Can CrossFit Increase Your Risk of Pelvic Floor Problems?

Have you heard of CrossFit? 

Maybe you know someone who’s tried it?

CrossFit is a brand of fitness that’s experienced phenomenal growth in recent years with increasing numbers of women joining in.

Despite CrossFit’s growing popularity there’s very little information available on CrossFit and pelvic floor safe exercise.

Read on now to learn:

• What is Crossfit?
• Who’s doing CrossFit?
• CrossFit & pelvic floor injury
• CrossFit exercises & the female pelvic floor
• Who’s at increased risk of pelvic floor dysfunction

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What Is CrossFit?

CrossFit is a form of functional fitness developed in the 1990’s.

CrossFit involves high intensity strength and conditioning exercises and in the early days participants were mostly police, tactical operations teams and retired military personnel.

These days Crossfit’s big business with over 10,000 affiliate centres world wide, international CrossFit games, CrossFit training seminars and trainer certifications and even a CrossFit journal.

Who’s Doing CrossFit?

CrossFit participant demographics are not readily found.

According to one online source – Rally Fitness in California, there is currently a 1:1 male to female ratio of CrossFit participants.¹

Increasing numbers of women have reportedly joined the Cross Fit community in recent years, especially with its broad and inclusive model of fitness.

CrossFit advocates some valuable principles;

• Gender equality
• Strong active women
• Inclusive community-minded fitness.

What caught my attention on the CrossFit.com website is the claim that CrossFit is universally suited to everyone;

“CrossFit is the perfect application for any committed individual, regardless of experience. We’ve used the same routines for elderly individuals and cage fighters…

We scale load and intensity; we don’t change programs”²

How is it possible for one form of fitness to claim to be universally appropriate by changing the load or intensity of the exercise?

Does this mean that all the CrossFit exercises are pelvic floor friendly for everyone or can they be modified pelvic floor safe by scaling the load and intensity?

Let’s take a closer look…

CrossFit & Pelvic Floor Injury

A general online search using keywords “CrossFit” “Safety” and “Injuries” revealed that CrossFit has come under fire from some for a range of potential safety issues.

Some criticism has been leveled at CrossFit’s no pain no gain culture, prioritizing achieving personal records over maintaining good form during heavy lifting exercises and the risk of overuse injuries.

There is minimal information currently available on CrossFit and pelvic floor safe exercise.

One You Tube video “CrossFit – Do You Pee During Workouts” features interviews with female CrossFitters discussing their bladder leakage problems during CrossFit workouts.

Bladder leakage during CrossFit workouts suggests pelvic floor overload with some of the exercises i.e. the internal load generated by the exercise is greater than what the pelvic floor can withstand causing incontinence.

CrossFit Exercises & The Female Pelvic Floor

Some exercises in women’s only gyms and women’s exercises classes including Yoga and Pilates need to be avoided or modified by some women who are at increased risk of pelvic floor injury.

Is CrossFit any different?

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The female pelvic floor is designed for childbearing making it vulnerable to pelvic organ prolapse when compared with the male pelvic floor (i.e. three pelvic openings compared with two).

The anatomical differences give the male pelvic floor a greater capacity to withstand greater forces and loading than the female pelvic floor – especially when compared with women after childbirth or menopause. Despite this we see images of female CrossFit particiapnts exercising alongside men, doing the same high intensity exercises.

Unfortunately avoiding pelvic floor overload with exercise isn’t as simple reducing load or intensity; specific exercises and exercise techniques are known to increase the load the pelvic floor e.g. deep squats reaching to ground level, breath holding and straining.

Let’s take a look at some of the commonly performed CrossFit foundation exercises remembering that CrossFit exercises are only scaled (i.e. modified) on load and intensity.

CrossFit Foundation Exercises & The Pelvic Floor

1. Metabolic Conditioning Exercises 

The metabolic conditioning exercises include high impact exercises. Studies have shown female athletes involved in high impact exercises have a high prevalence of bladder incontinence.³

Rowing and bike are both low impact exercise however both these forms of exercise need to be appropriate intensity along with some technique modifications to minimize the risk of pelvic floor overload in those individuals at risk of pelvic floor dysfunction.

