Part 1: Anatomy and Function
Guest Author: Jillian Seamon
The pelvic floor is an often overlooked, yet important group of muscles that weightlifters, both women AND men, need optimally functioning to be successful in sport and life. If you think of the core like a cylinder, the pelvic floor is the bottom, the diaphragm is the top, obliques and transverse abdominus are the sides, the abdominals are the front, and spinal erectors and multifidus are the back. If any part of this is not operating effectively energy will leak from that component, and thus, you will lose power. Often as weightlifters, we train the abs, the back, and even the obliques, but the diaphragm and pelvic floor need just as much love.
We are going to break up this article into two parts: 1. Anatomy and function and 2. How to strengthen the pelvic floor and integrate it into weightlifting. To get started learning about pelvic floor strength, we turn to subject expert, Megan Dupree, owner of Back in Balance Therapy, who describes the pelvic floor as a hammock of muscles that holds your hip bones together, holding all your insides up. “Think about it, whenever you’re not sitting or laying down, your entire axial skeleton [Axial skeleton = head, spine, ribs; see picture below] is suspended and being supported by your pelvic floor.” Read: the pelvic floor is really significant. The pelvic floor can either help increase or decrease your total power output. To understand this mysterious, stigmatized anatomical structure, a general overview of anatomy is necessary.
Dupree explains, “Your axial skeleton is where your central nervous system is housed, and the brain cares an absolute boatload about what each of those joints within it are doing. Therefore, the muscles that hold these bones of the axial skeleton are super important [i.e. pelvic floor].” If a piece of your axial skeleton is not functioning properly, for example, a weightlifter who overworked their neck or low back and the spine is out of alignment, your pelvic floor will work harder to stabilize your axial skeleton because it senses danger at the neck or low back. The brain is always going to try to protect the axial skeleton, so it will send stabilizing signals to all muscles involved, including the pelvic floor (and the infamous “tight hip flexors”, but that’s for another day). It might sound good that the pelvic floor is stabilizing, which is true, but it also needs to be mobile.
The Pelvic Floor and Breathing
Another metaphor Dupree uses to describe the pelvic floor is like a trampoline. In a good trampoline, the springs and the mat are perfectly wound and tight yet elastic so that when you jump on it, it shoots you back up. This is like a properly functioning pelvic floor. As you inhale, the pelvic floor expands and lowers to allow for the internal organs to drop since the diaphragm (which remember, is top of the core cylinder) is pushing down on them from the top, then like the trampoline, on the exhale, it tightens and rises. The more it drops (think multiple kids or one Wes Kitts on a trampoline), the more forceful the exhale (the more it shoots those kids or Wes back up), the stronger the pelvic floor reaction (not saying heavier people will have a stronger pelvic floor reaction, just that everyone should have the mobility of the pelvic floor to drop/inhale and rise/exhale fully). Now imagine that effect if you keep tight as you catch, hit the bottom and stand up your clean. That would make for a powerful lift, huh?
But what happens when it’s not functioning properly? If the pelvic floor is weak for whatever reason, as will be discussed a little bit later, like a trampoline with rusted springs or a stretched out old mat, there won’t be as much bounce back, not as much capacity for exhale, not as much power. If the pelvic floor is too tight, maybe it’s providing a lot of stability for the axial skeleton as previously discussed, there will be little to no drop, like a brand new trampoline and one small child bouncing on it, therefore little to no bounce back at all, and the inability to forcefully exhale fully, little power. Imagine either of these scenarios catching a clean. Not great.
The Pelvic Floor and its Relationship with the Feet
Like discussed already, the pelvic floor has serious connections with the axial skeleton, but it also has important relationships with the skeleton below it too – the legs and feet. Dupree explains, “Our feet are mediating the relationship the rest of our body is having with gravity… those foot joints tell the joints above that [the axial skeleton] about our position and how to react.” Humans have 33 joints in each foot (wow that’s a lot!); what each of those joints are doing is going to cue what happens to bones, ligaments, and muscles all the way up to the brain (input from foot joints > brain > output to pelvic floor to support axial skeleton). Therefore, it is crucial to be sure our feet are properly functioning to give ourselves a chance to have a strong pelvic floor. While Dupree understands the necessity of weightlifting shoes for our sport, she recommends loading your body barefoot as much as possible (e.g. warm ups, squats, deadlifts, accessory work), so that each of those 33 joints per foot have the opportunity to send quality signals up to the brain to allow output for optimal pelvic floor function. “If you can get your feet working optimally out of shoes, you have a better chance for them to work optimally in shoes.”
