You may be wondering: “What does my pelvic floor have to do with sports?”

The pelvic floor actually has a lot to do with sports! It supports many important aspects of core strength, balance, and stability—essential factors for sports training and performance.

If you didn’t already know, the pelvic floor is a group of muscles in your pelvis that supports your pelvic organs, allows for functions like urination and defecation, and plays an important role in sexual function and appreciation.

This group of muscles is very interconnected with the diaphragm, shoulders, hips, abdominal muscles, and back muscles, which all allow for efficient movement and balance.

The pelvic floor also helps support the body, provide balance, and maintain stability—and of course, allows for the movements performed during sports. Any sport you can think of involves the pelvic floor in some way!

It is an essential part of core bodily movements, yet often gets forgotten. Activities like jumping, squatting, lifting, running, and sudden movements are all supported by your pelvic floor.

This important muscle group helps you perform your sport more efficiently, and without injury. That is, as long as it is in good shape!

To properly support all of these quick movements and bodily pressures, the pelvic floor needs to be strong, coordinated, flexible, and able to handle increased intra-abdominal pressure and dynamic forces.

Therefore, pelvic floor physical therapy for sports training looks to improve pelvic floor health, strength, and core coordination; your physical therapist will likely also address aspects like breathing mechanics or muscle imbalances.

Physical therapy also looks to address any current dysfunctions of the pelvic floor that could be causing symptoms of incontinence, bowel troubles, sexual dysfunction, or pain—which not only impairs sports performance, but also long-term health and comfort.

Pelvic floor health is important even for those who enjoy sports recreationally, not just for aspiring or professional athletes.

Playing sports puts a lot of stress and pressure on the pelvic floor as it works hard to support your movements. Therefore, anyone who plays sports regularly should be mindful about their pelvic floor!

The pelvic floor experiences increased intra-abdominal pressure, repetitive impact, and muscle strain with many different sports. Some sports are even more prone to causing pelvic floor dysfunction, due to the increased reliance on the pelvic floor during some activities.

This is especially so for high-impact or high-intensity sports, or those that have repetitive motions.

In the next section, we’ll talk about these types of sports, how the pelvic floor supports them, and what pelvic floor dysfunctions are often found in individuals that play them!

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As we’ve discussed, sports often have high physical demands and therefore can create a variety of pelvic floor dysfunctions.

Pelvic floor dysfunction refers to when the pelvic floor is too tight, weak, inflexible, or poorly coordinated, which leads to a variety of uncomfortable symptoms that can disrupt sports performance. Therefore, pelvic floor physical therapy for sports training aims to address these conditions!

Some common pelvic floor dysfunctions found in individuals who play sports can include the following:

• Urinary incontinence: Bladder leakage, often as a result of movement.
• Urinary urgency: Needing to rush to the restroom suddenly, often resulting in leakage. 
• Urinary frequency: Using the restroom more often than normal.
• Pain during urination or bowel movements: Using the restroom may be painful if the pelvic floor muscles are very tight.
• Constipation: Straining or difficulties during bowel movements.
• Fecal incontinence: Uncontrollable leakage of stool or gas.
• Pelvic pain: Usually caused by muscle tightness, injury, or trauma.
• Prolapse: Occurs when an organ begins to fall from its typical place, as a result of insufficient pelvic floor support. This can cause a feeling of heaviness or bulging from the vagina or rectum.
• Nerve compression: Particularly pudendal neuralgia, which is compression of a nerve interconnected with the pelvic floor. Nerve compression causes symptoms like numbness or pain.
• Sexual dysfunction: Painful sex or other dysfunctions such as erectile dysfunction.

How do sports cause these conditions to develop? As mentioned earlier, people who play sports require a lot of support from the pelvic floor in order to perform quickly, efficiently, and for long periods of time.

This repeated stress from high-impact activities puts more and more pressure on the pelvic floor muscles, causing them to become strained.

There are many other factors that can contribute to pelvic floor dysfunction—bathroom habits, past childbirth experiences, surgeries, injuries, poor posture, stress, and more—so playing sports can add yet another contributor to pelvic floor dysfunction.

However, each sport has different needs and may require different forms of support from the pelvic floor. Some sports have a higher likelihood of needing pelvic floor physical therapy treatment, due to the nature of the activity.

Let’s look at some different types of sports and how the pelvic floor supports their movements and activities:

High-Impact and Running Sports

• Track and field, running
• Soccer, basketball, volleyball
• Tennis
• Gymnastics, cheerleading

High-impact activities refer to sports with rapid movements, directional changes, or movements like running or jumping. All of these activities increase strain and pressure on the pelvic floor.

