The Ultimate Pelvic Health Guide: Everything you need to know about Pelvic Health Physiotherapy for Athletes
You might have heard the term pelvic health physiotherapy before but are not sure exactly what it is. You might have been told you have pelvic floor dysfunction but aren’t sure what to do about it.
Maybe you’ve been told to stop all your sports and activities because of your pelvic floor symptoms, but deep down, you know that’s not the answer.
Well you’ve come to the right place!
In this blog post you will learn all the things that you need to know about what pelvic health physio is and how it can help you excel as an athlete.
This blog post will go over:
What is Pelvic Health Physiotherapy?
Pelvic health physiotherapy is a subspecialty of physio that takes a look at how the pelvic floor is working with the rest of the body during daily activities and sports.
It can be called a bunch of different names like pelvic floor physio, pelvic physio, women’s health physiotherapy or pelvic PT.
Pelvic health physio can't just be narrowed down to the pelvic region because we are a human body that is so incredibly interconnected. The body has systems that work together so that we can live an active life! Nothing works in isolation.
Now before we dive into more of what pelvic health PT is, let’s keep go through some background info.
What is the pelvic floor?
The pelvic floor is becoming a more frequently used term but you might not really know what it is.
For starters, it’s a pretty important part of our body.
The pelvic floor is a group of muscles that sit inside the bones of the pelvis. There are three layers of muscle and connective tissue with a network of blood vessels, nerves and internal organs all around this area.
These pelvic floor muscles travel from front to back, fan out to the sides and can look like slings attaching to the pelvic bones and other muscles and connective tissue that run towards the hip.
What does the pelvic floor do?
The pelvic floor muscles have a really important role in providing core stability.
But that’s not all they do. They actually have a bunch of jobs that happen in the background for our bodily functions and movements.
The pelvic floor muscles do the following:
Provide stability at the deepest core level.
Support the internal organs.
Support bowel and bladder continence by being an active sphincter to hold pee & poop in.
Act like a sump pump to move fluid (blood and lymphatic fluid) through the pelvis.
Have a role in sexual function.
If your pelvic floor is a happy one, it will be busy working away in the background for you to achieve all the things above.
These muscles are anticipatory, which means they will anticipate what type of support you need just before you need it.
Sometimes, we see a breakdown in this area, whether that be a change in situation, like pregnancy, or when a movement strategy tries to anticipate what the body needs but might be a bit off. When that happens, we can get pelvic floor symptoms.
What are pelvic floor symptoms?
Pelvic floor symptoms can show up in a few different ways.
There are some obvious symptoms such as:
Urinary incontinence or urgency
Bowel incontinence, flatulence (farting!) or urgency
Pelvic pain
Pelvic organ prolapse symptoms like heaviness or bulging
And there are a some less obvious symptoms that can present like:
Hip pain or tight hips
Chronic low back pain
Small bladder and the need to pee all the time
Painful sex or difficulty achieving an orgasm
Who is pelvic health physio for?
Traditionally it is thought that only people who have been pregnant and had babies need pelvic health physiotherapy. While those who’ve gone through a pregnancy are a large population of who use pelvic health PT services, that is not the only group that benefits.
Pelvic floor concerns can happen to anyone because everyone has a pelvic floor!
Binary, non-binary, male, female, transgender … regardless of how you identify, there is pelvic floor physio out there for you if you need it.
What is treated in pelvic health physiotherapy?
There are a lot of different conditions that are treated in pelvic health physiotherapy. The pelvic floor holds quite an important role so it can have an impact in a lot of different bodily functions.
Here is a list of some conditions that we treat here at HerSport Physio:
Urinary incontinence, urgency or high frequency: Whether you are leaking when you run, jump, or lift, if you’re having urgency and can’t make it to the bathroom, or complain of a small bladder and go pee just in case, this is all under the incontinence umbrella. We can help you stay dry and keep your pee in longer!
Chronic constipation, bowel urgency or incontinence: Things associated with bowel function are hemorrhoids, anal fissures, chronic constipation, urgency or leaking faeces. No fun at all.
