In this excerpt from her groundbreaking book on pelvic floor health and sports, physical therapist Dr. Rachel Selman, DPT, shares cues and guidance for women and men on how to do a Kegel exercise and a Reverse Kegel exercise.
It’s fascinating that we have a name for a pelvic floor muscle contraction—that is, the Kegel. By contrast, we do not have a name for a bicep contraction, calf contraction, or hamstring contraction. While I’m grateful that Dr. Arnold Kegel at least was talking about the pelvic floor in the 1940s, I’m not entirely sure why the contraction of the pelvic floor muscles came to be named after him. Long before Dr. Kegel was around, women were subconsciously contracting their pelvic floor muscles, yet he is credited with “developing” the movement! But I digress, as this terminology has clearly stood the test of time.
What Is a Kegel Exercise? Terminology and Explanation
When I ask an athlete to perform a Kegel, I am usually met with a look: Okay, did I do it? Let me walk you through the cues and descriptions I use to teach the basics of a pelvic floor contraction. A pelvic floor contraction should involve both a wrapping and a lifting movement. If I insert my finger vaginally or rectally, I am looking to feel both a squeeze of the finger and a pull of my finger up toward my head. This should be a slow and controlled movement—much like riding an elevator, with equal control and speed from floor to floor. Many of my clients are able to briefly engage these muscles at the top floor of the elevator (i.e., a quick pull to the top of the elevator), but they aren’t able to slow it down and aren’t able to pause at any of the floors if I were to ask. They are also often unable to tell me if their pelvic floor is “on” or “off,” and it’s difficult for them to subjectively determine whether they are still in a contraction after a few seconds. By comparison, imagine closing your eyes and creating a variety of positions with your fist. Even with your eyes closed, you’d be able to tell me exactly what your hand is doing—the extent to which it’s closed or open, the position of each of your fingers, and the amount of effort used to get there. I’m not suggesting that you have to be able to execute this exact same level of awareness and control with your pelvic floor, but I am adamant that generally improving control could help your sport performance, both consciously and subconsciously.
The reality is that we need varying amounts of pelvic floor contraction throughout our day, depending on the task at hand. When I’m standing in line at the grocery store, I may need a 2/10. When I sneeze, I may need a 10/10. When I step off a curb, I may need a 6/10. When I use the restroom, I may need a 0/10. The inability to achieve these nuanced levels of contraction will result in other muscles doing their best to help regulate the area around the pelvic floor. Again, compensations are manageable for short time periods, such as after an injury or surgery. However, relying on other muscles time and time again adds up, and clinical experience shows that the pelvis keeps the score. A trained professional can complete an external or internal pelvic floor assessment, but I understand that some people will not be interested in that option—and that is okay with me. I’m not here to force you to undergo exams that you’re uncomfortable with, but I do want to give you enough background to determine when an exam may be necessary.
Cues for How to Do a Kegel
- Imagine drinking a milkshake through a straw (if the straw was inserted into the vagina).
- Think about lifting a blueberry with the vagina.
- Tighten your butthole.
- Lift the muscles up and in, like a jellyfish floating up toward the head.
- For guys, the simple “nuts to guts” mantra is highly effective, as is the thought of jumping into a cold pool.
None of these should be accompanied by a butt clench or breath hold—I should not be able to see whether you are completing a Kegel.
Introducing the Reverse Kegel
If you are asking, “What the heck is a reverse Kegel?” I guarantee you aren’t alone! This is actually where most athletes struggle. They understand the Kegel. They know what it feels like to turn muscles on. They know how to quickly and effectively recruit muscles to generate force and speed.
But how exactly do they get out of that contraction?
When I’m doing a clinical assessment with an athlete who has a hard time with this, I often feel a very small lifting and closing. It’s palpable, and in many cases it might even be strong, but the range of motion is extremely limited. The athlete might need me to confirm that they performed the task (“Am I doing it?”), as the actual range of motion is so small that it’s difficult for them to sense it.
These athletes are often “resting” at a high level of engagement—in other words, their elevator is hanging out on the seventh floor instead of returning to the lobby. It’s much tougher to feel movement when you’re going only from floor 7 to floor 10, as opposed to moving from the lobby to the tenth floor. What their brain interprets as rest is actually a partial contraction that has developed as a result of the need to recruit these muscles for sport on a regular basis.
If you work a desk job, compare this to how you may think you’re relaxed until your friend says, “Get your shoulders out of your ears!” Suddenly you realize you’ve been sitting in a tense position all day without recognizing it. Or, if you are like me, you might relate more to the jaw-clenching example. I seem to perpetually do this in my sleep. It’s not that I tell my brain to clench my jaw—instead of consciously taking direction from me, my brain communicates directly to the muscles in my jaw, telling them to clench and hold pressure.
Our bodies get better at what they practice, so those who have never consciously practiced a reverse Kegel often require an awareness of what it actually feels like to let go. It’s not quite as easy as showing you how to move your shoulders downward, given that we can’t see the contraction in the pelvic floor. Further complicating the situation, symptoms associated with pelvic floor muscle clenching aren’t often discussed in physical exams, much less in athletic training rooms, making it more challenging to identify the pelvic floor when troubleshooting potential contributors.
Cues for How to Do a Reverse Kegel
- For women, imagine gently pushing out a tampon.
- For men, imagine gently pushing out a bowel movement.
- Breathe into your butthole.
- Think about the pelvic floor melting like butter.
- Imagine the pelvic floor “blossoming” like a flower.
I, for no particular reason, hate that last cue, but if that is the phrasing that best works for you, by all means use it! Just between you and me, asking an athlete to “blossom” creates a visceral reaction for me that often involves a clenching of my own pelvic floor.
For a reverse Kegel, I want to feel a gentle downward opening, without the athlete holding their breath or pushing down their abs. Holding breath or pushing abs down is known as “ab gripping”—when I ask some athletes to move the pelvic floor muscles away from their head, they will hold their breath, bear down, and push. This is not a voluntary or controlled reverse Kegel; it is simply forcing the muscles out of the way by creating an unsustainable amount of pressure above them. If I ask an athlete to sit on their hand (see my DIY assessment), I want them to feel a gentle lengthening of the muscles down into their hand as if they are initiating emptying the bladder or bowels (but without enough pressure to actually empty). Again, this should be controlled at each level with the ability to pause, hold, connect, and continue as desired.
Let’s floor it! See more from Dr. Rachel Selman and her groundbreaking book on pelvic health and sports.
About Floor It
Floor It is the groundbreaking guide to your pelvic floor, the unsung hero of core strength and your hidden powerhouse for sports.
Dr. Rachel Selman, DPT, the NSCA’s 2026 Personal Trainer of the year, offers a fascinating resource to understand pelvic floor dysfunction and pelvic muscle training for endurance sports, team sports, power sports, and sports that involve twisting like tennis and golf.