Understanding the Impact of Pelvic Floor Dysfunction on Female Athletes

As the mother of three competitive athletes, I have spent many long hours as a spectator, witnessing firsthand the effects sports has on the body. Amidst the physical issues from sports, there are so many positive attributes gained from playing sports. Many life lessons are taught on the field or gym floor; from mental toughness, perseverance and work ethic to the thrill of victory and the "agony of defeat" (anyone remember Wide World of Sports?). My children are confident in themselves and glorify God through their talents and abilities. They have learned how to be team players, how to listen and obey someone in authority, how to be assertive and how to build each other up. They have also witnessed good and bad behavior of both other players and adults.

My 17 year old son was born with a ball in his hand, playing five years of football, seven years of travel baseball and is now playing high school golf and baseball. My 14 year old daughter plays lacrosse and runs cross country. My 10 year old daughter is a level 5/6 competitive gymnast. We are a sports family. I am an aunt to several competitive volleyball players, two of whom are Division I collegiate players. I have nephews who play football, baseball and lacrosse and nieces who play volleyball, basketball and are competitive cheerleaders.

One of our favorite movies is A League of their Own. There's a scene when Tom Hanks tells Geena Davis that the catcher is doing well enough to play and he is not sure she is needed (after she quit the team when her husband came home from the war). The catcher, Alice, is shown with bruises and her nonverbal body language shows she is in a great deal of pain. In the photo below, she suffers a large bruise during one of the games. There's so many great quotes from this movie including "there's no crying in baseball" and "it's supposed to be hard; it's the hard that makes it great!" If you haven't seen it, I highly recommend you watch it. It's historical fiction in both a comedy and drama, played by a great lineup of actors and actresses.

Athletes are tough and this toughness is promulgated by coaches and parents who go along with the "no pain, no gain" mentality. We tend to think children are resilient and bounce back from injuries. If you talk to enough adults who were former competitive athletes, they will tell you how sports, especially contact sports, has affected their body and it's not always good! To quote one of my male pelvic pain patients, "you haven't played sports until you have fallen on your !$@!" The problem with falling is that each episode promotes a change in the entire nervous system, from the brain to the peripheral nerves controlling the extremities. For example, a fall to the tailbone or hip prompts the brain to protect vital organs, such as the kidneys, liver, ovaries (in females) and testes (in males). The response is contraction of fascia and muscles around the area to guard and protect and this change is permanent, unless there is intervention or treatment. So one injury, then another, then another causes so many changes that a person doesn't even know what normal is anymore. We often attribute it to "old age" or "having a baby" or some other excuse.

My private practice was started in 2009 with a vision to bridge the gap between orthopedic and women's health rehab and to offer a needed service for women with pelvic issues, especially during and after pregnancy. Seven years later, our clinic has treated over a thousand individuals, mostly women, but also a growing population of men and young adult women. Women are more prone to pelvic issues due to the inherent instability of the pelvic girdle from a structural standpoint, as described by physiotherapist, Diane Lee, as form closure. This instability requires a greater amount of force closure (muscular support) to keep the pelvis stable. Women who have had children are at greater risk as a result of hormones that increase laxity in ligaments, especially in the pelvic girdle. Middle age men have their share of issues as the prostate enlarges from the size of a walnut to the size of a golf ball, along with sedentary and stressful jobs. Young women are in a neglected group all of their own and have issues that are not being addressed. These are the top three issues I see in females who are in a "league of their own."

1. Pelvic Floor Dysfunction

Pelvic floor dysfunction describes a host of symptoms from urinary leaking, urinary urgency, waking at night to void, trouble urinating, pelvic organ prolapse, constipation, and pain with penetration. When a young female is leaking urine, it is not normal! Here's the good news: IT IS TREATABLE! At our clinic, we use a combination of hands-on treatment to address hip tightness along with muscle re-education for the deep core muscles and modification of exercise to include proper breathing for co-activation of the diaphragm and pelvic floor. The side effects of treatment include an improved sense of well-being and mobility, resulting in decreased pain and improved athletic performance! This is in contrast to the side effects of medication and pads, including a feeling of hopelessness and embarrassment. Is this what we want for our daughters?

