The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The Core Connection: Why You Might Be Peeing During Workouts
For active women who've experienced that embarrassing leak during a heavy lift, this episode challenges everything you thought you knew about pelvic floor function. Diving deep into the science of bracing mechanics, Christina Previtt unravels the fascinating relationship between breath, core tension, and pelvic health that revolutionizes how we approach strength training.
Forget the simplistic advice to "just do more Kegels." Research reveals a surprising truth: women who experience incontinence during lifting often have stronger pelvic floors than those who don't. Christina explains why coordination—not weakness—is frequently the real culprit, and how understanding the entire core canister system transforms both rehabilitation and performance.
The Valsalva maneuver (that instinctive breath hold during heavy efforts) has been unnecessarily vilified, especially for pregnant and postpartum women. Christina presents compelling evidence that this natural bracing strategy isn't inherently problematic—it's a trainable skill that, when properly executed, can actually support pelvic health while enhancing performance.
Whether you're an expecting mother concerned about safe lifting, a postpartum athlete working to rebuild your foundation, or simply someone who wants to lift without leaking, this episode provides actionable insights that bridge the all-too-common gap between rehabilitation and performance training. By understanding how proper bracing distributes pressure throughout your core system rather than directing it downward, you'll discover how to protect your pelvic floor while still challenging yourself in the gym.
Ready to transform both how you think about and how you feel during your lifts? This episode might just be the missing piece in your training and recovery puzzle. Subscribe to Barbell Mamas for more evidence-based conversations at the intersection of motherhood, strength, and pelvic health—where we're redefining what's possible for athletic women through every stage of life.
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Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome back to the Barbell Mamas podcast.
Speaker 1:Christina Previtt here and I hope you all had a wonderful long weekend and, if you were taking part in Memorial Day activities, that those activities went well. If you are one of those people that did Murph it is a Memorial Day special event, I would say in the CrossFit space I hope that it went well for you. I saw a lot of videos online of very hot gyms and people who were exhausted from doing that workout. For those that aren't in the CrossFit space, murph is a mile run, 100 pull-ups, 200 push-ups and 300 squats with a 20-pound vest and then a mile run. The vest is meant to be worn the entire time and there's a lot of discourse about do you break it up and do it partitioned, which is like you're breaking up that part, or unpartitioned, where you have to do all 100 pull-ups before you can move on. It's a big commitment, it is a very long workout and it is definitely one of those things where you're reflecting on a very, very hard thing that you are doing for your body and thinking about our military members and their sacrifices. So if you are still recovering from that, I hope that you are doing all right Today.
Speaker 1:I actually wanted to talk a little bit about the mechanisms or the muscles around bracing and why that matters to how we would treat pelvic floor issues if you have them with lifting the three things that often I am looking at, or I should say four, I guess If I am working with somebody who's got a pelvic floor issue with lifting, it is usually peeing or farting when they don't want to. So urinary incontinence or fecal incontinence, heaviness under fatigue or pain Usually that can be hip or low back pain. And you may think, christina, isn't that unique and different from pelvic floor dysfunction? And absolutely not, because it is all part of the same system, which is our bracing system and how we respond when we brace system and how we respond when we brace. And so I thought today might be a fun episode to break down what is happening as we lift heavy weights, why we talk about our breath and our bracing strategy so much when we lift heavy weights, and then what is some of our research around what is happening when we are leaking with lifting versus those that aren't having any pelvic issues with lifting. The reason why this came up is a couple of weeks ago I guess it would be a couple of weeks ago now. I posted about the mechanism of the Valsalva maneuver, which is a closed glottis You're not breathing in and out and you're bracing as hard as you can and I talked about like the physiology of it, like what is happening when we start to lift heavier and heavier and we get towards our max, whether you are trained or untrained, and that it blew up. That reel blew up.
