When performing Kegels, why do you recommend having a 4/5 on the Hruska Abduction Lift Test? Especially in women postpartum, I begin pelvic floor activation rather quickly, well before they could achieve this score. Why is this necessary from a PRI perspective?
The Hruska Abduction Lift Test score of a 4/5 ensures that the pelvis has external stability from the much larger musculatures such as the hamstrings, adductors, glutes, IO/Tas for the urogenital diaphragm to be in the correct position to function. You could certainly challenge me that you could start Kegels with a HAbdLT of 3/5, but in my experience starting prior to this, the urogenital diaphragm is challenged. I have started my postpartum patients getting the pelvis neutral and working on external pelvic stability with the PRI process with great outcomes. Remember when you engage the ischial condylar adductor with correct diaphragmic breathing, the puborectalis and pubococcygeus (pelvic diaphragm) muscles will ascend and perform a subconscious Kegel with exhalation. Maintaining a contraction of the ischial condylar adductor with inhalation will allow the puborectalis/pubococcygeus muscles to descend with frontal plane control of the outlet as to not allow this musculature to descend excessively (think prolapse). So, you are working on Kegels subconsciously with PRI activity at the start of care.
– Lori Thomsen, MPT, PRC
