Can you lift with pelvic organ prolapse (POP)?
This is one of the most common questions I get from clients who would love to keep lifting or return to lifting after being diagnosed with POP (pelvic organ prolapse).
The fear is high and the scientific research is disappointing low ☹.
A study in 2019 by Lori B Forner, https://pubmed.ncbi.nlm.nih.gov/31813038/ (QLD based researcher for Pelvic floor dysfunctions) with 3934 women who exercise showed some interesting results.
- the participants fell into four different groups:
1. Those who lift light: <15kg in exercise
2. Those who lift moderate: 16-50kg in exercise
3. Those who lift heavy: >50kg in exercise
4. Those who do not lift weight in exercise.
The RESULTS:
The total prevalence of POP symptoms was 14.4% (566 of the participants). Interestingly was that the group of light lifters (lifting weights ≤15 kg) were more likely to report symptoms of pelvic organ prolapse than women lifting weights greater than 50 kg (59.7% vs. 15.2%).
Although a survey was used to check POP symptoms and no internal assessment was performed in the study. This result might help break the myth that lifting heavy with prolapse can’t be done.
Over the past 16 years, I have worked with a significant number of female athletes with POP and set out a structured plan and helped them return to the barbell without recurring symptoms of POP. As pelvic health physio and S&C coach, this has become one of my big focus points.
It is an “injury” in our body as any other - if we hurt our shoulder, we would have to revise our training and set a strategic plan to rehab and be pain free before thinking about our heavy bench press again. Why would POP or other pelvic floor dysfunctions (incontinence when lifting) differ?
How do we get back to high-impact resistance exercises and the barbell?
In short, with discipline, patience and a structured plan 😊.
Start by seeing a specialised pelvic health / women’s health physiotherapist to help you with the correct coordination of the pelvic floor and deep core muscles. Yes, I said coordination, we need to learn how to contract and relax these muscles for optimal use in daily activities and exercise. An overactive pelvic floor is very common and can also cause pelvic dysfunctions!
They also will assess and discuss the use of pessary if this is an option.
Second, I put a big (let’s say HUGE) emphasis on breathing and control of intraabdominal pressure when tackling pelvic floor dysfunctions. Downwards pressure is one of the main reasons POP has occurred and therefore will trigger POP symptoms or incontinence until the correct techniques are implemented.
Third, I implement functional training of the pelvic floor and strength training focused on imbalances that cause unnecessary work for and pressure on the pelvic floor. You guessed it, hello dumbbells! In this stage we start with specific strength training.
Important is to teach my clients how to integrate the pelvic floor in all movement patterns -push/pull/hinge/squat. You can’t expect these muscles to take on the force in these specific movement patterns if you have not trained them that way! Setting a solid functional foundation is the key to progress and starting to lift heavier!
Fourth, start progressing load over time and ensure that your pelvic floor strength progresses linear with this. Slowly integrating bracing techniques where the upwards support of the pelvic floor balances the reduced downwards pressure from bracing; providing enough support to the pelvic organs in your lift. It’s like math 😊.
Many clients have had success with this approach if they are dedicated and humble enough to drop the weight for a little while and master every step of the process.
Get in touch with your pelvic health physio and feel strong and confident in your lifts!
Keep an eye out for another excellent research done by Lori B Forner in 2020 - comparing pelvic floor symptoms in runners vs Cross Fitters and starting another research on POP soon (if you are in QLD – she is looking for some subjects for her research).