2. Hip Pain and Tightness

This refers to hip rotation range of motion and muscular or capsular (joint) tightness in one or both hips. Typically, the right hip is locked up or not mobile if there are adhesions in the abdominal wall that extend into the hip joint. I believe it is a result of repeated falls and trauma to the pelvic girdle during sports. In addition, osteopaths claim the right hip becomes tighter from adhesions with more organs on the right than the left. The liver alone is like a three pound bar of soap atop the right kidney, restricting breathing as the kidneys move up and down with each breath. This can pull on the sacroiliac (SI) joint and contribute to back pain, hip pain, groin pain and sciatica. Visceral mobilization to the abdominal wall normalizes this restriction. In addition, mobility of the hip can be lost when tight hip muscles work harder to compensate for a weakness in the core.

3. Dysmenorrhea (debilitating pain with menstruation)

I discovered that most of my athletic female patients have debilitating menstrual cramps when I started screening each person and inquiring about their menstrual history. Visceral mobilization restores fascial mobility around the organs (viscera) and peripheral nerves that are responsible for abnormal muscle tension. In most cases, menstrual cramps either decrease significantly or cease altogether, even after one or two visits. This is one area that pelvic rehabilitation is able to improve quality of life for women in the childbearing years. Severe, debilitating menstrual cramps are not normal and are TREATABLE!

Here are some examples of the impact (pun intended) sports and treatment has had on young athletic females:

My 18 year old niece who plays Division I volleyball told me that she falls hard on the court at least 25 times a practice! That's almost 100 times a week! She has severe menstrual cramps, tight hips and sacroiliac joint issues. I have worked on her a handful of times when she is in town or I am visiting her out of state and she responds by feeling normal in her hips with improved range of motion and nothing obstructing her ability to perform. I have several other high school volleyball players who reap similar benefits when I mobilize the abdominal wall and hips.

Our 22 year old niece also played volleyball and received awards for the most "digs" in her high school career, causing her to fall a lot. I have treated her at family parties and in times of desperation when her cramps kept her in her bedroom or on the couch doubled over. She would benefit from further treatment, when we have more time to work on it. In the meantime, her cramps subside and she is more productive in her job and student life.

My 10 year old daughter has come home from three-hour gymnastic practices with large bruises from slamming her hips up against the bar. Along with unattractive bruises, she has abnormally tight muscles and loss of hip range of motion that pulls on her back. I have kept her home from practice several times to heal from the trauma her sport is causing her body. I treat her frequently to loosen her hips and dry needle her myofascial trigger points that are causing pain. I have taught her to "listen" to her body, take Epsom salts baths, and get a good night's sleep for the human growth hormone to do its job of healing.

Another college-aged female I am treating came to me with unresolved urinary leaking that did not improve by doing supervised Kegels (pelvic floor strengthening) with biofeedback at a hospital physical therapy clinic. She played basketball in high school and reported frequent falls on the court (no one else had probed into her sports history). She had severe hip tightness and fascial restrictions and her pelvic floor was tight. She was unable to do a Kegel since her pelvic floor muscles were already in a state of contraction, similar to attempting a bicep curl but only moving the elbow a few degrees. This makes the muscle shorter and tighter. Her hip tightness and menstrual cramps was resolved immediately and the pelvic floor tension improved allowing her to contract her muscles correctly. One doctor suggested surgery, and I wonder "for what?"

Sadly, female athletes take these issues into adulthood which can worsen in pregnancy and thereafter. Having two daughters, I am adamant that they receive treatment along the way or I wouldn't allow them to participate in competitive sports. Treatment and intervention is not a luxury, but rather a necessity! Healing must occur as trauma occurs or we are doing our young female athletes a huge disservice. With all the money we spend on them, shouldn't we increase the return on investment and give them a future without hip problems, menstrual cramps and pelvic floor dysfunction? Help is available! We offer a FREE online consultation to discover how visceral mobilization and hands-on treatment from one of our pelvic pain experts can improve mobility and pain. Call our office at (330) 528-0034 for more information or visit our website to learn more. You deserve more than living with "normal" pelvic issues.

Image Source: bleacherreport.com from the movie, A League of Their Own.

References: Lee, L-J, Lee, D. 2011. The Pelvic Girdle, 4th Edition. Elsevier, Edinburgh.

written by Janine Laughlin