Most athletes are familiar with “core control”, but, did you know that your “core” also consists of your diaphragm (your breathing muscle) and your pelvic floor muscles? There is a lot of emphasis placed on the abdominal muscles for good core control. While the abs are important for core control, we can’t forget about the other muscles that make up the core. There is an intricate relationship between the diaphragm and the pelvic floor, and dysfunction in either can negatively affect sports performance. Let’s explore this relationship.
Breathing Is Important!
You may already know that it is important to use your breath during athletic performance and challenging activities. But, have you ever wondered why? Our breath, which is controlled by our diaphragm muscle, is a crucial component of our dynamic core stability. When the core is working optimally, so is our power output and athletic performance. More importantly, when the core is working sub-optimally or is weak, it can manifest in many ways including unexplained hip or low back pain, urinary leaking, or decreased athletic performance.
An Unspoken Epidemic
Recent research has revealed that many athletes, including adolescent girls as young as 9 years old, are experiencing urinary leakage, otherwise known as incontinence, during sports performance. A recent study reveals that 1/3 of high school female athletes are experiencing urinary leakage during their athletic activities. Because of the perception and its personal nature, many girls may not be reporting this to family or healthcare providers.
There are social media group and forums full of suggestions on how to control leakage using various pads, tampons, or menstrual cups, which suggests incontinence is typical and not problematic. BUT, IT IS A PROBLEM! Incontinence is not normal at any age. Many women who have had children think urinary leakage is normal. Incontinence can be due to pelvic floor dysfunction, core muscle weakness or a tight c-section scar all which can occur after having a baby. However, urinary incontinence is more often an issue with the “intra-abdominal pressure system” and is not necessarily associated with pregnancy.
The Intra-Abdominal Pressure System
The demands we place on our bodies require a dynamic system of pressure management. Our intra-abdominal pressure is what needs managing; the pressure created in our abdominal cavity by our organs and all the connective tissue surrounding it. A weakness anywhere in this deep core system can cause pain and dysfunction. Think of how easily you can crush an empty soda can versus a sealed one filled with liquid. The walls may be relatively thin, but the pressure is what gives the can strength. Our “can” needs to be strong in order for us to produce the power needed for running, jumping, throwing and all the dynamic activities that we enjoy.
What is Our Core?
There are four primary core muscles that work together to maintain the pressure in our abdominal cavity and create the stability needed to move.
- The pelvic floor, which is often referred to as the “floor of our core”
- The transversus abdominis
- The lumbar multifidi (the deepest spinal muscles)
- The diaphragm
Improper Training Can Lead To Injury
Many athletes, from a young age, are trained to have “strong abs”. However, athletes who are solely using planks and other static hold exercises to build “strong abs”, do not fully train the core. Planks and static hold exercises don’t always translate into functional, dynamic stability, like jumping, kicking a soccer ball, or swinging a bat. Furthermore, our young athletes are being coached to keep their abs “sucked in” throughout all of their movements. Advances in orthopedic and pelvic health research show the importance of using our breath and avoiding static holds and “sucking in” during dynamic activities.
A lack of proper guidance from fitness professionals and too much emphasis on “sucking it in” or these long static abdominal holds can lead to athletes under training muscles they actually NEED for core control, which leads to increased risk of injury, compensatory strategies, chronic pain, suboptimal performance, and decreased power output.
The Dynamic Piston of Power and Stability That Happens With Breathing
Our diaphragm is by far one of the most amazing muscles in the human body. It is controlled involuntarily by the autonomic nervous system, so that we continue to breathe without actively thinking about it. But, it also has voluntary control so that we can take a deep breath or forcefully exhale on cue. Most importantly, the diaphragm and the pelvic floor have a crucial relationship as they are designed to mirror each other. For example, when we inhale, the diaphragm contracts and moves down into the abdominal cavity to allow the lungs to expand. The pelvic floor muscles gently descend as well to allow for the increase in intra-adbominal pressure. Then, with exhalation, our diaphragm relaxes and the pelvic floor muscles return to their resting position. Exhalation helps us to engage our transverse abdominis, and our pelvic floor muscles contract in concert with the transversus abdominis, which aides in our core control. It acts like a piston in an engine that we can use to our advantage. This is why you may have heard to use an exhale to lift something heavy or to stabilize before swinging a bat or golf club.
When Problems Arise
Issues with this pistoning action can occur when:
- There is a weakness in the core, the back or the pelvic floor
- You are statically holding or “bracing” the abdominal muscles
- You are holding your breath during challenging movements
Can Men Have Urinary Leakage and Breathing Issues?
Due to the differences in anatomy, boys and men are less likely to experience urinary leakage. However, they are more likely to experience chronic pelvic, hip or low back pain or unexplained recurring injuries, which can be a result of poor core control, muscle weakness, and an inefficiency with their breathing.
Physical Therapists are Experts in Restoring Movement and Function
One of the most effective strategies PTs use to facilitate recovery in athletes is sports-specific training, meaning strengthening the core muscles during the specific dynamic tasks to restore core control and optimal function. At One on One PT, we offer a multifaceted approach that incorporates the many tools that we have such as manual therapy, Triggerpoint Dry Needling, Pilates, Redcord Suspension and The Neurac Method, Blood Flow Restriction Training, all with the focus on enhancing sports performance.
When to Seek Help
At any point, you should consult with a Pelvic Physical Therapist if you experience any of the following:
- Persistent hip, groin, low back, or pelvic pain
- Pain with movement
- Heaviness feeling in the pelvis or increased vaginal or rectal pressure
- Unexplained discomfort, chronic injury or pain in one or both legs, abdomen or low back
- Increased urgency to go to the bathroom (bowel movements or voiding bladder)
- Persistent leakage during activities like running, jumping, coughing, sneezing
If you or someone you love is experiencing these issues, contact our clinic and schedule an evaluation today!
About The Author
Dr. Laura Glazebrook joined One on One Physical Therapy after spending 6 years specializing in neurological disorders, including stroke, brain injury, spinal cord injury and multiple sclerosis at the Shepherd Center in Atlanta. She continues to remain active in neurologic rehab, but enjoys integrating her passion for pelvic health into her practice. She enjoys providing a personalized approach to restoring optimal function for both neurologically involved patients as well as patients with pelvic health concerns and postpartum women. Laura has integrated her passion for pelvic health into her practice and is actively working to improve awareness of pelvic health concerns for individuals with neurological impairments. She participates in community outreach to educate support groups and healthcare professionals on pelvic health issues, and presented pelvic health considerations for neurologic patients at the Physical Therapy Association of Georgia’s fifth annual neuro symposium. Laura grew up in a dance studio, but currently enjoys an active lifestyle including running, triathlons, Pilates and yoga. In her time outside the office, she and her husband enjoy traveling and navigating the mayhem of parenting. You can email Laura at firstname.lastname@example.org. To learn more, visit www.onetherapy.com.
–Poświata A, Socha T, Opara J. Prevalence of stress urinary incontinence in elite female endurance athletes. J Hum Kinet. 2014;44:91-96. Published 2014 Dec 30. doi:10.2478/hukin-2014-0114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327384/
-Logan BL, Foster-Johnson L, Zotos E. Urinary incontinence among adolescent female athletes. J Pediatr Urol. 2018;14(3):241.e1-241.e9. doi:10.1016/j.jpurol.2017.12.018. https://www.jpurol.com/article/S1477-5131(18)30077-9/fulltext#articleInformation