Heavy Lifting and Pelvic Floor Dysfunction
Look anywhere, continence foundation, pelvic floor first website, and literally every other resource for pelvic dysfunction and you will see that:
a) heavy lifting causes or contributes to pelvic dysfunction, and
b) that heavy lifting is contraindicated for post natal populations because it causes or contributes to pelvic dysfunction…
But what is heavy lifting? is it a percentage of body weight? is it anything heavier than the weight of the child? Is it 20kg for everyone, no matter how strong you and your pelvis is?
And what about our responsibility to train a woman for their activities of daily life? is it better for her to lift a 15kg carset + baby without any awareness of how to do it safely or with training?
Does the risk change with the movement? is a heavy bench press just as risky as a back squat? is a back squat on parr with a clean and press? or kettle bell swing the same as a deadlift?
What does the research say?
Actually, the research doesn’t answer many of these questions at all! In fact, a couple of studies have shown the opposite. For example, holding your breath (like they do in weight lifting) is NOT the same as straining (or “bearing down”). This study showed that the Valsalva manoeuvre still creates a vacuum in the pelvic floor, distinctly the opposite of straining. This study showed that heavy lifting (with a head strap, of 20kg on average) only displaced the pelvic floor, and possibly increased risk of prolapse, during the follicular phase of their menstrual cycle. Neither of these studies show that all Heavy Lifting, whatever they define it to be, is contraindicated in all women.
Generally, activity is good for the pelvic floor, and lifting is an integral part of a woman’s activities of daily life.
I have some food-for-thought to propose. Perhaps it’s not the lift that is risky, but the way we lift.
I have four things to consider about the way we lift that may have more of an effect on pelvic floor than simply lifting.
If we teach the “exhale on exertion” breath, rather than a “bracing breath” that they teach in weightlifting communities – would that make a difference? While the study above shows a vacuum effect with healthy populations, we cannot see inside the body of all humans to know that they have not got a stretched or dysfunctional floor. Furthermore, this connects the pelvic floor lift with an unconscious reflexive action… breathing, which may get the deep core working reflexively too!
If we taught them grounding techniques through their feet to increase glute activation and decrease the core load? I couldn’t find a study on using the same technique through your hands, but i’d like you to try the yoga technique of pushing your hands in to the floor (evenly through each finger tip and the heel of your hand) and feet what happens to your shoulders, rotator cuff, and abs… there’s something to it!
If you have “upper cross” syndrome, you’ll be bearing down, or loading your pelvic floor more than you do when you’re aligned. If you have “lower cross” , your pelvis is not in optimal alignment for the pelvic floor to work well.
Knowing whether your client is Hypertonic or Dysfunctional is often just one trip to the physio away. Both a hypertonic (too tight) and a hypotonic (loo weak) pelvic floor will be dysfunctional, so knowing which one is contributing to the client’s back pain will make all the difference in your coaching and exercise choices.
If these techniques make a difference, then suddenly lifting weights, including relatively heavy ones, is opened up to us for training women with pelvic dysfunction, and we can start actually training them for life! Relatively is an important concept, because what is heavy for one person is not heavy for the other. And i’d like to open another point on this for discussion – that heavy for the arms is not the same as heavy for the pelvic floor. Heavy for the legs is not the same as heavy for the pelvic floor. The concept of “heavy” is fluctuating and variable from person to person and physiology to physiology.
In addition, many of the movements associated with weightlifting (i think bench press, lat pull down, back squat…) are very simple to coordinate with the pelvic floor lift, as well as exhale on exertion! Exercises like Lat Pull Down and Shoulder press are actually supported, if performed when seated, which can actually reduce the load on the pelvic floor! Seems like a win-win to me.
If you’re a trainer or a physio, you can learn these techniques in our courses! See here for upcoming sessions!