Look anywhere, continence foundation, pelvic floor first website, and literally every other resource for pelvic dysfunction and you will see that:
a) heavy lifting causes or contributes to pelvic dysfunction, and
b) that heavy lifting is contraindicated for post natal populations because it causes or contributes to pelvic dysfunction?
But what is heavy lifting? Is it a percentage of body weight? Is it anything heavier than the weight of the child? Is it 20kg for everyone, no matter how strong you and your pelvis is?
And what about training for your activities of daily life? is it better you to lift a 15kg carset + baby without any awareness of how to do it safely or with or without training?
Does the risk change with the movement? Is a heavy bench press just as risky as a back squat? Is a back squat on parr with a clean and press? Or kettle bell swing the same as a deadlift?
What does the research say?
Actually, the research doesn’t answer many of these questions at all! In fact, a couple of studies have shown the opposite. For example, holding your breath (like they do in weight lifting) is NOT the same as straining (or bearing down). This study showed that the Valsalva manoeuvre still creates a vacuum in the pelvic floor, distinctly the opposite of straining. This study showed that heavy lifting (with a head strap, of 20kg on average) only displaced the pelvic floor, and possibly increased risk of prolapse, during the follicular phase of their menstrual cycle. Neither of these studies show that all Heavy Lifting, whatever they define it to be, is contraindicated in all women.
Generally, activity is good for the pelvic floor, and lifting is an integral part of a woman’s activities of daily life.
I have some food-for-thought to propose. Perhaps it?s not the lift that is risky, but the way we lift.
I have four things to consider about the way we lift that may have more of an effect on pelvic floor than simply lifting.
- Breathing
If you learn the ‘exhale on exertion‘ breath, rather than a ‘bracing breath’ that they teach in weightlifting communities, would that make a difference? While the study above shows a vacuum effect with healthy populations, we cannot see inside the body of all humans to know that they have not got a stretched or dysfunctional floor. Furthermore, this connects the pelvic floor lift with an unconscious reflexive action? breathing, which may get the deep core working reflexively too! - Grounding
If we learn grounding techniques through your feet to increase glute activation and decrease the core load? I couldn’t find a study on using the same technique through your hands, but I’d like you to try the yoga technique of pushing your hands in to the floor (evenly through each finger tip and the heel of your hand) and feel what happens to your shoulders, rotator cuff, and abs, there’s something to it! - Posture
If you have upper cross syndrome, you’ll be bearing down, or loading your pelvic floor more than you do when you’re aligned. If you have lower cross , your pelvis is not in optimal alignment for the pelvic floor to work well in the first place. - Assessment
Knowing whether you are Hypertonic or Hypotonic is often just one trip to the physio away. Both a hypertonic (too tight) and a hypotonic (loo weak) pelvic floor will be dysfunctional, so knowing which one is contributing to your back pain will make all the difference in your exercise choices.
If these techniques make a difference, then suddenly lifting weights, including relatively heavy ones, is opened up to us for training women with pelvic dysfunction, and we can start actually training for life! Relatively is an important concept, because what is heavy for one person is not heavy for the other. And I’d like to open another point on this for discussion – that heavy for the arms is not the same as heavy for the pelvic floor. Heavy for the legs is not the same as heavy for the pelvic floor. The concept of ‘heavy’ is fluctuating and variable from person to person and physiology to physiology. You need a trainer that works with a pelvic health physio to know for sure. You can look up your closest one here.
In addition, many of the movements associated with weightlifting (think bench press, lat pull down, back squat) are very simple to coordinate with the pelvic floor lift, as well as exhale on exertion! Exercises like Lat Pull Down and Shoulder Press are supported if performed when seated, which can actually reduce the load on the pelvic floor! Seems like a win-win to me.
Clare Hozack is an ex-Australian Sailing Athlete, current Strength and Conditioning Coach, and trainer for mums for 19 years. Clare has both coached and experienced pelvic dysfunction, spinal injury, and other core dysfunctions and is passionate about empowering mums to lift, move, and LIVE healthily; by both rehabilitating the properly post birth, and pushing them past their mental and physical limitations once they’re able to. Clare is creator and managing director of IntoYou, a small training studio in Collaroy Plateau dedicated to this cause.