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Beyond Kegels

Why Kegels Don't Cut It!

  • Dr. Arnold Kegel, MD, an American gynecologist, recognized the importance of pelvic floor muscles (PFM) in the 1940s to address bladder leakage.
  • Since then, we've advanced our understanding, moving beyond the term "Kegels" to "Pelvic Floor Muscle Training" (PFMT).
  • The PFM are closely linked to organs like the bladder, vagina, rectum, anus, and penis, with mutual influence that can complicate proper activation or contraction.

However, standard PFMT (Kegels) has several downfalls that can lead to poor outcomes:

Standing Optimizes Pelvic Floor Muscle Training

The pelvic floor muscles form the base or "floor of the core," are most active when upright and standing. Optimal PFMT requires standing. Studies show standing outperforms other positions for PFM performance.

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  • Standing was found to be a more effective position for achieving and sustaining an elevation of the pelvic floor muscles (PFM) compared to lying, regardless of gender. Displacement of pelvic floor elevation differed when measured in the standing and supine positions. PFM movement was significantly higher in the standing position. This finding may be due to the improvement of proprioception by standing measurement, or by factors such as gravity and intra-abdominal pressure. (Kelly et al. 2007)
  • Perineometer (pressure meter) evaluation of PFM strength was significantly higher in standing position when compared to the others. Time of PFM contraction was significantly longer in the standing position suggesting improved endurance in this position. (Gameiro et al 2013)
  • Vaginal squeeze (contraction) pressure assessed with manometry was higher in a standing than in a lying position (Mastwyk et al 2022)
  • A standing posture with hip joint external rotation facilitated increasing PFM myo-electric activity measured with sEMG compared to neutral hip rotation (Ishihara 2023)
  • Positions that challenge gravity and pelvic biomechanics, such as the squat, plank, and quadruped, facilitate greater activation of the PFMs. The lowest percentage activation was in the supine position (16.23%), while the highest recruitment was observed during the parallel squat (40.69%)as measured using sEMG. (Rodríguez-López 2025)

Findings of Systematic Review (Summary of recent research) (Huang et al 2023)

  • Resting voluntary contraction (RVC) values of the PFM in the standing position was significantly higher than that in the supine position, indicating that the resting pressure of the PFM in the supine position did not accurately reflect the upright muscle state. The data obtained from the evaluation in the upright posture captured the natural relaxation position and movement of PFM in daily life, reflecting the functional state of the PFM most of the time.
  • In normal healthy people, contraction of the PFM before exertion is a natural response and does not require conscious exertion, which is closely related to the functional significance represented by the RVC value. Therefore, standing posture may be more useful for training and studying the function of PFM in response to increased intra-abdominal pressure and muscle fatigue.
  • Compared with the supine position, standing position is also more helpful to analyze the PFM function and its related mechanisms in women with stress urinary incontinence.

References:

  • Gameiro MO, Miraglia L, Gameiro LF, Padovani CR, Amaro JL. Pelvic floor muscle strength evaluation in different body positions in nulliparous healthy women and its correlation with sexual activity. Int Braz J Urol. 2013;39(6):847-852. doi:10.1590/S1677-5538.IBJU.2013.06.11
  • Kelly M, Tan BK, Thompson J, et al. Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: an experimental study. Aust J Physiother. 2007;53(3):187-191. doi:10.1016/s0004-9514(07)70026-0
  • Mastwyk, S., McClelland, J., Cooper, M.M. et al. Pelvic floor muscle function in the standing position in women with pelvic floor dysfunction. Int Urogynecol J 33, 2435–2444 (2022). https://doi.org/10.1007/s00192-021-05003-6
  • Huang L, Zhang ZY, Liu H, et al. Most of the pelvic floor muscle functions in women differ in different body positions, yet others remain similar: systematic review with meta-analysis. Front Med (Lausanne). 2023;10:1252779. Published 2023 Nov 6. doi:10.3389/fmed.2023.1252779
  • Ishihara H, Maeda N, Komiya M, Mizuta R, Oda S, Naito K, Urabe Y. Investigation of effective standing posture for increasing activity of pelvic floor muscles: a cross-sectional study. J Phys Fitness Sports Med. 2023;12(6):155-160. doi:10.7600/jpfsm.12.155
  • Rodríguez-López ES, Martín-Márquez LM, Acevedo-Gómez MB, López-Illescas Á, Benito-de-Pedro M, Ojedo-Martín C. Which Positions Optimize Pelvic Floor Activation in Female Athletes? Life. 2025; 15(1):58. https://doi.org/10.3390/life15010058

Get the Best PFMT Results with Fluidity Rx

Fluidity Rx offers an optimal protocol for PFMT, elevating outcomes beyond traditional methods:

Fluidity Rx Ball Feedback for Pelvic Floor Muscle Training

Uses a ball to provide feedback, helping users feel and understand PFM engagement with optimal cueing, counts, repetition, and breath usage.

Fluidity Rx Standing Pelvic Floor Muscle Training

Standing increases control and strength due to gravity, integrating PFM into daily movements, facilitating better functionality.

Women with Stress Urinary Incontinence are 17 times more likely to heal if they strengthen their pelvic-floor muscles [1]

Women with Stress Urinary Incontinence are 17 times more likely to heal if they strengthen their pelvic-floor muscles [1]

How Fluidity Rx Optimizes Pelvic Floor Function

Potential Effects of Excess Fast-Twitch Fibers:

The pelvic floor ideally comprises 70% slow-twitch and 30% fast-twitch muscles.

  • Weakness increases fast-twitch fibers making fast-twitch muscles more dominant then they should be in the pelvic floor.
  • Fast-twitch (Type II) fibers are designed for quick, powerful contractions, but they fatigue quickly.
  • In contrast, slow-twitch (Type I) fibers are built for endurance and sustained support — which is exactly what the pelvic floor needs most of the time.

Fluidity Rx restores the ideal balance of slow- and fast-twitch muscles with balanced choreography, cueing, counts, holds, and breath, enabled by Fluidity Rx Stability Devices.

Strengthen Pelvic Floor Muscles with Fluidity Rx

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Fluidity Rx Original Stability Device

The Fluidity Rx Original Stability Device enables 360 degrees of movement, delivering the only authentic home stability training experience. Patented worldwide for its innovative design and functionality, this device was crafted by MIT engineers, supports up to 300 lbs, and folds down to just 5” for exceptional portability.

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Fluidity Rx Original Stability Device
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Fluidity Rx Dual Deluxe Stability Device

The Fluidity Rx Dual Deluxe Stability Device allows one or two users to train simultaneously, with independently height-adjustable sides for personalized support. Created by MIT engineers, it delivers the strength of a wall-mounted unit in a fully portable design - supporting up to 400 lbs and folding to under 20” for easy upright storage.

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Fluidity Rx Dual Deluxe Stability Device

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