Pelvic pain: At HerSport Physio we treat pelvic pain that can show up in a number of different ways.
Pain during pregnancy or postpartum, pain in the low back or glute area, pain in the deep hip, lightning crotch, sharp shooting pain in the pelvis, pain around the genitals, pain during or after running or exercise, pain with sex, or pain during the menstrual cycle.
Tailbone, SIJ or pubic symphysis pain: Often this type of pain is very local and can make it hard to do daily activities and sport. These can show up during pregnancy, postpartum or after a trauma like a fall.
Pelvic organ prolapse: Symptoms can feel like a heaviness or bulge around the vagina or rectum. It can feel like there is a bubble or a tampon that is not sitting quite right. Sometimes there is a visible bulge if you look down there with a mirror.
Symptoms can vary but are often worse in an upright position, after longer bouts of activity or sports, with bearing down or bracing when lifting.
Chronic low back pain or chronic hip pain: If you’ve tried all the traditional treatments for low back pain or hip pain and it just doesn’t go away or keeps coming back, the pelvic floor might be contributing!
Diastasis recti or abdominal separation: This refers to the widening between the two sides of the six-pack ab muscles, the recti abdominis. With pelvic health physio, the ab separation or widening can be addressed and an increase in strength and function can be achieved.
Prenatal and postpartum: During this time, the pelvic floor and core can be greatly affected by the changes of growing and birthing a human being.
Prenatal pelvic floor physiotherapy can help manage symptoms during pregnancy like pain or leaking, can help improve birth outcomes with education, labour and delivery prep and provide exercise guidance to help the pregnant person remain active.
After the baby is here, postpartum pelvic floor physiotherapy provides pelvic floor strengthening exercises, core strengthening, and guidance on how to safely return to exercise and sport without pelvic floor symptoms (like leaking heaviness, or pain).
Outcomes after having pelvic health physiotherapy at HerSport Physio
Here are some of the things are our clients are saying after pelvic health physiotherapy:
I can run without leaking!
My low back pain that I’ve had for years has been so much better!
I felt very prepared to cope with pain during my labour.
I was able to advocate for a great pushing position during labour.
I can lift heavy weights without fearing my prolapse will get worse.
My c-section recovery was so smooth and I’m able to get back to exercise.
I felt confident to continue CrossFit training during my pregnancy.
My core feels stronger after having some specific diastasis exercises.
I can jump without peeing!
What does pelvic health PT look like for athletes?
Pelvic health physiotherapy for athletes looks like integrating all that we know about the pelvis into what we know about the rest of the body during the demands of sport.
We look at how well these systems are operating together so we can optimize function to influence performance and to keep you symptom-free.
It’s more than just kegels.
Pelvic health physiotherapy for athletes may include:
Watching you move - How do you accomplish a movement task? What comes naturally? What is challenging?
Breathing strategies - What bracing or breathing techniques are you using during your movements?
Strength testing, especially around the hips, pelvis and low back. These muscles are neighbours to the pelvic floor. Everyone wants good neighbours!
Impact and load tolerance - How does your body respond to impact or load? This includes running form, jumping and landing mechanics, and weight lifting form.
Internal pelvic floor assessment - Although never mandatory, but this type of assessment can provide valuable information for your rehab plan.
Trying something new and different to see how that impacts your symptoms.
Making a plan for your training - Implementing new strategies for things such as lifting, postural adjustments, or strengthening exercises.
What does a pelvic health physio treatment look like?
Pelvic health physio treatment will look different for every athlete.
For most athletes, a treatment session will include assessing the movements that are giving you trouble and then providing you with a specific exercise plan to help address those challenges.
The pelvic floor can also be assessed internally, either vaginally or rectally. A physiotherapist can insert one or two fingers in the vaginal canal or rectum to assess pelvic floor muscles.
how much tension or flexibility there is
how you manage downward pressure
how strong the muscles are when they contract
how well the muscles can lengthen and relax
The assessment is offered in multiple positions such as lying down, standing, or squatting, to see how the pelvic floor responds in different positions and under different loads.
