Dr. Tamra Wroblesky, PT will be speaking at the inaugural Women's Camp in Las Vegas in August. She provided this piece to USA Weightlifting members. The views expressed are those of the author and are not necessarily those of USA Weightlifting.
Chances are if you’re reading this, you spend your days under the barbell or coaching someone who does. Your goal is simple: to lift as heavy as possible. My goal is also simple: to save pelvises. You may not know it yet, but our goals are intricately linked and a better knowledge of the pelvis might be the missing piece in your performance. Intrigued? Read on to learn how to supercharge your pelvis.
Why does my pelvis matter so much?
The pelvis is the center of your body; the very core that transitions your upper body from your lower body. If it’s in pain, weak, or cannot move well, it won’t matter how strong your arms or legs are. Remember, pelvis = power. The body isn’t separated into independent parts; it is an integrated bundle of systems working in elegant synchronicity. I know that sounds simplistic, but it’s also realistic. As a physical therapist, my job is to calm the parts of your system that are overworking and build up the parts that are underworking in order restore balance
At the bottom of your pelvis lies the pelvic floor. This group of small muscles is responsible for supporting your internal organs, maintaining urinary and fecal incontinence, stabilizing the hips and pelvis, pumping blood and lymph through the pelvis, and aiding in sexual performance. As you can see, the pelvic floor already has enough to do. Your pelvic floor muscles shouldn’t also be performing the functions that your abs, glutes, and other surrounding muscles were meant to serve. Before I even evaluate the pelvic floor, I take a look at everything around it to see if there is proper mobility of the surrounding joints and adequate strength of the muscles. Most commonly, my patients have poor hip mobility, which is usually attributable to restrictions in the deep hip rotators (you are probably already familiar with the piriformis.) You may be less familiar with the obturator internus. This is my favorite muscle, although it is also arguably the most poorly-designed muscle. It sits on either side of the pelvic floor internally and wraps around the back of your pelvis to attach to your hip externally. It sits right next to your bladder (sometimes contributing to a strong urge when you don’t have to pee), and is located in your groin, as well as the inside of your sit-bone. For a tiny muscle, it sure knows how to get around! Not surprisingly, most of my patients have extremely tight obturators. Proper hip rotation and a strong pelvis leads to decreased pain. Trust me, happy hips = happy life (especially during training).
Quick pelvis facts:
There are several movements you should be able to perform without pinching or experiencing pain in your hips. For example, you should be able to sink into a deep squat and turn your knee in and out without discomfort. Check out our hip mobility warm-up video to see if you can perform these movements. You should also not experience hip, groin, or pelvic pain during exercise, sitting, or sex. Pelvic pain means something in your system is out of balance and needs to be brought back into balance. If you are pain-free, your pelvic floor muscles should be able to perform a contraction (commonly known as a Kegel) without using your gluteal (“butt”) muscles. Your pelvic floor muscles are made up of type I and type II muscle fibers so they need to be trained for endurance as well as strength. During the day, your pelvic floor muscles need to have a low level tone to help support your organs and prevent you from peeing or pooping yourself. When you go to the bathroom, they should relax.
Common pelvic problems:
-coccyx (tailbone) pain
-pain with sex
Why does my breathing and posture matter?
We’ve all heard it before- “focus on your breathing” or “don’t forget to breathe.” Yes, yes, “namaste,” you know your breath is important. Of course, this is easier said than done when you are holding a barbell, almost twice your bodyweight overhead. Breathing plays a huge role in regulating your nervous system by telling your body when to relax and when to ramp up. But did you know that your diaphragm, the primary breathing muscle, is the mover of your mid back? It is in a synchronized dance with your pelvic floor.
The dance is as follows:
(Diaphragm inhale: pelvic floor travels down and relaxes-- Diaphragm exhale: pelvic floor travels up and contracts.)
This is why Kegels are initially taught on the exhale, when your pelvic floor is traveling upwards in a good training position. Training your core is extremely important because it provides a bullet proof vest to stop pressure from traveling to your pelvic floor. Think “core + pelvic floor” when you lift weight off the ground. Also, remember to maintain your breath throughout the day. Holding your breath is not healthy for your pelvic floor because it increases the pressure traveling down to those small muscles. That does not mean it’s dangerous to hold your breath before a big lift, but it does mean that you need to train correctly before learning the valsalva. And you certainly shouldn’t be holding your breath when performing 60, 70, or 80% reps. The more you can maintain your breath when lifting, the more you can utilize the pressure system to improve your performance.
Quick pressure and posture facts:
Imagine the space between your ribcage and your hips as a soda can. When lifting, try to maintain the nice cylindrical shape of your “soda can” in order to to effectively distribute the load and reduce pressure traveling downwards. The goal is to make less work for your pelvic floor. To accomplish this, work on your mid-back mobility. Check out our Thoracic Mobility 1 video for an easy way to warm up this portion of your spine that tends to be very stiff.
Common pressure/posture problems:
-prolapse (when your internal organs begin to fall downward)
-poor thoracic (mid-back) mobility
-poor diaphragmatic breathing
-forward head/rounded back
Why does leaking when lifting matter?
