may have tried (and feel like they’ve failed) with Kegels (pelvic floor exercises) and are looking for a better and more effective solution for their pelvic floor dysfunction.
So, I took a delve into the research to try and answer this question!
Research supporting pelvic floor exercises
Firstly, it’s important to point out that the effectiveness of pelvic floor exercises is well-researched. Now, of course, I haven’t been through every piece of research BUT here are some key points – many of these were included in a course I did with Helen Keeble (a women’s health physio)
Here’s what the research tells us:
Contracting other related muscles is not recommended as replacement for Kegels
(Kruger et al, 2018)
Pelvic floor muscle training is still required to increase PFM strength and function
Not able to rely solely on physical activity or exercise to improve pelvic floor muscle strength
(Ludviksdottir et al, 2018; Middlekauf et al, 2016; Skaug et al, 2023)
Pelvic floor muscle training is an exercise that improves PFM strength, endurance, power, relaxation, or any combination of all of these (Bø et al, 2017)
Pelvic floor muscle training reduces pelvic floor muscle dysfunction in women who are participating in high-impact sport.
Pelvic floor muscle training improves maximal voluntary contraction and resting pressure. (Fukuda et al, 2022)
Research studies that support functional exercises are better than Kegels
I’m going to reference 2 studies that I see being used as the basis for being able to say that functional exercise is better than Kegels.
The first is by Dr Bruce Crawford, who looked at 10 functional movements with a natural pelvic floor engagement. He measured the pelvic floor muscle recruitment and found that combining a KEGEL + the natural engagement of a squat or lunge etc created more pelvic floor muscle recruitment than a Kegel ALONE. But a kegel was required to create that significance.
A study by Ojukwu et al in 2022 found that the use of adductors and abdominals can work well as an adjunct to PFM exercises;
Twenty-one postpartum mothers with recent vaginal deliveries performed six trials, including the typical Kegel’s exercise; two abdominal exercises (curl-up and abdominal hollowing); two hip adductor exercises (adductor ball squeeze and auto-resisted hip adduction); and a combination of abdominal, hip adductor and pelvic floor muscle contractions (combo). Generally, the pelvic floor muscles were statistically significantly most active during the combo trial.
Combining strength training & pelvic floor muscle training
A study by Virtuoso in 2019 found that it was the combination of pelvic floor muscle training plus strength training that brought about faster resolution of leaking amongst older women versus pelvic floor muscle training alone.
What to do with this information!?
Firstly, It’s vital to recognise that there is no “one size fits all” when it comes to your pelvic health, pelvic floor dysfunction and symptoms. There are many factors that can contribute to symptoms outside of pelvic floor muscle strength.
That said, many people will benefit from a combination of approaches that 1) improve strength and flexibility of the pelvic floor muscles and 2) can incorporate the pelvic floor muscles (and rest of the core) into movement. We want the pelvic floor to be able to do it’s thing, but we might also need to add strength or more flexibility to other (connected) areas such as glutes and hips, so that the pelvic floor can work optimally.
Beth Davies is a highly experienced personal trainer and coach specialising in female pelvic health, pelvic organ prolapse and exercise. Her programmes educate, empower and support women back to training or their active life, eliminating symptoms and building strength and confidence. She has been featured in women’s lifestyle magazines and websites, including Stylist, Metro, Woman & Home and Marie Claire UK.
Beth’s training and coaching for women with pelvic organ prolapse provides face-to-face personal training in Leamington Spa, Warwickshire, and online across the UK and Europe.