The Female Impact Athlete

Hello, Bestie! If you’re like me, you were active in sports growing up. I was competitive in gymnastics and track and field from the time I was 3-years-old until I was about 22. While regular physical activity is fantastic and important for living a healthy life, certain high-impact sports can have an effect on pelvic floor function. Let’s talk about it!

What is considered a “high-impact sport?”

High-impact sports are those that cause intense pressure and wear to the body. In particular, high-impact sports affect the weight-bearing joints of the body, including the hip, knee, and ankle joints. Sports that involve a great deal of running, jumping, and jolting movements are more likely to be high-impact. Such sports include gymnastics, football, running, basketball, cheerleading, and plenty more. In comparison, low-impact sports usually don’t involve both feet leaving the ground at the same time. These include golf, swimming, archery, and more.

Why does this matter and what does it have to do with pelvic health?

Well, I’m glad you asked! High-impact sports have been shown to be correlated with pelvic floor dysfunction (PFD), namely urinary incontinence (UI) (1). One study, which is admittedly a pretty old study from 1994, looked at the prevalence of UI in female, college athletes (2). Let me paint the picture for you: these were all athletes at a large state university with the average age of about 20 years (AKA they were young!). None of these ladies had a history of pregnancy—this is important to note because we know pregnancy and delivery are risk factors for UI (1). The study surveyed every varsity female athlete at this college and out of the 156 that were surveyed, 144 responded (pretty incredible response rate!). What they found was, in some senses, not surprising: for the most part, ladies in high-impact sports experienced more UI than those in low-impact sports. The results were as follows for percentage of athletes with a history of UI: gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%. For comparison, the results for lower-impact sports were as follows: swimming 10%, softball 6%, and golf 0%. While it might seem obvious that those participating in high-impact sports experience more UI than those participating in low-impact sports, I think what is not obvious, and therefore what is most intriguing, is the fact that these are young, nulliparous, elite athletes who are experiencing UI. Why is it that some of the most talented athletes, who experience a high level body awareness and muscle control, have a difficult time maintaining urinary continence? Let’s chat a bit about why this might be the case.

To answer this question, let’s walk it back a few steps. Remember way-back-when when we talked about possible causes for stress urinary incontinence (SUI)? During that chat, we discussed how SUI can be the result of two types of PFD (3). The first type is, in my opinion, the most obvious: the pelvic floor muscles (PFMs) are too weak to provide adequate support to the urethra during high-impact activities and therefore urine is leaked during such activities. Now, does this seem like the kind of SUI you would imagine elite athletes are facing? Think about it: these athletes have dedicated their lives toward exercise, endurance, strengthening, and perfecting the way their body moves. They have spent countless hours in the gym and on the field and they have an innate love of competition (maybe—who am I to assume?). I’d guess that it’s more likely these athletes are facing the second type of SUI which results from non-relaxing PFMs.

Remember, in order for the PFMs to be most effective, they need to be able to relax (lengthen) completely and contract (shorten) completely. Think back to our bicep muscle analogy: If you want to pick up a glass of water from the table and bring it to your mouth to take a sip, you will need to straighten your arm (bicep lengthening) to grab the cup and then bend your elbow to bring the cup toward your mouth (bicep shortening). If your bicep muscle is stuck in its shortest state, you will not be able to straighten your arm. This would make it a lot more difficult to pick up the cup effectively. The bicep muscle only performs to its maximum potential when it is able to both lengthen and shorten. The same is true of the PFMs. If they are stuck in their shortened, contracted position, they will have less power and ability to contract when needed during increased impact moments in order to stop the leakage of urine.

What does this mean? Should young, female athletes avoid high impact sports?

Everything we’ve chatted about today points to a historic lack of focus on certain aspects of female athleticism. Young women don’t need to avoid high-impact sports, but perhaps education and training of the pelvic floor should be built into workout regimens. As a former collegiate athlete in a high-impact sport, I am not surprised by the results of the studies that have shown increases in SUI in the female athlete population. I remember my friends talking about “leaking urine,” but lacking the knowledge needed to take steps toward resolving the issue. Elite female athletes (and, heck, probably male athletes, too) need to be provided with a better understanding of the pelvic floor including what is normal and what is not normal so that training and treatment can be adjusted accordingly.

If you’re an athlete, have you experienced SUI during your workouts (or just in your normal daily activities)? When did you realize it wasn’t normal to experience SUI during workouts? If you’re still suffering from SUI or another type of PFD, talk with your pelvic health provider to take the next steps toward a leak-free life.

XOXO,

Your Pelvic Bestie

References:

1.     Yang J, Cheng JW, Wagner H, Lohman E, Yang SH, Krishingner GA, Trofimova A, Alsyouf M, Staack A. The effect of high impact crossfit exercises on stress urinary incontinence in physically active women. Neurourol Urodyn. 2019 Feb;38(2):749-756. doi: 10.1002/nau.23912. Epub 2019 Jan 8. PMID: 30620148.

2.     Nygaard IE, Thompson FL, Svengalis SL, et al. Urinary incontinence in elite nulliparous athletes. Obstet. Gynecol. 1994; 84:183Y7.

3.     Louis-Charles K, Biggie K, Wolfinbarger A, Wilcox B, Kienstra CM. Pelvic Floor Dysfunction in the Female Athlete. Curr Sports Med Rep. 2019 Feb;18(2):49-52. doi: 10.1249/JSR.0000000000000563. PMID: 30730341.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives