While we often think of the core and pelvic floor in terms of pregnancy and early postpartum, your core and pelvic floor are so much more. Understanding your core and pelvic floor basics, your tendencies, and how to counter those tendencies can help you reduce symptoms, minimize risk of complications, and have a positive impact on your athletic performance.

What is your core?

Your core is more than your rectus (or 6 pack abs). Rather, your core is a system of muscles that work together for optimal function. Think of your core as a canister, including:

• Diaphragm – syncing and managing pressure from the top
• Transverse abdominis – deep corset muscles
• Pelvic floor – supporting your pelvic organs (uterus, bladder, and bowel)

When you inhale, your diaphragm naturally contracts allowing your lungs to fill with air. At the same time, your pelvic floor lowers or lengthens, and your belly relaxes.

On exhale, your diaphragm relaxes, pushing the air out of your lungs. In other parts of your core, your transverse abdominis contracts and your pelvic floor contracts and lifts. These are super gentle contractions that you may not even feel happening, but the system is important to be aware of when it comes to counter any tendencies that you may have and decrease symptoms in your athletic endeavors.

It looks like this:

Core, Pelvic Floor, and Athletic Performance

Maintaining an appropriate level of tension in the pelvic floor allows you to have the strength necessary to hold the pelvic organs in place while also allowing the relaxation necessary for urination and bowel movements.

That’s important both inside and outside of the gym.

While it may seem that you want a strong pelvic floor, it’s more important to have a coordinated system, one that’s responsive to the task at hand. Ex: deadlift, sneeze, or run. Too little strength, too much tension, or too much pressure generated in one area can lead to potential issues like incontinence, pelvic organ prolapse, or diastasis.

A Coordinated Pelvic Floor

You want awareness, not hyper awareness of your pelvic floor. When you’re hyper aware of your pelvic floor, as often happens after a prolapse diagnosis, with leaking, or during pregnancy, you’re more likely to try to hold everything tight, ending up with excess pelvic floor tension. Your pelvic floor can’t hold that much tension, especially when adding impact or load, likely leading to an increase in symptoms.

Once you have awareness of your system and tendencies, you can translate that into your lifts. 

Using Exercise to Help Your Core and Pelvic Floor Symptoms

Breath holding

Are you someone that holds their breath all the time, bearing down, or sending pressure to the midline? If so, how can we redistribute that pressure using your breath so it’s not concentrating in one spot?

Try breathing into your lats. That’s a cue that works well with athletes to get you to have full ribcage expansion at the start of your exercise which helps to prevent you from collapsing at the top of your core and bearing down into your pelvic floor.

Click here to watch this video.

You can also play around with exhaling either through the whole exercise or through the portion of exertion in a lift. By timing this exhale, you’re allowing your body’s natural system to take place where the pelvic floor slightly lifts on exhale. You’re not looking to have to do this with every rep of every exercise. The goal is to make it automatic so you’re not thinking about it forever.

Tension

Do you have a tendency to constantly suck in your abs, grip your glutes, or clench your jaw?  Tension isn’t isolated. Holding tension in your core, glutes, and jaw means tension in your pelvic floor too.

You’ll want to downtrain and lengthen the system in that case. That may look like reducing tension in your workout by not squeezing your glutes when you squat or at the top of a deadlift, not doing a kegel while you’re jump roping, or relaxing the belly in a run. 

What about coning and diastasis?

Coning along the midline of your belly doesn’t automatically mean diastasis.

A diastasis is a naturally occurring separation of the left and right side of the abdominal wall at the midline, linea alba. The tissue of the linea alba is designed to stretch during pregnancy. Sometimes it just stays a little more stretched out postpartum.

When looking at diastasis, you test for both the width and tension of the linea alba. If you have a slightly wider gap but are able to generate tension in the tissue, that’s not likely an area of concern. Likewise, if you see coning present and the coning is soft to the touch, that may not be as much of a concern.

If the area of coning is more firm to the touch, that may indicate excess pressure being pushed into the midline. Sometimes we can help to manage that pressure with form shifts or breathing pattern changes. Ex: if you have excess pressure into the midline with snatch, pullup, or overhead press, what happens if you bring your ribcage down a bit and not thrust out? The pressure is still there but it’s likely less.

This is also an area that you may need to play around with either more or less core engagement. That doesn’t mean an all out contraction. Instead, look for gentle 2/10 effort.

