Considerations for Your Pelvic Floor in a High Pressure World
Over the weekend, I hosted my second women’s health and fitness workshop at my local gym, Forte Fitness, NC. This event's topic was on understanding
and addressing incontinence as a female athlete. Many of those who attended shared a love of challenging exercise like Bootcamp, HIIT, Crossfit, running, etc. All were women, some were moms, some were coaches, and everyone came to learn more about their bodies.
Although some might think that discussing strategies for high intensity activity is a little out of my realm as a trainer who works primarily with new moms and moms to be, I’ve had enough experience in this field to know that pelvic floor dysfunction does not discriminate. It can happen to anyone (men, women, and children) and the strategies we discuss are still very much applicable. And yes, those who have never had children can still experience PFD symptoms. What’s more is that we are living in a world of extremes. Our athletic endeavors far surpass anything our parents or grandparents did for recreational exercise. We are training like athletes. Which means we need to understand how to maintain our function even more in these “high pressure” environments. And my ultimate goal is to help you get back to the activities you love doing with the tools and knowledge to keep you moving forward, without setbacks like these!
I’m often surprised by the number of women who have been mothers for 5, 10, 20+ years who truly believe that they are no longer postpartum. It’s as if postpartum only refers to maybe that first or second year after having babies. This, along with a host of other reasons is why I think so many women carry on for years experiencing incontinence, symptoms of pelvic organ prolapse, loss of sensation, painful or unpleasurable sex, etc. Is it because we think we can't heal anymore? That it's too late? It’s as if somewhere along the way, we’ve convinced ourselves that we’re just supposed to smile and not acknowledge that our vaginas aren’t happy and still be expected to train for a half marathon, crush a Tough Mudder, and compete at high levels in Crossfit or powerlifting competitions.
Mamas, once postpartum always postpartum. This shouldn't be looked at as a burden, but rather, just a fact. Your body is changed and we need to consider this as we are both returning to exercise after having babies, and even when we’re in our fitness prime. If you are experiencing symptoms of pelvic floor dysfunction at any stage in the game, this is a sign that your body is not functioning at its best. But guess what? There’s hope. There are strategies. There are resources.
Before we go on, if you are one who does experience incontinence while exercising, laughing, sneezing, or coughing, type “Pelvic floor physical therapy near me” into your google search bar and make yourself an appointment. You can also click here to search the national database for women’s health PT’s.
If you’re having trouble finding a PT or knowledgeable coach/trainer in your area, shoot me an email and I’ll do my best to get you connected. As a personal trainer, I can watch your form, make sure we are cueing the exercise properly to best serve you, ask you questions, but there is no way myself or any other personal trainer for that matter can completely understand what is happening to your body when you leak without the collaboration with a physical therapist who specializes in this area. Make a physical therapy appointment today!
As women, we tend to be slightly more prone to these issues as we discussed in the
workshop. A few of those reasons can be that we grow and birth babies, our female
anatomy has three points of weakness rather than two, and our hormones are constantly fluctuating from the moment we hit puberty to when we go through menopause and beyond. (More on this soon.)
One of the major topics we discussed over the weekend was the core and pelvic floor as a system. Understanding this is truly the foundation to understanding our body’s function. So here’s a quick overview for those who are new to the group:
The core and pelvic floor want to work together. They are a team. Like the 1992 DREAM TEAM (Michael Jordan, Scottie Pippen, John Stockton, Magic Johnson, Chris Mullen) when they’re all working together properly.
It's also nice to think of the system as a canister: You’ve got your top, bottom, front, back, and sides (as you see in the diagram to the right). This entire system of muscles provides support and stability to the pelvis and spine. AND this lovely system manages pressure placed on the body through movement and exercise, to protect those very precious internal organs located within the pelvic region: Uterus, bladder, rectum, etc. Kind of an important job, right?
A valuable question to address here: Is ALL pressure on the system bad? Nope. Hello gravity. It’s the unmanageable pressure that we want to address. And this is different for everyone. The unmanageable pressure is what causes a breakdown in function in the first place.
Want to know the crazy part? The part that usually drives new clients nuts? The mechanics of this potentially well-oiled machine rely almost entirely on the utilization of proper breath and alignment. The core and pelvic floor are your built-in pressure system. They want you to manage any load or force placed on your body with ease. It’s up to us to give them the chance to do so. It’s that easy, but that hard at the same time.
