Q: I know breath holding is bad from my pelvic floor. Should I never hold my breath again? M

A: This is a great question as we continue to expand our conversation about intra abdominal pressure in pelvic health issues, is it a friend or foe? Historically, we have counseled women away from certain activities because of perceived high IAP in order to protect their pelvic health. Breath holding has been a major high-IAP generating no-no!

However, breath holding occurs in every level and type of sport competition. There is no way that two basketball players scrambling for a loose ball are giving any attention to their breath in the moment. They are breath holding for sure to grapple the ball away from each other. Gymnasts hold their breath as they move into ariels. A CrossFitter needs to hold their breath to lift heavy. Breath holding is one of our available stability strategies. It is intended and appropriate for a high demand challenge, a heavy lift, or in the midst of learning a new skill. 

The demand common to many sports is there is no time to think consciously in the midst, instead you just act, based on hours and hours of practice training sport specific patterns. The brain in that high intensity moment may reflexively choose breath holding as a part of the strategy to assist with the central stability needed to sustain performance. So, in my humble opinion, we need to train our athletes that encounter breath holding in their performance…for breath holding.  That higher IAP generation from a breath hold becomes an issue only if is if it is not balanced with the muscular counterbalances of the continence system (their deep/anticipatory core).

I figure the brain is way smarter than me, it can decide how much of what component (pressure or muscle) is needed in that moment better than I can train it. With that in mind, off the ice, mat, or game, I train a brain strategy that links the components of that deep system: diaphragm, TA, pelvic floor, pressure management timed in with function and repetition of movement patterns. I train this for inhale/eccentric control, exhale/concentric control  and speed of the system elements.  AND I train for breath holding if that is a part of their sport.

First, I teach “blow before you go” as a way to use reflexive exhalation recoil of the TA and PF to pull up and in (more on this concept here). Then in that protected, prepared position, I add a breath hold on top while they practice a sport specific jump or lift, etc. My clinical reasoning is that if they start with that exhale and PF recoil/lift, then it is up and prepped when the inevitable breath hold comes. Versus having the PF and organs in a descended position, then add the high IAP of a breath hold, AND an added challenge such as a heavy lift or tumbling pass.  Practically this would look like a quick blow, with PF recoil/lift up, then hold your breath on top of that prepped PF while performing a challenge. This keeps the pelvic floor on board as a part of the central stability system and shores up the incontinence or poor proximal hip control on landing a jump that might accompany a pelvic health issue.

It is this precise foundation to build the rest of the sport specific activity around. A CrossFitter may need to put a puffed out bracing strategy on top of this for a max lift. A gymnast may need to train a flexible response on top of this in order to complete an ariel move. Please note: This is a sport specific training suggestion, a recreational jogger shouldn’t train for breath holding or use breath holding in their run. Breath holding is for high loads, and intense demand, it is not the  strategy you should use to pick up a pencil or to get out of a chair. 

Training in a reflexive response and preparing the system for the inevitable breath hold that comes along with some sports will embed strategies for the brain to have access to while they are in the midst of play and can’t think about it. As we begin to acknowledge pelvic health issues within sport for our female athletes, and that women want to participate in high levels of sport and fitness, we must create rehab and training strategies that keep them in their sport, while preserving their pelvic health. I think these two things can and should co-exist.

I am still learning how to build better strategies, wanna walk this new path with me?

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