Female athletes leaking urine? What?
I think it’s fair to say we are now aware that incontinence in women postpartum is common (but not normal). However, many are not aware that this problem also occurs in female athletes, who have not been pregnant or had a baby……have I got your attention? That’s right, female athletes are leaking urine too. There are stats reporting that up to 50% of female collegiate athletes leak urine while training/playing sports. You get the idea. We KNOW this is happening, so I’m not going to present research to you. What I do want to talk about is why this is happening and what should be done about it.
I have many questions to ask you. Let’s start with this one:
Why does this happen to females that have not had a baby?
In order to answer this, we need to better understand the system(s) involved.
Let’s talk CORE! Everyone usually thinks of a six pack (rectus abdominus) and obliques when they hear the word “core”, right? These muscles are prime movers of the trunk (rectus abdominus = trunk flexion, obliques = trunk rotation, lateral flexion and flexion) and definitely part of the core. But let’s get deeper (and more technical). Below those muscles you have the transverse abdominus muscle, which wraps around your trunk; between your legs you have your pelvic floor muscles; and inside your rib cage, you have the diaphragm. This group of muscles is what we really mean when we say “CORE”. These muscles work together to control your trunk and pelvis while you move. They do this by automatically coordinating with your breath and regulating intra-abdominal pressure. For example: when you go to pick up a kettle bell, these muscles activate before you do, without your conscious awareness. Interesting, right? So let’s say this system is not activating automatically or not coordinating well. Can you still pick up that kettle bell? Of course. The body is amazing and can accomplish a lot BUT with this suboptimal strategy, eventually there is fallout as some other muscle will have to pick up the slack. This fallout can be in the form of hip pain, knee pain, shoulder pain, etc. and you guessed it… leaking (incontinence).
Why would this system not be functioning optimally, especially without trauma to the pelvic floor?
Think of the abdomen and trunk like a container with pressure inside. This pressure is managed by the coordination of your breathing (diaphragm and rib movement), pelvic floor (yep— it needs to move too, in fact it lengthens and shortens with your breathing) and your transverse abdominus (which also lengthens and shortens with your breath). If there is an imbalance in this system, it cannot manage the pressure inside and then…. leaking. This leaking is often a result of too much pressure from either the diaphragm (poor breathing strategy) or from the abs (gripping). When there is too much pressure in the abdomen, the pelvic floorcan’t manage the increased stress (see Julie Wiebe’s video better understand this concept: https://www.youtube.com/watch?v=cW9mwfy-6-I). The system becomes uncoordinated and cannot regulate the intra-abdominal pressure. Now add impact like jumping, explosive movements, heavy lifting, etc….and the system cannot meet the demand.
Does how you train your core affect your continence and injury risk?
After watching that video, it should be a little more obvious that the answer is YES. Ask yourself these questions: how are female athletes being taught to recruit their core? Is it:
to hold their breath?
to squeeze/brace/tighten their abs?
If the answer to these questions is yes, then your female athlete’s training may be compromising their function and performance. These cues are training a strategy that is not compatible with the system and is not dynamic. The coresystem is meant to be dynamic, as is human movement. Static holds of abdominals and breath holding strategies just won’t cut it and won’t carry over into sport.
Do alignment and movement patterns contribute to this system and how it functions?
Absolutely. We have touched on deeper functioning of the core and how breathing and abdominal training can affect the function of this system. Alignment and movement patterns play an important role as well. Your posture affects how available the muscles in this system are. For example: if you stick your chest out, it will be very difficult to have a good breath (you will find that your breath will be mostly in your upper chest) which will affect how well your diaphragm and ribs move and affect the function of the deeper core system. Likewise, if you squeeze your glutes (butt muscles) or are cued to tuck your tailbone in standing or with exercises, this often puts you into a posterior pelvic tilt with flexion of the lumbar spine. In this position, your transverse abdominals are less available (harder to recruit/activate), which will also affect coordination of the deeper core system.
This system is complex. Dynamic and optimal functioning of this system is unique to each individual. There is no “one size fits all” cue or fix.
Bottom line: your female athlete needs to be working with health care providers and trainers who are knowledgeable about: the function of this system, the unique needs of female athletes and how to integrate their needs into training and sport. Leaking urine is a sign that this system is not functioning optimally, thereby putting them at increased risk for injury (if not injured already) and limiting their performance capabilities.
Food for thought: although this blog is referring specifically to female athletes, the system in male athletes is the same, and the same argument can be made for their rehab and training.
I am writing this blog from the perspective of a physiotherapist with a special interest in this topic and working with female athletes. I have taken many courses and read many research articles on the subject. None of the ideas presented in this article are originally mine and I have learned most of my knowledge on this subject from Julie Wiebe, PT. http://www.juliewiebept.com
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