So, the major question that many ask once they learn about the fundamentals of alignment and breath is how the hell do they put all of the pieces together while exercising? The truth? Practice. Developing a better sense of your body and its function is the best place to start. Understanding its cues, feeling the body react and move differently when slowing it all down---It takes time. It takes commitment to your body to let it heal and learn better mechanics. But once you understand it and feel the difference when you perform an exercise without leaking or other symptoms of PFD, it’s pretty freaking cool. It is worth the work. You are worth it.
Although I always wish for more time, we did have a chance to play around with a few movements during the workshop that some of the women identified as the exercises that most often cause them to leak. One of them is the ever so popular jumping jack.
Now, if you are jumping and leaking would I suggest that you continue doing that exercise? For the time being, until we sorted things out and you found yourself a PT, no I wouldn’t. However, I also know that the second I say, “Don’t do that,” a handful of you are going to start tuning me out and go to the next available rebounding class and jump your sweet little hearts out. So, although I’d say that omitting jumps until you’ve mastered foundations is key, I also want you to have the information that so many of us wish we knew long ago.
QUICK SHOUT OUT TO ALL TRAINERS AND GROUP FITNESS INSTRUCTORS: If you’re coaching women, statistics show 1 in 4 experience symptoms of pelvic floor dysfunction. Many of us consider this to be a conservative and skewed number as this data is based off of self-reporting. But with that information, might you consider possibly using a different exercise? One that might still get the blood pumping but not put a large number of your class in compromising positions without proper strategies in place? Or can you think of a way to offer options so that it doesn’t make them feel like they’re being singled out? Do they have to jump to be successful in your class? Just a few thoughts. And I have love for you! I just love our pelvic floors more. (And if you'd like more information on how you too can become well-versed in women's health and fitness, shoot me a note!)
So, let’s talk about some common issues with the jumping jack that may bring on symptoms. Here I am sounding like a broken record but, IF YOU ARE LEAKING DURING AN EXERCISE, you now know that this is COMMON but NOT NORMAL (sorry for all the caps but this is important). I highly recommend that you see a PT and/or at the very least work with a trainer who is well versed in pelvic floor function during exercise. And if they are doing their job correctly, they are going to tell you to see a PT too.
Here are two quite common reasons why we might be experiencing symptoms during an exercise like the jumping jack:
1. Rib Flare: Usually when we jump, we flare our ribs up and our head pulls up, placing a
ton of pressure on our low back without allowing the front part of our core to provide much support. This can often bring our pelvis into an anterior tilt with hip bones spilling forward. This then can keep our pelvic floor from being able to relax and contract as it would like to during movement.
2. We aren’t breathing or our breathing is shallow and in the chest.
Additionally, the open and closing movement of the legs and arms may be too much for an uncoordinated pelvic floor to manage without compromising function.
If you find yourself doing one or both of these things when watching your jacks in the mirror, try this and see if you notice a difference:
1. Change your gaze from up and out to down and think about bringing your sternum down towards your naval. A slight forward lean may help too. All of this can bring your ribs down and align better with your hips---which allows for a more neutral pelvis---which gives your core and pelvic floor a better shot at supporting you during high pressure exercises like jumping.
2. BREATHE. Have you ever put a pot on the stove to boil water, popped the top on, and then walked away? A few minutes later you might’ve heard some sizzling from water spilling over the sides as the pot boils over. If we don’t alleviate that pressure of a jump through breath, it will either press out into the abdomen or down into the pelvic floor. Fill your ribcage with air and continue to inhale and exhale and inhale and exhale as you perform the exercise. Avoid that all too common breath hold. And if you find yourself unable to breathe during the exercise, slow it down until you can. (Another big topic to be discussed on another day is understanding your threshold and honoring it with a pace that best suits you.)
Here’s a comparison of a jumping jack with ribs up and flaring with a jumping jack with functional breath and a more stacked, ribs down position.
Of course after drilling jumps and practicing better strategy use during weighted squats,
deadlifts, kettlebell swings, and overhead presses, the best way to end any workout is resetting with legs up and breathing deep. This is also a great way to start a workout, especially if you feel more symptomatic at the end of the day during a workout, or you've already been on your feet for a big portion of the day. Taking just a little bit of pressure off of the pelvis and allowing the pelvic floor to relax could help with better function during your workouts and beyond. Tough day? Legs up girl!
Think you want to give these adjustments a try? I’d LOVE for you to let me know how you feel afterwards.
Up Next: Identifying and understanding your threshold and how to move past it.
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