Updated: Jun 16, 2018
Let's Evaluate Our Work with our Female Clients and Athletes
When I first started personal training in 2005, I was one of the few women on the gym's training staff. I was frequently the only woman in the weight room. Fast forward 13 years and it still sometimes takes my breath away to see just how many women are now confidently taking up their rightful space among the barbells, dumbbells, and kettlebells. As many leaps and bounds as the fitness industry has made to be truly inclusive of women, we still have some work to do. This is an invitation to roll up our sleeves and dig a little deeper into how we can fully service women in fitness.
There are many issues that we could discuss that tend to impact more female athletes than their male counterparts. Eating disorders, hypermobility, hormonal fluctuations (to name just a few) are more likely to be concerns with your female athletes (this is not to say that these issues don't affect men!). Throughout this blog, however, I'd like to focus on the deep core system, especially the pelvic floor.
As we intuitively know as instructors, trainers, and coaches: it's not just what you do, but how you do it. The strategy (breath, positioning, tension) we use influences not only the success of our lifts, but the impact on our bodies. Traditionally-taught strategies in hardstyle kettlebell practices (and throughout strength and conditioning) may not always be enough, or appropriate, to keep female bodies performing their best. In fact, some of those strategies may encourage scenarios for symptoms of concerns like pelvic floor dysfunction to be introduced, or persist.
Before we discuss strategy, I want to first make sure we're on the same page about what these considerations are, and how (at least some of) your training population is likely experiencing, or has experienced, them.
There are four key considerations that I would like to address, and of which, I believe, every strength coach, male or female, should have an awareness.
These considerations include:
Anatomical differences between female and male strength participants, particularly regarding the pelvis
Postpartum (which is a lifelong consideration, not simply 6 weeks!)
If we do not understand the specifics of these considerations, it is possible that the work we do with our clients and athletes could have consequences that significantly impact their quality of life.
Before discussing the differences between male and female bodies, let's briefly define the "core canister".
Our "core" is our deep central stability system which sets the stage for movement throughout the body. Anyone who has participated in fitness for more than, say, 3 seconds has heard of the importance of the "core". Frequently, the core is discussed as being an ab-only system that needs planks to thrive. Instead, it is helpful to recognize the dynamic and interactive nature of our deep core system. To fully appreciate it, we need to recognize that it's not simply our abdominal musculature that provides structural support, but the "communication" between our diaphragm (towards the top), pelvic floor (the bottom), transversus abdominis (the sides/front), multifidi (spinal stabilizers) and even our glottis (the top) (which allows for, or prevents air, from entering/exiting).
The entire system works as a team to provide centralized stabilization to our bodies. If any one part of the system is not working well, it can be difficulty for the rest of the "team" to work as well.
Our core has a postural role, as well as playing a role in respiration. On inhale, the diaphragm descends to allow for the lungs to fill with air, which pushes the abdominal contents down and out slightly, as the pelvic floor and abdominal muscular yields to the increase in pressure. On exhale, the pelvic floor recoils, the abdominal wall gently compresses in and the diaphragm ascends. The process of breathing manages pressure and is influenced by conscious muscular recruitment (meaning, if we are thinking about firmly bracing our abs, it's going to be more challenging for the abdomen/pelvic floor to yield).
Our core system manages pressure (intra-thoracic/abdominal/pelvic) which provides support to our trunk. In order to regulate pressure effectively, we have to think about managing it from the top, sides, and bottom. An excessive degree of pressure beyond what the players in the core system can manage can result in concerns like hernias and pelvic organ prolapse. Too little pressure does not allow for us to complete lifts effectively and safely.
Those of us who have been coaching strength understand the importance of pressure, but, in my experience, the emphasis has typically been on creating a maximum effort of pressure to keep our spines "safe" while we execute challenging feats of strength. We absolutely need pressure, yes, but the long-time focus on generating significant degrees of intra-abdominal pressure without also discussing what else is happening is a missed opportunity that could have detrimental impact on our health and our lifts.
When we cue women (or anyone, really) to have a very strong abdominal brace, we may be cueing an overwhelm of the deep core system. If I'm locking down my abs and holding my breath, for instance, that pressure has to go somewhere. Many women and many coaches are unsure of how to ensure that we aren't just bearing down on the pelvic floor at this point. We're unsure because we aren't talking about it and we haven't known what to look for, or even that it's a problem. The unfortunate reality, though, is that many female strength participants experience leaking, pain, pressure, bulging, and other symptoms that clue us in to the fact that their deep core system is not operating at its best.
Structural Considerations Make Women More Likely Than Men to Experience Symptoms Related to Pressure Mismanagement
To demonstrate why, I'm going to have to make mention of something we typically don't talk about in the weight room (but should!): the VAGINA! Caps lock was intentional there; go ahead and picture me with a megaphone yelling "vagina" in a room full of dudes getting ready for a season of football.
Anyway, yes, we need to talk about vaginas. Here's the thing with the female pelvis: there's this extra hole (we call her the vagina) that allows for pressure to have an extra "out". The vagina's lack of a true sphincter adds to the potential that things can begin to head south here. The pelvic floor and the pelvic organs provide support to maintain continence, manage pressure, and keep our organs inside our body, but this system does not always fire on all cylinders (get it?! core canister?! cylinder?! never mind....)
Women Experience Pelvic Floor Dysfunction at Significantly Higher Rates than Men
Nulliparous women experience stress incontinence four times more often than men, and women experiencing one or more pregnancies, more than fourteen times more often (MacLennan, Taylor, Wilson, Wilson, 2000).