3 Keys to Support Pelvic Floor Health Through Athleticism

What if I’m not pregnant and experiencing incontinence?

Your pelvic floor is such a central part of your anatomy and functions in reaction to and in support of our spine, abdominals, hips, glutes and even how we breathe.  So, if you have incontinence with activity, aka stress incontinence, please see a pelvic floor physical therapist for a personal evaluation, this is not just for pregnancy and postpartum.  Also, you are not alone.  So many women suffer with stress incontinence in silence and you can get full resolution with the right treatment.  If you would like help finding someone in your area, please let me know.

I think the best way to support your pelvic health and prevent or remedy incontinence during sport is truly understanding your pelvic floor function and how your movement or tendencies support your pelvic floor or not. 

For basic anatomy of your pelvic floor check out my instagram posts, pelvic floor function 101, Part 1 and Part 2.

Assessing your ability to relax and lengthen, lift and close quickly, and your endurance, are all the first line in determining your pelvic floor function.  You can do this with a physical therapist, who can also teach you how to self-assess.  

Here are the 3 main ways to support your pelvic floor function through athleticism!

Mange Pressure

To support your pelvic floor, you need to be aware of and control the amount of pressure physically pushing down on your pelvic floor.  Your pelvic floor should act like a trampoline to intra-abdominal pressure coming from your diaphragm.  It descends with an inhale and springs back up with an exhale.  If you can’t complete a skill without having to bearing down, grunt, or hold your breath, then this skill may be outside of your current strength ability and unable maintain optimal pressure on your pelvic floor.  Instead, promote deep core support from the bottom up like an elevator; first, a pre-contraction of your pelvic floor, then drawing in your TrA and exhaling through the effort through the hard part of the movement.  This literally blows off pressure of your pelvic floor which may be causing leakage or prolapse symptoms over time.  Respect your body’s strength where it’s at without compromising your pelvic floor.

Gain Full Range of Motion of your Pelvic Floor

Some people are pelvic floor clinchers and butt tuckers, this over-activation of your pelvic floor and posterior pelvic tilt posture never allows your pelvic floor to go through its full range of motion.  Instead, those muscles are always shortened.  This can be the cause of some people’s pelvic pain, urinary urgency, and also stress incontinence.  A shortened muscle can’t react quickly to changes in pressure and can also be weak.  So, if you are in an activity that consistently requires a posterior pelvic tilt, then it is imperative to perform pelvic floor lengthening and anterior pelvic tilt mobility.  Activities such as belly breathing with cat/cow, child’s pose and happy baby pose are great to get out of that tucked and clinched posture.

Build Strength and Coordination in the Supporting Cast

Your glutes are facilitators or your pelvic floor and strong glutes change the resting position of your pelvic floor.

Strong glutes = elevation of your pelvic floor = elevation of your bladder, uterus and colon = happier bodily functions!

Maintain active and passive hip rotation.  Hip internal rotation is crucial to allow for full range of motion of your pelvic floor.  So, don’t just work on stretching into split positions, but also hip internal rotation!  Add strengthening into rotation, like lunging with a twist, cross over step ups and lateral step ups, or 90/90 hip drives from the floor.  This increased hip motion will also support a healthier back and it’s no surprise low back pain and pelvic floor dysfunction often show up together.  Check out my “glutes” instagram highlights for a rant on hip rotation.

Athlete Question 2: Are backbends safe during pregnancy?

First, I want to pose a question to you.  How would you like to perform or participate in circus arts after pregnancy?  A lot of what we CANdo during pregnancy isn’t unsafe, but does not set us up for optimal long-term athleticism.

Second, I’m not a huge fan of “yes” and “no” lists, but instead support you to perform “informed movement” and then you can decide what’s best for you and your baby.  However, “keep doing what you’ve always done” is not informed advice.   

To my knowledge, and literature review, there is nothing saying this position is inherently unsafe for baby.  I can’t find anything to validate that the baby will get confused on which way is up an down or other wives tales.  I’m up for being called out if this is completely wrong.  

Also, certain movements are going to feel good, serve you, and be beneficial for different people and at different parts of your pregnancy.

Okay, off of “one size fits all” pregnancy movement soap box.

Safety Considerations 

There are safety considerations with an increase in exercise, or change in position of your head below your heart, or your heart below your hips during pregnancy.  These are due to an increase in blood volume, and a decrease in resistance of your blood vessels, which can both cause a drop in blood pressure and not allow adequate blood return to your vital organs and baby.  The difficult part is strict guidelines because every person responds differently!  

My best advice regarding inversions is have knowledge of your blood pressure, heart rate, and placenta placement from your physician before practicing any inversions.  This article is NOT a blanket movement prescription.  Be aware of lightheadedness, dizziness, nausea and numbness or tingling in your extremities; these are all signs you and baby are not getting enough blood flow and are not signs to push through.

