We're delighted to have Antony Lo aka The Physio Detective writing for us about this hot topic in the CrossFit world. This one's for those of you pre-pregnancy, or if you're later down the track postpartum, once you've done your postpartum rehab.
You’ve been watching how much fluid you have been having. You went to the toilet before the WOD started. You came to the box prepared - dark leggings with a nice pattern. You have a change of clothes for afterwards, just in case. You might have put a tampon in even if you aren’t on your period (it is NOT recommended)! Or you might be wearing a liner or pad. You haven’t had any water during the strength portion because you knew double unders was in the metcon. You’ve been keeping an eye on the toilets and noticing there can be a line up so if you need to go, maybe now is the time. Should you go to the toilet again just in case? I’ll bet you probably did (no judgement). Sound familiar? That’s because it is really common.
Some studies have put the prevalence of incontinence at ~50%. Of female athletes who haven’t had children, that can be as high as 80%. Yet despite these figures, 60% think that it is taboo to talk about it and 30% reported it as being more embarrassing than depression or cancer.
Of the nearly 700 people who have filled out a survey I put together, around 70% of people who leaked did so on double unders. Around 50% reported box jumps were a problem and next was running coming in around 33%.
OK, we’ve established that it is a problem, it is real and others are dealing with it. You might have mentioned it to your coach but they might have shrugged or say “that’s women’s business” or even having coaches dismiss it saying “everyone leaks a bit - how else do you know if you have gone hard enough?”
Stress Urinary Incontinence (SUI) is the type of leaking we are talking about here. There are other types but this is the most common.
OK - SUI happens because the pressure you develop in the abdominal cavity exceeds the mid-urethral closing pressure - basically the pressure in your tummy (which pushes on your bladder) is too much for the ability of your sphincter to resist against and it lets some urine through. The amount could be a few drops or it could be your whole, full bladder. We develop this pressure, called intra-abdominal pressure (IAP), by simply being upright. When we move or breathe or use our muscles, we increase the IAP. Add weights or bouncing around and there is an increase in IAP, sometimes enough to overcome your ability to control your bladder.
Right off the bat, let me say that an assessment with a pelvic floor physical therapist / physiotherapist who understands CrossFit is the best. This may require an internal assessment. If that doesn’t sound appealing to you, then I do in-person and remote consults where you don’t have to undress and definitely no internal examination! There are many reasons why you might have SUI that is beyond the scope of this article so if you want more information, please feel free to reach out on social media or email and I can point you towards good local resources near you.
The exercise itself requires you to become stiff - we teach a hollow hold and that you should bounce on your toes only - and this works the best for double unders but it might not be the best for you.
Having inefficient technique like in this video can lead to increased IAP and leaking.
Learning the technique I teach in this video can help stop leaking. Using #tensiontotask is important because if you brace hard and struggle, you will really increase the IAP - get stronger slowly and keep working the high, slow singles.
Another strategy you can use to help stop leaking is to practice singles or doubles until the point you are about to leak. Then stop and rest and time the amount of rest you take. Then do a second set and stop just before you leak. Time your rest again and do this for 3-5 sets in total. If you track this practice, and basically everything else is ok, then you will see that you will improve - you have to work the whole system together as a team and wait for the weakest member (usually the pelvic floor) to catch up to the other awesome muscles you have.
Specific pelvic floor muscle training may be helpful and research suggests that it does help in general but learning how to coordinate everything is easier said than done. If we continue the team theme, then it is better to have a champion team than a team of champions - it is better that you coordinate what you have well than to have everything really strong but not able to work efficiently together.
Accessory training can also help - I like using running, plyometrics, lateral hops, box jumps, power cleans and snatches as well as jerks and basically any exercises that requires impact.
Using the same strategies listed above, you can continue to develop the coordination of your team members (the muscles of your body) and by keeping the training just under the threshold for leaking, you are stressing the system to adapt.
Be patient and hang in there. There’s some really good physios out there who can help you solve these problems.
If you are interested in how to help your pelvic floor and core, HATCH mamas get 54% off the Bulletproof Your Body - Core and Pelvic Floor Course Parts 1 and 2 for just $50 USD, usually $109 (USD). Antony has also thrown in a free talk: "Stop Hurting Women with Exercise." Click the unique link here to find the course bundle.
If you like a personal session with Anthony, please email him at [email protected] or via Facebook/instagram/ Twitter @physiodetective. Every time you see double unders in the WOD, you shouldn’t dread it for the leaking that might happen, just dread it because they jack your heart rate up!
Antony Lo The Physio Detective is a CrossFitter and has worked with all levels of CrossFit Athletes from beginners to CrossFit Games Champions. You can find him on social media @physiodetecitve.