Athlete and the Pelvic Floor

While information about "core" strengthening and pelvic dysfunction can be found in the athletic literature, often there remains a disconnect between the level of depth of knowledge among many of the coaches, trainers, and athletes when related to issues of urinary continence. The prevalence of urinary and fecal incontinence related to impact sports has been established, and it has been determined that having children is not a necessary precursor to developing symptoms of leakage. It has been my experience that the term "athlete" can mean different things to different professionals. For example, Institute founder Holly Herman has always been adamant about mothers as "athletes" regardless of the level of sport involved; the simple act of lifting strollers, car seats, children, grocery bags, and kneeling, squatting, lunging involved requires a significant level of athletic ability. With this in mind, knowing the actual requirements of the typical daily activities of any patient is critical to providing a meaningful rehabilitation approach.

So how is the pelvic floor related to athletics? Faculty member Michelle Lyons addresses this question in her new course (offered for the first time in the US this August in Ohio) titled The Athlete and the Pelvic Floor. The course is designed to "bridge the gap between pelvic floor therapists and sports medicine practitioners." Gender and sport specific issues will be covered, and participants will have the opportunity to combine concepts from respiratory, pelvic, and orthopedic perspectives.

With regards to urinary incontinence in female athletes, pelvic floor rehabilitation has been demonstrated to be an effective approach. In a study by Rivalta et al., three nulliparous women described urinary leakage during sport (volleyball) and daily life. Intervention included functional electrical stimulation with internal sensor completed 20 minutes 1x/week using a 50 Hz frequency, biofeedback 1x/week for 15 minutes, pelvic floor muscle exercises, and pelvic floor muscle exercises with a vaginal cone, all for three months. The vaginal cones were weighted, of three different weights, and used for up to 10 minutes at a time. Treatment adherence was recorded by a physician at a weekly visit. The pelvic floor muscle strengthening protocol used the "Kegel" protocol from 1952- at least 300 pelvic floor muscle contractions/day divided into six sessions, avoiding coactivation synergies. The chosen protocol is interesting to note as most therapists trained in pelvic rehabilitation would choose a functional approach to exercising, with less emphasis on avoiding co-contractions as long as the patient performs pelvic muscle contractions appropriately. The combination of biofeedback, and electrical stimulation, and cones is also not typical, yet is evidence that pelvic muscle strengthening in a relatively short period of time can ease symptoms of leakage with functional activities.

The good news is that all women at a four month follow-up were able to report involvement in sport and daily life without urinary leakage. All three women were also able to discontinue use of a panti-liner used to prevent leakage into clothing. Join Michelle Lyons as she covers a wide range of pelvic dysfunctions in athletes and how the best evidence combines with clinical practice pearls to get your patients back to function.