Please remember that this type of assessment is never mandatory and you need to feel completely comfortable with having it done before a physiotherapist continues.
A pelvic health physio treatment for athletes may also include:
Video feedback - using video to help describe what type of changes we want to make with your movement.
Exercises in the form of both strength or mobility.
Breathing and bracing strategies.
Discussion on how other parts of life and training impact your symptoms - nutrition, sleep, recovery habits, and stress levels to name a few.
Why is pelvic health important for athletes?
Pelvic health physiotherapy is a key part of rehab that often gets forgotten or overlooked. The pelvic floor is so important in core stability and is a part of every movement we make.
If you as an athlete have some idea on how your pelvic floor is functioning, it can have a big impact on managing symptoms and optimizing strategies that will ultimately influence your performance.
When we include the pelvic floor muscles in our assessment and treatment, you are provided with a holistic, full body approach that can help figure out the root cause of the issue.
We are intricate human beings and not isolated body parts so making sure we are looking at the entire body and how it operates can be a game changer.
Pregnancy and the pelvic floor
During pregnancy, the pelvic floor and abdominal wall are impacted a lot. Growth happens in a relatively short period of time and the abs and pelvic floor lengthen to support the changing body and growing baby.
With these changes it is not uncommon for people to experience symptoms and can make someone second guess their participation in exercise and sport.
Some common pregnancy pelvic symptoms are:
Increased frequency of urination
Leaking or incontinence
Vaginal heaviness
Low ab or round ligament pain
Constipation
SIJ pain
Pubic bone pain
Low back or hip pain
Traditionally, there have been many conservative views about how to approach movement and sports during pregnancy to “play it safe.”. But we know that exercise is important for both the pregnant person and the growing baby and we are starting to see clear research evidence saying it is very safe to do so.
Of course, each individual will have their own risks that they need to assess with their birth provider. But if you have a low risk pregnancy and have been cleared by your birth provider, exercise is important!
But we definitely don't want pelvic symptoms to limit your ability to remain active throughout pregnancy.
Pelvic health physiotherapy during pregnancy can help:
Reduce and manage your pain
Manage new symptoms like leaking or heaviness.
Provide education on pelvic floor and abdominal changes
Create a plan to optimize pelvic floor function throughout pregnancy
Help keep you as active as you want in your sport or exercise
Prepare you for labour and delivery and early postpartum recovery.
It is never too early or too late in your pregnancy to start with pelvic PT!
Postpartum and the pelvic floor
Once your baby has arrived, you may be wondering how to get your body moving again. What’s safe? What can I do? How long do I wait to start exercising? And what about these new symptoms?
It is fairly common to have some pelvic floor symptoms in the postpartum period, and sometimes a diagnosis can leave you feeling alone and confused on what your future of exercise and sport may look like.
Some common postpartum symptoms are:
Feelings of heaviness or bulging in the pelvic area
Urgency to get to the bathroom
Incontinence
Pain in the pelvic region
Low back pain
Diastasis recti and core weakness
Pelvic health physiotherapy as an early intervention can be so helpful in managing all those things.
Early intervention (before the 6-week mark) can include:
C-section scar management - including how to manage pain, introduce movement and scar care
Strategies to care for your baby - nursing/feeding positions, how to move from lying down to standing, lifting and carrying tips
Pelvic floor and core exercises
Treatment for pain management
General exercises and movement guidance
Safe progressions and a plan to get you back to sport
Moving past the first six weeks, pelvic PT can help plan your successful return to sport.
We work on managing symptoms, talk about timeline expectations, specific strengthening exercises, introduction to load and impact and sports specific exercises to create a realistic plan for you.
Perimenopause and menopause considerations
Perimenopause is the time when you start to have a change in hormone levels as you head towards menopause. This can start anytime between 35-50 years old. Every person’s experience is different and symptoms may vary during this time.
Menopause is when you haven’t had a period for a full 12 months. This is when estrogen levels drop and stay low for the remainder of your life (unless hormone replacement therapy is implemented).
The hormone estrogen has an impact on the urogenital system so symptoms associated with this area can increase. Leaking, urgency and higher urinary frequency are common. Hot flashes, vaginal dryness, and pain with sex can also be symptoms.
With a drop in estrogen, bone density and lean muscle mass are affected, unless you do something about it!
Exercise, especially weight lifting, is so important during this period of time to increase lean muscle mass and increase bone density. It can also reduce the intensity of hot flashes which is a bonus!
Pelvic health physio can help with all of the above perimenopause and menopause symptoms.
Not sure how to start a weight lifting routine that is safe and specific to your pelvic floor needs? We can help!
Have specific pelvic floor symptoms that need attention? We can work on pelvic floor function, habits and strategies around symptoms to help you manage these challenging years.
HerSport’s approach to pelvic health physiotherapy for the athlete
At HerSport Physio, we don’t think your sports participation should be limited by your pelvic floor. For far too long, female athlete concerns and pelvic floor dysfunction have just been ignored.
Not any longer.
We take all symptoms seriously, big or small and pelvic health physiotherapy can help you solve them so you can get back to sport and exercise worry-free.
It is reported that up to 50-80% of female athletes deal with pelvic floor symptoms like incontinence at some point in their athletic career. But no one talks about it! Which then leads to uncomfortable feelings of embarrassment and maybe even decisions to stop sports to avoid these unwanted symptoms.
We understand how important your sport and participation is. You will not be told to stop something you love. Instead, we make a plan to specifically address your concerns and work with you to meet your sports demands.
How HerSport Physio is different
At HerSport Physio we aren’t afraid to try things differently. We aren’t afraid to push your limits to increase your capacity. We aren’t afraid to think outside the box and try something new.
You will spend less time up on a treatment table and more time in the gym working through exercises to increase mobility, strength and problem solve with your physio to find the best strategy you need.
You will walk away with a plan full of pelvic floor education and ways to modify things to help you stay active and in your sport, with the ultimate goal of reducing symptoms.
Let’s see how far you can go!
Do I need pelvic health physio?
Not sure if you have pelvic floor symptoms? Not sure if pelvic health physiotherapy is for you?
Take a look at these questions to see if pelvic physio could be a fit for you:
Do you experience urinary leaking with things like coughing, sneezing, jumping or running?
Do you feel vaginal or rectal heaviness or bulging especially during and after upright activities or sports?
Do you struggle with chronic low back pain or hip pain?
Do you always feel tightness in your back or hips regardless of how much stretching you do?
Are you pregnant?
Have you given birth to a child?
Do you struggle with painful periods?
Are you eager to get back to sports after being pregnant and not sure what to start with?
If any of the above sounds familiar, pelvic health physio is your answer.
Finding a pelvic health physiotherapist near you
Finding the right person to help you can be hard.
If you are from London, ON, we have two pelvic health physiotherapists that treat at HerSport Physio. We offer both in person and virtual services to anyone residing in Ontario.
If you are still on the fence, we offer complimentary meet-and-greet calls so you can determine if what we offer is a good fit for your needs.
Not from the area? Take a look at these two directories to find a pelvic health physio near you!
Pelvic Health Solutions: https://pelvichealthsolutions.ca/find-a-health-care-professional
WOC PFPT Directory: https://www.vaginarehabdoctor.com/woc-pfpt-directory/
Other local health and wellness providers that we recommend for female athletes:
Mobilita Function and Performance owned by Dr.Dana Poeta, Chiropractor
StrongHer Fitness owned by Stephanie Paplinksie
Align Wellness Co. owned by Kassandra Fuller
About the Author
Karla Van Beveren is a sports physiotherapist with a special interest in pelvic health for the female athlete.
Karla has worked in high performance sports environments for over 15 years, providing care for international and olympic level athletes.
She has been a part of the medical teams for Hockey Canada’s and Canada Soccer’s National Women’s Teams at the Sochi Olympic Winter games, IIHF World Championships, CONCAF tournaments, PanAM Games and the Canada Summer Games along with countless international tournaments and training camps.
Her unique approach is a blend of sports performance rehab and pelvic health physiotherapy, ultimately creating an environment for athletes to get the full comprehensive care that they need for optimal performance.