Your core and pelvic floor play an important functional role within your body. Understanding the core and pelvic floor basics and becoming aware of these tendencies, as well as learning how to manipulate pressure and tension, will help you be able to use this system for positive impacts in your athletic performance.

Want to learn more beyond core and pelvic floor basics? Join us for the FREE Workshop below to learn the strategies you need to prioritize your safety + performance while being mindful of your core + pelvic floor system.

More and more pregnant women are choosing to continue their athletic endeavors in the gym. These athletes deserve quality coaching and better guidance than the all or nothing approach that has permeated the prenatal fitness space of days past. As a coach, learning the how to of training pregnant women effectively is important in order to be able to help them navigate through this phase of their athleticism and help to set them up for a better return to fitness postpartum. 

1. “Listen to your body” isn’t the best advice.

Pregnancy can be such a confusing time for an athlete. You come from a place of understanding and knowing your body to one where your body is rapidly changing in ways that you may or may not have ever experienced before. When it comes to training pregnant women, telling them to just “listen to your body” can be hard for them to interpret.

Is it normal to have pain in a particular lift, leaking when running, and why does their pelvis feel like it’s on fire when they lunge? These are common concerns that your pregnant athletes may face. Instead of limiting them in their movements or giving generic “do what feels good” advice, you should be able to give your athlete modifications for load, volume, and exercise selection based on their needs and refer out to the appropriate professionals when needed. 

This free e-book covers the adjustments you can make in each trimester of pregnancy:

2. You can build muscle during pregnancy, but that’s not the goal.

PRs are possible during pregnancy, but you shouldn’t be chasing them. Just because something isn’t “heavy” for your athlete doesn’t mean it’s not heavy for their pelvic floor. For training pregnant women, it’s important to take the natural increased load and pressure on their pelvic floor into consideration when making weight and exercise selections.

Instead of trying to build strength or train for birth, pregnancy should be a time for maintaining strength and preparing your athlete for a better return to exercise postpartum. Pregnancy is also an ideal time to work on technique which can help make for better athletic performance. Working on mobility, accessory drills, unilateral training, and slowing down the tempo can all help to maintain strength during pregnancy and improve your technique for postpartum.

3. Know your pregnant athlete’s tendencies for their core and pelvic floor

You know the importance of form and movement for the knees, hips, and shoulders, but do you know about the importance of the core and pelvic floor for your pregnant athlete?

During pregnancy, it’s not just about modifying ab or impact exercises, although that’s a great start. How your athlete is moving is oftentimes more important than what movement they’re choosing to do. In order to understand how your athlete is moving, you need to assess your athlete’s tendencies for tension, pressure, and position within movement. 

You need to understand how much tension your athlete generates normally, plus how much they generate in their lifts. Ex: Do they constantly grip their glutes, clench their jaw, or suck in their abs throughout the day? Do they then squeeze their glutes at the top of a deadlift or maintain a kegel while jumping?

How your athlete manages intra abdominal pressure is also important. Are they breath holding, pushing out into their midline, or bearing down into their pelvic floor? By paying attention to these tendencies, you can give your athlete alternate strategies to help them reduce pressure. One of the easiest ways to help reduce intra abdominal pressure is through breathing strategies like “breathing into your lats” or “exhaling through the movement or on exertion.”

Proper breathing and bracing, pressure reduction, small form shifts, and reducing tension on the midline and pelvic floor will have the greatest impact on your athlete’s core and pelvic floor and help them to reduce their risk of incontinence, pelvic organ prolapse, and diastasis recti.

Watch this video on bracing here.

4. Weighing risk vs reward for the developing fetus isn’t enough. We need to think long term for the pregnant athlete as well.

Whether you realize it or not, you’re weighing risk vs reward on a regular basis. This is especially true in regards to training during pregnancy. Many guidelines weigh the risk of the developing fetus vs the training methods, which is absolutely important but not the only thing you should consider.

Your pregnant athlete is important too. Their core and pelvic floor, their ability to reduce their risk for disorders, and their long term athleticism and training goals are also very important factors to consider when weighing risk.

In order to appropriately weigh risk vs reward with movement, your athlete first needs to be educated on potential impacts in an informative, not judgemental, way. Only then can they decide if a movement or training method is worth it for them to continue during their pregnancy or if a pause for a few months might be more beneficial long term.

It’s not always black and white. It’s also not always do or don’t do. There are a vast variety of movement modifications and pressure management strategies you can do to help your athlete reduce their risk without removing a movement completely.

