In Defense of the Modern Kegel

Do we even need to say the words “pelvic floor” in class to teach a client about it? Not necessarily. The goal is for clients to develop sensation, to feel movement and shape change in the pelvis, and to recognize it as normal. As movement educators, we can guide them there.

But here is where I want to push back on a growing trend in our field: the idea that talking about, cueing, or directing awareness to the pelvic floor is somehow doing our clients harm.

The Pendulum Has Swung Too Far

A Kegel is synonymous with Pelvic Floor Muscle Training (PFMT). Most of us can recall a class where an instructor threw in the cue to “engage” or “pull up on your pelvic floor” repeatedly during Footwork, Snake, Tendon Stretch, regardless of whether it was warranted. That was one extreme, and the backlash against it is understandable.

But I recently attended a pelvic health movement course (excellent content overall) where I kept hearing a version of the same refrain: we do not want clients thinking about their pelvic floor, we should not reference it, the movements and breath sequences we teach will speak to it naturally.

I sat with that and thought: we discussed the hip in detail. We talk about pelvic motion, lung mechanics, and diaphragm tissue. But asking clients to visualize the soft tissue of their own pelvis is off limits?

This kind of overcorrection has become a pattern in our field. A few years ago it was the psoas. Then it was policing the language we use to describe movement. Each time, there is a kernel of truth, and each time, the nuance gets lost. Movement educators work across an enormous range of contexts and clients. We need every well-tested tool in our toolbox, not a rotating list of things we are no longer allowed to teach.

What the Research Actually Says

Here is the one thing I want you to take away from this article: most people never think about their pelvis or pelvic floor, and that is usually not a good thing.

Beyond the clinical perspective, which is in and of itself enormous and powerful, we have strong scientific evidence that awareness of our pelvic floor matters.

When the brain is functionally blind to a region of the body, the outcomes tend to be poor over time. A systematic review by Diaz-Alvarez et al. (2022) analyzed data from 2,507 women across seven studies, all healthy women with no diagnosed pelvic floor dysfunction. Researchers taught participants about their pelvic anatomy, how to sense it, and how to care for it. The result: fewer issues as they aged. The authors concluded that because so many women have deficient awareness of this region, educational interventions and verbal instruction are critical preventive tools for the general female population.

That is not a case for ignoring the pelvic floor. It is a case for paying attention to it.

Two Cochrane Systematic Reviews, among the most rigorous forms of evidence available, make the case clearly. Dumoulin et al. (2018), drawing on 31 trials and over 1,800 women, found significant support for pelvic floor muscle training in treating stress, urgency, and mixed urinary incontinence in women. Woodley et al. (2020), focusing specifically on antenatal and postnatal populations, examined PFMT for both the prevention and treatment of urinary and faecal incontinence during pregnancy and after birth, a review particularly relevant for those of us working with pregnant and postpartum clients.

That said, it is worth stating clearly: not everyone needs to do Kegels. For those managing urinary incontinence or other pelvic floor dysfunction, developing volitional control of this musculature is essential and well supported by evidence. But even for someone with a perfectly healthy pelvic floor, there is real value in mapping that territory: learning the sensations, noticing the subtle differences between quadrants, and understanding how tissue responds to breath and position. That is a different skill than what happens when the pelvic floor activates in concert with the whole body during a plank or a squat. Both matter. But the deliberate awareness that comes from targeted pelvic floor work, from calling that tissue to attention and listening to what responds, builds a kind of body literacy that whole-body movement simply does not provide on its own.

Dr. Kegel

Dr. Kegel practiced in the 1940s and was groundbreaking. He recognized that simply telling a client to tighten did next to nothing, and went on to develop a sensation-based practice, inventing a visual biofeedback device called the Perineometer, an air-pressure sensor placed in the vagina that let patients sense and see whether they were using the right areas of their pelvic floor with the right amount of effort. By all accounts, he was probably our first pelvic floor physical therapist, often using palpation to help guide patients.

Some of his directions, like “stop the flow,” or his use of progressive overload, we would not adopt today. But the biggest takeaway is one we can absolutely carry forward: the use of sensation, paying attention to it, introducing it to the brain, and logging it for future reference.

His use of biofeedback lives on today in many physical therapy offices. In the movement studio, we do not have those devices, but we have something equally powerful: the informed use of position, breath, props, and movement cues. We can use the floor, the wall, a textured mat, or a prop to create the feedback the body needs. We can structure positions that open what is habitually compressed and compress what is habitually open. When we do this with intention, we create the conditions for the pelvic floor to respond in both directions and across all four quadrants.

The Pelvis Is Not an Island

What we now understand, and what research continues to confirm, is that the pelvic floor does not function in isolation. It is influenced by breath, by rib position, by hip mechanics, by the ground beneath us. Nor is it one undifferentiated structure. It has two halves, left and right, and because movement of each half influences the tissue, it can behave differently side to side, front to back, and along diagonals. I love the image of the pelvic floor as a diamond: four quadrants, each capable of responding differently to load, breath, and movement.

