While becoming more well known in general, the pelvic floor is typically not the first thing that comes to mind in relation to sports and athletics… more so thought of in relation to women, pregnancy, menopause and leaking urine.
While it is true that women and girls are more at risk for pelvic floor dysfunction (more on that below), all of us (regardless of age or gender) have pelvic floors. And while the pelvic floor is great at controlling bladder and bowels, supporting our internal organs, pumping fluids from our legs back to our heart, and sexual function post-puberty, it also plays a major role as part of our core control and central stability system.
As such, all of us, and especially in sports, need a healthy, adaptable and resilient pelvic floor to enhance the capacity of the “deep” or “anticipatory” core muscles (also including the respiratory diaphragm, transverse abdominis, and multifidus) to allow for speed, agility, coordination, and overall performance. Especially due to its close proximity to the deep hip musculature that is used for a lot of sports.
While leaking urine or stool, perineal heaviness, pelvic pain, pressure, constipation are all common signs that there is pelvic floor dysfunction, more subtle signs like sacroiliac joint dysfunction or instability, recurrent injuries, reduced core coordination, hip, hamstring or groin pain/ strains, etc. may go under recognized as a potential contributing factor. As such, these more common athletic injuries may be mistreated or not fully understood and managed. In these cases, there may be a part of pelvic floor/ core dysfunction that is limiting proper or complete rehabilitation and progression forwards.
As women, we are even more at risk for pelvic floor dysfunction due to our anatomy (i.e. wide pelvis, more reliance on ligaments for stability over just boney alignment in men, 3 holes instead of 2, hormones that change our ligament laxity at certain times). However, a population that goes under the radar as far as pelvic floor dysfunction are our young women and girls – especially around puberty as our body changes (i.e. pelvic widens, increased weight in our chests, etc.).
If we think about where the pelvic floor attaches (at the bottom of the pelvis connecting pubic bone to tailbone and both sits bones) a widening and opening the pelvis stretches the musculature that attaches there, making it lose its inherent strength and function/ control (see my previous post on length vs. strength). This means that our young women and girls are subconsciously having to relearn and reintegrate coordination and stability with the rest of the deep core muscles while still trying to maintain performance. Some girls are better at this than others, but for many this is where their core dysfunction can start and continue on for life. Further, a lot of high performance athletes are also adding strength and conditioning training focusing on agility, power and strength. This is great, however, there is little focus or poor instruction on the more subtle and nuanced integration of true deep core control with these activities. This can put these athletes at more risk for pelvic floor dysfunction (likely high tension, potentially leading to urinary urgency, frequency or leakage, painful intercourse, constipation or other recurrent injuries due to poor coordination and stability) from over gripping, bracing and poor control strategies.
While no longevity studies have looked at this specifically, how we move, function and train throughout our lives, including as early as middle or high school, set us up for healthy movement and the capacity to be resilient and adaptable when learning something new, managing natural body changes, recovering from injury, and the like.
It is my new mission to work with our young women and girls to give them the education, awareness, connection and empowerment in their health, especially as it pertains to our uniqueness as women, assisting them to move, perform and train in sports how they desire; before they have 3 kids and are now postmenopausal. A big part of that is related to our pelvic health and how we relate to our “womanhood”. Think of how much we could prevent if we started just a bit earlier?
Andrea Plitz, Physiotherapist and Yoga Teacher. Andrea has a clinical focus in women’s health including applied pelvic health, complex orthopedics and concussion rehab. She currently lives and works in Ottawa, Ontario, Canada.
Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.