Speaker 1:But one of the things that I think shocked me the most was how many people that were in the birth space, the exercise in pregnancy, the pelvic health space, even some of our strength and conditioning coaches, who were responding with things like oh it's good to know that there's research to back this up, or it's cool to see that you found a research study that backed up what you've been saying all along, and I thought it was really interesting because, well, from a research perspective, it's always interesting to me because sometimes we never go outside of our own spaces and so in like our birth provider spaces, we don't often look at our strength and conditioning research, and as physiotherapists, we may not look at our exercise research, for example, and what that means is that sometimes it's hard to make some of these connections. And then I'm thinking well, if our providers are having a hard time making these connections about why their therapist is making these recommendations, then probably our patients, or you all who are listening to this podcast, are having some of the same difficulties with those bridges, and I think then it makes sense for us to take a step back. Talk about the Valsalva maneuver, not even talk about the pelvic floor just yet and then layer those things in. When we are talking about bracing, that is us preparing for a strenuous or highly effortful task and that can be taking your baby out of a crib if that is strenuous for you. For some of my older adults that can be getting up from a chair or going up and down stairs. For some of my power lifters that can be 315 or over, squat, 275 or over.
Speaker 1:And so when we're thinking about strain, the first embracing, the first thing that's really important for us to recognize and things for us to have front of mind is that what is considered strenuous or effortful is highly personal and it is totally depending on your level of fitness. So what is considered strenuous to you may be a 20% effort for somebody else, or what is a 20% effort for you may be a max effort to somebody else. And that probably isn't very surprising with this is when we're seeing some of these blanket restrictions for example, don't lift over 20 pounds in your pregnancy you can kind of see why this doesn't really make a lot of sense, because the idea with those recommendations is to avoid highly strenuous tasks, high effort movements, and that's not a universal load Like it's what's highly strenuous for you may not be highly strenuous for me, or vice versa. And so when we are thinking about a bracing strategy and we are starting to really you know think about being very intentional about our bracing, this becomes very important and very relevant as something becomes more effortful From a exercise perspective.
Speaker 1:The flip of that is, in order for our body to get stronger, we need to expose it to effortful movement, and that may be one rep maxes For some people. They're doing really heavy sets of 10 so that they're really fatigued by the end. But the variable that stays the same whether you're doing a 3x10 or a 3x3, is that the effort should be sufficient or relatively high in order for our muscles and our bones to get stronger, which is what we are trying to do when we are doing strength training in general, because the Valsalva brace happens under high strain, high effort, and the goal of strength training is to expose ourselves to high strain and high effort. The second thing that doesn't really make a lot of sense is for us to talk about avoiding the Valsalva maneuver or avoiding this no breathing type of bracing, when we are talking to people that we are trying to get them doing strength training or if you are trying to do strength training and I don't mean that to say that I never change a person's breath when they are exercising, but what I'm saying is the thought that often happens in the pregnancy postpartum pelvic health space, that the Valsalva maneuver is bad or that it should always be avoided, is a fatally flawed argument, because it doesn't take into account that if we are trying to prepare you for life, like if you are going to move a couch, you are probably going to be holding your breath at some point when you are bracing because you are working really hard to move that couch right, and that means that we want to prepare your body for it so that you don't get afraid to put in effort, whether that's in life or in the gym, because you're worried about constant like issues with your pelvic floor or that you're going to cause irreparable damage. And as a profession for me in the pelvic health space, that's something that we need to take ownership with. That we have to be very mindful about the way that we're communicating things, because sometimes we can make a lot of people feel afraid. And so what happens?
Speaker 1:When you start to lift heavier and heavier tasks, we see that all the four muscles of the core canister, or the four sides of the core canister. They start to contract at higher and higher amplitude as the weight or the strain of your task goes up. So your core canister is your chest wall, diaphragm at the top, your obliques and your transverse abdominis, mostly at the front, your anterior core wall. You have your pelvic floor muscles at the bottom and then you have your stabilizer muscles, so your erector muscles and your multifidi muscles, kind of all of those little tiny muscles and those big muscles along your back that they all contract together in order for you to apply strain or effort against a couch, a chair, a load on a barbell right. So you contract all those sides together. It creates inner abdominal pressure. That pressure allows the spine to get really stiff and rigid so it doesn't move, and then that creates this solid platform for you to push, pull, squat, deadlift, lift against in general, so that inner abdominal pressure us to perform effortful movement.
