Weightlifting and the pelvic floor
I’ve been working with a lot of folks who are curious about the pelvic floor’s role in strength training. Many people use a valsava maneuver when lifting heavy weights (think closed throat/glottis breath hold). Is a valsava “bad” for your pelvic floor? And how can we have a more nuanced discussion about lifting mechanics?
If you’re a real geek about this stuff, I would suggest reading this study which has been helpful for how I talk about lifting and the pelvic floor!
The reason why the valsava is sometimes vilified is it creates an increase in intraabdominal pressure. This is helpful for maintaining spinal stability, but more challenging for the pelvic floor if done inefficiently. If we think of our whole core (think underneath the rib cage all the way to the pelvic floor) as a balloon with pressure coming in and out through our breathing, the valsava increases pressure. This can be hard on the pelvic floor, sometimes leading to incontinence or pelvic organ prolapse.
Now, some of this is about approach. Instead of inhaling into your belly/the front of your core, it might be more strategic to breathe into your rib cage and your back body instead. This will help mitigate some of that pressure down and out on your pelvic floor.
Additionally, you can always add in a little pelvic floor contraction. Inhale into your rib cage. Perform a short exhale with a kegel, and then do your vaslava maneuver. This can also help as well.
Do we need to be doing a valsava all the time? This article highlights that our bodies will naturally do an involuntary valsava maneuver at 80% of a repetition maximum. Rather than always resorting to valsavas, I was told from pelvic floor mentors to coach people to use a pelvic brace up to 70% of a person’s RM and see if there are any performance challenges. To try a pelvic brace, you can inhale, and as you exhale, contract your pelvic floor and imagine you’re drawing your hip bones in towards each other to engage the deep core. Personally I don’t follow my mentors advice–I feel way more stable doing a VM during any slightly heavier squat or deadlift. I think all of this is person dependent, and it helps to work with someone who can get into the nitty gritty of form and function with you (In the study linked above, you’ll see proper positioning of a pelvic floor therapist performing an assessment while someone squats! It’s awkward for everyone but helpful if a client is open to it!). If you’re feeling curious about the role of the valsava on your pelvic floor, it might be useful to receive an pelvic floor physical therapy or occupational therapy evaluation.