Movement Considerations

As your baby and belly grows there is a normal separation of your rectus abdominus, the muscle bellies of your six pack muscles, so the tissue in between the muscle bellies, your linea alba, gets thinner.  This is total normal and happens in 98%-100% of women in their third trimester!  For most women this heals naturally back together 6-12 weeks after birth, for others it won’t, but everyone, in my opinion, needs rehabilitation to resume optimal function of their abdominal wall postpartum.

The most superficial abdominal muscle group separates during pregnancy to accommodate for baby.  The deep abdominals, your transverse abdominis, become crucial to supporting the abdominal contents up and in and away from adding pressure to the thinned linea alba tissue.

Please check out Brianna Battles article and resources for more information specifically on abdominal seperation or diastasis recti repair.


So, although the separation is normal, we want to support the tissue integrity as your belly grows and not put excessive stress on thinning tissue, I liken it to continually putting stress on tissue that is sprained.  There are some things you obviously can and can’t control when it comes to stress on your abdominal wall; the size of baby, your unique anatomy and structure, genetic tissue integrity, and forces pushing out onto the abdomen.  This often happens with heavy lifting and bearing down or large amounts of extension through your abdomen, such as arching back or back bending.

Every movement requires an appropriate amount of muscular tension necessary to complete the task at hand.  Reaching to the back seat of your car requires less abdominal tension than going into a full backbend, but both require anterior abdominal muscular tension, whether you think about it or not.  During pregnancy, the ability to create tension across your abdomen changes, therefore the tasks have to change too, in order to maintain integrity and support the thinning tissue.

Here is my recommended self-monitoring checklist to assess if stress on the abdomen is too much to support healthy tissue, which may be adding to your rehabilitation timeline postpartum.

  • Can you maintain a transverse abdominis (TrA) contraction through the movement?  The TrA hugs your pelvic and abdominal contents in, taking some pressure off of the thinning linea alba. 
  • Is this movement causing any doming or coning in the center of my belly?  This movement is now creating more force on the thinned linea alba than it can contain with adequate muscular tension.  Reduce the range of motion or load of the movement if it is causing doming or coning.
When pressure inside your abdominal cavity exceeds the tension your abdominal wall is able to create you will see doming or coning.  This is putting excessive stress on your linea alba and could be increasing the separation of your abdominal wall.  Deep core engagement not only reduces stress on your linea alba, but also maintains coordination of those deep muscles and provides feel good support to your low back.
  • Are you holding your breath to complete the movement?  Holding your breath or bearing down creates more pressure forward through your abdomen and down on your pelvic floor.  These tissues are a little more lax than normal, so this is not supporting optimal abdominal tissue or support of your bowel, bladder or uterus (read: may lead to stress incontinence).

Other areas that you can continue to focus on to maintain back bending mobility, other than your lower back and abdominal extension are, your hip extension and your upper back extension.  You can also support your growing belly and pelvic floor by working on core engagement through anti-rotation and anti-side bending activities: palloff presses, sideplanks, or pulldowns or check out my “Monday Modifications” on instagram for different levels of pregnancy and postpartum core exercises.

So, it is really up to you and your body and why this movement is important to you.  That’s the bigger question, how is back bending serving you and how can we continue to feed that part of your life while still respecting the changes happening in your body?

Can you CIRCUS during pregnancy?

A direct response to circus artists’ questions about training during pregnancy.

It may seem odd that this is my first pregnancy and postpartum blog post, but let me back up and fill you in on why this makes perfect sense. 

First, @cirquephysio aka Dr. Jen Crane is one of the first people who told me to take my pelvic health knowledge and practice online.  So, it only seems right to provide some myth busting, women’s’ health info for her fierce following.  First question:

Can we REALLY stretch during pregnancy?

Short answer. Yes. Work on active mobility and only stretch passively, as far as you can while keeping your pelvic floor and/or TrA engaged.

But you know that’s too easy right? So, some basic anatomy and reasoning behind the madness is below.

Of course, for other athletes, lifters, runners, and even from physical therapists’ and physicians’ view point, most answers would be, “of course, stretching is great!”  And it is.  In fact, moderate, relaxing, stretching has been shown to reduce incidences of preeclampsia, over a walking practice.  But let’s be real, the mobility practice cirque artists have is far more intense than a “walking practice.”  So let’s talk about specific considerations for stretching at the end of your range of motion and how pregnancy may change how your body responds.  Stretching may also change how your pelvis feels and pelvic floor reacts during this time.

First, let’s separate mobility into two camps.

  1. Passive structural mobility or the amount of mobility your ligaments have.  Ligaments attach bone to bone and are out of our conscious control.
  2. And dynamic mobility or the muscles that pass over your joints and allow for a conscious increase or decrease in range of motion through contraction and relaxation.  These are also under control of our nervous system.  

Both make up your overall mobility.  Most of the time when stretching we are affecting the peripheral muscles: hip flexors, hamstrings, adductors, and even rectus abdominis or your 6 pack muscles.   Many times, in contortion, you are also affecting ligaments or passive structures.

During pregnancy, there is hormonal influence on your ligaments and soft tissue that makes your joints more mobile – this is totally necessary to prepare your pelvis for growing and carrying a child and delivery.  Embrace this as a good, healthy process!  There is also hormonal influence on how our body repairs tissue, so let’s support the process from the beginning.  You may notice you have increased muscle soreness, and fatigue during this time, as well.  Hormones effect everything from pain perception, energy demands (you are growing a freaking spine!), and ability to remodel tissue.  Read: greater rest times and built in “rebuilding time.”  I know Jen has my back on this one. 

With less structural support from the ligaments, the muscles around your pelvis are imperative to provide some more stability.  Luckily, these deep muscles do just that; activate to stabilize before a movement or stretch of the overlying muscles, such as your hip flexors.  However, due to the growing baby, this innate “turning on” of your transverse abdominis and pelvic floor can be inhibited.  So, consciously engaging your deep transverse abdominis, pelvic floor, and even coordinating your breathing and diaphragm to exhale before a deep stretch provides your pelvis some additional stability.  This will help to ensure your stretch targets the intended muscles; reducing stress on the ligaments of your pelvis.

You still with me?

Stretching during this time isn’t bad; it’s never a “yes” or “no” for a certain activity during pregnancy, but instead a “how” and “why.”  Continuously, passively, stretching a muscle that overlays a more mobile joint may not be as effective or healthy for that joint, without the proper deep muscle engagement.  This may cause some soreness to the pubic bone area, or where your low back and pelvis meet; your sacroiliac joints.  These joints are intended to soften, but continued stress on these structures without muscular support can cause pain consistent with a sprain.

Without continued deep core (TrA, pelvic floor, multifidus and diaphragm) and glute training, your peripheral muscles, such as your hamstrings and hip flexors, may start to feel tighter during pregnancy.  When muscles sense excessive boney movement (such as around your pelvis) they retract up like a rubber band.  They are trying to hold shit together as a protective mechanism.  So, in order to continue to gain mobility you need to provide deep muscular engagement first and change your focus to active mobility.  Common muscles that may seem “tight” during pregnancy are the lats, pecs, hip flexors and hip external rotators, due to the normal biomechanical changes of pregnancy.

First, practice pre-contraction of the deep core to meet the needs of the movement. 

Second, stretch only to the tension of your deep core engagement allows.  When you lose engagement you are resting on your ligaments.              

Third, switch your training priorities to active mobility and deep core coordination and endurance. 

Fourth, THIS is not forever!  Although it may feel like it.  Respect that the amount of time hormonal changes endure postpartum is different for each person from four months after stopping breastfeeding, to a year postpartum.  Care and intention now will make a difference long-term.

I’ve over simplified the systems of our static and dynamic stabilizers into three layers and how they change during pregnancy, so you can better understand what you are feeling and how mobility work may need to change.

1.     Skeleton – more mobile due to hormonal ligamentous changes.

Colored areas are all areas of pelvic softening.  The pelvic floor muscles line the inside of this structure and hip muscles and glutes line the outside.

2.     Deep core – needs more conscious activation to provide a stable foundation to gain mobility

The three main parts of your deep core system: the pelvic floor, the diaphragm and your transverse abdominis.  These are all intended to be synchronized in activation before a movement.  This automatic contraction may need to be brought to a conscious action during pregnancy and postpartum

3.     Peripheral muscles – may be feeling tighter due to continued protective neuromuscular activation

This is a great illustration of the pull and power the adductors have on the pelvis around an area of softened ligamentous support.  Utilizing the muscular support of your pelvic floor and TrA is a great way to take pressure off of your pubic symphysis. 

Manage expectations. 

So, if you are going to go into a deep hip extension stretch, see how far you can go while keeping your TrA engaged. Or if you are going to work on pancake splits, see how far you can go while keeping your pelvic floor engaged.  It may not be as far as you want, but you can be assured you are stretching your peripheral muscles and not straining the joints of your pelvis that are just trying to do their job by helping you grow a human!

Client Question: Pregnancy and Deadlifting…

Bump Management and Modifications

Why talk about deadlifting during pregnancy? Have you ever reached across to a car seat to lift a baby or bend and reach over a crib? This motion of a hip hinge and lift is actually very functional for new moms and also can be very difficult.  It requires strength and coordination of muscles that have been stressed and stretched during pregnancy. Also, some mommas love to lift weights as a part of their regular activity, so we need to know how to support and modify this movement for function and for fitness. 

Athlete’s Question:

“I’m still deadlifting, but having upper left abdominal discomfort and cramping during the lift. I also feel like I need to change something up soon with my positioning, like going into sumo, as my bump gets bigger.”

Read more for how I work through these types of questions with clients

Read more