More and more women define themselves as athletes and continue to pursue fitness as they expand their families. There is a huge need for coaches who understand training pregnant women. Learn how to coach your client to maintain strength, protect their core and pelvic floor, and return to exercise postpartum in our FREE mini course – an Introduction to Coaching Pregnant and Postpartum Athletes.

When you’ve been diagnosed with pelvic organ prolapse, it can be so easy to fall down a rabbit hole of worry that you can’t exercise with a prolapse. You may see advice that warns you from squatting, running, or high intensity workouts like CrossFit, but that doesn’t have to be the case.

Just because you’ve been diagnosed with prolapse or are experiencing prolapse symptoms doesn’t mean you can’t return to doing the activities that you once loved. Keep reading below for tips on how to continue exercising with prolapse and how to help reduce symptoms with exercise.

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs descends or collapses into the vaginal canal. The type of prolapse is named after the pelvic organ that is descending. The most common types of pelvic organ prolapse are: Cystocele (bladder), Rectocele (rectum), and Uterine (uterus).

The presence of pelvic floor symptoms is not correlated with the severity of the prolapse. You can experience valid symptoms with a grade I pelvic organ prolapse. You can also experience no change or reversal of grade yet experience a relief or reversal of symptoms. 

Is it OK to exercise with a prolapse?

Yes! Exercising is not only safe to do when you have pelvic organ prolapse, but it can also help you in your pelvic floor recovery. While there are no movements inherently off limits when you have prolapse, there are adjustments that you may need to make in order to reduce your risk of increasing your symptoms.

The following 3 tips can help to make your exercises pelvic floor-safe:

1. Avoid straining and bearing down into your pelvic floor.

While some downward pressure into the pelvic floor is normal, excess pressure or bearing down into the pelvic floor muscles can lead to an increase in prolapse symptoms.

One way to help avoid bearing down into your pelvic floor muscles when you lift is to ensure that you are bracing in a way that equally spreads intraabdominal pressure instead of concentrating pressure downward.

Try breathing into your lats. You’re more likely to get a full ribcage expansion at the start of your brace which helps to prevent you from collapsing at the top of your core and bearing down into your pelvic floor.

Not sure if you’re bearing down when you brace? A movement assessment with a coach or an internal pelvic floor assessment with a pelvic floor physical therapist can help you to determine this.

Bonus tip: Make sure you’re being assessed in the lift position (ex: squatting) and not just lying on your back.

Another way to help reduce bearing down into your pelvic floor is through breathing pattern adjustments.

 Try exhaling either through the whole exercise or through the portion of exertion in a lift. By timing this exhale, you’re allowing your body’s natural system to take place where the pelvic floor slightly lifts on exhale.

You don’t have to breathe this way forever. The goal is to practice when needed until your tendency shifts away from bearing down into your pelvic floor.

2. Reduce pelvic floor tension.

When you’re scared that your pelvic floor muscles aren’t supporting you the way they should be, it’s very easy to either consciously or subconsciously want to try to hold everything in by engaging your pelvic floor muscles.

But constantly engaging your pelvic floor muscles, ex: doing a kegel with every rep, holding a kegel while you run, or engaging throughout the day doesn’t allow your pelvic floor to perform optimally. This may actually increase your pelvic floor symptoms.

Your pelvic floor needs both contraction and relaxation. When you’re holding a pelvic floor contraction longer than needed, the pelvic floor muscles tend to become fatigued and unable to rebound as quickly or support with higher loads like they should be.

Instead of holding a pelvic floor contraction, try only contracting when necessary and having the effort of your pelvic floor contraction match the effort of your activity.

For example, carrying your laundry, deadlifting a 35lb kettlebell, and a 250lb barbell deadlift aren’t going to need the same level of bracing or contraction. 

3. Form isn’t everything, but it can matter when you exercise with a prolapse.

You don’t need to try to stay in an “optimal” form pattern with all of your movements. That’s not the way we are made to move through daily life. But if your pelvic organ prolapse symptoms are increasing with certain movements, a form shift may help to reduce your pelvic floor symptoms.

For example, if your lifting form or limitations in ankle or thoracic spine mobility have you leaning more forward in a squat, you may have increased pelvic floor pressure with that movement.

By taking a more stacked position with your ribcage over your pelvis, you’re more likely to reduce downward pressure into your pelvic floor and help to reduce your pelvic organ prolapse symptoms with that movement.

You don’t have to give up the fitness and active life that you love – you can exercise with a prolapse! By avoiding bearing down into your pelvic floor, reducing tension, and making small form adjustments, you can help to reduce your pelvic organ prolapse symptoms and return to the workouts that you enjoy.

Want to learn more about your pelvic floor symptoms and exercise? Join us for a FREE workshop to learn the strategies you need to prioritize your safety + performance while being mindful of your core + pelvic floor system.

Pelvic floor pain during pregnancy may seem like a normal thing, but there are exercises and lifestyle tips to help you manage that pain. It’s not something you just have to live with!

Let’s take a look at some of the more common types of pelvic floor pain you may experience during pregnancy and what you can do to help manage it.

Is pelvic floor pain normal?

As your pregnancy progresses, pressure from the growing baby and growing belly puts extra strain on the pelvic floor and pubic bone. That extra pressure is a normal part of pregnancy.

However, just because excess pressure on the pelvic floor is normal, doesn’t mean pain needs to be normalized.You can have pressure without pain. You can also find ways to help reduce pressure down into your pelvic floor during your workouts.

If you’re experiencing pelvic pain during pregnancy, the first step is to check in with your medical provider. A pelvic floor physical therapist or occupational therapist is also recommended.

Pelvic floor therapy during pregnancy can help to greatly reduce pain caused by multiple factors as well as help to prepare your pelvic floor for delivery.

What causes pelvic floor pain?

There are numerous possible causes for pelvic floor pain during pregnancy. Let’s look at the 3 most common:

Symphysis Pubis Dysfunction

There’s a space between the right and left side of your pubic bones at the bottom. This is called the pubic symphysis.

During pregnancy, you can sometimes have more than normal movement at this space creating pain with movement, especially single leg movement. Many people describe this pain as a sharp stabbing pain in the crotch earning symphysis pubis dysfunction the nickname “lightning crotch”.

Pelvic Floor Tension

It may seem like you want to maintain a tight pelvic floor, but pelvic floor tension can actually contribute to pelvic floor pain. Instead of doing a high volume of kegels or subconsciously holding tension in your pelvic floor throughout the day, aim for a coordinated pelvic floor – one that contracts when needed and relaxes as well.

Sacroiliac Joint Pain

The sacroiliac joint is where the hip bone meets the sacrum. Pain here can feel like a sharp pain in the back of the pelvis and may or may not travel down the thigh. 

What can I do to help?

Lifestyle Adjustments

Here are simple lifestyle adjustments that you can make to help manage pelvic pain during pregnancy:

• Wear supportive shoes with little to no heal
• Sit down when putting on pants
• Keep both legs together when getting in and out of a car or bed
• Sleep with a pregnancy pillow or a pillow between your knees
• Wear a support belt or undergarments
• Stop sucking in your belly, clenching your glutes, and tensing your pelvic floor throughout the day
• Reduce stress

Exercises to Help Pelvic Floor Pain During Pregnancy

Strengthening your core and glutes and practicing pelvic floor relaxation can be a great place to start to help manage pelvic floor pain in pregnancy.

Glutes

While you may feel more comfortable reducing single leg exercises if you’re experiencing certain types of pelvic pain during pregnancy, you can still strengthen your glutes to help support your pelvis.

• Side Lying Hip Abduction
  Using a ball with this side lying hip abduction helps to give compression around the pelvis while also strengthening through a full range of motion

Core

You want to focus on the deep core muscles when navigating pelvic pain. Try this exercise:

• Kneeling Hip Thrust with Banded Pull Down
  Take a big 360 degree inhale then exhale just before you start to thrust. Continue your exhale as you complete the thrust and band pull. As you exhale, gently contract your transverse abdominis muscles.

Pelvic Floor Relaxation

Visualization can be really helpful when trying to focus on relaxing the pelvic floor. Try this exercise below:

• Supported Child’s Pose
  Take a big diaphragmatic inhale to lengthen the muscles of the pelvic floor. Then slowly exhale as you let some of that tension within your body go.

Note – You’re not bearing down into the pelvic floor here. Instead, you’re allowing your pelvic floor to naturally expand as your diaphragm lowers. Can’t focus on your pelvic floor? Focus on relaxing your glutes here instead.

You don’t have to put up with pelvic pain as a normal part of pregnancy. These lifestyle factors and exercises can help you manage pelvic pain during your pregnancy and beyond.

Want to learn more ways to navigate symptoms that occur during pregnancy?
Learn how to continue the workouts you love during pregnancy while keeping your body and baby safe with our free guide: How to Adjust Exercise in Pregnancy.