Strength Training, Crossfit, and your Pelvic Floor: What You Need to Know

The benefits of strength training are undeniable. In fact, the Department of Health and Human Services recommends strength training for all major muscle groups at least two times per week. Challenging your muscles to move through resistance from weights, bands, machines, or even body weight helps develop and maintain strong bones; increases muscle growth, power, and endurance; increases metabolism; reduces the risk of injury; and helps manage chronic conditions such as back pain, arthritis, diabetes, heart disease, and depression. Unfortunately, a 2018 study found that only 22.9% of U.S. adults aged 18-64 met the exercise guidelines for both aerobic and muscle-strengthening activities.

Despite all of the positive effects of strength training and national recommendations for muscle strengthening, many people do not challenge themselves enough with resistance training, avoid strength training altogether, or are hesitant to group try classes such as Crossfit that have a heavy weightlifting component. Crossfit, a branded fitness program that involves constantly varied functional movement performed at high intensity, incorporates interval training, Olympic weightlifting, plyometrics, gymnastics, calisthenics, and powerlifting. Crossfit, and similarly designed fitness programs have become incredibly popular – and for good reason – they have a strong community feel, constantly interesting and varied workouts, and offer incredible health benefits of resistance and aerobic training across fitness disciplines.

Fear of injury (or re-injury!) is a major barrier to getting started or continuing a strength training program, and in particular, fear of injury to the pelvic floor muscles holds many people back. Unfortunately, many people with conditions such as diastasis recti, urinary leakage, or prolapse may have been told or choose to avoid strength training altogether. Similarly, many frustrated athletes have to limit their workouts or are sidelined by pelvic floor dysfunction and associated symptoms such as urinary leakage, pelvic pressure, and pain. Read on to see what you need to know about lifting weights, Crossfit, and your pelvic floor – and how you can minimize the risks, stay in the game, and reap all the benefits.

Pelvic Floor, Deep Core: Why They Matter for Weight and Strength Training

The pelvic floor is a group of muscles and connective tissue spanning from the pubic bone to the tailbone. We depend on our pelvic floor for many important functions  – maintaining urinary and fecal continence, helping us breathe, engaging in sexual function, supporting our internal organs, and maintaining control for our trunk. 

To maintain trunk and core control, we depend on four muscle groups that form the “true core” or deep core. The pelvic floor muscles form the bottom of the core; the respiratory diaphragm muscle sits just below the rib cage and forms the top of the core, the deep, corset-like transverse abdominis muscle forms the front, and our multifidi muscles make up the back of the core. These four muscle groups work closely together to manage intra-abdominal pressure for everything from daily tasks like walking and bending to challenges like lifting heavy weights, loading up the car seat, and jumping. 

Intuitively, when we lift heavy objects, the demand for trunk control increases, and accordingly so does the demand on our deep core and our pelvic floor muscles!

Is it safe for me to lift weights, and how do I know if it is too much for my body?

Many people may be hesitant to start weight training or Crossfit classes due to the increased demands on our pelvic floor, abdomen, or low back; which is particularly pertinent for people who have issues such as leaking, prolapse, or pain. However, science tells us that loading tissues through resistance training is also exactly how those muscles and tissues get stronger, and more resilient (not to mention all of the other benefits of strength training!). In fact, studies have shown that strength training is just as effective for improving range of motion as stretching! Good news for Crossfit and similarly designed fitness program enthusiasts – scientific research shows that the injury rate with CrossFit was comparable to or lower than injury rates with other sports such as distance running, Olympic weightlifting, track and field, and military conditioning. It is important to keep in mind that there is not a “one-size-fits-all” approach and what constitutes a “heavy” weight and challenging workout is unique to each person. 

With respect to the pelvic floor and deep core, below are some general guidelines for when you should consider scaling back, modifying, or stopping an exercise:

  • Urinary or fecal leakage: this indicates that the control or strength of your pelvic floor muscles is not strong enough to meet the load coming from above.
  • Increased pelvic pressure: increasing pressure felt through the vagina or rectum could also mean that your pelvic floor is experiencing more load than it can tolerate, which may be related to a pouching down of our internal organs with heavy pressure changes.
  • Pain: Yes, sometimes workouts are “painful” to our muscles, so this is a relative term. However, some pain patterns may be more related to injury or dysfunction, and more likely to cause issues beyond muscle soreness. If you experience pain in a workout – consider the following:
    • Is it your familiar pain? Does this feel similar to the regular pain in the regular places that you experience? If so, consider stopping the exercise or making modifications
    • Does the pain last after you stop the exercise? You might be straining more than just the muscles.
    • Is the pain on one side, even though the exercise is working both sides equally? Chances are this is too much load for the muscles/joints/ligaments on one side, consider stopping or modifying.

Tips for getting started with resistance training and Crossfit

  • If you have not been active recently or have a chronic condition, consider checking with your physician before beginning a strength training program
  • Do what is fun and accessible! Doing what you enjoy will help you stick to it better. Explore different ways to strength train – at home, at the gym, with a coach, in a group exercise class, or through programs such as Crossfit.
  • Always get a good dynamic warm-up. Consider brisk walking or light jogging and movement preparation such as performing the movements you plan to do in your workout with light weight.
    Incorporate full-body movements such as squats, deadlifts or hinging, pushing, and pulling movements. Start with higher repetitions and sets of movements to focus on technique.
  • If you are ready to take the leap into Crossfit or similar programs, get to know your gym and your coaches! Many gyms offer free introductory sessions to meet the staff, get to know the equipment, and practice movements with plenty of individualized coaching and teaching. Remember that all exercises are scalable and can be modified to a version that works best for your body.

Still not sure if strength training is right for you or how to get started? Need more help and guidance? Or are you sidelined from strength training or do you avoid certain movements because of pelvic floor issues? Reach out to us or a local pelvic PT for further help!