Written by: Danielle Landrum, SPT
A Personal and Professional Journey into Pelvic Floor Therapy
I want to give everyone a warm welcome to my personal, evidence-based perspective on my recent therapeutic endeavors. This will be an illuminating three-part blogging series filled with various relevant research studies discovered from a thoughtful scavenger hunt on the World Wide Web. I want to forewarn my audience of my tendency to add in a touch of my two cents within the designated subject matter. Despite the personal excerpts, the real purpose is to provide some clinical ammunition, new ideas, and strategically attempt to empower my fellow PT people who might be feeling a little burnt out.
I have recently ventured down the new and extremely unfamiliar path of pelvic floor physical therapy. I have been slightly wary of this new journey, partially due to my lack of experience with this specialty and partially from society somehow curating the idea that these intimate bodily issues should not be openly discussed. However, I have sternly confronted these outdated and harmful ideologies to facilitate my evolution into an open-minded clinician. I want to give a genuine shoutout to the Regis Doctor of Physical Therapy program for giving me the initial exposure to pelvic floor therapy as well as my clinical instructor, Danna, for providing the leadership and guidance I urgently need on this embarkation.
Understanding Pelvic Floor Dysfunction (PFD)
The simple truth is that over 1/3 of women who reside in the United States struggle with a pelvic floor disorder.1 What is a pelvic floor disorder? Some common issues include urinary incontinence, recurrent urinary tract infections, pelvic pain, menstrual cycle irregularities, and sexual dysfunction all of which have numerous physical and psychosocial repercussions.2If any of those terms are unfamiliar to my readers then I will politely and respectfully encourage a side quest away from this article, onto the internet for a quick search, and perhaps a moment of enlightenment. The prevalence of urinary incontinence is worth recognition and intervention from the PT community. There has been a tremendous breakthrough in the past 5 years with regard to the popularity of pelvic health, which is both uplifting and empowering. Many people think it is strictly suited towards postpartum women or elderly individuals, both of which are untrue.
The Misconceptions of Pelvic Floor Health in Sports
I am fully aware that I hold a strong internal bias surrounding the impact of physical therapy. With that being said, physical therapy can be the monumental shift individuals need to alter their lives. Immersion into a compassionate rehabilitation environment can provide the appropriate education, activities, exercise, pain relief, and human connection needed to heal or recover. Anybody who understands the psychological influence of an individual’s environment knows that calculated immersion results in meaningful cognitive behavioral change and neural adaptations.
As a former collegiate athlete, I have found myself gravitating towards the sports PT community simply because of my involvement and how dynamic treatment can be.
Yes, I know I just took a really hard left turn from pelvic floor to sports, but stay with me here. I want to make the connection between the two topics. The women’s athletic community has failed for years to break down the stigma surrounding pelvic floor dysfunction and how overwhelmingly common it is for women in sports. Recent research reveals that between 25-50% of female athletes, particularly ones who participate in high-impact activities, experience urinary leakage or similar pelvic floor symptoms during intense training sessions.3 Sports such as volleyball, gymnastics, running, and weightlifting/powerlifting are at a higher risk for dysfunction due to repetitive increases in intra-abdominal pressure and energy availability.4 Athletes with PFD should be screened for signs of RED-S since there is a high correlation between energy deficiency and urinary incontinence.5 The clinical reasoning is simply due to the fact that other treatments would be prioritized depending on the severity.
The Link Between High-Impact Sports and Pelvic Floor Dysfunction
The types of training that are typically prioritized are strength, speed, or endurance-based. Just to be clear, these training methods should be prioritized because they are pivotal exercise physiology principles designed to develop and progress athletic performance. However, pelvic floor muscle training should be able to coexist with these foundational pillars in a program. Pelvic floor muscle training or PFMT has been shown to be highly effective and reliable to correct dysfunction when implemented properly. The most effective programs include progressing isolated contractions of the pelvic floor or “Kegels” into sport-specific movement patterns.6
Integrating Pelvic Floor Muscle Training into Sports Rehabilitation
Within my first two weeks here at Fyzical, I have observed numerous pelvic floor treatment sessions and variations in how dysfunction can present. We have not gotten to work with any patients who fall within this specific demographic, but I am currently manifesting their future evaluation by writing this blog. I did witness an advanced pelvic floor coordination exercise with a male patient involving an isometric contraction paired with a single-leg ball toss. Higher-level pelvic floor activities, similar to the one previously mentioned, could be taught to female athletes by an experienced clinician to destigmatize leakage and promote confidence. Confidence is a crucial cornerstone for athletic performance, and occasionally leaking could completely derail a performance. A short supervised PFMT module or session could be utilized for high-risk sports teams or individual athletes. Even if it is just a session informing women about the anatomy of the diaphragm and how to coordinate the pelvic floor during a breathwork exercise. I always appreciated the house analogy that compared the diaphragm to the roof and the pelvic floor to the flooring/foundation. This tidbit could make a big difference in someone’s performance, health, and psychoemotional state. The tricky part about implementation would be the unique function and capability of each athlete. I am here to spark some ideas and brainstorm, but I apologize because I will not be ironing out all the execution details. I also cannot emphasize how extremely important it would be to find the appropriate specialists for a teaching role. Spreading
information about women’s health, wellness, and performance is just as important as guaranteeing safety and security. I felt as if an empowering call to action was fitting given the overall tone of this post.
The Ethical Responsibility to Screen and Educate
To wrap things up, I will simply say it is part of our ethical and professional responsibility to screen for certain risk factors in this population. PFD has more prevalence than we might think. As a doctoring profession and movement experts in the healthcare field, we have the unique ability to build personal relationships with patients while optimizing quality of life. It is essential that we provide the best resources and guidance to patients so they can take an active role in their rehab and make an informed decision about their health. Here’s to fewer leaks, stronger peaks, and a pelvic floor that never quits.
Citations
- National Institutes of Health. How many women have pelvic floor disorders? Published October 21, 2013. Accessed August 10, 2015.
- http://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/pages/risk.aspx 2. Baylor College of Medicine. Why is it important to talk about pelvic health? Center for Research on Women with Disabilities. Accessed October 16, 2025. https://www.bcm.edu/research/research-centers/center-for-research-on-women with-disabilities/a-to-z-directory/pelvic-health/why-is-it-important-to-talk-about-pel vic-health
- Whitney KE, Holtzman B, Cook D, et al. Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes. J Pediatr Urol. 2021;17(3):290.e1-290.e7. doi:10.1016/j.jpurol.2021.01.041
- Demeco A, et al. Efficacy of pelvic floor rehabilitation in female athletes: a systematic review. Sports. 2024;12(1):[pagination pending].
- Dietze-Hermosa M, Hitchcock R, Nygaard IE, Shaw JM. Intra-abdominal pressure and pelvic floor health: should we be thinking about this relationship differently? Female Pelvic Med Reconstr Surg. 2020;26(7):409-414. doi:10.1097/SPV.0000000000000799
- Rasovska A, et al. Pelvic floor muscle activation in functional and loaded positions among female athletes. Int Urogynecol J. 2024;[Epub ahead of print].