Strength and Weightlifting Sports

• Powerlifting, weightlifting
• CrossFit
• Bodybuilding

Whether you’re simply lifting something at home or lifting heavy weights in the gym, the pelvic floor is supporting you!

However, constant heavy lifting challenges the pelvic floor and puts a lot of pressure on the pelvis and lower body. Heavy lifting itself significantly impacts the pelvic floor, but can be even worse if lifting is done with improper techniques.

Combat and Contact Sports

• Martial Arts
• Wrestling
• Boxing
• Rugby
• Football
• Hockey

All of these intense sports require core activation and endurance to perform strong and sudden movements.

Additionally, these sports often involve direct impact to the body which not only puts pressure on the pelvic floor, but also risks further injury or straining.

Cycling

Whether it be mountain biking or spin classes, cycling can take quite a toll on the pelvic floor.

Prolonged sitting, especially on a hard, narrow seat such as a bike seat can compress important nerves in the pelvic floor. This can lead to dysfunctions such as pudendal neuralgia.

Diving

Swimming may seem like a low impact sport, but those who dive rely much more on their pelvic floor. Therefore, divers are more likely to experience pelvic floor dysfunction.

Equestrian Sports

Similarly to cycling, the prolonged sitting on a hard surface (a saddle) coupled with the bouncing motions while riding a horse can put a lot of strain on the pelvic floor.

Additionally, during more demanding activities like racing or show jumping, the core and pelvic floor muscles must engage and coordinate frequently. This engagement and activity can contribute to pelvic floor tension and dysfunction.

Dance and Performing Arts

Dance and other theatrical performances may require extreme flexibility, as well as movements such as jumping, running, and lifting.

These activities require a lot of endurance, core engagement, and support from the pelvic floor, which can result in straining or tension.

Winter Sports

• Figure Skating
• Skiing
• Snowboarding

These sports require a stable posture in order to maintain balance, speed, and safety. This requires a lot of core activation and support from the pelvic floor!

Additionally, some types of figure skating can require movements like jumping or lifting, which can further strain the pelvic floor.

Other

• Yoga
• Pilates

Although these activities can be a fantastic way to stay flexible and fit, some individuals may overuse or over-stretch their muscles, leading to pelvic floor dysfunction.

Pelvic floor physical therapy for sports training looks to address dysfunctions and improve performance through a healthier, stronger, and more flexible pelvic floor.

Not just a healthier pelvic floor, but also a pelvic floor that is balanced and coordinated with other major areas of the body: the shoulder, hips, core, back, and so on.

While pelvic floor dysfunctions may seem unrelated to sports performance, they actually have a direct correlation to the health of your pelvic floor.

Dysfunctions such as bladder or bowel problems, painful sex, or pelvic pain signal a problem with the pelvic floor.

If the pelvic floor is experiencing dysfunction, it likely isn’t able to perform properly during a sport, either.

Therefore, your physical therapist will create a unique treatment plan curated to the demands of your specific sport and your unique symptoms.

Your provider will identify potential causes of your pelvic floor dysfunction and address those causes—this will help lower your risk of future injury, encourage long-term function, and improve performance. 

Addressing Pelvic Floor Dysfunction

To start, your physical therapist will discuss your medical history and any past injuries, surgeries, or childbirth experiences you may have had.

They’ll discuss your symptoms, as well as any movements that may trigger pain or discomfort (running, jumping, lifting, etc.).

Your provider will evaluate your muscle tone and health to look for tension, trigger points, weakness, pain, or tenderness. You can expect to undergo tests of endurance, strength, mobility, and coordination to your abdominals, low back, hips, and pelvic floor.

They may even evaluate your ability to perform sports-specific movements, such as squatting, jumping, lifting, or running. This includes your breathing technique, posture, and activation of certain muscles during specific movements.

After gaining a better idea of your current muscle balance, posture, pelvic floor health, and symptoms, your pelvic floor therapist will work to address any dysfunctions—bladder or bowel symptoms, sexual dysfunctions, pain, and so on.

They’ll address these dysfunctions with a variety of treatment methods, such as the following:

Pelvic Floor Education and Training

Even though the pelvic floor plays such an important role in a variety of sports, many individuals may not know much about this part of their body, what it feels like, or that you can control it.

Therefore, your pelvic floor therapist will educate you on your pelvic floor and lead you through a variety of exercises so that you can regain control and coordination of this muscle group.

The pelvic floor is able to involuntarily and voluntarily contract and relax in order to perform many of its functions.

