Fiona McMahon PT, DPT New Year New You! It’s all well and good, but if you are dealing with pelvic pain or dysfunction this can be an especially tough time of year when you want to get fit, but the gym can feel like it is off limits. Do you have to stay on the sidelines until you get better? Or is there a way to integrate a workout routine into your recovery from pelvic dysfunction? The first thing I would suggest is to get a good pelvic floor physical therapist. Before we become pelvic floor physical therapists, we receive broad based education in sports physical therapy. What that means, is we have the ability to think about and treat the pelvic floor as it relates to sports and exercise. We also can take a close look at the health of the pelvic floor and assess if there are any exercises you probably shouldn’t be doing right now. If you do try something and you symptoms flare, it is an excellent opportunity for you and your physical therapist to determine why and help correct the issue so it doesn’t happen again. The tricky thing with writing this blog, is there are no hard and fast rules, no “don’t do that” or yes “definitely do this” in terms of exercise. The literature out there is really varied. There are many studies that sing the benefits of exercise for the pelvic floor, while others caution against it. Before we get into some exercise guidelines, let’s look at what the data say. The Research I read a few studies about the impact of exercise on the pelvic floor and thought the data are mixed, I did come away with some important takeaways. The first of these takeaways is that pelvic floor dysfunction is exceedingly common with a prevalence of 1 in 4, which most of us in the field would feel is on the low side, given how personal the subject is and that many people may not want to talk about it. Because pelvic floor dysfunction is so common, it is something all fitness professionals should at least think about when recommending exercise programs. The next consideration that honestly I did not need to read a study for, nor do you need to read to in this blog to learn is that exercise is overwhelmingly good for you! Exercise can improve health in a multitude of different ways from heart health, bone health, even mental health. There are huge potential benefits to be gained from starting an exercise program. What was unclear are the risks. One hypothesis is that exercise can strengthen the pelvic floor and leave it nice and healthy well into your old age. The next hypothesis is that exercise can increase the burden on the pelvic floor which may be rough on the pelvic floor. SO WHAT DO I DO?! Freak out. No don’t do that. Let’s just put on our critical thinking hat and dissect the second hypothesis a bit more, shall we? “Exercise may increase intra-abdominal pressure (IAP), which may be harmful to the pelvic floor.” Okay so what does that mean? There are certain but not all exercises that increase the pressure from your abdomen down on your pelvic floor. A good example is a person in the upper echelons of powerlifting holding their breath to make their core stiffer to lift up a massive weight. Can you imagine the grunt? That breath holding serves a purpose to allow the weightlifter to crush her competitors and put up the most weight, but also creates a heck of a lot of downward pressure on the pelvic floor (increased IAP). We also see increases in IAP in sports that involve jumping, think running (which is essentially a hop from one foot to the next), basketball, or trampoline training. These increases in IAP may actually worsen pre-existing pelvic conditions for a number of reasons. If you are already suffering from prolapse the pressure coming down on your pelvic organs may worsen it. If your pelvic floor is weak from being either too tight or too loose, you will likely experience as loss of urine with your workout. It may worsen pelvic floor tightness and make pain worse. Total bummer right? Seems like it, but all is not lost. Not all exercises dramatically increase IAP and they are really lovely places to start when returning to fitness. One study found that the mean IAP increase with Pilates exercises was less than that of getting up out of a chair (seems like a safe activity to do!) I would suggest going to a 1 on 1 session (Pilates Rehab, ideally), a few times before jumping into a group class so you can explore how your body likes to work with Pilates. We offer Pilates at Beyond Basics with special focus on pelvic floor patients. Other exercises that are pretty gentle are the elliptical machine, walking (especially on a slight incline if you want to get your sweat on), and swimming. I can hear some of you yawning in the back. For the high intensity people who do like running and crushing weights at the gym, I hear you! There are ways in physical therapy where we can train your body to both absorb more of the ground impact force and thus decrease IAP as well as improve your pelvic floor’s response to increased IAP. A good pelvic floor physical therapist can help you develop better pelvic floor mobility, length and strength to deal with IAP appropriately, as well as strengthening other muscles in your body to share more of the burden. This ultimately results in a decrease in load on your pelvic floor. The caveat being is sometimes you do have to be patient and work on some of the fundamentals before you can really let it rip with more intense exercise. But as a previously injured athlete, I can assure you the wait is worth it. Start Slow When adopting a new exercise it can be really easy to go all in. But I highly advise you to go slow. This allows for a few things. One for your body to get used to the increased activity, and two for you to develop a sustainable routine. I would strongly encourage those of you with pain and dysfunction in your pelvic floor to consult with your local pelvic floor PT to help guide you to safely returning to exercise. Stretch Don’t skip it! I am so guilty of this and have paid the price more than once. Stretching after a workout is so helpful. Amy, the founder of BBPT has some excellent stretches in her book, Heal Pelvic Pain. Last Thoughts There is a way to make exercise work for you if you are suffering with pain or dysfunction. Reach out to your PT to help guide you and have fun out there. Sources: Dias N, Peng Y, Khavari R. Pelvic floor dynamics during high-impact athletic activities: a computational modeling study. Clin Biomech. 2017;41: 20-27 Gephart L, Doersch K, Reyes M, et al. Intraabdominal pressure in women during Crossfit exercises and the effect of age and parity. Baylor University Medical Proceedings. 2018; 31(3) 289-93 Karmakar D, Dwyer P. High Impact exercise may cause pelvic floor dysfunction FOR: Scale, strengthen, protect. BJOG Debate. Kruger J. Against: is high-impact exercise really bad for your pelvic floor. BJOG Debate.