March 10 2025

Pelvic Floor and Athletic Performance

Athletic Performance and the Pelvic Floor

Dr. Hannah Williams, PT

Pelvic Health Specialist

At Peak Health and Performance we value an integrative, holistic approach to rehab and training. With years of training and experience in orthopedic, sports, neurologic and pelvic PT, we have found that the best treatment for you is just that. A fully customized, integrated plan specific to you and just you. We believe including modalities like dry needling and electrical stimulation are powerful tools to get back to moving the way you want. Just ask Joe Rogan – He recently talked about how the exact same ESTIM machine helped him get back to good movement!

We can all agree core strength is crucial for any and all athletic activities like lifting, sprinting, throwing, cycling, etc. The core builds the foundation for strength, endurance, and technique. Sometimes it doesn’t take much for us to notice how much harder activities can get once any part of our core is compromised. However, some of us can spend years with a partially compromised core and not know or believe it to be normal.The truth is most of us, even body-aware athletes, are disconnected from our full core; thus, at best, leaving us at a slight disadvantage, and at worst, functioning with a severely compromised core.

Before we dive in, let me introduce myself! I’m Dr. Hannah, Physical Therapist at Peak Health and Performance. I specialize in post-operative, sports, tactical, and pelvic health rehabilitation and training. I am certified in trigger point dry needling and Neufit ESTIM, both of which are profound tools on the road to recovery and enhancing performance. Now, let’s review exactly what our core is.

The core is made up of 4 components:

Abdominal walls (wrapping all the way around the body)
Spine
Diaphragm
Pelvic Floor

These components work together supporting posture, stability, breathing, coordination, and power. This becomes only more important as the intensity and complexity of our movement in training and performance changes.

Often the focus on strength and performance in athletics, leaves some major gaps or unfortunate consequences, which can sometimes lead to overtraining, inadequate recovery, stress, and poor biomechanics. Prioritizing recovery for the major muscle groups you need for your sport is of course important. But the pelvic floor is like the forgotten middle child even though it is crucial to the makeup of a healthy core. Without proper training throughout the body as a whole, performance suffers and injuries increase. Remember, you are only ever as strong as your weakest part.

If you are an athlete, experience urinary leakage or pelvic pain, there is likely dysfunction within your pelvic floor. This is true for males and females in any sport, though typically those participating in high impact sports often experience this more. These are not symptoms to be ignored, as pelvic floor dysfunction puts your core at a disadvantage. Not to mention pain or leakage aren’t pleasant, deeper issues aside.

Maybe you’ve never thought about it before but now you’re questioning: I’m an athlete but I’ve never really thought about my pelvic floor…What happens to my pelvic floor when I’m running/lifting/training/etc, or competing? The truth is so much! And playing with a compromised pelvic floor is quite a disadvantage.

Athletic Performance and the Pelvic Floor

Manages intra-abdominal pressure changes during impact activities 1.
1. Think jumping rope or jumping jacks. Every time feet hit the ground the pelvic floor activates. Muscles contract and relax reflexively – like an inner trampoline – to keep vital organs in place, manage the stress on the bladder and other organs, all while managing pressure within the abdomen.
Improves lumbopelvic stability, thus increasing coordination for powerful movements
1. Consider pitching. The arm is important but the power and coordination stem from the athlete’s core. The pitcher “winds up”, twisting through the core allowing them to stretch the body like a rubber band. This action rides on the mobility of the hips and torso.
Improves core stability, enabling sudden changes in directions 1.
1. The core is an anticipatory muscle group, meaning it contracts before movement, whether it’s a twist, pivot, or lift. For it to contract properly, the breath, abdominals, and pelvic floor need to be working in sync.
Enhances breath by connection with the diaphragm 1.
1. There are many different ways to breathe. Using the diaphragm can improve stability, strength, and endurance. When an athlete understands their diaphragm and pelvic floor relationship, they possess the ability to alter breathing patterns based on task and demand. This makes anyone wildly efficient. For example, lifting versus running require different breath strategies.
Reduces your risk for injury 1.
1. Research found a specific connection for female athletes with an imbalance between super strong hip muscles and weak core muscles. Think dancers or runners. The hip muscles overcompensate for core weakness leading to increased low back and knee injuries 1. A stabilized pelvic floor can release pressure in the abdomen and assist the core during large powerful movements to reduce the risk of injury.

Because pelvic floor strength is so important there is a temptation to assume the issue is “just weakness.” However, we typically see far more athletes that have the opposite problem. And a strong pelvic floor is no good if you can’t coordinate it when you need to. A “hypertonic” or tight pelvic floor is often the culprit. If muscles have difficulty relaxing, they cannot be strong or activating properly when the core is used.

Warning Signs of Pelvic Floor Dysfunction 2

Bladder leakage with exercise
Pain or pressure in your pelvic area, lower back, or hips
Pain during a bowel movement or while urinating
Frequent Urination and difficulty emptying the bladder
Constipation
Pain during sex, using tampons, or Gyno exams
Erectile dysfunction or pain with erection/ ejaculation

It is important to take note of these warning signs. Disregarding pain in your body can have an adverse effect on your pelvic floor health.

If you suspect you may be suffering from a hypertonic, weak, or dysfunctional pelvic floor there are options to resolve your symptoms and improve performance at the same time. Please consider a Physical Therapist who knows how the body works together as a whole. Peak Health and Performance is here to help you restore balance in your body. We train you on pelvic floor awareness for better muscle activation and recovery. And we implement evidence-based, proven methods of movement pattern assessment and neurological based physical therapy to get you performing at your best. book a session with Dr. Hannah today!

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families, and thankful to offer specialized services in orthopedics, post-operative, neurologic care, and pelvic health.

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