Pelvic Floor Health and Strength Athletes – We can do better.

This is a big area of growth for the fitness industry, we’re only JUST starting to warm up to the fact that we need to take better care of prenatal and postpartum women- but what about our strength athletes? What about the women who are not postpartum? How do we normalize talking about the pelvic floor while avoiding puddles on the platform and still hitting PR’s? 

Here’s what I know: 

  • A lot of women will have some sort of PF dysfunction – pain, leaking, pressure, prolapse…
  • A lot of women don’t know Pelvic Floor Physio is an option
  • Pelvic floor physio can be incredibly effective
  • Pelvic floor physio doesn’t work for everyone – and sometimes surgery isn’t even a guarantee
  • Leaking during exercise is VERY common
  • A dribble or a full bladder is still considered incontinence
  • Some women are horrified if/when they leak during exercise
  • Some women plan for it and wear pads or change their tights afterwards
  • Some women are labelling leaking as a badge of honour in their sport
  • Some women only have leaking during max loads/PR attempts
  • Some women only have leaking during movements like skipping and box jumps
  • Most women will experience some form of leaking in their lifetime

Before we dive in, I want you to know that no matter what your experience is- It’s OK. You’re not broken and you’re not alone.

I think a lot of people don’t understand the time and physical demands placed on your body when it comes to strength sport. Pushing to the ABSOLUTE limits isn’t something most women (wait- most PEOPLE) are willing to do and often we react strangely to the unknown. Pelvic floor aside – there’s a large amount of the general population that doesn’t understand why anyone would arch their back for bench press. There’s such a stigma around spinal flexion and extension that anything beyond neutral is considered ‘wrong’ and ‘unsafe.’ When actually, the arch is important for a few reasons, but that’s not what this is about.

In every certification i’ve done surrounding pelvic floor health there’s a strong emphasis on breathing technique and allowing the pelvic floor to contract and relax WITH breath. Then we look at a sport like powerlifting where the standard for lifting is a valsalva maneuver – which from the outside just looks like breath holding. Just like the back arch, knowing WHY a specific technique is used goes a long way. A valsalva should help you maintain intra-abdominal pressure (IAP) throughout a lift. Which is why you’ll see a lifter take a big breath before an attempt. NOW: without going internal, it’s impossible to know exactly what’s happening to cause any sort of leaking but if liquid is coming out I can assume that pressure is not being maintained the whole time. Think of a pop can that gets shaken up- one tiny hole and it’s everywhere.

Then there’s the pink-factor (insert giant eye-roll here). In sports that have long histories of male-dominated competition we females get the short end of the stick. ‘Shrink it and pink it’ is often the case with equipment and most, if not all, research studies have been done on men. While their anatomy is similar, it is definitely not the same and when you throw hormones into the mix, you’re going to get much different results. For example, some women find leaking to be more prevalent when they’re menstruating- this is something we absolutely cannot compare to our male counterparts. We’re also JUST learning that menstruators have different times in their cycle that allow for better outcomes of different types of exercise- WILD.

My rehab background bias tells me that we should avoid crashing through the fence into symptom-city and that moving lighter weights and going up to the fence, leaning in then progressing as such is the smart solution…but what if that’s not an option? What if heavy weightlifting is part of their identity as an athlete? What if it’s a competition and PR’s are the goal? What if you’re cycling through a lot of reps and there’s just no way you can regulate your breathing? What if it’s not just the pelvic floor? 

The first obstacle will always be having an athlete that WANTS to make a change. If you’re not willing to acknowledge your weaknesses and put in some work then I can’t help you. It’s the same as any rehab journey- if you truly want your back to stop hurting, you’re going to need to make some changes and put some effort into it. That said, if you want longevity in your sport, and long term pelvic floor health then I highly suggest working on these 5 areas of growth. (Note: not all will be relevant to everyone)

  • Breathing- belly breathing is out, in order to prep for some good IAP you’re going to have to work on some 360 breathing. Using this technique with some pelvic floor relaxing will go a long way. This also brings us back to the valsalva- A lot of lifters will hold their entire breath, if you exhale a little (causing your pelvic floor to naturally contract) THEN hold for the remainder…it might alleviate some of the pressure going down. And speaking of valsalva- are you distributing that pressure evenly? Or is it all going down? Your pelvic floor has to support your organs AND it gets all this pressure down onto it? It’s pretty strong but we’re not doing it any favours if this is the case. 
  • How’s your belt? A lot of heavy lifters will use a belt and no one’s making you stop BUT let’s consider going without for your lighter lifts, I suggest anything lower than 80% 1RM. Your pelvic floor and abdominals are a wonderful natural weight belt. Without being the goldilocks of weightlifting belts, try something different – thickness, stiffness, tighter, looser…sometimes a small change can make a BIG difference. 
  • Happy hips – Hip and low back pain have direct correlation to the pelvic floor. This is what I mean when I say it might not be the pelvic floor itself. We know our bodies are incredibly interconnected. Tension in one area can cause increased tension in another and when something’s gotta give…it’ll be the weakest link. A solid warm up  routine that includes hip mobility, core activation, and breath connection is key.
  • Technique- I think this goes without saying but if your technique is sound you’re less likely to have injuries and problems as the weight increases. And going back to a few points ago – TRY SOMETHING DIFFERENT. If you’re really good at sumo deadlifting, get better at conventional – train your weaknesses, train the sticky spots, spend time getting uncomfortable, become a master of your craft. (Note: no one is making you switch your preferred stance for competition- not forever, just for now.)
  • Load- not every season can be a build. This goes with injury prevention too but if you’re constantly chasing PR after PR or are forever in competition season something will give, and I don’t just mean your pelvic floor. Your body needs time to rest and rebuild. This would be the time to step back and work on that pelvic floor dysfunction, technique and experiment with change. 

I will always recommend you see a pelvic floor physio, always. That said, not all physio’s are created equally. If you find a physio who knows your sport and its demands then that would be amazing. If they don’t know but are willing to learn both from you and your coach that would be the next best thing. If they’re not willing to learn and discourage you from lifting or your sport then I suggest a second opinion. There are very few reasons someone would be discouraged from lifting all together and it’ll entirely depend on your situation but your physio should be meeting you where you’re at. The excuse of not having one in your area is invalid – a lot of work can be done remotely and via tele-health. Cost is always a factor but if it truly means something to you then you’ll make it work or your provider might have options for you.

Imagine if we treated our pelvic floors like any other muscle in the body. Imagine if we could have open conversations the way we do about our janky knee or the niggle in your back. Creating longevity for women in sport is always my goal through education and empowerment- Please share with your strong friends.

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