CrossFit.com FAQ recommends these exercise substitutions for running: “box jumps (shown above), cross-country skiing, heavy bag work, kettlebell or dumbbell swings, weighted stair-climbing or box-stepping”. All these substitution exercises are either high impact or heavily loaded exercises and therefore inappropriate alternatives to running for women with increased risk of pelvic floor dysfunction.

2. Weight Lifting Exercises

Weight lifting is a risk factor in the development of pelvic organ prolapse.⁴

Weight lifting increases pressure within the abdomen that is transferred directly to the pelvic floor. It’s reasonably to foresee that if the pelvic floor is weak or not functioning well, some weightlifting exercises and techniques will generate sufficient pressure within the abdomen to overload the pelvic floor contributing to pelvic organ prolapse.

Women with or at risk of pelvic floor dysfunction are wise to avoid Olympic lifts (i.e. clean, press, snatch) using heavy weights where the weight is lifted from ground level. Lifting weight from ground level in a deep squat position increases pelvic floor loading and hence the risk of pelvic floor stretch, weakening and/or overload. Kettlebell swings pose a similar risk to the dysfunctional pelvic floor.

3. Gymnastics Exercises

The gymnastics exercises include a number of  body weight exercises (i.e. muscle ups, pull ups, dips and men’s push ups). These body weight exercises involve supporting some or all of the body weight through the upper limbs. Lifting the weight of the body through the upper limbs increases the load on the pelvic floor.

Intense core abdominal exercises increase the load on the pelvic floor. It has been shown that when women with pelvic floor problems perform abdominal curls or sit-ups their bladders move downwards.⁵

Box jumps are high impact landing exercises. The pelvic floor needs to be strong and functioning well to counteract the considerable landing forces on the pelvic floor associated with vertical jumping.

Who’s At Increased Risk of Pelvic Floor Dysfunction?

Not everyone!

In fact it may well be that some young women with good pelvic floor function may benefit from exercises that load their pelvic floor.

One hypothesis is that the pelvic floor muscles of these young women may strengthen to cope with repeated pelvic floor loading. Despite this theory there is also likely to be an individual pelvic floor fatigue threshold which would be very difficult to determine in advance i.e. how much pressure the pelvic floor can potentially withstand.

Women at increased risk of pelvic floor dysfunction with inappropriate exercises include:

• Mature age
• Previous pregnancy and childbirth
• Associated health problem e.g. chronic cough, chronic lower back pain, overweight, chronic constipation and straining, pelvic radiotherapy
• Pelvic floor dysfunction; pelvic prolapse, incontinence, pelvic pain, pelvic floor muscle tension
• Pelvic surgery e.g. pelvic prolapse surgery, hysterectomy, continence surgery
• Associated lifestyle factors e.g. regular heavy lifting, strenuous physical activity

Men at increased risk of pelvic floor dysfunction with inappropriate exercises include those with:

• Associated health problems e.g. pelvic radiation therapy
• Pelvic surgery e.g. prostate surgery
• Pelvic floor dysfunction e.g. pelvic floor spasm, pelvic pain, rectal prolapse

CrossFit & Pelvic Floor Summary

Some young women may have the pelvic floor function that allows their body to withstand the high intensity strength and conditioning CrossFit exercises.

Unfortunately many of the foundation exercises cannot be modified to reduce pelvic floor loading by adjusting the load or intensity. The heavy lifting and strenuous exercises characteristic of CrossFit may promote pelvic floor dysfunction in individuals who are already at risk.

References

1. http://rallyfitness.com/blogs/news/16063884-latest-crossfit-market-research-data

2. Cross Fit Training Guide, p 22 http://www.crossfit.com/cf-seminars/CertRefs/CF_Manual_v4.pdf

3. Eliasson K, Larsson T, Mattson E. (2002) Prevalence of stress incontinence in nulliparous elite trampolinists. Scandinavian Journal of Medicine and Science in Sports 12:106-110.

5. Thompson J, O’Sullivan P, Briffa K and Court S (2005) Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. International Urogynaecology Journal 16:285-292.