Several years ago I wrote two newsletter articles on previous "pelvic floor experiments" I had done (one on coughing and one on wrist pain). Now it's time to report on my latest pelvic floor experiment: vaginal weights.

Vaginal weights come in a variety of shapes, sizes, weights, and materials, and are used for strengthening the pelvic floor muscles.

In a standing position, in the same way that holding a hand weight provides resistance during a biceps contraction (i.e. a biceps curl), a vaginal weight placed in the vagina, on top of the "hammock" of the pelvic floor muscles, provides resistance during a pelvic floor muscle contraction (i.e. a Kegel). The added resistance makes the muscles work harder, and thus become stronger, than they would working only against gravity.

I admit, I have been somewhat of a skeptic when it comes to the usefulness of vaginal weights. I can trace my skepticism to Elizabeth Noble, the incredible Australian PT who was the founder of the Women's Health Section of the APTA. In the prenatal exercise instructor course that I took from her many years ago as a newly-graduated PT, she told us that vaginal weights were not very effective for postpartum women, because (to paraphrase) "women with roomy vaginas can just tuck the weight away somewhere, and think they are strengthening their pelvic floors when they aren't." However, a crack in my skepticism occurred a few years ago when I heard a seminar on jade eggs (I also wrote a previous newsletter article about those). Jade eggs have historically been used in many traditional societies for improving women's pelvic floor health. Amid the many advantages of jade egg use, however, one potential disadvantage is concerns about ease of cleaning. Fast forward to last year, when a vaginal weight set designed by a pelvic PT came on the market, called the Intimate Rose Kegel Exercise System. I was impressed by the design, the very reasonable cost, and the ease of cleaning the weights, so I bought a set to try. While I haven't used them as consistently as I need to (yet), I have physically felt the following benefits of using a vaginal weight.

First, using a weight gives you feedback about your intraabdominal pressure control during position changes.

In pelvic PT, we teach almost every PT patient to do a "pelvic brace" during position changes (for example, moving from sit to stand). The pelvic brace involves exhaling, gently contracting your pelvic floor muscles (PFMs) upward, and gently contracting your lower abdominal muscles inward, while maintain a neutral lumbar spine position. Many patients squeeze their upper abdominal muscles instead of their lower abdominal muscles, which creates a downward pressure into the pelvis, which will push a vaginal weight out of the vagina. With a vaginal weight, you have to engage the muscles correctly and with the correct timing in order to keep the weight up and in the vagina while you change positions.

Second, using a weight makes you engage your PFMs completely.

As a pelvic PT, I think I have pretty good awareness of how to do a pelvic floor contraction, but using a vaginal weight shows me very clearly where I need to improve in engaging each part of the PFMs (front/back, left/right, superficial/deep). In addition, in order to fully engage the pelvic floor, you have to fully engage the lower abdominal muscles as well (and sometimes even the deep low back and hip muscles). Holding in a vaginal weight helps you find parts of those muscles you didn't know existed!

Third, using a weight helps you build PFM endurance, strength, and dexterity.

The pelvic floor muscles are made up of both slow-twitch fibers (about 30%) and fast-twitch fibers (about 70%). The slow-twitch fibers are the postural fibers that should be able to work all day long against gravity without tiring. The fast-twitch fibers are called into action with quick heavy loads on the pelvic floor (such sneezing, lifting, or landing during running). With a weight in the vagina, you can do a variety of exercises and functional activities that challenge your pelvic floor over longer or shorter periods of time to build these different capacities. It's really easy to determine which areas you need to work on by whether or not the weight stays where it should.

So far, my pelvic floor experiment with vaginal weights has been a success, and I look forward to seeing longer-term benefits from using them. One important caveat, though... Most women with pelvic floor problems such as urinary incontinence and pelvic organ prolapse have PFMs that are overactive (meaning they are turned on all the time). In this case, learning to how completely relax ("downtrain") the PFMs is critical, prior to (or in conjunction with) using vaginal weights to build PFM awareness, endurance, strength, and dexterity. Your PT at CTS can help you determine the best plan of care for your needs.

Katherine Dahl, PT, MPT, CD(DONA)

At CTS we treat a variety of disorders that you wouldn't think a Physical Therapist would treat. People tend to think of physical therapy as a means of restoring normal body movement as it relates to muscles, bones, joints, ligaments and tendons.

But what about the things under the muscles and bones?

Have you ever thought about where your organs attach? Or what they are attached to? Several therapists at CTS are trained to help restore normal mobility to your organs, which helps restore normal organ function and improve your overall health and vitality. Who doesn't want more vitality?

A few years ago, my husband had a physical with his primary care doctor. Among many things, they did a routine blood test including cholesterol and liver enzymes. His test results were the worst we had seen in years. He had high cholesterol and elevated liver enzymes despite a mostly healthy diet. Knowing that 3/4 of our cholesterol is actually produced in the liver and only 1/4 comes from our diet, I treated his liver. I mobilized all of the ligaments of the liver that attach to his diaphragm, and a few more that attach to other structures below his liver. Then I did some lymphatic drainage to his liver lymphatic pathways and corresponding lymph nodes. Less than 2 weeks later, he had a repeat blood panel that was completely normal. Around the same time, I had 2 other patients with elevated liver enzymes that also had normal test results just weeks after the same treatment.

Another common disorder I see is SIBO, or Small Intestinal Bacterial Overgrowth. SIBO is defined as the presence of excessive bacteria in the small intestine. But many believe SIBO is really an imbalance of gut flora or bacteria. What happens is the large intestine bacteria can get into the small intestine, where they do not belong, and cause inflammation, immune responses, digestive unrest, and unpleasant gut reactions every time a person eats. I have recently seen a lot of these people with these symptoms, and they have been struggling for years. Many have dysfunctional Iliocecal valves, essentially the doorway between the small and large intestine. Even if this is dysfunctional, the reason it is dysfunctional could be different for everyone. Others have tissue restrictions affecting the stomach, duodenum or small intestine, and therefore need mobilization to restore normal mobility. But many others have what I call a pressure system dysfunction. I can often trace it back to a head injury, facial surgeries, dental work, birth trauma, etc.

The tissue and fluid restrictions in the head, mouth, or chest can create dysfunction all the way down to the pelvis.

It is different for everyone, but with trained hands I can essentially feel the tissue restriction, release it, and move on to the next restriction. The goal is to restore normal mobility and motility to all of your organs and to restore a normal pressure system between the head, chest, abdominal and pelvic cavity.

Many of the practitioners who do this type of therapy are trained in multiple disciplines developed and taught mostly by Osteopathic Doctors trained outside of the USA. Visceral Manipulation, Craniosacral Therapy, Lymphatic Drainage, and Brain Therapy are just a few of the relevant disciplines. Most clinicians make it their life's work and really try to enhance their hands by taking a variety of the different disciplines, which can all work together for more effective treatment. This type of therapy, combined with a healthy diet, exercise, emotional work, and support from a naturopathic doctor or medical doctor is what we need to get to the root cause of all disease. Let's heal for life.

Kim Zevin, DPT