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May 31, 2024

Training the Pelvic Floor for Athletes

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Climbing is a meditative practice—it requires unobstructed attention and focus. For many, this is the appeal of the sport. But what happens when something in your body is distracting you from the wall? At the very least it can limit your climbing performance, and, at worst, it can stop you from getting on the wall completely. Worries about leakage or pelvic pain might be annoying for some and can be debilitating for others. These experiences are so common; it is estimated that 1 in 4 females have symptoms of a pelvic floor disorder.1 Other studies estimate between 18-80% of female athletes experience urinary incontinence.2 But while pelvic problems are overwhelmingly prevalent, they do not need to be accepted as part of life. It’s just a sign that your pelvic floor, like any other muscle in your body, needs some love and attention.

It is likely that you or someone you know has experienced pelvic floor dysfunction. In our society, we often shy away from conversations about “the black box of the pelvis” due to the stigma surrounding it. If someone does speak up, they will often be told that these problems are common and “just the way it is” as we age or after giving birth. While these problems are common, they are absolutely not normal. Even as a young adult who has never given birth, I used to experience some pelvic dysfunction when I hopped down from a boulder problem or quickly reached for a hold. Many people stop climbing altogether when these issues appear—but it doesn’t have to be this way.

So when should you be concerned? What should you look for? And what can you do about it? Let’s discuss.

There are an array of possible signs and symptoms associated with pelvic floor dysfunction, many of which can be masked by pain and dysfunction in other body areas such as the low back or hips. Allow me to categorize a few base issues inorder to simplify pelvic floor dysfunction. Keep in mind that this list is non-exhaustive; if you are experiencing any pelvic-related issues not expressly outlined below please consult a pelvic floor doctor of physical therapy or physician.

People may be diagnosed with incontinence or overactive bladder. Leaking can be of urine, gas, or feces. This could be due to an underactive or overactive pelvic floor. It is helpful to seek the assistance of a pelvic floor physical therapist to determine the cause of leakage. This way, the correct treatments can be utilized. However, there are some pelvic floor basics, discussed later, which can be helpful for most people to master.

Symptoms:

Otherwise known as a descent of tissues. Some may present with symptoms, others may not. Organs are intact but due to weakness or lack of support, one organ may be leaning on another depending on the type of prolapse. The body is still strong and resilient, it just needs a little extra support.

Symptoms:

Simple, yet complex at the same time. Pain originating from the pelvic floor may present as hip pain, low back pain, or pain in the pelvis itself. For this reason, it is important to assess all of these structures to get to the root of the issue. Pain does not always correlate with damage or injury. Pain is affected by stress, trauma, mental state, nutrition, coping strategies, social support, previous experience, and a laundry list of other factors aside from physical body structure. The experience of pain is unique to the individual so it is difficult to generalize.

Symptoms:

Symptoms:

Otherwise known as abdominal doming or coning. It is common postpartum but can affect people of any sex or gender. It is simply stretching of the fascia, or strong connective tissue, in the outermost layer of the abdominals. It is best to have this assessed by a doctor of physical therapy to determine if and how it may be impacting function.

The Rock Rehab Pyramid is a framework developed by Dr. Jared Vagy to help climbers self-manage climbing injuries. The pyramid consists of four phases: 1) Pain, inflammation, and tissue overload, 2) Mobility, 3) Strength, and 4) Movement. This rehabilitation and injury prevention program begins at the bottom of the pyramid and progressively advances up until you fully recover. For more science-based, injury prevention and rehabilitation information designed specifically for climbers check out the book Climb Injury-Free.

Pelvic floor dysfunction is common and treatable. Addressing this area can only benefit climbers by encouraging increased hip mobility and strength, core stability, and proper breathing. If you or someone you know experiences any of the symptoms discussed, these exercises may be an excellent starting point. If you are already being treated by a pelvic floor physical therapist that is less familiar with climbing, the information discussed may be a great adjunct to your care.

