What does a FITPRO/PT need to know about Pelvic Health and when to refer to a Pelvic Health Physio?

Many of the Fitpros are offering specialised services for Pregnancy, Postnatal and Midlife fitness. The public are also becoming more informed about Pelvic, Women's and Men's health and menopause and it is therefore essential for Fitness Professionals (Fitpros) and Personal Trainers (PTs) to have a basic understanding of Pelvic Health to effectively support their clients and ensure their well-being during exercise.

By having a solid understanding of pelvic health, Fitpros can better support their clients' overall well-being and fitness journey while minimizing the risk of pelvic floor dysfunction or injury. A Fitpro, might wish to refer a client to a Pelvic Health Physiotherapist when they notice symptoms or issues related to pelvic health during exercise or training sessions. These symptoms can include but are not limited to:

• Pelvic pain - any pain in and around the pelvis which has not resolved with exercise or other treatment

• Incontinence/leakage from the bladder or bowel with cough, sneeze activity or urgency (just can't wait) or frequency, needing to empty the bladder more than normal

• Pelvic organ prolapse - symptoms of dragging sensation, heaviness in the pelvis or something coming down vaginally

• Diastasis recti (separation of the abdominal muscles)

• Pelvic floor weakness or dysfunction

  
  

  Anatomy of the Pelvis and Pelvic Floor: 

  Having a basic understanding of the structure and function of the pelvic floor and pelvic floor muscles is crucial. The pelvic floor is a group of muscles that help to support the pelvic organs, control bowel and bladder function, and contribute to sexual function. In addition to this the pelvic floor and pelvic organs have a relationship with the diaphragm, supporting ligaments of the pelvis and abdominal, back and hip muscles, and contribute to core strength and function. A common misconception is that if there are pelvic symptoms that the pelvic floor muscle are weak. A full assessment from a professional will be needed to evaluate the causes of any symptoms including a detailed history, evaluation of pelvic floor function, range of movement strength, flexibility and coordination and to devise a treatment plan. The Fitpro will be a key part of the team evaluating whether a referral is needed and delivering pelvic safe exercise.

  
  

  Common Pelvic Health Conditions: 

  Familiarity with common pelvic health issues such as pelvic pain, birth injuries, different types of incontinence, pelvic organ prolapse, and diastasis recti is important. It would be great if Fitpros could have an understanding of these conditions, be comfortable with discussing these issues with clients and knowing what questions to ask as well as recognising signs and symptoms of these conditions and being confident to provide appropriate advice, guidance and referrals.

  
  

  Risk factors for Pelvic floor Dysfunction

  Knowing the risk factors and potential causes of pelvic health issues can help Fitpros tailor exercise programs to each individual client and provide advice on prevention. Factors such as pregnancy, childbirth injury, menstrual cycle, contraception, hormones, perimenopause, menopause, constipation, surgery, posture, exercise ( or lack of) aging, obesity and osteoporosis are all relevant as well as how certain exercises or movements can contribute to or relieve pelvic floor dysfunction.

  
  

  Exercise Modification

  Fitpros should be aware of exercises and movements that may exacerbate pelvic health conditions or put undue stress on the pelvic floor. It is essential to consider how to modify exercises to minimize risk while still achieving fitness goals and also what exercises can be helpful for different conditions.

  
  

  Education

  Educating clients about posture, mobilisations/stretches and breathing techniques with exercise can help maximise the function of and protect the pelvic floor. Fitpros should know when to emphasise engaging the core muscles, including the pelvic floor, when to relax and recognise when breath-holding is useful or unhelpful during exertion. For female clients a knowledge of the menstrual cycle is helpful as well as how symptoms change during this time. Understanding when to encourage clients to push the boundaries and when to hold back due to risk of injury, depletion or fatigue is essential.

  
  

  Onward Referral

  It is helpful for Fitpros to know when and why to refer clients to pelvic health physiotherapists or other healthcare professionals for assessment and treatment and be able to sign post clients to local resources and specialists who can provide specialised care for pelvic health issues.

  
  

  Communication

  Open communication about pelvic health concerns is a challenge and it is helpful if Fitpros know the questions to ask in order to facilitate clients feel comfortable seeking assistance when needed. It is helpful to create an open and supportive environment for clients to discuss pelvic health concerns ( in private if neccessary) whether that be through a questionnaire, email, text or through verbal communication. Fitpros should encourage open communication and provide non-judgmental support to help. For any help and support for Fitpros and their team, interested in education about Pelvic Health Conditions and how to manage them or simply wanting more information, please contact Nicki Travlos at info@invictuspelvichealth.com or 07379499756. If you are working with midlife women, please do ask for a copy of my published chapter on Pelvic Health in the Peri and Menopause from the ARGH to ZEN of Perimenopause.