In my book, A Movement Educator’s Guide to Pregnancy and Childbirth, I detail what I call the Conditioning Breath, a modern, refined take on pelvic floor muscle training that incorporates subtle technique shifts, varied positioning, and an emphasis on sensation over effort. The real paradigm shift is not in the exercise itself but in the mindset: less is more, awareness comes first, and the goal is movement not only in both directions but across a full spectrum of response, varying in percentage of effort, rate of engagement, and degree of activation. We are not working with an on/off light switch. The pelvic floor is a dimmer, capable of calibrating its response to whatever the body needs and whatever the task demands.

When instructors understand pelvic mechanics deeply, we can use targeted breath and movement to unlock the quadrants that are not responding in a given client. That is sophisticated, individualized teaching, and it requires us to be willing to talk about the pelvis: thoughtfully, precisely, without shame.

It also requires us to adopt a “yes, and” mindset. Yes, there is exceptional evidence that PFMT works, and we need to combine it with smart, whole-body movements that specifically inhibit some areas of the pelvic floor while facilitating others.

Try It Yourself

The sequences below move through three layers of work: assessment, breath patterning, and targeted activation, followed by mat and Reformer exercises that bring pelvic floor awareness into integrated training. Work through them with curiosity rather than effort. Notice what is easy to feel, what is harder to access, and what shifts with position or load.

Jellyfish Breath

Unlike the popular elevator cue, which tends to direct pressure centrally and downward, the jellyfish mirrors the optimal spreading and gathering we are actually looking for. On the inhale, the pelvic organs and tissues spread wide toward the interior perimeter of the inferior pelvis. On the exhale, the pelvic floor is drawn upward from the outside edges inward, like the bell of a jellyfish gathering itself. This distributes pressure and load more evenly across all four quadrants, rather than concentrating it in the center.

Setup: Sit comfortably or come into a forearm-and-knee position. Sense the distance between the pubic bone and the tailbone, and between the two sitting bones.

The Inhale: Through the nostrils, tongue on the roof of the mouth, teeth slightly apart, lips softly together, take a steady, paced inhale. Visualize the pelvic organs and tissues dropping and spreading wide. You are looking for a sense of lengthening, or even a gentle bulging, as the pelvic floor widens and descends eccentrically. If this is difficult to feel, try placing a heating pad under the pelvis when seated. The warmth can help introduce this area to the brain. After a few practice sessions with the heating pad, the downward eccentric lengthening becomes easier to access without it, though you may need to revisit the prop periodically to remind the body.

The Exhale: Through the mouth, experiment with soft open lips versus pursed lips and notice which gives you a more sequenced, steady sense of gathering and lifting. Create a slow, even exhale from beginning to end. Visualize the pelvic floor being drawn upward from the pelvic side walls, like a Chinese lantern rising from its edges. (Image borrowed from Marie-José Blom.)

The Pause: At the end of the exhale, rest for a few seconds before initiating the next inhale. Try to find a sense of floating in that pause.

Repetitions: Cycle three to four times, then rest. At first you may need to rest between each breath cycle. This is precise, attentive work.

The Diagonal Lift

Found on page 59 of A Movement Educator’s Guide to Pregnancy and Childbirth. Practice this on its own or add it at the end of the Jellyfish Breath once that pattern feels established.

Setup: Come into a comfortable supine, forearm-and-knee, or seated position. Take a few breath cycles to relax the pelvis and release any unnecessary tension throughout the body.

The Movement: Bring your awareness to the center, inside of the pelvis. On a slow, steady exhale, visualize tractioning the inner anus upward and forward toward the back of the pubic bone, a diagonal climb along the interior of the pelvis. Tissue only; the bones do not move. Hold for a few seconds at the top and notice both the sensation at the front of the pelvic floor and the subtle deep abdominal engagement that accompanies it.

The Release: Take time to fully release and relax the pelvic floor before the next repetition. The release is as important as the lift.

On the Mat

The two sequences above lay the groundwork for the mat and Reformer exercises that follow. Each exercise asks the pelvic floor to respond in the context of integrated movement, and each targets different quadrants of the pelvic floor diamond. As you work, bring the same quality of attention you developed in the breathing sequences: notice which quadrants are being facilitated, which are being released, and where sensation is clear or quiet.

In any of the positions below, feel free to pause and take a cycle of the Jellyfish Breath or the Diagonal Lift.

Unleveled Knees on All Fours

This inhibits and opens the left posterior and right anterior quadrants of the pelvic outlet. Switch sides and it will be the opposite.

