The pelvis is literally and figuratively at the core of our being, making it the foundation of our health. The pelvis is the source of our power. It holds the controls in directing our basic human movement. It produces the power to squat a heavy barbell and drive an opponent off the ball. Above all, it holds the power to have sex, make love, ignite pleasure, and facilitates the creation of another human being and giving birth, ultimately evolving our human race.
As the warrior-poet Ben Parker said, with great power comes great responsibility; in this instance, it’s a responsibility that we often overlook and neglect. Harness the power to control your pelvic floor and you will become a more masterful mover, reduce your risk of pain and injury, and skyrocket your sexual prowess.
In the first of this series on integrating the pelvic floor into performance, I will show you just how important pelvic floor health is to leveling up all aspects of your overall health and athletic potential.
A Pain in the Ass
There tends to be a stigma surrounding pain in the region of the pelvic floor for both men and women. Groin pain while working out, leaking, discoloration, and genital pain with sex are all common complaints that cause hesitation in seeking help due to a sense of taboo and cultural norms. Many women often jump right to their OBGYN, when in fact most of the time it’s an orthopedic issue that can be solved with a good pelvic health PT. Guys, on the other hand, tend to ignore these issues out of fear of embarrassment and the thought of something being wrong with their super-power tool.
Of course, there are some important things to consider when teasing out pain below the ribcage. How strong is your bladder? You should be able to hold urine in for roughly 3 hour time spans throughout the day, unless, of course, you drink your weight in water or alcohol. While having mad dribbling skills like Lebron James on the court is cool, dribbling after going to the bathroom just means your shit is weak. Speaking of shit, you should be doing so 1-2 times a day. And, they should be happy like the emoji. Constipation can actually be a huge contributing factor to pelvic pain. The descending colon sits on the left side of your abdomen, where backed up fecal matter accumulates; this extra weight puts additional stress and pressure on the muscles of your pelvic floor and hip in this region, potentially leading to overactivity and tightness.
Now that we’ve got the dirty business out of the way, let’s talk movement. The site of your pain is not always the source of your problem. Many strong, powerful athletes (men and women alike) have terrible hip mobility. This includes normal joint range of motion, and the ability to control that range of motion. Some pelvic floor muscles attach from the pelvis and into the hip; these are considered internal and external muscles. If you experience low back, hip, or groin pain, the muscles of the pelvic floor need to be considered. Who’s ever been given the dreaded diagnosis of “piriformis syndrome?” This muscle, along with another very important little hip rotator known as the obturator internus, are often prone to problems and a common site of pain. Conversely, however, they are usually not the source. The culprit comes from that limited hip rotation, causing extra pull on these muscles and limiting their ability to function appropriately.
Integrating the Pelvic Floor Into Performance
The entirety of the muscles making up the pelvic floor help support your abdominal visceral, control urination and defecation, and play a role in sexual performance and pleasure. This diaphragm of muscles works in conjunction with the diaphragm that sits above it, which is integral in controlling our breathing. These two very important structures create the top and bottom of the cylinder known as our trunk, with their main synergistic role being pressure control throughout the day. Athletes need to be even more efficient at regulating this pressure, especially when lifting heavy and going overhead with weight.
One huge problem in the female athlete population is stress urinary incontinence, or the leaking that is commonly associated with impact activities like running and jumping rope. This problem is dependent on the pressure being produced from the activity, in conjunction with the capability of the pelvic floor muscles around the urethra, and the integrity of the fascial connections suspending structures like your bladder. If all are strong and working together, we usually don’t see any issues. It’s when we lack efficient coordination and the ability to attenuate forces and the associated pressure that we “run” into problems.
Attenuation is how we distribute forces throughout the body with activity. For example, bending the ankle, knee, and hip into a good, toes-forward universal athletic position when landing from a jump, allows the body to store that energy into the neuromuscular system, demonstrating this principle perfectly. That energy from the landing is then loaded into muscles like the hamstrings and glutes, allowing us to release it and produce a powerful movement. Why do we think that the pelvic floor acts any differently? The pelvic floor must also go through an excursion like the muscles of the lower leg, in order to store energy, contract, and prevent leaking during athletic activity. This is how the body prepares for impact, from right before heel strike or walking, to catching a heavy clean in the bottom position of a squat.
It’s Not All About the Kegels
This is why the “gripping” action of the pelvic floor through the Kegel exercise doesn’t fit well with what is happening mechanically with the rest of the body. Try going out for a run or sprinting and trying to hold your pelvic floor the entire time. The muscles of the pelvic diaphragm can’t generate any power unless they are allowed to go through that excursion – the lengthening and contraction necessary to maintain function. Think about the last time you hit a set of heavy hammer curls on Jacked Street. In order for the bicep to produce force to give you the pump and peak you desire, it must first lengthen. This is called a co-contraction, and is assisted by the contraction of your tricep. However, you don’t have to think about flexing your tricep in order to lengthen your bicep; this action naturally occurs.
The same phenomenon is present with the sling of muscles that make up the lower diaphragm in your body. This is a neuromuscular strategy that taps into the preparatory capacity of the pelvic floor. This should happen naturally, yet so many athletes continue to struggle. Unlike the big prime movers of your lower body, it will take more time to train these smaller muscles and allow them to catch up.
We begin in a stage of conscious incompetence. You understand there is a problem and just need some education to help solve the puzzle. Developing these muscles, like the pubococcygeus, takes utilizing breath and focused work on engagement of these specific muscle groups with concentrated effort, allowing us to enter a stage of conscious competence. However, this is not ideal for sport where speed is king. You shouldn’t have to think about contracting your pelvic floor when trying to throw a 90 mile an hour fastball. We then need to integrate into faster movements and layer in speed, in order to gain unconscious competence with this neuromuscular strategy.
Where Do We Begin?
The pelvic floor is always “on.” The majority of the time they are endurance muscles and only relax when needed to release waste from the body. However, it’s still important to train their fast twitch, power function. Remember back to the last time you had to pee so bad on a car ride, or got a case of Montezuma’s Revenge? Those little muscles were then working overtime, contracting as hard as they possible could to save you some embarrassing moments. They also have the capability to shift to a more fast orientation with exercise. Stabilization and bracing when catching heavy weight in a clean or jumping rope prevents the common leaking that occurs in many gyms all over the world.
Some athletes have pelvic floors that don’t know how to relax. Their muscles tend to stay “tight” and have difficulty contracting and relaxing. Other athletes tend to have the more commonly thought of “weak” pelvic floor muscles. Their muscles often have a hard time coordinating contractions, leading to poor pelvic positioning (think constant anterior pelvic tilt), leaking, and bulging in some cases.
This is why solely focusing on Kegel exercises (strong contractions of the pelvic floor that most women perform after childbirth) don’t work. If your muscles are truly “weak,” then varying different rep ranges and lengths of holds for this exercise could help you tremendously. What happens if those little guys are overworked and stressed out? In that case, learning how to relax these muscles would be much more appropriate. This is where the breath comes in to play. The high intensity, sympathetic state created by the training environment needs to be down-regulated in order to quiet these muscles down, and this is where most athletes fall short,due to lack of education or time at the end of sessions.
How to Integrate and Connect Your Diaphragms
- Lay on your back, knees bent, and feet flat on the floor.
- Breath in, moving air down the front of your chest, down to your belly, and expanding your pelvic region.
- Exhale, pushing that air up your spine and out the crown of your head.
- While Exhaling, contract your pelvic floor by squeezing your anus and lifting your testicles (guys) or pulling up your vulva (girls).
- Hold this contraction until you exhale completely.
- Repeat, moving smoothly and under control for 5 minutes.
Master Your Movement: Stay in Control
Whether weakness or excess tension is your primary dysfunction, a lack of coordination and control of the pelvic floor, along with poor movement variety and efficiency, is your primary concern. However, you also need to be aware of how stress impacts your life. Un-managed stress from training, lack of recovery, terrible sleep, or rocky relationships can be the underlying source to your pelvic pain and decreased performance, both physically and sexually. The second part of this series will focus on uncovering commonly neglected aspects of daily life that add to this stress, and offer strategies to combat the negative aspects of physiological “load,” ultimately leading you to a more satisfying and enjoyable life.
PT, DPT, FAAOMPT, OCS, ATC, CSCS Former baseball catcher and an avid outdoorsman. Worked with Division 1 basketball, football, and track and field at the University of Pittsburgh, along with the Pittsburgh Pirates and Arizona Cardinals organizations. Received a Bachelors in Athletic Training from the University of Pittsburgh in 2011 and a Doctorate in Physical Therapy from Duke University in 2014. Is board certified in Orthopedics and a Fellow through the American Academy of Orthopedic Manual Physical Therapists. Is a PT with the United States Olympic Committee and USA Shooting. Currently operates his performance therapy practice in Scottsdale, AZ with Dr. Tom Incledon of Causenta Wellness, and became a Power Athlete Block One Coach in September of 2017.
Dr. Zanis utilizes the Power Athlete Methodology to optimize performance, reduce injury risk, and rehab his clients and athletes through movement assessment, coaching, and individualized program design.
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