Speaker 1:When we are thinking about our breath mechanics, we see a couple of different things and the generation of inter-abdominal pressure, and this was the study that I had talked about. So the first thing that we know is that the generation of interabdominal pressure or the bracing for heavy lifting is a skill, and it is a skill that can be trained. How we know this is that when we compare resistance trained people to those who don't typically do resistance training in their day-to-day the inner abdominal pressure at a similar relative load so 30% of one person's heaviest lift versus 30% of another's the people that are resistance trained seem to be better and generate more inner abdominal pressure with their bracing strategy than somebody who is untrained. And we can kind of see that If you are a person who has had a couple of years of resistance training under your belt, you are much better at bracing than somebody who isn't. And it actually makes your capacity to change your breath strategy, for example, a little bit harder, because you really have put in a lot of repetitions to try and get that inner abdominal pressure and that brace dialed in so that you can perform at a higher level. So that's the first thing is that inner abdominal pressure or bracing strategy can be trained, and so those that are resistance trained are better at generating inner abdominal pressure than those that are not, which shouldn't be that surprising.
Speaker 1:The second thing that we saw in some of our research is that it does not matter if you are resistance trained or not. As the strain of the task goes up, your spontaneous breath goes down, your spontaneous breath goes down. What I mean by that is that when you start lifting heavier and heavier, you're going to notice that you're not going to be breathing in and out at regular intervals anymore. You're going to close off your glottis, close off your throat and you are going to hold your breath. And that is true if you do resistance training regularly, which we would expect those people to do, a hold your breath type of brace. But that happens also in our non-resistance trained controls. And this is where I will say that if you are working at over 80% strain, you are, at least transiently or temporarily, holding your breath through movement. And it's because we see that that breath at 80% of their relative max is essentially zero. And oftentimes, too, even when we think about the most common breath strategy that we talk about in pregnancy, postpartum and pelvic health, which is the exhale on exertion, we are holding our breath on the other face, right For a squat. People often talk about breathing out out of the bottom of the squat, but you're seeing that most people are holding their breath on the way down and then breathing out on the way up, so you're at least transiently doing a Valsalva brace.
Speaker 1:When we think about now layering in the pelvic floor right, because it is a skill, there are times when that skill can be done incorrectly. And when we're thinking about people who are peeing with lifting or don't feel good in pregnancy or returning postpartum with heavy lifting, now we have to think is there something going on with that skill? Is there a movement issue that is going on that is leading us to be more likely to have pelvic floor issues? Similar to a squat, where, if somebody brings their knees in this valgus fault, right, we're going to try and correct it. I'm not going to say that you're going to blow your knee out squatting that way right, it's just less efficient and we tend to be stronger when we keep our kneecaps tracking over our second toe when we squat, right. I'm not going to say that you're doomed to dysfunction if your bracing is a little bit off, but you're definitely going to feel stronger and more supported if we are thinking about bracing the right way or working on the skill of bracing.
Speaker 1:Now, when we think about what is happening at the pelvic floor so so often when people are peeing when they're lifting, we assume that it is a weakness problem and in some scenarios it can be right. Early postpartum I can probably make the argument that for a lot of people, that early weakness from an injury right, because your pelvic floor goes through a stretch injury with a vaginal delivery, you know maybe not so much as much early postpartum if you had a cesarean section without any trial of pushing right, but there might be some weakness. If you are going for a one rep max, it might be the side of your core canister that has relative weakness compared to the other side. So there may be some scenarios weakness compared to the other side. So there may be some scenarios. But our research on comparing the muscle activity of the core canister in those with incontinence or who are leaking with lifting versus those that don't, is actually telling a different story. When we looked at some of our research and this was a study that was published in 2019 by DeSantos and colleagues taking women who were continent and incontinent this was athletes what they saw was that those who had incontinence tend to have a stronger and faster pelvic floor than those that didn't, and we're actually seeing this same story really happen as well in our running. Research is that those who have incontinence with running actually tend to have a stronger contraction of their pelvic floor than those that don't. We don't actually know why this is. Of course, I have my thoughts and I'm going to share them with you, but it goes against this argument that it is always 1000% a weakness problem.
