Considerations for Optimal Sports Performance

Did you know that it is important to use your breath during challenging activities? But, have you ever wondered why? Our breath, which is controlled by our diaphragm muscle, is a crucial component of our dynamic core stability. When the core is working optimally, so is our power output and athletic performance. Even more importantly, when the core is working sub-optimally, it can manifest itself in many ways including insidious hip or low back pain, urinary leaking, or decreased athletic performance. As the above issues become more well known in the athletic and rehab communities, we feel it is important to make the information more accessible to our community. 

An Unspoken Epidemic

Recent research has revealed that many athletes, including adolescent girls as young as 9 years old, are experiencing urinary leakage during sport. A recent study reports that a third of high school female athletes are experiencing urinary leakage, otherwise known as incontinence, during their athletic activities. Because of the perception and its personal nature, many girls may not be reporting this to family or healthcare providers. However, many forums and groups on social media are full of suggestions on the various pads and other compensatory strategies (such as wearing a tampon or menstrual cup) to control the leakage, suggesting the issue is typical and not problematic.  Incontinence is often associated with postpartum women and pelvic floor trauma, so many people assume leakage is due to weak pelvic floor muscles that occurs after having a baby. Incontinence is more often an issue with the intra-abdominal pressure system. Due to the differences in anatomy, boys and men are less likely to experience urinary leakage due to these issues. However, they are more likely to experience chronic pelvic, hip or low back pain or unexplained recurring injuries, which can result in frequent trips to the doctor or recurring visits to the physical therapist for strengthening without getting to the root cause of the symptoms. In some cases, recurring injuries and chronic pain may lead to unnecessary surgeries or early retirement from a beloved sport or pastime. 

Importance of Sport Specific Training

So many athletes, even at younger ages, are being trained that “strong abs” are the primary determinant of stability. Sometimes these issues can arise when athletes are solely using planks and other exercises incorporating static holds of the abdominal muscles, which in isolation are not enough to fully train our core. The problem often becomes that training the muscles this way doesn’t necessarily translate into more functional stability with movement, like jumping, kicking a soccer ball, swinging a bat or performing gymnastics. Some young athletes are being coached to keep their abdomen engaged, or contracted, throughout all their movements. Advances in orthopedic and pelvic health research is showing the importance of using our breath and avoiding static holds during dynamic activities.

A lack of proper guidance from fitness professionals and too much emphasis on “sucking it in” or these long static abdominal holds can lead to athletes under training muscles they actually need for core stability. This can lead to increased risk of injury, developing compensatory strategies or chronic pain, suboptimal performance, and decreased power output.

The Dynamic Piston of Power and Stability

Our pelvic floor is often referred to as the “floor of our core”, as it works together with our deepest core muscles: 1) the transversus abdominis, 2) the lumbar multifidi (the deepest spinal muscles), and 3) the diaphragm to maintain the pressures in our abdominal cavity and create the stability needed to move. 

Our diaphragm is by far one of the most amazing muscles in the human body. It is controlled involuntarily by the autonomic nervous system, so that we continue to breathe without actively thinking about it. But, it also has voluntary control so that we can take a deep breath or forcefully exhale on cue. Most importantly, the diaphragm and the pelvic floor have a crucial relationship as they are designed to mirror each other. When we inhale, the diaphragm contracts and moves down into the abdominal cavity to allow the lungs to expand. The pelvic floor muscles gently descend as well to allow for the increase in intra-adbominal pressure. Then, with exhalation, our diaphragm relaxes and the pelvic floor muscles return to their resting position.  Exhalation helps us to engage our transverse abdominis, and our pelvic floor muscles contract in concert with the transversus abdominis, which aides in our core stability. It acts like a piston in an engine that we can use to our advantage. This is why you may have heard to use an exhale to lift something heavy or to stabilize before swinging a bat or golf club. 

When Problems Arise

Issues with this pistoning action can occur when:
-there is a weakness in the core, the back or the pelvic floor
-we are statically holding or “bracing” the abdominal muscles
-we are holding our breath during challenging movements

Physical Therapists are Experts in Restoring Movement and Function

One of the most effective strategies physical therapists use to facilitate recovery in athletes is sports-specific training, meaning strengthening the core muscles during the specific dynamic tasks to restore optimal function. In our clinic, we offer a multifaceted approach and often use Pilates apparatus, RedCord and the Neurac Method to determine and strengthen any weaknesses in the kinetic chain that may be leading to the issues with performance. Your recovery team may include many professionals, including an orthopedic or sports physical therapist, a pelvic health physical therapist, and/ or a massage therapist.

When to Seek Help

At any point, you should consult with your PT and explore a pelvic health evaluation if you experience:

• Persistent hip, back, or pelvic pain

• Pain with movement

• Heaviness feeling in the pelvis or increased vaginal or rectal pressure

• Unexplained discomfort, chronic injury or pain in one or both legs, abdomen or back

• Increased urgency to go to the bathroom (bowel movements or voiding bladder)

• Persistent leakage during activities like running, jumping, coughing, sneezing

Sources:

-Poświata A, Socha T, Opara J. Prevalence of stress urinary incontinence in elite female endurance athletes. J Hum Kinet. 2014;44:91-96. Published 2014 Dec 30. doi:10.2478/hukin-2014-0114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327384/ 

-Logan BL, Foster-Johnson L, Zotos E. Urinary incontinence among adolescent female athletes. J Pediatr Urol. 2018;14(3):241.e1-241.e9. doi:10.1016/j.jpurol.2017.12.018. https://www.jpurol.com/article/S1477-5131(18)30077-9/fulltext#articleInformation