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Is CrossFit safe for my pelvic floor?

CrossFit has become extremely popular over the last few years. It involves a mixture of weightlifting, gymnastics and metabolic conditioning (aka cardio to you and us!). With no two workouts ever the same and with each workout being infinitely scalable, up or down, it’s clear to see where its popularity stems from.

Each year the CrossFit Open takes place in every Crossfit Box (aka gym) across the land. The Open involves a new workout released every Friday for 5 weeks and sees willing participants compete against their other CrossFit buddies near or far. This year, 220,657 women worldwide entered the CrossFit Open and, as it draws to a close, we at PFP are reflecting on what it - and other workouts like it (think anything high intensity, heavy load or high impact) - means for women in sport and in particular for pelvic floor health.

By nature, CrossFit is the very definition of high impact, heavy weights and intense exercise. These types of exercise have often been given the label of not being pelvic floor ‘safe’ as they are thought to be attributed with pelvic floor dysfunctions e.g. pain, leaking or heaviness. However, anything - exercise wise or even everyday movement – could in theory be labelled pelvic floor 'safe' or 'unsafe'. This is because the physical safety boundary is relative to each of us as individuals. No two pelvic floors are the same with regard to power, reaction time, coordination, technique and endurance. As the saying goes, we are the sum of all our experiences and this applies to our pelvic floor muscles too. Put simply, if you are doing this type of exercise well, gradually increasing load when necessary and taking adequate rest days, it is pelvic floor considerate and can be so even with pelvic floor deficits or weaknesses. If you have any signs of pelvic floor dysfunction during movement or exercise then of course get checked out by a pelvic health physiotherapist but by restricting your activity and eliminating high impact exercise could you be doing your pelvic floor muscles more harm in the long run?

Using the 2019 Crossfit Open weekly workouts as examples (i.e. 19.1, 19.2, 19.3, 19.4 and 19.5), we will highlight a few movements that are often thought not to be pelvic floor safe but we will shed light on some of the benefits that each may offer you.

19.1 – Wall balls – (weighted deep squat with a throw upwards on standing)

Flexibility is key for a healthy anything, pelvis included. Being able to squat low whilst keeping your heels flat on the ground is a great flexibility marker for the lower body as a whole. Squatting down low is extremely healthy for the pelvis. It’s also the anatomically favoured and most beneficial position to toilet in. Being able to move your pelvis through a full range of movement will promote great circulation and keep the pelvic floor muscles flexible. If you add a wall ball (aka medicine ball) to this too then bingo! You’re strengthening at the same time. Be sure to work on squat depth before adding load.

19.2 – Double-unders (really fast skipping)

Skipping really quickly, or really slowly, (or jumping of any description) is up there on the most feared and avoided list for ladies who leak during exercise. Just because a particular movement gives you symptoms, it may not be the movement itself causing the symptom. For example, leaking during skipping may not be because you are skipping, but because the pelvic floor is unable to absorb and respond to the load being placed on it. We wouldn’t advocate continuing a movement at the same level in the same way that causes symptoms like leaking, but we would encourage you to scale it down to a level where the leaking isn’t present and then work back up from there. Responding to jumping, running or bounding is crucial for pelvic floor function so it's really important to strip back and build back up.

19.3 - Handstands

Any upside down movement, or simply just getting your pelvis higher than your shoulders can be great for offloading the pelvic floor muscles, as well as introducing variety. Everyday, our organs and pelvic floor muscles are subjected to the downward pull of gravity. Getting more upside down can take many forms; headstand, handstand, downward dog, pike push up, bridge or even just lying down with a pillow under the hips. Doing a few pelvic floor squeezes in this position is also beneficial, it can help the symptoms of a prolapse and can strengthen the diaphragm (diaphragm and pelvic floor = think puppet on a string). The stronger the diaphragm, the more suspensory support can be offered to the organs.

19.4 - Weightlifting 

As women, bone health is a key consideration for our future health - we must do some exercise that involves impact or weights, and ideally twice a week according to the World Health Organisation guidelines. The great thing with weight training is that it is infinitely scalable – start with a portion of body weight and build up to body weight by adding barbells, dumbbells or kettlebells. Being overweight or carrying extra weight is a risk factor for pelvic floor muscle dysfunction, but when weight training is done in the right way for you, it will aid to strengthen your pelvic floor. As a rough guide, if you are getting pelvic floor symptoms during weight lifting, drop the weight by 50% and then gradually build back up to a place that doesn’t see symptoms present.

19.5 – Volume!

The last workout of the Crossfit Open consisted of doing 105 thrusters (squat with a barbell and overhead press as you stand up) and 105 chest to bar (pull up so that your chest touches the bar) as fast as you could. When you see workouts like this or when you are in an exercise class, it can feel hard to say no or to stop. If you have pelvic floor symptoms and absolutely cannot change the number of reps then change the weight and/or the speed to get into a symptom-free zone. Try not to fear volume, because including appropriate volume in your exercise routine is great for building endurance..

If you are curious to know how your pelvic floor muscles are behaving and at what level of exercise you should currently be working at then book into see your local women’s health physio.