By Leda McDaniel
If you have been pregnant or know others who have; If you have taken Pilates or yoga classes; If you are a female endurance athlete…then, you may have heard mention of “the pelvic floor,” “Kegel exercises,” or even “pelvic health physical therapy.” Could Kegel exercises or pelvic health physical therapy improve your health or performance as an endurance athlete? They definitely have the potential to! Just like screening other areas of your body for strength and function could help your overall health and athletic performance, there are a myriad of reasons to see a pelvic health specialist if you have not done so before!
In Episode #12 of the More Than Miles Podcast, Physical Therapists Dr. Kate Mihevc Edwards and Dr. Kacy Seynders, interview Dr. Blair Green, a physical therapist and pelvic health specialist. They demystify pelvic health physical therapy and get into explanations for what composes the pelvic floor (hint: it is just muscles!) and why these muscles are often neglected or forgotten in an athlete’s training plan and attention. They also talk about why an evaluation of these muscles, or general screen, could help with overall health and performance as an endurance athlete.
Now, you may be wondering if you could benefit from seeing a pelvic health physical therapist and what this type of physical therapy is all about. Early in the podcast episode, Dr. Green discusses some common reasons to get a pelvic health screen, and these include:
· Having any urinary incontinence or leakage with exercises or activity (Dr. Green says, “…with coughing and sneezing or jumping. Whenever it’s happening, any type of urinary leakage is not normal, even if it’s just a few drops.”
· Having any pain, pressure, or discomfort in the pelvic area with exercise or activity (including sexual functions).
· Having hip or back pain that is not getting better (pain from the pelvic region could refer to these areas!).
· If you are pregnant or have recently had a baby. Dr. Green recommends EVERYONE see a pelvic health physical therapist after having a baby to restore normal function of the pelvic floor muscles and abdominal/core muscles.
· If you are near menopause pelvic health physical therapy could help as you go through these hormone changes and their potential sequelae. Did you know that as a woman loses estrogen during this time, ligaments and muscles naturally experience decreases in strength? So, it is important to optimize pelvic floor muscle strength going into menopause!
If you fit into one of these categories, you may be thinking of seeking out a pelvic health specialist. But you may also have some fear if you have never been to one of these specialists before. As Dr. Green emphasizes in the podcast episode, you should not be afraid to seek out these services. We tend to fear experiences that are foreign to us or that we do not know a lot about. To reduce fear and anxiety associated with a first visit to see a pelvic health specialist, Dr. Green gives a thorough explanation of what to expect and what the components of a first visit or examination may look like. She begins by saying that her practice’s office is much more comfortable an environment than a gynecology examination. Factors that make this a more relaxed experience are the less sterile environment and her explanations and adjustments for patient comfort that go with each part of her examination with a new client. She notes that usually part of the exam is an internal examination, where she is feeling muscles and trying to see if they have normal “tone” or if they are relaxed when at rest and able to activate when a person is trying to contract them. These muscles are part of the “deep core” and as a group are referred to as the “pelvic floor.”
Dr. Green also talks about the fact that these issues are more common than you may think and others are likely struggling with similar things, so being honest and open about what you are experiencing could be helpful to provide encouragement for others to seek care. Dr. Kate and Dr. Kacy reiterate that seeking out these services should NOT be taboo and can positively impact your overall health and health as an endurance athlete because of the need for the muscles of the pelvic floor to function well under hard and long endurance training loads. They explain that by building strength, endurance, and control in the muscles of the pelvic floor an athlete can optimize how they function synchronously with the diaphragm muscle in breathing and efficient respiration during exercise and training! Also, building strength in this area can positively impact efficiency and load taken at nearby areas like the hips and low back. As, you can see, you cannot neglect your pelvic floor muscles in your training!
The importance of core muscles cannot be overstated for athletes and a truly comprehensive list of core muscles should include not only abdominal muscles (all layers!), but also muscles of the low back and pelvic floor! Dr. Green explains it this way, “the goal of our deep core, or what I sometimes call our ‘anticipatory core,’ is to help maintain intrabdominal pressure with activity.” She goes on to say how the pelvic floor muscles are a part of these, ‘anticipatory core,’ muscles and describes the different parts of these core muscles as a three-dimensional configuration of front and back abdominal wall muscles with the bottom “floor of the core,” composed of the pelvic floor muscles.
Check out the full podcast episode to learn more about pelvic floor muscles and diaphragm synchronicity in what has been called the “pelvic piston.” Also, give it a listen if you want to learn more about certain diagnoses that pelvic health physical therapy can be especially helpful for including “POP” (Pelvic Organ Prolapse), stress urinary incontinence, and diastasis recti (abdominal muscle separation). Also, check out the podcast episode if you are intrigued, but still wondering if pelvic health physical therapy could be for YOU! (Yes it could!)
You can find more information about Dr. Blair Green and her physical therapy practice at:
You can also find her on facebook: @CatalystGA or Instgram @catalyst_GA.com