Speaker 1:Part of my thoughts around why those with incontinence can actually have stronger pelvic floors is that they're probably working on their pelvic floor because they don't want to be peeing anymore. For many people, they do not think about their pelvic floor until something is going wrong If they're, you know, peeing, pooping, having hemorrhoids or issues when they don't want to be, or you are pregnant or postpartum, and that's when a lot of our education which is great focuses on this muscle group that we don't really pay a lot of attention to when we are outside of those two scenarios. And what that means is is that if you start peeing when you don't want to be, you know, quick Google search is going to tell you to do your Kegels and so you're going to start working on pumping those pelvic floor muscles to try and make your condition better, and that may not be necessary with those people that do not have incontinence, and so that's kind of where I think that the discrepancy is coming from, that those who are having issues are probably focusing on it a little bit more, but it's telling you that it is so much more than that, and this is where I think we are missing a big piece of the puzzle. Do I do pelvic floor muscle training? Of course, but I think one of the biggest benefits that we don't talk about enough is that pelvic floor muscle training, of course, but I think one of the biggest benefits that we don't talk about enough is that pelvic floor muscle training isn't just strengthening. It's strengthening relaxation and coordination of the pelvic floor, and the pelvic floor isn't in isolation. It is part of this core canister system and because it's part of this system, it allows us.
Speaker 1:We want to really think about, you know, we want to take into account what's happening at the pelvic floor, but then we want to go in and teach this bracing mechanic the right way, so that individuals feel better and more supported in how they are lifting weights, whether you are a male, a female, pregnant, postpartum, having pelvic floor dysfunction, not having pelvic floor dysfunction, or working on your performance, and so what we are starting to see in my clinical practice and the research is starting to get there too is that for many people it is a coordination issue and if you have sufficient strength, with the right coordination, those two things together is going to clear up a lot of your issues. That coordination. By coordination what I mean is that when you are bracing, all those sides of your core canister are contracting together and you are allowing pressure to go to all sides of your core canister and kind of evenly distribute across your midsection. What is often taught in strength and conditioning is to take a big inhale breath, which we will do as we are trying to lift more weights, to take up more space. But then you get taught to bear down or press down into your pelvis and if you are using a weightlifting belt, you get told to push out against the belt. What that is going to do for a person who has some issues going on at the pelvic floor is it's going to make your symptoms worse. Now, it's not making you prone to dysfunction, right, it's not dooming you for life, but it is making you more likely to be symptomatic in the activities that you enjoy.
Speaker 1:Where I come in if I'm coming in as a therapist and you're coming to see me with these issues is I check your pelvic floor and I make sure that you know, when I ask you to Kegel or do a pelvic floor contraction, that you're squeezing those muscles. When I ask you to relax, that you're able to relax, and then I take a look at what your pelvic floor is doing. When I ask you to brace, as if you are doing something heavy and what I'm looking for is relative to your contraction and your relaxation kind of think about that as your range of motion what are you doing when you brace? And if you're bracing and your pelvic floor looks a lot like your relaxation, that tells me that there's a coordination issue when you are bracing. And so I will do that you lying on your back in supine and then I will repeat that in a standing exam to see you know when we put gravity on your body because that is how you are lifting what is your pelvic floor and what is your core doing during those movements. And then sometimes I'll even add a weight in the room to see you know does your bracing change a little bit when I put some weight on your body? And that tells me a lot about your coordination and how you are lifting, but what it also tells me is that you're leaving some performance out on the table as well, right, because if we can clean up your bracing mechanic and really dial in that movement, what that's going to do is it's going to make you feel more supported through your trunk, right, and what it's going to allow me to do, or and then allow you to do, is become less worried about, one, pelvic issues when you're lifting. And then, two, allow you to have that performance advantage where you are getting the best recruitment you can, to have the most capacity to exert force when you are lifting. And what this now is doing, if we kind of take this full circle, is it's taking our mechanisms of a movement right, bracing in general and lifting in general, taking those mechanics, thinking about them from a performance perspective, throwing them through the lens of pelvic health rehab in general.
