Whether you’re training for your first 5K, competing in CrossFit, playing Division I sports, lifting heavy in the gym, or chasing your kids around the backyard, your body relies on one often-overlooked group of muscles: your pelvic floor.
Most athletes don’t think about their pelvic floor until something goes wrong.
Maybe you leak urine when you run or jump. Maybe you have persistent hip or low back pain that won’t go away. Maybe you feel pressure or heaviness during workouts. Or perhaps your core never feels quite as strong as it should, despite countless planks and ab exercises.
The good news? Pelvic floor physical therapy isn’t just for treating symptoms it can also help athletes move more efficiently, generate more power, recover better, and reduce injury risk.
Let’s take a closer look.
What Is the Pelvic Floor?
The pelvic floor is a group of muscles that forms the bottom of your core. These muscles support your bladder, bowel, and reproductive organs while working closely with your:
- Diaphragm
- Deep abdominal muscles (transverse abdominis)
- Multifidus muscles in your spine
- Gluteal muscles
- Hip muscles
Together, these muscles create a pressure system that stabilizes your trunk during movement.
Every squat, sprint, jump, throw, swing, or lift depends on this system working together.
Why Athletes Should Care About Their Pelvic Floor
Many people assume pelvic floor therapy is only for pregnancy or older adults. In reality, pelvic floor dysfunction is surprisingly common in athletic populations.Research has found increased rates of pelvic floor problems among:
- Runners
- Gymnasts
- CrossFit athletes
- Olympic weightlifters
- Volleyball players
- Basketball players
- Soccer players
- Dancers
- Tennis players
- Triathletes
These sports involve repeated impact, rapid changes in direction, heavy lifting, or large increases in abdominal pressure all of which place demands on the pelvic floor.
That doesn’t mean sports are harmful.
It simply means these muscles deserve the same attention as your hips, shoulders, knees, or core.
The Pelvic Floor Is Part of Your Core
Many athletes spend hours strengthening their core. But if you’re ignoring your pelvic floor, you’re only training part of the system. Your pelvic floor works with your diaphragm every time you breathe.
As you inhale:
- Your diaphragm moves downward.
- Your pelvic floor naturally lengthens.
As you exhale:
- Your diaphragm rises.
- Your pelvic floor gently recoils and contracts.
This coordination helps create stability while allowing your body to efficiently transfer force between your upper and lower body.
When this timing is disrupted, you may notice:
- Reduced power
- Poor balance
- Decreased endurance
- Compensatory movement patterns
- Increased strain on the hips or low back
Can Pelvic Floor Therapy Improve Athletic Performance?
Pelvic floor therapy isn’t a shortcut to running faster or lifting heavier overnight.
Instead, it helps optimize the systems that allow athletic performance to happen.
When the pelvic floor functions well, athletes often notice improvements in:
Better Core Stability
The pelvic floor contributes to spinal stability during dynamic movement.
When these muscles coordinate properly with the deep abdominal muscles and diaphragm, athletes often feel stronger and more connected during lifts and explosive movements.
Improved Force Transfer
Power doesn’t come from one muscle.
It comes from efficient coordination throughout the body.
Whether you’re swinging a golf club, serving a tennis ball, throwing a baseball, or sprinting down a field, force must transfer through your trunk efficiently.
A well-functioning pelvic floor helps provide that stable foundation.
Better Breathing Mechanics
Many athletes unknowingly hold their breath during exercise or breathe inefficiently.
Pelvic floor physical therapy often includes breathing retraining to improve:
- Endurance
- Core control
- Recovery between efforts
- Pressure management
Better breathing frequently translates into more efficient movement.
Improved Movement Efficiency
Sometimes an athlete doesn’t need to get stronger.
They need to move better.
When muscles coordinate efficiently:
- Less energy is wasted.
- Movement becomes smoother.
- Fatigue often decreases.
- Performance can improve without increasing training volume.
Pelvic Floor Problems Can Limit Performance
A pelvic floor that’s either too weak or too tense can interfere with athletic performance.
Common symptoms include:
Urinary leakage
Many athletes assume leaking during exercise is normal.
It isn’t.
Leaking during:
- Running
- Jumping
- Box jumps
- Double unders
- Trampoline exercise
- Heavy lifting
is common—but it should never be considered an expected part of exercise.
Pelvic Pressure or Heaviness
Some athletes notice pressure during:
- Running
- Squats
- Deadlifts
- Hiking
- Long competitions
This may indicate pelvic organ prolapse or poor pressure management.
