A Pelvic Floor Solution

This is a post from Julien Pineau of StrongFit. It was so well written and important that I thought I would repost it for posterity. I have stated this many times, but perhaps hearing it from someone else will ring a little more true. 

I consider Julien a true master when it comes to movement principles and is the inspiration for my training, rehab, and how to coach my clients.. What I have learned from him in the past has been better than what I have learned from the so called "Experts" in the last decade of my experience in the training industry. 

A Pelvic Floor Solution

One of the main topics that we have heard reported in gyms across the country and from our female athletes are issues dealing with the pelvic floor.  This topic drove our desire to start the StrongFit Women’s group. Intense exercise, box jumps, and heavy barbell squats have been around forever, but until more women started performing them in CrossFit, these “new” issues dealing with the pelvic floor were not discussed openly.

With CrossFit’s more intense exercise regimen becoming more popular with women, I saw pelvic floor issues popping up more and more.  I then realized how common this issue is and my belief is that the problem is getting worse, but I believe I know why.  First, this is not just an issue for female athletes, but also men have a genetic weakness in their lower abs as well.  Through personal experience, when I was in my 20s, I ended up needing hernia surgery. The surgeon explained that there were holes on each side of the abdomen where the muscle did not close completely.  During strenuous, prolonged, and intense movements fat would seep through that opening and then I was left dealing with a hernia.  He explained further that hernia surgery for men is so common that it is not a matter of if it's going to happen, but when it's going to happen.  So, I believe that this is actually more of a lower ab issue, which can affect the pelvic floor, and is not exclusive to female athletes. Unfortunately, it has only been getting worse due to imbalances within athlete’s programming.

Pelvic floor issues originally became associated with women who have had kids, were in their 40s or 50s or had recently began training in CrossFit’s very intense environment.  The belief was that it was something that this population was going to have to tolerate.  But now we're starting to see that it is not just women in their 40s and 50s who have had kids. We are now seeing 20-year-olds with no children, who are very strong, athletic women, who compete in the CrossFit Games, who cannot go through an intense exercise routine without incontinence (lacking the ability to control your bladder) and those types of issues.  These symptoms signal of a more serious issue.  I began to hear women talking about uterus prolapse.  This kind of escalation of pelvic floor issues is far more scary because now you are talking surgery, all while I believe that this can be prevented.  It is my theory that these issues with incontinence, lower ab weakness, and other issues within the pelvic floor come from overuse of external torque.

If you are not aware of my work and explanations in regards to external torque (ET) and internal torque (IT), please review my videos so the following explanations will make sense. ET targets the rectus abdominis (which is the six-pack) and the erectors along the lumbar spine, simultaneously.  They reinforce each other and as one gets stronger, so does the other.  So, as athletes develop the six-pack, the lumbar spine is capable of flexing harder and this is why you see the arch in the low back so pronounced amongst CrossFit Games athletes.  Games athletes are a great representation of this occurring because you can see that arch, the six-pack is getting thicker and thicker, but their waists (external obliques) are staying small.  Personally, I believe that it makes for a great aesthetic look and elite CrossFitters are some of the most athletic, gorgeous women out there; but, you can see that a major imbalance has started to form between the external torque chain and internal torque chain in these athletes.  The arch must have equal pressure on both sides to stay structurally sound and, right now, we are starting to see a collapse because athletes are working external torque, but not enough work is done toward internal torque.  Many of you have been taught to engage external torque in the squat and in the deadlift, and that is leading to problems.  Remember, while you squat you should be using internal torque on the way down and out of the hole (external torque only as you reach above parallel) and the deadlift should be internal torque the entire time.  Athletes are creating fantastic amounts of tension and are defaulting to external torque almost exclusively, utilizing their six-pack and erectors on the lumbar spine.  All this tension is great, but it is pushing down into the external obliques, transverse abdominis, and basically the pelvic floor.  While the ET chain (rectus abdominis “six-pack” and erectors) has been becoming capable of greater performance and has been getting exponentially stronger, the IT chain (external obliques, transverse abs, and pelvic floor) has been neglected.  The stronger that the ET chain becomes, the more that the athlete will default to those muscles to accomplish a movement, therefore causing atrophy of the IT chain of muscles to become greater.  The combination of greater performance, more weight on your back, and the generation of greater external torque is worsening the issue of the pelvic floor.  This is why I believe that we are seeing incontinence and, if there are more cases of the prolapse of the uterus and it is attributed to strength training/programming, we might as well close our doors because that type of injury would close every CrossFit gym out there.

The good news is there are ways to fix this issue.  We came up with the External Obliques Opener with a variation of adding leg raises and the T-Spine Opener, which allows the athlete to feel, activate, and strengthen the external obliques, transverse abs, and low abs because they are all connected.  The External Oblique Opener was not originally created to strengthen the pelvic floor, but I have discovered that it does and it makes complete sense due to the obliques, transverse, and low abs all being one unit and complete unit.  I have tested this hypothesis on my athletes and it is working.  

During the External Oblique Openers, I have found that athletes become capable of activating the proper torque chain (ET/IT) to assist them in controlling their incontinence.  During the Opener, if I placed the kettlebell (KB) above the belly button, causing the athlete to engage the rectus abdominis and lumbar spine, the athlete had no control over keeping themselves from peeing.  However, if I immediately placed the KB below the belly button, causing the athlete to engage the external obliques and transverse abs, urination would stop.  Now, I have been training two Games athletes, one that is older and has had children and one that is younger and has not, and I can tell you that the youngest one, who's very athletic, could not do the External Obliques Opener at all.  She could not engage the proper muscle groups or activate the proper torque chain to push the KB up and she would report the urge to pee a lot during heavy squats and intense training.  This became consistent enough across multiple athletes, so that tells me the issue dealing with the pelvic floor occurs within ET.  Now, I'm not saying you can't do external torque exercises, but I am saying we need to balance ET with IT and strengthen the muscles that make up the IT arch.  

Where do you begin?  All athletes should do the External Oblique Opener everyday, 2 sets of :60 seconds, for 6 weeks, to see a major difference in the strength of the pelvic floor. Strengthening the right muscles will allow athletes to begin seeing and feeling a difference during heavy squats, heavy deadlift, and intense exercise.  I will link to the YouTube videos for the External Oblique Openers and the T-Spine Openers below. For those of you taking this on, please keep us posted on your progress.

Julien Pineau

Crossfit Bytown