Speaker 1:And then, you know, the added layer for me with the Barbell Mamas podcast is pregnancy and postpartum, right, and then allowing those two things to blend so that we are preventing pelvic floor issues, right, we're talking about, you know, you being able to contract the right muscles at the right time to protect your body and protect your performance and then also rehabilitate if things are askew or some of our coordination is off. Or sometimes we have to rework those skills in pregnancy and postpartum because our body feels a little bit different and then allows you to come back to that performance, come back to that capacity, whether that's post-rehabilitation, postpartum, in between pregnancies, even during your pregnancy and it allows us to really kind of solidify and bring those things together. But when we don't connect those things, we don't connect what we're doing in pelvic health to what you are experiencing in the gym, to what our research on exercise is saying, sometimes we can miss really pivotal pieces of the puzzle and then when you are coming to your provider it feels like there's a missing link or that there hasn't been a full circle connection between all of these things together and I hope that me kind of going through with this podcast episode and really deep diving a little bit more into you know what is happening from a muscle and breath perspective. It allows those puzzle pieces around the pelvic floor with heavy lifting and lifting in pregnancy and postpartum to fall a little bit more smoothly into place. So I hope that you all found this helpful.
Speaker 1:I was thinking about doing something very similar with the running space because, again, this is another. As I mentioned, this is another area where many people think that it's a pelvic floor weakness issue and it's seeming to be a little bit more of a coordination and running mechanics issue, which honestly to me, is good news. Those are all things that we can work on and we can try to rehabilitate in a way that doesn't have you doing a million Kegels. We start there, we start with the contraction and relaxation of the pelvic floor. But where I really think that we need to go from a research perspective, from a rehab perspective, from an exercise perspective, is that we need to stop just doing pelvic floor muscle training, and we don't need. We need the exercise professionals and the rehabilitation professionals to come together and really create a solid foundation for people, and that's where I think our research is going to start showing heightened effectiveness.
Speaker 1:And now I'm just going down a research rabbit hole just to go on a soapbox, as I tend to do. What we are seeing is that this is where our research is after prostatectomy, for example. So if you had prostate cancer, you were a male and you had your prostate removed. What we see is that pelvic floor muscle training plus functional training, the combination of that two treatments, is more effective than pelvic floor muscle training alone, which, like there's so much of me as a researcher and as a clinician, that just says duh. We haven't gone there yet from a research perspective or interventional studies in general in any of the pregnant postpartum or pelvic floor with exercise spaces, and it just derives me bananas.
Speaker 1:I have a long list of research projects. Margie, if you ever listen to this, I'm so sorry You're going to be stuck with me for life, but definitely something that we want to be thinking about and something that we want to be bringing to the table. All right, if you guys have any other questions, comments, concerns, let me know. If you want me to do that running one, I probably will next week, if I'm being honest. Try and get that together for us, or maybe the week after, it depends.
Speaker 1:I'm at Female Athlete Conference next week, which is going to be really exciting, and so the week after, so this week, I'm at a summit with all of our friends within the pelvic floor course that I teach, which is amazing, and then I literally come home and then I'm off to Boston for Female Athlete Conference and it was like the most fun. Like every person that I had wanted to meet and connect with in the pelvic health space was there two years ago. This year is going to be very similar. I get to meet people that are long-term internet friends of mine that I get to meet in person. I've actually never met my postdoctoral supervisor.
Speaker 1:I do research and exercise in pregnancy. I've been working with Margie for over a year and I have never met her in person just because she's in Alberta and I'm in Ontario, and so I will probably have a podcast that's coming about the big takeaways from that conference, because it is definitely one of the forward thinkers in the women's health space. There's always a component around pregnancy, postpartum and pelvic floor dysfunction. Last year there was a big emphasis on female athlete triad, relative energy deficiency in sport in the new clinical guidelines, and so I'm just super excited to see what they have on the docket for next year or this year next week, and I will make sure that I share all of that with you all. If you have any other questions, as I said, let me know. Otherwise I will see you all then and have a great remainder to your day.