To better understand these movements, you will engage in treatments such as neuromuscular re-education and biofeedback to feel and practice controlling your pelvic floor muscles in real time.

As you become more familiar with your pelvic floor and controlling it, you will be able to engage in relaxation or strengthening exercises led by your physical therapist!

Manual Therapy

Manual therapy is a great treatment option for individuals with tight muscles, trigger points, or pain.

Manual therapy is a treatment involving the hands or tools, which manipulate and mobilize tissue to release muscle tightness, mobilize nerves, and improve blood flow.

This treatment can relax muscles, reduce pain, and improve mobility. Some examples of manual therapies utilized at Hive include dry needling, tissue scraping, cupping, and more.

Behavioral Modifications

Another important aspect of treating pelvic floor dysfunction is addressing any possible contributors that could be present in your daily life.

While playing sports obviously has a large impact on the pelvic floor’s health, there are many other factors that can create tension, weakness, and poor coordination, such as:

• Poor sitting, standing, or toilet posture
• Straining on the toilet
• Improper lifting or other mechanics
• Prolonged sitting
• Holding urine for too long
• Inadequate fiber intake or hydration
• And more

Your physical therapist will identify these potential causes of dysfunction and help you adjust them as needed.

Long-Term Maintenance

In addition to the behavioral modifications listed above, your physical therapist will teach you techniques for at-home care too, such as relaxation strategies, pain management, and exercises to keep your pelvic floor in good shape.

It is a good idea to check in with your physical therapist every so often to maintain proper pelvic floor health, prevent dysfunction, and to encourage optimal sports performance.

Pelvic Floor Sports Training

Once your pelvic floor dysfunctions have been addressed, your pelvic floor physical therapist will start incorporating activities into your treatment plan that will improve your muscle balance and activation, endurance, coordination, and strength.

You can expect to engage in the following activities:

Muscle Strengthening

Your physical therapist will curate an exercise plan to strengthen your core, hips, back, and pelvic floor—which will support your movements during your sport and allow for better muscle coordination.

Asymmetry in the muscles can cause straining and tension, so it is important that the whole body is aligned and well balanced.

Mobility and Postural Improvements

You can expect to engage in stretches and mobility exercises that will improve the flexibility and mobility of your hip flexors, adductors, glutes, and other related areas in order to reduce strain on your pelvic floor.

Additionally, your physical therapist may adjust your posture during specific sports movements to further reduce tension on your pelvic floor. 

Muscle Coordination

With muscle coordination practice, you’ll learn to better activate your pelvic floor and core muscles properly during movements specific to your sport.

This coordination is essential for both performance and safe engagement of the pelvic floor. This can involve training for movements like lifting, jumping, running, and more.

Breathing Strategies

When it comes to pelvic floor physical therapy for sports training, you can’t leave out your diaphragm! The diaphragm plays an incredibly important role during sports activities, as it maintains your breathing and muscle function—both of which are essential for intense exercises.

Additionally, the diaphragm works in coordination with the pelvic floor. It is important that these two structures are properly coordinated in order to support your movements and manage your intra-abdominal pressure, especially while playing a sport.

Sports Modifications

In some cases, it may be necessary to modify your sports techniques, intensity, or movements that could be exacerbating your symptoms of pelvic floor dysfunction.

This could mean modifying heavy lifting techniques, altering high-impact activities, or adjusting other aspects of training that could be worsening your dysfunction.

Your physical therapist can also address any movement patterns specific to your sport that could be causing pain, tension, or straining.

Scar Tissue Management

If you are someone who has experienced a previous surgery or injury, you may have scar tissue that is restrictive or uncomfortable.

Scar tissue is capable of hindering movement and tissue function, so your physical therapist will address any scar tissue and teach you how to manage it at home, too. This treatment can help improve tissue mobility, function, and overall comfort.

Education and Prevention

Your physical therapist will teach you the importance of maintaining good pelvic floor health and ways to incorporate long-term pelvic floor care while playing sports.

This can include starting an at-home exercise program, understanding intra-abdominal pressure, and learning relaxation techniques or mindfulness strategies to reduce tension.

Physical therapists are experts of the body, and can answer any questions you may have about the pelvic floor or training strategies!

If needed, your Hive physical therapist can further address your health needs by collaborating with other professionals such as trainers or sports medicine physicians.

Hive’s providers are always open to collaboration, as it is a great way to support a comprehensive and holistic plan of care.

While under Hive’s care, you can expect to receive a variety of treatments depending on your individual needs and unique sport. Some treatment methods commonly used at Hive Therapy and Wellness for pelvic floor sports training include:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback