Performing Artists and Pelvic Floor Dysfunction

In Pelvic Floor Dysfunction, Pelvic Health, Pelvic Pain by Alexa SavitzLeave a Comment

By Alexa Savitz, DPT, PHRC Pasadena

Reflecting on my previous years as a former professional dancer, I too often heard dressing room conversations with cast members sharing stories of accidents or urinary leakage happening over a few laughs, during partnering, while lifting, or jumping. At that time there was little to no education around what our pelvic floor muscles even were and it was assumed these accidents were normal. Not only are episodes of urinary leakage not normal in any case, but performers tend to also report hip pain, low back pain, pain with sex, constipation, and increased stress/anxiety that may play a role in pelvic floor dysfunction. All people with a pelvis regardless of age, gender, sexual orientation, race, can experience pelvic floor dysfunction. Symptoms of pelvic floor dysfunction are also not limited to dancers but common in gymnasts, circus artists, musicians, vocalists, figure skaters, cheerleaders, and trampolinists. 

 

A little bit about the pelvic floor muscles and function

 

The pelvic floor is designed to wear many different hats (insert your “A Chorus Line” top hat). It has a role in stabilizing our pelvic girdle and trunk while transferring loads with movement, provides support for our organs, performs sphincteric closure and relaxation for daily bowel and bladder function, sexual function, and acts as a sump pump to move lymphatic fluids through our body. The pelvic floor muscles also interact with our hip muscles including the piriformis and the obturator internus (think of your “turnout” muscles). The pelvic floor is also part of our core and interacts with our low back muscles known as the multifidus, the transverse abdominals, and our diaphragm. With that being said, any performer with low back or hip pain should also be screened for pelvic floor dysfunction. 

 

OI anatomy

Why does pelvic floor dysfunction happen in performers? 

 

Teixeira et. al 2018 performed a systematic review looking at the prevalence of urinary incontinence in female athletes. They reported stress urinary incontinence had a 44% prevalence in female athletes described by six out of the eight studies included. Two studies compared female athletes and sedentary women and reported that female athletes are 2.77 times more likely to present with complaints of urinary incontinence. There are many possible reasons why pelvic floor dysfunction is so common amongst performers. Some of those reasons may include habitually over-recruiting or holding the abdominals in, compensation for decreased strength in the gluteals, lumbar spine, or core, over activity of the pelvic floor due to the presence of hypermobility, clenching or repeated holding of the pelvic floor muscles, increased stress/anxiety, and decreased rest days between training and performances. The nature of most performing arts activities include an overall increase in demand on the pelvic floor. 

 

What is the research saying?

 

Recent research is bringing to light just how common these dressing room conversations may be, and how they are not being discussed with healthcare providers. Research is growing, but continues to be minimal on the mechanisms and pathophysiology in the athletic population. This is not only true for dance, but also for gymnastics (team and rhythmic), cheerleading, and other high-impact athletics. Most of the recent research discusses increased prevalence of urinary incontinence and pelvic floor muscle dysfunction. 

 

From the research that is currently available, dance, gymnastics (team and rhythmic), and cheerleading all place high demand and increased load on the pelvic floor to stabilize the trunk and pelvis while performing high impact activities. Not only is the demand on the pelvic floor greater upon landing, but pelvic floor muscle (PFM) demands also increase when performing the jump phases of challenging leaps, tumbling, and lifts. 

 

Urinary incontinence is the involuntary loss of urine and includes the following sub-categories: stress urinary incontinence being involuntary loss of urine with an increase in intra-abdominal pressure, urgency urinary incontinence which is involuntary loss of urine associated with symptoms of urgency, and mixed urinary incontinence defined as a combination of stress and urge UI. The most commonly reported symptom from the research presented is SUI in performing artists. In addition to PFM dysfunction, performing artists may present with hip or low back pain referred from the pelvic floor which may be associated with reports of urinary or bowel incontinence and/or pelvic pain. 

 

In conclusion

 

If any of these symptoms sound like you, we are here to help at PHRC. As pelvic floor physical therapists, we have the tools to assess pelvic floor muscle function with a whole body approach and see if it is a contributing factor to that nagging hip pain or the low back pain that has never quite resolved. With the recent surge in education around the pelvic floor and pelvic floor dysfunction, more performers are seeking the care they need to confidently get on stage and into the studio. Pelvic floor dysfunction in adolescence through adult performing artists deeply affects quality of life, mental and physical health, training, competition and performance, and can lead to increased dropout rates from their art or activity. At PHRC, we are here to open the conversation and support performers so that they may continue to pursue their artistic dreams on and off the stage. 


References: 

Bø K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Med. 2019; 50:471-484. 

Gram MCD, Bø K. High level rhythmic gymnasts and urinary incontinence: prevalence, risk factors, and influence on performance. Scand J Med Sci Sports. 2020; 30: 159-165. 

Rebullido TR, Gomez-Tomas C, Faigenbaum AD, Chulvi-Medrano I. The Prevalence of urinary incontinence among adolescent female athletes: a systematic review. Jour of Funct Morphol Kinesiology. 2021; 6 (12).

Skaug KL, Engh ME, Frawley H, Bø K. Urinary and anal incontinence among female gymnasts and cheerleaders-bother and associated factors. A cross-sectional study. Int Urogynecol Jour. 2021; https://doi.org/10.1007/s00192-021-04696-z

Sorrigueta-Hernandez A, Padilla-Fernandez BY, et. al. Benefits of physiotherapy on urinary incontinence in high-performance female athletes. Meta-analysis. Jour Clin Med. 2020; 9, 3240.

Teixeira RV, Colla C, Sbruzzi G, Mallmann A, Paiva LL. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol Jour. 2018; 29: 1717-1725.

Thyssen HH, Clevin S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol Jour. 2002; 13: 15-17. 

Whitney KE et. al. Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes. Jour of Pediatric Urol. 2021; https://doi.org/10.1016/j.jpurol.2021.01.041

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Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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