If you have signs and symptoms consistent with pelvic floor dysfunction, or symptoms that are different from what was discussed in this article, you should consider contacting a pelvic floor doctor of physical therapy for a more thorough examination and assessment. Many of these conditions are best treated with the help of a physical therapist or OB/GYN. If you are pregnant or postpartum a pelvic floor doctor of physical therapy should be an essential member of your care team. This will ensure optimal outcomes for you and your baby, in addition to progressing your climbing goals through it all!

If you experience a sudden change in bladder or bowel function, and/or abnormal or excessive bleeding seek immediate medical attention.

Sam Lemminger is a physical therapist in Fort Collins, CO. I love to treat orthopedics, pelvic health, and neuro diagnoses. I attended the University of Wisconsin – Madison for my bachelor’s degree in Exercise and Movement Science and was also on the cheerleading team. After participating in organized sports for my whole life, I was looking for new ways to stay active and started climbing. I started with bouldering but have recently been spending more time top roping. I love being on the wall because it’s therapeutic and makes me feel strong. Aside from climbing I love to run, do yoga and CrossFit, bake, and spend time outdoors.

You can connect with me on Instagram @samlemm or email me at [email protected].

Dr. Jared Vagy “The Climbing Doctor,” is a doctor of physical therapy and an experienced climber, has devoted his career and studies to climbing-related injury prevention, orthopedics, and movement science. He authored the Amazon best-selling book Climb Injury-Free, and is a frequent contributor to Climbing Magazine. He is also a professor at the University of Southern California, an internationally recognized lecturer, and a board-certified orthopedic clinical specialist.

To learn more about Dr. Vagy you can visit theclimbingdoctor.com or visit him on Instagram @theclimbingdoctor or YouTube youtube.com/c/TheClimbingDoctor

Kevin Cowell is a physical therapist, clinical instructor, and rock climber based out of Broomfield, CO. Kevin owns and operates The Climb Clinic (located at G1 Climbing + Fitness) where he specializes in rehab and strength training for climbers and mountain athletes. He found his passion for climbing in Colorado while attending Regis University for his Doctorate of Physical Therapy and has since become a Certified Strength & Conditioning Coach (CSCS), Board-Certified Orthopaedic Clinical Specialist (OCS), and a Fellow of the American Academy of Orthopaedic Manual Physical Therapy (FAAOMPT).

You can contact Kevin via email at [email protected] or by visiting www.theclimbclinic.com. Also, be sure to follow Kevin at @theclimbclinic on Instagram for free rehab and strength training resources.

Julien Descheneaux is a master of physical therapy who dedicates himself exclusively to rock climbing injuries, having treated over 1,200 climbers. He’s been covering Quebec competitions as a certified Sport First Responder since 2014. He is also the author of the online class “Climbing injuries at the upper quadrant” for the Quebec PT Board (OPPQ) and gives regular clinics and conferences on the subject. He founded PhysioHR in 2016, the first PT clinic inside a rock climbing gym in Canada and is currently the resident PT at Bloc Shop Chabanel.

You can contact Julien via email at [email protected] or by visiting https://www.physioescalade.com/.

Todd Bushman is a doctor of physical therapy, clinical instructor, Certified Strength and Conditioning Specialist (CSCS), and climber of mountain, rock, ice, and plastic. Todd is a dedicated climbing specialist based out of Bozeman, MT where he practices full time. He is actively pursuing advanced training to become a Certified Orthopedic Manual Therapist (COMT) through the North American Institute of Orthopedic Manual Therapy. Todd is also available for remote consultation regarding climbing injuries, movement analysis, and strength training.

You can contact Todd via email at [email protected] or visit him @try.hard.pt on Instagram.

Carly Post is a physical therapist in Los Angeles, California. She is passionate about climbing and enjoys helping people move better and optimize their ability to participate in their lives to their fullest potential. She can be reached at [email protected] and on Instagram at @carlypost