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The Effect of Commonly Performed Exercises on the Levator Hiatus Area and the Length and Strength of Pelvic Floor Muscles in Postpartum Women

Siff, Lauren N., MD; Hill, Audra J., MD; Walters, Samantha J., MPH, IBCLC; Walters, Ginny; Walters, Mark D., MD

Female Pelvic Medicine & Reconstructive Surgery: May 2, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000590
Original Article: PDF Only

Objective The aim oft his study was to compare the effects of 10 common exercises to traditional pelvic floor muscle (PFM) contractions (Kegel) on levator hiatus (LH) area and PFM length and strength.

Methods This is a cross-sectional study of 15 healthy postpartum women. Ten exercises were studied. These were common variations of leg, core, and back exercises used in yoga, Pilates, strength training, and physical therapy. Each participant performed all 10 exercises at a single visit in 2 examination settings: transperineal ultrasound and perineometry. Ultrasound measured the LH area and PFM length, and perineometry measured the muscle strength (peak squeeze pressure).

Results Kegel generates an increase in squeeze pressure (24.3 cm H2O), shortens the muscles (−0.46 cm) and narrows the LH (−0.13 cm2). The bird-dog and plank exercises were not different from Kegel in any measurement. While the leg-lift ultrasound dimensions are similar to Kegel, leg lifts generated peak squeeze pressures stronger than any other exercise (including Kegel). Whereas ultrasound dimensions were similar to Kegel, tucked and untucked squats and thigh adductions generated weaker contractions than Kegel. While crunch generated a squeeze pressure similar to Kegel, the ultrasound dimensions showed a significantly wider LH and longer muscle than Kegel. Bridge, clam, and plié exercises affected the PFMs differently than Kegel in all measures.

Conclusions Bird-dog, plank, and leg-lift exercises should be evaluated as alternative exercises to Kegel as they affect PFM strength and length and LH area similarly to Kegel, and leg lifts generate a stronger contraction than Kegel.

From the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH.

Correspondence: Lauren N. Siff, MD, 1250 E Marshall St, Box 980034, Richmond, VA 23298. E-mail:

This work was presented at the 37th Annual Scientific meeting of the American Urogynecologic Society in Denver, CO, on September 30, 2016.

The authors have declared they have no conflicts of interest.

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