• Place a circle band (medium tension) around the outer thighs.
• Come onto all fours and place a half yoga block or less underneath the left knee.
• Tuck the toes under and keep them on the floor throughout the exercise.
• Sitting bones point to the back of the knees, spine lightly flexed.
• Take one breath cycle to feel your left-side abdominals and the sense that 70% of your weight is on your left side. Keep that throughout.
• Inhale and expand your back body.
• On the exhale, reinforce the connection of your left side and float your right knee up. The left femur should not move.
• Hold at the top and inhale.
• On the exhale, stay on your left side as you float the right knee down.
• Do 3 to 4 repetitions and change sides.

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Wall Drag

This opens the right anterior and closes the right posterior pelvic outlet.

• Lie on the floor with your feet on the wall. Keep a little bend in the knees; they should not be straight.
• Keep the right foot on the wall and hug the left knee in.
• Exhale, sending the front ribs in and down, as you press into the foot on the wall and drag the heel a bit down toward the floor.
• Keep a neutral head and neck position throughout.
• Take 2 or 3 breath cycles, reinforcing the pelvis slightly rolled back, the front rib connection, and the ball of the big toe, the toe pad, and the outer heel of the right foot along with the heel drag.
• Without moving the right foot, try to externally rotate the right femur. Hold and cycle the breath 1 or 2 more times before you release and change sides.

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On the Reformer

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Backbody Mermaid

Start with the left leg in internal rotation. This positioning automatically opens that side of the pelvic outlet, and the ribcage and breath focus helps achieve even better results in the pelvis.

• Start in a “Z” position with the left lower leg up against the shoulder blocks and the right lower leg in front.
• Place the right hand on the footbar and sidebend to the right.
• Exhale and thread the top arm under the bottom arm. Flex the spine and pull back away from the footbar.
• Hold this position for 2 breath cycles. Send the inhale into the left back body and use the exhale to connect the left front ribs.
• On an exhale, come back into a side bend and return to the beginning position.
• Push or pull on the shoulder block closest to you and sidebend up and over the headrest.
• Wrap the right arm over the top of the head and try to touch the left ear. Hold this position, then on an exhale rotate the head and chest toward the floor.
• Hold this position for 2 breath cycles.
• On an exhale, come back to the sidebend and extend the top arm up and over the head.
• Inhale, rise to the beginning position, and change sides.

Lunge Rotation Facing the Back

This inhibits and opens the left posterior and right anterior quadrants of the pelvic floor. Switching sides facilitates the opposite quadrants.

• Stand to the right side of the Reformer, facing the back. Create a small lunge with the right leg back and left leg stepped forward. Place the closest strap onto the right thigh and attach it to the rope. An optional 3 to 8 lb weight can be held in the right hand.
• Inhale as both legs lengthen and pivot to the right while externally rotating the right leg (open hip position).
• Exhale, pivot back to the lunge position, and bend both knees.
• Begin rotating the pelvis to the left (closed hip position) and shift the left hip back. Let the whole spine, neck, and head follow the rotation to the left.
• Reach the right arm forward and down toward the headrest and the left arm behind, orienting everything to the left.
• Hold the rotation and the position of the right foot and ankle, pressing the outer right leg into the strap to engage the right glutes.
• Feel the pelvis slightly underneath you, spine lightly rounded.
• Hold this position for 2 to 3 slow breath cycles. On the inhale, send air into your back body; on the exhale, internally rotate your front ribs and reinforce the connection of the pubic bone to the left inner thigh as the right thigh presses outward.
• Complete 3 to 4 repetitions, then change sides.

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A Tool Worth Defending

The modern Kegel, taught well, is not the enemy. Blind repetition without sensation, context, or feedback is the problem. When we strip awareness away entirely in the name of correcting that error, we leave our clients exactly where they started: disconnected from a part of their body that matters deeply to their long-term health.

We can do better. And I believe most of us got into this work because we want to.

References

Diaz-Alvarez, L., Lorenzo-Gallego, L., Romay-Barrero, H., Prieto-Gomez, V., Torres-Lacomba, M., & Navarro-Brazalez, B. (2022). Does the contractile capability of pelvic floor muscles improve with knowledge acquisition and verbal instructions in healthy women? A systematic review. International Journal of Environmental Research and Public Health, 19(15), 9308. https://doi.org/10.3390/ijerph19159308

Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(10), CD005654. https://doi.org/10.1002/14651858.CD005654.pub4

Woodley, S. J., et al. (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 2020(5), CD007471. https://doi.org/10.1002/14651858.CD007471.pub4

Thomsen, L. (2025). Pelvic restoration [Online continuing education course]. Postural Restoration Institute.

All ideas and assertions expressed in The CORE are those of the individual contributors, offered to spark conversation, enrich understanding/inspire growth and share diverse perspectives within our community. They may not necessarily reflect the views of Balanced Body®.