Pelvic Health and Sport: The Missing Link in Performance

Pelvic Health and Sport: The Missing Link in Performance

Pelvic health is having its moment in the sun—and not just in the postnatal or clinical rehab space. More athletes are beginning to realise that performance, power, and injury resilience are deeply connected to a part of the body that’s often overlooked: the pelvic floor.

Pelvic Health: Not Just a “Women’s Issue”

Pelvic health isn’t exclusive to pregnancy or postpartum recovery. The pelvic floor—a group of muscles forming the base of the pelvis—plays a crucial role in both male and female athletes. These muscles support the bladder and bowel, contribute to core stability, and help manage intra-abdominal pressure during movement.

And the stats? They’re hard to ignore.

• Around 33% of elite athletes report urinary incontinence, with significantly higher rates in females (45%) compared to males (14.7%)
• In high-impact sports, ~25.9% of female athletes experience urinary incontinence
• Some sports show extreme prevalence—up to 75.6% in volleyball athletes

This isn’t rare. It’s common—and often underreported.

The Athletic Pelvic Floor

Whether you’re sprinting, lifting, jumping, or changing direction, your pelvic floor is working in sync with your diaphragm, deep abdominals, and back muscles. This system is often referred to as the “canister”—a pressure-regulating unit that stabilises the spine and pelvis under load.

Recent research in elite youth athletes found:

• 43.7% reported pelvic floor dysfunction symptoms
• Only <30% were aware of pelvic health, and
• 88% had never been screened

Even more striking?

• 78% of athletes didn’t disclose symptoms, and
• 95% never sought help

So while symptoms are common, they’re also largely hidden.

What Does This Mean for Sport?

If the pelvic floor isn’t functioning well, athletes may experience:

• Urinary leakage during exercise (especially with running, jumping, lifting)
• Pelvic heaviness or pressure
• Reduced core efficiency and power output
• Increased risk of injuries (e.g. hip, groin, or lower back)

In fact, symptoms like leakage during training have been reported in 22.7% of athletes, most commonly during jumping (40.5%) and running (19.6%)

This highlights how closely pelvic health is tied to the demands of sport.

Performance Starts at the Pelvic Floor

From a physiotherapy perspective, optimal pelvic floor function isn’t just about preventing symptoms—it’s about enhancing performance.

A well-coordinated pelvic floor can:

• Improve force transfer between the upper and lower body
• Enhance trunk stability under load
• Support efficient breathing patterns
• Reduce compensatory strategies that lead to overload elsewhere

On the flip side, dysfunction—whether weakness, overactivity, or poor coordination—can disrupt movement patterns and limit performance potential.

It’s Not All About Kegels

One of the biggest misconceptions is that pelvic health = endless Kegels.

In reality, pelvic floor training should be:

• Individualised (not everyone needs strengthening—some need relaxation and down-training)
• Functional (integrated into real movement patterns, not just isolated contractions)
• Coordinated with breath (the diaphragm and pelvic floor work as a team)

For athletes, this might look like:

• Exhaling with effort during lifts
• Learning to manage pressure during high-impact tasks
• Integrating pelvic floor awareness into strength and conditioning

Red Flags That Shouldn’t Be Ignored

Symptoms like leaking, pain, or heaviness during or after exercise are not just “part of being an athlete.”

They’re common—but not normal.

And importantly, they’re treatable.

The Takeaway

Pelvic health is performance health.

With up to 1 in 3 athletes experiencing symptoms and many never seeking help, there’s a clear gap in education, screening, and support.

As physiotherapists, we have an opportunity to shift the narrative—from reactive treatment to proactive optimisation. By integrating pelvic health into sports physio, we can help athletes move better, feel stronger, and perform at their full potential.

Because strength doesn’t just come from the big muscles you can see—it starts from the foundation you can’t.