Contents

1 The Hidden Powerhouse: Why Does the Pelvic Floor Matter for Athletes?

2 Anatomy of Strength: Mapping the Core and Pelvic Connection

3 Breaking the Silence: Common Pelvic Issues in Sports

4 The Core Secret Weapon: Breathing, Bracing, and Balance

5 Pelvic Floor and Peak Endurance: Going the Distance Without Breaking Down

6 From Leaking to Lifting: Solving Incontinence in Athletes

7 The Power You’re Sitting On: Creating Explosiveness

8 Strain, Pain, and Gain: Recognizing Overload

9 Pelvic Rehab: The Comeback

10 Mobility Matters: How to “Stretch” for Pelvic Health

11 Training Smarter: Pelvic Floor Exercises that Actually Translate to Performance

12 Align to Shine: The Big Toe, Posture, and The Pelvic Floor

13 The Mental Game: Stress, Anxiety, and Pelvic Tension in Athletes

14 Fueling the Foundation: Nutrition and Hormones for Pelvic Health

15 Game Ready: Integration and Implementation

Introduction

While the topic of pelvic health and the research to support it is rapidly evolving, the current awareness (or lack thereof) is limited in scope and reactive in nature. Too often—and in many cases unknowingly—pelvic floor dysfunction in athletes is dismissed as an inevitable byproduct of high-level training or reduced to isolated symptoms as opposed to being understood as a dynamic system that directly influences performance, recovery, and long-term well-being. Traditional assessment pathways tend to overlook the unique biomechanical demands placed on athletic bodies and the associated nuance the pelvic structures respond to load, stress, and adaptation. Athletes train tirelessly to optimize their strength, speed, endurance, and skill. They fine-tune nutrition, optimize recovery, and push limits. Yet, this system remains chronically overlooked despite its central role in both the body and in sport.

A responsive and adaptive pelvic floor is not optional for athletes. It is a critical part of the kinetic chain that determines not only how efficiently force moves through the body, but also how the body is protected against injury. For too long, pelvic health has been relegated to postpartum women or clinical settings when it is inherently fundamental to sport well before the point of symptoms. The goal of this book is to change the narrative. It’s time to call the pelvic floor muscles off the sidelines and into the starting lineup of training and performance. We’ll explore how the pelvic floor functions in movement, breath, and sport. We’ll discuss the reality of pelvic health challenges that athletes contend with and the research that illuminates their lived experiences. We’ll review solutions—from training strategies and rehabilitation to prevention, performance optimization, and a shift in mindset from bounce back to come back.

I’d like to pull up to add a quick note regarding the fact that this book is written for athletes. If your immediate reaction is “I’m not an athlete,” or “I work full-time,” or “I don’t look like an athlete,” or “I don’t lift heavy enough or run fast enough for this to apply to me,” I want you to reconsider. Dr. Stacy Sims identifies anyone who is “exercising on purpose” as an athlete. So I’m thinking it’s safe to say, You are, in fact, an athlete. While I have worked with a fair number of professional and college athletes in my career, I remain equally as impressed by the recreational athletes who work hard to stay active despite the demands of life when sport is not their career. Once I have convinced my clients that they are athletes, it allows them to be more intentional, more understanding, and more focused on the work we do together, which makes my job easy. I often joke that I boss people around for a living as the reality is I cannot do the work for you. The approach I will share with you depends on your understanding, compliance, and discipline. It’s up to me and/or the providers on your team to explain the how and why in a way that prompts you to want better for both your present and future selves. When you consider yourself an athlete, you will be more successful at implementing the approach.

If you are reading this book either for your own development or to triage a problem, understand that as with anything, finding a provider who shares your goals and can help you progress is critical. Nothing in this book is medical advice – it is educational material to help you better understand your body and the way it reaches for the goals you put in front of it. You lead the draft of your healthcare team. While the pelvic health realm is vastly underserved, I hope this book gives you a foundational knowledge to address the stigma, better understand your experience, and challenge the narrative that we must accept the aches and pains of an athletic lifestyle. I worked hard to write this book in a way that made sense both to the athlete and to the coaching or treating professional, but if you come across a concept that doesn’t click for you or terminology that feels confusing, please don’t hesitate to reach out to someone you trust—and that can include me. Every athlete—regardless of level, age, gender, or sport of choice—deserves providers and coaches who understand this muscle group.

For any professionals who might be along for the ride, coaches or fellow practitioners, you wouldn’t be here if you didn’t want better for your athletes and clients. I hope that you will have the power to empower and equip the population you work with by the end of this book. Elite athletes will have different training demands and volumes that can and should be taken into consideration with the techniques presented in this book, just as you would do with programming for any other muscle group. My goal here is not to relay strength and conditioning or rehab principles, but instead to teach you about the role of these muscles in a way that allows you to implement the principles you already know and use for the rest of the body.

Finally, I want to acknowledge and appreciate the fact that you care enough about yourself or the clients you’re working with to read this book. That’s an incredible indicator of how much you honor the work you do and the level at which you expect yourself to perform. Pelvic health is an easy topic to brush off and assume that the responsibility belongs elsewhere or that it isn’t actually affecting you. It’s easier to ignore or delay work for muscles you can’t see. It’s less daunting to assume you’ve reached your peak than to question if there are bigger goals just waiting to be pursued. You’re choosing to pull this topic into the light, challenge the status quo, and do better, both for our own health and performance and for that of generations to come. Thank you for being here. Let’s floor it!