Lifting Heavy with Confidence: Pelvic Muscles Training and Strategies for Athletes

By Dr. Julie Pettit-Lane PT, DPT

Are you leaking with a heavy squats or deadlifts? Do you feel pressure or heaviness as you perform more reps? Needing that “just in case” pee before double unders or box jumps? These are common concerns of many athletes, but you don’t need to be one of them! With the right pelvic muscle training and strategies, athletes can lift heavy and train hard without these worries holding you back. 

Pelvic Health and Heavy Lifting: What Athletes Need to Know

Here’s the scenario. You are at the gym working up to a heavy single back squat. Things feel great, you think you might just get a PR! You load the bar up, brace, get to the bottom and on the way up… you feel like you are going to pee yourself. What happens next? Either you bail to avoid embarrassment, or get the PR but grab a towel to dry the ground and make a quick exit to change your pants. 

What happened? You felt strong, your legs and glutes had the strength, but the weight was too much for your pelvic floor. Sometimes the pelvic floor is not strong enough, is too strong (holding tension), or the coordination is off.

Why the Pelvic Floor Matters in Strength Training

Your pelvic floor is actually part of your core. When bracing for a heavy lift many think about pushing air around the midline, but not always about the top and bottom of the core.

Think about the core as a canister:

• Front and sides are the abdominals (rectus abdominus, external oblique, internal oblique, and transverse abdominus)

• Back is the spine and back muscles

• Top you have the respiratory diaphragm

• Bottom is the pelvic floor

These muscles work together to create a solid midline to assist in bracing for lifting and to create a solid foundation for core to extremity. Having a solid core creates a stable base and effective force transfer to the extremities, maximizing power and reducing risk of injury. 

Common Pelvic Challenges for Athletes

What happens when there is a mismatch in strength and coordination of the muscles of the core?

This can lead to:

• Back injury

• Hip pain

• Decreased performance

• Pressure or heaviness in the vaginal canal

• Leaking of urine, stool, or gas

These symptoms can happen during lifting, most often in deadlifting, squats, or cleans, but also with other movements such as double unders, box jumps, or running. Symptoms often increase with heavier loads, higher volume with impact, and increases in intensity or fatigue. 

Techniques to Lift with Confidence

Proper bracing is key. This is especially true when a lifting belt is involved! Many athletes have a tendency to “press out” to create a rigid core. While this creates great tension on the sides of the core, it creates an increase in tension at the bottom, on the pelvic floor, which cannot always tolerate that high amount of pressure.

Rather, it helps to create equal tension and pressure along the sides, top, and bottom of the core. Think of a draw “in” rather than push out, like a child or dog is about to jump on your belly, or someone is about to punch you in the stomach. 

As mentioned above, the respiratory diaphragm is the top of the core canister. This means that breathing strategies and alignment can be helpful when the pelvic floor isn’t quite ready yet.

• Exhaling on the most challenging portion of a lift can be helpful to release some of the pressure the pelvic floor is working against

• Leaning slightly forward when jumping can improve alignment to bring ribs over the pelvis decreasing the amount of work the pelvic floor has to work against

While these are some strategies, it does help to work on the pelvic floor itself to make it stronger, more mobile, or improve coordination.

How Pelvic Floor PT Helps Athletes Return Stronger

How do you know if and how your pelvic floor is holding you back? Is it a weak pelvic floor? Is the pelvic floor strong but isn’t able to relax and move? Or is it just a coordination thing? This is where pelvic floor PT can help! 

An assessment of the pelvic floor can reveal limitations in muscle mobility or coordination. You can also work 1-on-1 to improve alignment, positioning, and breathing and bracing strategies. Depending on your limitations and goals, you can work together with your therapist to create a customized plan to get you back to PR’s without fear or embarrassment!

Why Cash Based PT Works Best for Pelvic Health

Many insurance-driven physical therapy practices are bound by what insurance will cover.

If leaking or pain only occur:

• At 80% or more of a one rep max lift

• During running

• With jumping

This may not be deemed “medically necessary” and therefore, not covered by insurance, since this is beyond the expectation of what is required to participate in daily activities. Or, all too common, insurance companies determine that enough progress has been made and will no longer cover future PT visits, even if you have not reached your goals. 

Without the limitations insurance puts on your goals and PT visits, you get more time and individualized coaching to create a plan that works for you. We work with you to reach your goals, not what someone behind a desk decides your goals should be. We are able to work 1-on-1 with you to create an individualized, athlete-centered treatment delivered in a specific, progressive, purposeful manner. 

Where to find a pelvic health physical therapist who can help you with pelvic muscle training and strategies for confidence with lifting (and one who understands your needs and training demands)

If you’re looking for a pelvic health physical therapist in South Portland, our clinic, Infinite Capacity Physical Therapy serves the Greater Portland area and we’d love to help you. We help athletes and active adults manage pain and symptoms so they can continue training and their active lifestyles.

If pelvic symptoms are holding you back, don’t ignore them. Schedule your pelvic health session today.