Ignoring these symptoms often causes athletes to reduce activity unnecessarily.
Hip or Low Back Pain
The pelvic floor works closely with surrounding muscles.
When it isn’t functioning well, nearby muscles often compensate.
This can contribute to:
- Hip pain
- SI joint pain
- Low back pain
- Groin pain
Pain During Exercise
Some athletes experience:
- Some athletes experience:
- Pelvic pain
- Tailbone pain
- Pain with cycling
- Pain during running
- Pain with sitting after workouts
These symptoms are often related to pelvic floor muscle overactivity rather than weakness.
Strong Doesn’t Always Mean Better
One of the biggest myths in pelvic health is that everyone needs more Kegels.
For many athletes, that’s simply not true.
Highly trained athletes often develop pelvic floor muscles that are already very strong—but also overly tense.
An overactive pelvic floor may actually reduce performance by limiting:
- Muscle coordination
- Breathing mechanics
- Force absorption
- Mobility
- Recovery
Sometimes the goal is strengthening.
Other times it’s relaxation.
Most often, it’s learning how to contract and fully relax the pelvic floor at the right times.
What Happens During Pelvic Floor Physical Therapy?
A pelvic floor physical therapist looks far beyond the pelvic floor itself.
Your evaluation may include:
- Breathing assessment
- Core muscle coordination
- Hip strength and mobility
- Running mechanics
- Squat and lifting technique
- Balance testing
- Movement analysis
- Pressure management during exercise
When appropriate, your therapist may also perform an internal pelvic floor assessment to evaluate muscle strength, coordination, endurance, and tension. This examination is always optional and only performed with your informed consent.
Treatment is individualized and may include:
- Exercise progression
- Core retraining
- Breathing techniques
- Manual therapy
- Soft tissue mobilization
- Mobility work
- Return-to-sport progression
- Education on lifting mechanics
- Sport-specific movement training
Pelvic Floor Therapy After Pregnancy
Many athletes return to exercise after having a baby without ever having their pelvic floor evaluated.
Even if you feel “fine,” pregnancy and childbirth can affect:
- Core coordination
- Pressure management
- Running mechanics
- Jumping ability
- Strength production
Pelvic floor physical therapy can help athletes safely return to:
- Running
- CrossFit
- Weightlifting
- Cycling
- Pickleball
- Tennis
- Soccer
- Recreational sports
with greater confidence and reduced risk of injury.
You Don’t Have to Have Symptoms
One of the biggest misconceptions is that pelvic floor therapy is only for people with pain or leakage.
Many athletes seek pelvic floor physical therapy proactively to:
- Optimize performance
- Improve lifting mechanics
- Enhance core control
- Reduce injury risk
- Improve recovery
- Return safely after surgery or childbirth
- Address movement limitations before they become injuries
Think of it like working with a strength coach—you don’t wait until you’re injured to improve how your body performs.
When Should an Athlete See a Pelvic Floor Physical Therapist?
You may benefit from an evaluation if you experience:
- Urine leakage during exercise
- Pelvic pressure or heaviness
- Hip, low back, or SI joint pain
- Tailbone pain
- Pain with running or cycling
- Core weakness that doesn’t improve
- Difficulty generating power
- Persistent abdominal separation after pregnancy
- Pain during sex
- Recovery after pelvic or abdominal surgery
- A desire to optimize athletic performance
Pelvic Floor Therapy in St. Louis
At Legacy Physical Therapy, we work with athletes of all ages and activity levels—from recreational exercisers to competitive athletes—who want to move better, feel stronger, and perform at their best.
Our one-on-one evaluations look at the entire movement system, not just the pelvic floor. By addressing breathing mechanics, core coordination, mobility, strength, and sport-specific movement patterns, we help athletes overcome pain, improve performance, and return to the activities they love with confidence.
Whether you’re dealing with urinary leakage during workouts, pelvic pain, lingering postpartum changes, or simply want to maximize your performance, our team can create a personalized treatment plan designed around your goals.
Ready to Perform at Your Best?
If you’ve been told that leaking during exercise is “normal,” or you feel like something is limiting your performance despite training hard, it may be time to look deeper.
Schedule a FREE phone call with a PT at Legacy Physical Therapy in St. Louis to discover how pelvic floor physical therapy can help you build a stronger foundation for every workout, competition, and everyday activity.
