Pelvic floor

The pelvic floor is the group of muscles that supports the pelvic organs and maintains bladder and bowel control, needing both strength and contraction speed during high-impact activity.^{1Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 8.} Goom and colleagues describe these muscles as weak and injured in most clients after childbirth, with many needing instruction and supervision to contract them correctly.^{1Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 8.} Moderate-paced running produces ground reaction forces of 1.6 to 2.5 times body weight, some or all of which may reach the pelvic floor.^{1Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 8.} A systematic review of female athletes found 4.59 times the risk of pelvic floor dysfunction with high-impact exercise compared with low-impact exercise.^{2Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 9.}

The NSCA recommends pelvic floor training in pregnancy and postpartum programs, citing postural support and reduced urinary incontinence risk during pregnancy.^{3Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 526.},^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 528.}

In practice

• Pelvic floor muscle training, including Kegel exercises, can be done daily during and after pregnancy to lower urinary incontinence risk.^{5Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 410.} ACSM describes near-maximal contractions in sets of 8 to 12, at least 3 times a day on most days.^{6Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 411.}
• ACSM advises pregnant clients to contract the pelvic floor before and during heavy lifts and avoid the Valsalva maneuver and excessive pelvic floor pressure.^{5Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 410.}
• For clients with diastasis recti, ACSM advises avoiding pelvic floor exercises, which it says can widen the separation, and seeking physical therapy advice.^{6Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 411.},^{7Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 412.}
• Refer for a specialist pelvic health assessment if a client reports urine or stool leakage, urgency that’s hard to delay, or pelvic heaviness, pressure, bulging or dragging.^{8Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 10.}