“When should I think about my pelvic floor and breath in fitness, and when can I rely on it to happen automatically?” Always? Never? Some? This is a real time issue for female athletes returning to fitness or sport after pregnancy and delivery. My answer here represents the shift in thinking I hope to continue to promote at the intersection with pelvic health and fitness needs. This conversation shouldn’t result in a formula, instead it should result in a reasoning process to help you know WHEN it can be beneficial or necessary to use a strategy that involves conscious activation (thinking about it). Then you can move from conscious engagement to relying on an automatic response. This process repeats as you build that strategy into new and bigger challenges. Read on…

Hey Julie!

I’ve recently been lifting heavier weights. I didn’t use your strategies while doing so and now I’m symptomatic. Your strategies truly work, it’s crazy how quickly I notice when I’m not using them. For anyone who doubts you send them to me lol! 

Thanks…Kathleen  (IG @kathleengerms ; used with permission)

Hey Kathleen!

I am so glad you have benefitted from the concepts! I want to clarify, that the intention of the strategies I share is to rebuild automatic responsiveness of the system (with the pelvic floor as a component of that system). You trained that automaticity well. First by reconnecting the components of the system (pelvic floor, breath), learning how to use them in a balanced way as a team, then blending them in and under a gradually progressed fitness program you love. This took conscious engagement initially and then it became automatic and subconscious. In other words, your brain took over and it became your new baseline.

Consequently, you no longer needed to activate that system with any conscious thought or cueing at the level you were moving, fitness-ing, mom-ing and loading (and your form would also be automatic and supportive of your lifts and movements at this point, too).

How can you be sure your pelvic floor is working?

How can you be sure your pelvic floor has become or is becoming automatic at that level of activity?

You don’t leak, or have symptoms (pain or heaviness) in your day to day function or with the activities that formally triggered your symptoms. This is particularly true when you can’t think about it. For example, when you have to run across the street quickly and dodge traffic. That moment of “oh that was cool, I didn’t leak even though I just did a quick sprint”. Or the leaks, heaviness or pain are coming later and later in a run. Also, only a few of the challenging activities at the gym are still symptomatic, while many others are now symptom free.

When do you need to think about the pelvic floor and breath in fitness again?

You will need to think about it when you have an added challenge. A new load, you “lifting heavier”, is a new challenge. Though it is likely the same skill (a back squat for example), a new load will require some conscious attention to strategy, form, and engagement. This would be true for any athlete, with or without an injury. Then as you consciously participate in the movement, your incredible brain learns again how to apply the ideas and strategies to make them automatic for that new load. Your muscles then build and adapt to that new load and it becomes easier over time.

If you pick a new skill, you will likely need to pay closer attention to how you are managing your pressure, preparing for the challenge, your form, more conscious recruitment of the pelvic floor perhaps, excursion of the pelvic floor, breath mechanics, etc. (a.k.a. your strategies). This will train that system and strategies into the new activity or skill, with the hope that the cycle will continue to repeat.

When they fire together…

This is known as the Hebbian Theory of how we learn skills- “If they fire together (the strategies and movement patterns), they wire together”. The brain connects the dots and learns anew. It will integrate the systems and strategies into the new skill. Thus these “wired together” strategies and movements will become more and more automatic as you practice within each new challenge. You essentially create, and then recreate new baselines. Through a repeating cycle of conscious participation, followed by brain adaption and learning at each new level and type of challenge a new baseline is born*. This is supported by the continued practice, gradually progressed load, volume, distance, and time to build your strength and capacity around that new “wired together” strategy.

Pretty cool.

This isn’t just about the pelvic floor and breath in fitness!

This isn’t simply a description of how we rehab pelvic or abdominal health after pregnancy or how we rehabilitate any part of the body. It is how we learn motor skills, create adaption in tissues and build resilience. We just need to start applying these ideas to pelvic health considerations in fitness and sport.

Take Care! Julie

Want to learn more?

Read more about the rebuilding the reflexive response of the pelvic floor here . More about the role of alignment (or form) versus positional variability here. 

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*Of course, you may eventually come up against the limits of your humanity, unless you are an Olympian. Even then world records last and last for decades for a reason.

Thanks for the question Kathleen Germs (@kathleengerms on IG; used with permission)