Pelvic Floor Strength in the Athletic Population

Today I would like to discuss the importance of pelvic floor muscle strength in our athletic population. People tend to link pelvic floor muscle exercises (also known as Kegel exercises) with pre and post-natal women. Whilst this is one population where pelvic floor muscle (PFM) strengthening is important, it is definitely not the only group that need to incorporate pelvic floor muscle strengthening into their weekly exercise programs.

Pelvic floor muscle weakness can also be a major issue for our male and female athletic population. Body builders and athletes participating in high impact sports such as running, HIIT classes, gymnastics, basketball and volleyball are also at a higher risk of developing symptoms linked to pelvic floor muscle weakness. These symptoms can include incontinence (the inability to control the bowel or bladder), prolapse, sexual dysfunction and pain.

For body builders, it is the frequent increase in intra-abdominal pressure bearing down on the pelvic floor muscles that can lead to this weakness. Intra-abdominal pressure is created when the abdominal musculature contracts to support the trunk in preparation to move one’s body against resistance or weight. Whilst this is important for certain exercises, the increase in demand on the body calls for an increase in pelvic floor muscle strength to withstand these forces.

It has also been shown that while the demands on the pelvic floor muscles are much higher during sports such as running, the pelvic floor is not adequately strengthening during high impact exercise alone (Ludvikstottir et al 2018).

Athletes should consider incorporating specific

pelvic floor muscle strengthening exercise

to accompany sports that place higher demands on the

pelvic floor muscles than low impact exercise.

Phase 1) Learning the correct Kegel contraction

The first step in strengthening your pelvic floor muscles is learning to do a Kegel contraction. This can be challenging, as unlike other muscle contractions, you cannot see a Kegel contraction externally. When you perform a Kegel contraction you should feel the base of the pelvis drawing in and up towards the diaphragm. If you are unsure of how to perform a correct Kegel contraction please consult with your physiotherapist or pelvic floor specialist who can provide a pelvic floor muscle exam.

Phase 2) Maximal and Submaximal Kegel Contractions

Once you have learned to perform a Kegel contraction, you should challenge the pelvic floor muscles in different ways. Performing quick maximal contractions followed by full relaxation of the pelvic floor is one way to strengthen these muscles. To improve endurance of the pelvic floor muscles you should also learn to perform a longer submaximal contraction of the pelvic floor muscles followed by a full relaxation of these muscles before the next contraction. Progress these exercises from positions such as lying on your back or side, to sitting, and eventually performing these exercises in standing.

Depending on your ability, parameters of phase 2 exercises can differ significantly. Example parameters of these exercises would be as follows:

• Maximal Contraction in standing: 2 second contraction 100% effort, relax for 2 seconds. 2 sets x10 reps.

• Submaximal Contraction in sitting: 10 second contraction at 30% effort, relax 10 seconds. 2 sets x10 reps.

I have included a video demonstration of exercises in Phase 3, 4 and 5. These steps all incorporate Kegel contractions with movement. As you progress through each phase, the exercises become more functional and will therefore have better carry-over into high impact exercises such as running.

Phase 3) Beginner: Toe taps with Kegel contraction

Begin by lying on your back with hips and knees bent and feet flat on the floor. Find a neutral pelvic position where the lower back is neither excessively arched nor slumped and instead your spine finds it’s natural curvature on the mat. From here, lift both feet off the mat whilst maintaining neutral pelvis. Tap one foot down to the ground and then return it to it’s previous lifted position, then repeat this movement on the opposite foot. Exhale as you lower your foot and inhale as it returns to the lifted position. With each exhale, contract the pelvic floor muscles, then relax them completely with each inhale. Watch that your pelvis does not rock forward back as your legs move, instead creating a stable base for the legs to move from.

3 sets x15-20 reps each leg

Phase 4) Intermediate: Squat with Kegel contraction

Once it becomes easier to perform Kegel contractions with exercises in supine (lying on back), side lying and prone (lying on stomach), you can progress to more functional exercises in standing.

Perform a squat, inhaling as you lower and exhaling as you lift. You should initiate your squat by sending your hips back and allowing your knees to soften. Make sure your knees track over your second toe as you move through range. Relax the pelvic floor muscles as you lower into your squat, once at the lowest point, contract the pelvic floor muscles approximately 50% of your maximal contraction and maintain this Kegel contraction as you return to standing. Relax the pelvic floor muscles once in standing and begin to lower into your next squat.

3 sets x12-15 reps

Phase 5) Advanced: Jumping with Kegel contraction

Once you are able to perform Kegel contractions in functional exercises such as squatting and lunging it is time to challenge the pelvic floor muscles in plyometric (jumping and landing) exercises.

Begin in a semi-squat position and activate the pelvic floor muscles about 30-50% of a maximal contraction. Jump and land in the same position aiming to keep the pelvic floor muscles active. Relax and re-set the pelvic floor before performing the next jump. Progress to continuous jumping with the aim of maintaining this submaximal Kegel contraction throughout. Notice that the pelvic floor muscles naturally contact more as you land as these muscles assist in shock absorption in loading exercises.

3 sets x10 reps progressing towards 3 sets x60 seconds continuous jumping

Pelvic floor muscle strengthening should be performed 3-4 times each week in addition to other exercise. Like other exercise programs, parameters (reps, sets, contract and rest time) will differ person to person based on their pelvic floor muscle strength, control and endurance.

References:

Ludviksdottir, I., Hardardottir, H., Sigurdardottir, T., & Ulfarsson, G. F. (2018). Comparison of Pelvic Floor Muscle Strength in Competition-Level Athletes and Untrained Women. Laekna Blaoio, 104, 133-138 doi.org/10.17992/lbl.2018.03.177