When I traveled to a recent weightlifting competition in Florida, I was shocked to discover that a mop is used to clean up urine from female athletes. A MOP! This is not a grocery store that needs a clean up on aisle 3. This is a high-level athletic event. I have even seen women celebrating their pee on the Internet, saying they are proud of how far they can push their bodies and aren’t ashamed of the puddle on the floor. I agree we shouldn’t be ashamed of our pee (or our poop for that matter), but that does not mean that leaking is okay. Leaking during lifting is often a sign that there’s a problem, whether it’s improper lifting mechanics, muscle imbalances, or any number of urological dysfunctions. Listen to your body and get help if you experience any urinary or fecal incontinence. Not only will you fix a problem, but you will also improve your performance. If your body is operating effectively, you will lift more weight. And isn’t that your main goal?
Quick bladder facts:
Bladders come in all shapes and sizes, but you should be able to hold your pee for 2-3 hours. When you are in the bathroom, the urine stream should be strong, steady, and in the middle of the toilet. If it goes off to one side, that might mean you have some tightness in your pelvic muscles. You should completely empty your bladder without dribbling at the end. You also should not be waking up in the middle of the night to pee.
Common bladder problems:
-stress urinary incontinence (peeing when coughing, sneezing, working out, laughing, jumping)
-urge urinary incontinence (overactive bladder)
-prolapsed (dropped) bladder
Why does my poop matter?
“How are you pooping?” is my favorite question to ask someone (I’m a real hit at family parties), because it’s the easiest way to tell how healthy a person is. (Sometimes I forget other people don’t talk about pee, poop, and pelvises all day.) There are five components to bowel health: water intake, diet, exercise level, stress level, and correct abdominal and pelvic muscle movement. You need all five to be operating at correct thresholds in order to have good bowel movements without straining. If one or more are lacking, you can become constipated, which increases the weight and pressure pushing down on your pelvis.
I recently led a pelvic health workshop at a weightlifting gym in Pennsylvania. After my seminar, I did independent consultations with lifters, many of whom were complaining of one-sided hip pain. They saw physical therapists, massage therapists, and chiropractors, received active release treatments, dry needling, core and hip stabilization exercises, and half a dozen other interventions that would help their pain temporarily, but it would always return. After I did my evaluations, I found most of them were not pooping regularly- some only 2-3x a week! When you don’t have regular bowel movements, your hip muscles tighten up to help support the increased weight of your stool. After we discussed the five components of bowel health, it became obvious that several common factors were contributing to the “back up.” Many of the lifters were experiencing stress from trying to balance their lifting schedules with their responsibilities at work and at home. Some lifters had increased their protein intake tremendously, without also increasing their fiber intake. Others were forgetting to drink enough water during the day. I also found that many of their stomachs were rock hard, and not in a good way. After six abdominal massages that weekend (did you know there’s a massage to help you poop!?), I was able to help six lifters have a bowel movement that night or the next morning and not surprisingly, their hip pain went away. (Also not surprisingly, the gym owner told me I wasn’t allowed to come back unless I brought air fresheners for his bathrooms.)
I’m not saying a magic belly rub is the secret to your hip pain, but it’s a start. Your intestines are so close to your hip flexors and core muscles and your rectum is so close to your pelvic muscles and deep hip rotators that pooping should no longer be overlooked.
Quick bowel facts:
Healthy pooping is the key to happy hips. You should be going 1-2x daily, or every other day. Your poop should come out easy without straining and look like a nicely formed log. You should feel empty when you are done. When you sit and have a bowel movement, lift your legs up on a stool or try to use a lower toilet. Our bodies were designed to squat and poop as it decreases your anorectal angle, which reduces straining and overusing your pelvic muscles.
Common bowel problems:
-Irritable bowel syndrome (IBS)
-prolapsed (dropped) rectum
Your pelvic health is an essential, but often overlooked, component of general wellness and peak athletic performance. Hopefully this brief introduction has inspired you to check in with your own pelvic health and shown you how some simple changes can improve your health and your gains. (And for goodness sake, no more mops!) So next time you are under the barbell, just remember pelvis = power, BREATHE, “leakfree is the way to be”, and healthy pooping=happy hips.
If you need to find a specialist to supercharge your pelvis, come see me and my team at the Jersey Shore or head on over to the following links for physical therapists in your area.
Section on Women’s Health: http://pt.womenshealthapta.org/
Herman and Wallace Pelvic Rehabilitation Institute: https://pelvicrehab.com
Dr. Tamra Wroblesky, PT is the co-owner of Inner Dynamics Physical Therapy (innerdynamicspt.com), a pelvic and women’s health specialty clinic located in Ocean, NJ. She is a USAW certified Sports Performance Coach, teaches the importance of pelvic health for performance at gyms, and works closely with weightlifters and other athletes. She has special interests in treating the female athlete, with an emphasis on preventative protocols to limit injury and reduce the occurrence of incontinence and pelvic pain. She can be reached at firstname.lastname@example.org.