Sections of the Pelvic Floor
It may not be necessary for weightlifters to have a fully comprehensive knowledge of pelvic floor anatomy, but there are some key points to note. First, the pelvic floor consists of three sections on each right and left side- front, middle, back. The front section is your pee muscles and your lady pleasure parts (clitoris). If someone leaks or pees themselves when lifting, it’s usually due to dysfunction with this part. Here’s the real kicker, the front section of the pelvic floor is innervated by nerves that come out of your spinal cord exactly where the diaphragm attaches to the spine (T10—L1). Boom, relationship. But wait folks, there’s more. As weightlifters, we do a bajillion pulls and front squats for days, thereby most of us have really strong, yet tight mid-spine extensors (about the bottom of the rib cage). If we are stuck in mid-spine extension all of the time, and don’t have the mobility to flex our mid-spine, our diaphragms won’t be able to function optimally, and because of its relationship with the nerve roots for the front section of the pelvic floor, may lead to dysfunction and leaking or inability to hold your pee. So, the moral of the story here is balance of spinal extensors and flexors and proper diaphragm function (another story for another day) to give yourself the best opportunity to optimize the front section of the pelvic floor.
The middle and back sections of the pelvic floor are much more muscular and more closely related to low back (lumbar) and hip function (specifically, hold two sides of pelvises together, femoral head movement, vaginal and rectal muscles, and male reproductive organs). Like the front section, if there is dysfunction in the lumbosacral area, the nerve roots (where the nerves come off the spinal cord) to the middle and back sections may be compromised and lead to pelvic floor issues there. But that’s not all.
The Pelvic Floor and its Relationship to the Endocrine and Digestive Systems
Here is where it gets really interesting. Because the nerves for the pelvic floor come from the same nerve roots as the nerves that supply vital organs such as the intestines, pelvic floor function is related to endocrine and digestive health, on two-way streets. This means that pelvic floor dysfunction can either cause or be caused by digestive issues such as Irritable Bowel Syndrome (IBS). Additionally, the endocrine system closely interacts with the digestive system in the gut microbiome, so the endocrine system can either cause or be the cause of digestive issues and pelvic floor dysfunction. If the pelvic floor is dysfunctional, it could be coming from a lack of hormones (endocrine system). Estrogen, testosterone, and cortisol are hormones that have a lot to do to determine blood supply to these areas. If blood supply is lacking, the pelvic floor will not be able to function optimally both for physical performance and to accomplish “happy times” in the bedroom, as Dupree called orgasms. Like mentioned, it’s a two-way street, so proper performance and “happy times” increase blood supply to the area (just like any other muscle you train), which helps to increase strength. Conversely, if there’s a lack of blood supply to the area, you may not be able to have proper performance and “happy times”. Therefore, to have an optimally performing pelvic floor, it is essential to be sure your digestive and endocrine health are on point. (Dupree made sure to note that there are plenty of high-level athletes who live with certain conditions and figure out a way to perform. Working with the right health care provider is key.)
This was a lot of information, so take some time to digest it and reach out if you have any questions. In Part 2 of “The Pelvic Floor and Weightlifters”, we will go over how the pelvic floor moves in relation to weightlifters and how to strengthen it.
If you would like to learn more or have questions about your pelvic floor function, Megan Dupree is available for consultation (remotely or in person) and treatment: Megan Dupree, Back in Balance Therapy, LMT, NKT3, DNA2, AiM, AP2, SFG, NASM, Prenatal Bodyworker and Movement Coach, Pelvic Floor Educator and Speaker
Written by Jillian Seamon, an Athletic Trainer at St. Lukes Fitness & Performance Center in Pennsylvania. Jillian also competes as a member of East Coast Gold Weightlifting Team, under our very own Leo Totten, for Team USA.