The Power Is in the Pulse: Why Movement Beats the Isolated Kegel

"The power is in the pulse." (Dr C)

The isolated Kegel, lying still and squeezing a muscle you can't see, is hard to feel and easy to forget. PfilAtes takes a different route: we hold each movement at the point where the pelvic floor is already switched on, and then we pulse. Pulsing is the critical element of the PfilAtes program.

Why the hold point matters: the EMG

In a study presented at the Society of Gynecologic Surgeons in 2016 (Crawford B, Am J Obstet Gynecol 2016;214(4 Suppl):S468), 100 consecutive patients referred for pelvic floor rehabilitation wore surface EMG sensors. All 10 movements produced significantly higher mean peak pelvic floor activity than the isolated Kegel (p<0.001). Bridge was highest (56% greater), followed by Hovering (49%) and Lunge (42%), with Corkscrew lowest (21%).

Two caveats: this measured muscle activation, not bladder symptoms, and individuals vary. Some ranges dipped below zero, so choose movements that work for each client.

A 2024 Cochrane review (Hay-Smith et al.) suggests movement works better with a deliberate pelvic floor contraction than without one.

The three critical elements of the pulse

1. Small range of motion around the hold point, the point of peak passive pelvic floor activation.
2. Percussive breath: a short, forceful exhalation with the mouth open, engaging the transversus abdominis at the exact moment of the pulse.
3. Voluntary pelvic floor contraction, layered on top of the engagement the movement already provides.

Try this week: the Bridge pulse

1. Set up: On the back, knees bent, feet hip-width and parallel, a soft ball between the knees.
2. Rise: Exhale and roll up one vertebra at a time, only as high as is comfortable (pelvic curl, half bridge, or full bridge).
3. Hold at the top: This is peak engagement. Squeeze the ball, contract the glutes, and keep breathing.
4. Pulse:
   • Small range: lift and lower the hips a little, staying near the top.
   • Percussive breath: on each lift, a sharp open-mouth "ha!"
   • Voluntary contraction: lift the pelvic floor on that same "ha," then soften knees, glutes and pelvic floor as you lower and inhale.
5. Release fully before rolling down.

Cue to borrow: "Small lift, sharp 'ha,' squeeze up. Now let it all go."

Afterwards, ask clients to rate the contraction they felt (0 none, 1 mild, 2 moderate, 3 strong) and note any movement that caused pain. The highest-rated, pain-free movements become their shortlist.

Stay in your lane

PfilAtes is fitness, not treatment. Refer to a pelvic health physical therapist or physician if a client reports pelvic pain, pain with movement, a heaviness or bulge sensation, blood in the urine, new or worsening leakage, or can't feel any contraction at all.