Archive for September, 2014

Kegel and the Game “Telephone”

September 27, 2014

Andrew Siegel, M.D.

When I was in junior high school (yes, junior high…no such thing as middle school back in those dark ages!) we had parties and played silly games such as “spin the bottle” and “telephone.” In both games a group of us would sit in a circle, and with respect to the more sedate “telephone,” the first person would whisper a few sentences into the ear of the person sitting next to him or her. That person would repeat it to the next person, and so on around the circle. The last person would announce the message they heard. The message that the final person announced was virtually always very different and distorted from the original message, usually in a very funny way. My point is that the final “product” bore little, if any, relationship to the original, with each step in the communication process resulting in increasing adulteration.

And so it is with the exercise program that gynecologist Arnold Kegel popularized 65 years ago, with which the game “telephone” has seemingly been played. What is being bandied about now as Kegel exercises bears little to no resemblance of what Arnold Kegel described so brilliantly in his series of medical articles. As a consequence of this adulteration, current Kegels are often ineffective Kegels. Arnold Kegel died in 1981; if he were alive today to see the distortion and misinterpretation of his legacy, I am certain he would be unpleased.

I have carefully studied all of the medical journal articles that Arnold Kegel crafted in the late 1940s. In these scientific works, he explained his program of pelvic floor exercise that he used successfully on thousands of his female patients. I will happily provide PDF copies of Kegel’s articles to any reader interested in the classic, original, unadulterated works. I have distilled Kegel’s message to the following four principles:

  1. Muscle education with the development of the nerve pathway from brain to pelvic floor muscles.
  2. Feedback to confirm to the exerciser that the proper muscles are being used.
  3. Resistance that challenges the exerciser.
  4. Progressive intensity against resistance so that the exerciser can measure and monitor progress over time as pelvic floor muscle strength increases.

So, in accordance with the seminal work of Arnold Kegel, pelvic floor exercises should incorporate muscle education, biofeedback, resistance, and progressive intensity. Kegel recognized four phases of the process of pelvic floor muscle strengthening: “awareness, transitional, regeneration, and restoration.”

Now here is the problem—if you Google search “Kegel exercises” you will get over one million results, but virtually every exercise “program” that you read about—even those publicized by esteemed medical institutions—are knockoffs and meager dilutions of the rigorous resistive pelvic floor exercise regimen advocated by Arnold Kegel. These current programs require very little time, limited physical effort and most often lack in using the benefit of resistance.

Your search will often uncover a printable pamphlet suggesting a several month program of 10 contractions squeezing against no resistance to be done three times daily while stopped at a red light when driving your car or at other down times. What these current programs share in common is that guidance, training and direction are inadequate with programs lacking the feedback to confirm the engagement of the proper muscles. It is of no surprise that many who undertake these ineffective, bastardized pelvic floor muscle exercises ultimately abandon them as they fail to help the situation at hand. The recommendation of doing these exercises while multitasking is a recipe for certain failure. Properly executed pelvic floor exercises—like physical therapy—demands attention, focus and gravitas.

Exercise physiology has taught us that when it comes to muscle training, doing lots of sets with low resistance develops tone and definition, whereas doing fewer sets with maximum resistance builds strength and bulk. The same physiology can be applied to the hidden pelvic floor muscles. A successful exercise program mandates intensity to be successful as muscle adaptation will not occur unless the muscle is subjected to sufficient stresses and resistance.

Kegel devised the “perineometer,” a resistance device that enabled women to work out their pelvic floor muscles against the force of resistance. This device gave visual biofeedback regarding the engagement of the proper muscles and the actual strength of those muscles and allowed women to witness the gradual increase in the strength of their pelvic floor muscles. In terms of intensity, Kegel’s recommendation was “twenty minutes of exercise three times daily, with a total of at least 20-40 hours of progressive resistance exercises spread over 20-60 days, keeping records of maximum contractions each exercise period.” This is a far cry from any of the current programs that you will come across! Additionally, most exercise programs do not utilize a tool that parallels the essential role played by Kegel’s perineometer.

So many of the mainstream programs out there do not hold muster and are terribly ineffective. There is an enormous demand for effective pelvic floor muscle training programs, and the number of people who could potentially benefit from an effective program that adheres to the successful foundational principles laid down by Arnold Kegel is huge. So what to do?

And thus was born the concept of the Private Gym pelvic floor training program, developed through the collaborative efforts of an international team of experts including myself. The Private Gym’s Basic Training program strengthens the pelvic floor muscles with a series of progressive male Kegel exercises without resistance. The Resistance Program uses resistance equipment to maximize pelvic floor muscle strengthening. This program completely adheres to the foundational principles of Arnold Kegel, and then some. The Private Gym program incorporates muscle education, biofeedback, progressive intensity, and resistance. The new dimension added is progressive resistance, so that as pelvic floor muscle strength increases, the trainee can increase resistance accordingly. In other words, as your pelvic muscles get stronger, they can be challenged with increasing resistance. With Kegel’s perineometer, women worked out against the same resistance and over time were able to generate stronger contractions, but with the Private Gym resistance device, you not only develop strength by making progress against resistance, but ultimately increase the resistance in order to optimize the strength of the pelvic floor muscles.



And don’t worry ladies, our Private Gym for women program is in the works.

Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. Finally and most importantly, I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book:

For more info on the Private Gym: