Gymnasts and Pelvic Floor: This Area of the Body is Part of the Entire Core System

Pelvic Floor Issues are Common in Gymnasts of All Ages

The first thing to know is that pelvic floor issues are exceedingly common in athletes. 52.5% athletes deal with incontinence to some degree. A literature review demonstrated that the prevalence of urinary incontinence can range from 28% to 80% in sports such as trampolining, gymnastics, aerobic gymnastics, hockey and dance.2

This pelvic floor dysfunction comes at a steep price. 28% of US women who report urinary incontinence find it to be at least a moderate barrier to exercise. Of the women with urinary incontinence, 11.6% did not exercise because of it, 11.3% exercised less, 12.4% changed the type of exercise and 5% stopped exercising in a group setting altogether. For women with severe urinary incontinence, 1/3 did not exercise or exercised less because of urinary incontinence. This represents a lot of women and athletes who are changing their physical activity due to this issue!

Ideally, the transverse abdominus and our pelvic floor engage in co-contraction (meaning that they contract together, at the same time). For gymnasts who suffer from stress urinary incontinence, meaning that physical demands such as tumbling or vaulting increase their incontinence, working on this co-contraction via targeted exercises will improve their symptoms.³

It doesn’t have to be limited to a sports thing, though – even coughing and sneezing are a form of stress that can lead to urinary incontinence in some women. And yes, after having a baby, the odds of developing urinary incontinence go up – however, women and teens who have never been pregnant can be affected. Keep in mind, the statistics listed above are on all athletes, not exclusively on moms!

While Surgery is Available, Corrective Exercises are a Great First Step

Unfortunately, prolapse surgery is not an easy fix. For at least 50% of women, surgery alone won’t solve their problem and they will still need to engage in corrective exercise to teach the muscles how to show up the way they need to in order to handle the movements we are asking them to do.

The good news is that the very same exercises that are used to heal in rehab post-surgery can be used to help avoid the need for surgery for many women. So the cool thing is - the exercises can be tried before surgery is considered, potentially saving lots of time, money and heartache! The surgery will be there on the back burner if needed, but trying corrective exercises first makes a lot of sense!

Part of the goal of corrective exercise is to re-learn how to handle pressure in our system. There are gender differences to take note of! Research has shown that 50% of female athletes bear down as their core activation strategy versus 10% of men.

Ideally, we all will breathe in a 360 fashion - meaning that our lungs expand in all directions and we do not have to bear down towards our pelvic floor in order to increase stability in the system. 

Another core problem comes when someone holds their stomach in on purpose. Many women and girls develop a habit of holding their stomach in (especially in judged sports where one is wearing a leotard such as with gymnastics) which then causes the pressure to go to the only place it can – downward to our pelvic floors. 

The good thing is there are ways to decrease pressure that has nothing to do with watering down skills or sticking with easier conditioning. 

We can...

• Work on relaxing our throat/glottis during movement
• Decrease breath holding in favor of doing a purposeful exhale before movement
• Work on our deep breathing (meaning 360 lung expansion) all day long.

Yes, sometimes we will want to peel back our skill work while we practice these things, but after you get good at the new ways of training, moving and breathing, you will find yourself stronger than ever and capable of reaching new heights with your training!

Don't Forget About Getting Great (But Not Overly Tight) Glutes!

Did you know that overly tight glutes can also lead to peeing while tumbling or vaulting? This is because the pelvic floor cannot work optimally when the glutes are overly contracted. If you can develop the ability to lengthen glutes when engaging in dynamic movement your pelvic floor will be a lot more naturally responsive, just as nature intended! Then you won't have to think about a Kegel or anything like that while you are tumbling.

Doing Kegels when it’s not appropriate (it varies from person to person) can even make things worse. Being able to lengthen the glutes gives the pelvic floor a lot of support. Exercises to lengthen also feel really good because they stretch out the glutes. Exercises like airplanes, sitting into squats especially biasing toward thetight side, hip hikes and stretching into a deep squat can all really help.

Very few traditional gymnastics stretches actually help open up our deep hip rotators, which are part of our glutes and are muscles that work on overtime in a sport like gymnastics to help us stay on the beam and stick landings. Sometimes we need extra stretching into internal rotation to ease this tightness.

Strengthening the glutes in the right way can have amazing results too, since stronger glutes takes the pressure off the deep hip rotators. There is synergistic activation between the glutes and the pelvic floor.⁴ Sometimes a little bit of extra practice on these muscles working together can be useful, but then ultimately, we want to teach the gymnast to be able to isolate contracting just one or the other on command. 

The way our pelvis is tilted can also be important. To get out of the common gymnastics posture of being in an anterior pelvic tilt (meaning that if our pelvis were a bowl, we would dump water out the front) we can work on inhibiting excessively active hip flexors. We also want to work on loosening paraspinals (muscles around the spine) as well as the QLs (quadratus lumborum) in the lower back and overly tight glutes. Gymnasts in particular tend to have super tight paraspinals due to all of the arching and straining that is done to complete skills.

To inhibit the hip flexors and paraspinals we can work on hip flexor releases as well as focusing on back and side breathing - otherwise known as 360 breathing as mentioned above. Again, splits and bridges don’t always fully stretch the hip flexors – instead they tend to crank more on the lower back. We can also relax the QLs with this same 360 breathing as well as by building up the glutes with exercises such as clamshells with our feet fixed on a wall as well as side planks.

When working side planks it's important to be able to breathe in a way that the side and back ribs are able to move and our body is slightly angled toward the floor to work more abs and hips and less back. We can also work on building the glutes and abs in a balanced way. Working the multifidi is another important component. The multifidi are a muscle that helps stabilize our spine, and it can only be worked during low level activities such as bird dogs on the hands and knees done with zero motion. It’s also the first muscle to fall asleep and have trouble coming back online when there is a back injury. Scapular muscles are another great thing for gymnasts to focus on.

Gymnastics conditioning tends to hit the large muscles such as the lats and rhomboids of the back really well, but not as much the smaller stabilizer muscles that are critical for core strength and shoulder, elbow and wrist health. My favorite exercises for muscles these muscle groups are various forms of Ys as well as serratus push-ups and a serratus foam roller up the wall exercise. 

Our adductors (inner thigh muscles) also work synergistically with the pelvic floor.⁵ Strong adductors work like the anchors for the pelvis giving it support, strength and stability. We can work adductors by adding something to squeeze between our thighs such a pit foam block or a small ball or foam roller during corrective or typical gymnastics conditioning exercises.