Should You Squeeze Before You Lift? A Clear Guide For Active Moms

Ever been told to “Kegel before you lift” and wondered if it actually helps? We take a clear-eyed look at leaking under heavy loads, how bracing strategies can make or break pelvic pressure, and why a breath-first approach often outperforms constant clenching. As pelvic health and barbell training collide, we break down what’s happening inside the core canister—pelvic floor, abdominal wall, chest wall, and back muscles—and how they’re meant to coordinate automatically as load increases.

We unpack the two big camps in pelvic health: prime the pelvic floor before every rep, or trust the body’s automatic scaling. Drawing on a new pilot study using the FemFit intravaginal sensor, we talk through what researchers found during squats, deadlifts, leg press, and curls with and without a pre-contraction. The key takeaway: priming didn’t push pelvic closure above interabdominal pressure, and in deadlifts both rose together. That challenges the idea that a pre-Kegel meaningfully prevents leaks at high loads, and it reinforces a smarter path—optimize breath and points of performance to guide pressure, then build capacity.

We also get practical for pregnancy and postpartum athletes. You’ll hear how to use pelvic floor training as a short-term coordination tool during recovery, when to start with low-load exhale strategies, and how to progress back to heavy bracing for top sets. Think of it like any rehab: deploy targeted drills to restore timing, then discharge them so the system can run automatically. Along the way, we share coaching cues that reduce bearing down, improve trunk stiffness for safer force transfer, and help you lift heavier with fewer symptoms.

Whether you’re a recreational lifter or chasing PRs, this conversation gives you the why and the how: fewer leaks, better mechanics, and a plan that respects both performance and pelvic health. If this helped reframe your setup under the bar, share it with a training partner, subscribe for more evidence-informed episodes, and leave a quick review so others can find the show.

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Transcript

The Kegel Debate In Strength Training

Leaking Under Heavy Loads

Bracing Errors And Pelvic Strain

The Core Canister Explained

Pregnancy, Postpartum, And Pressure

The Knack And Stress Incontinence

Pros And Cons Of Pre-Contraction

Automatic vs Voluntary Activation

New FemFit Pilot Study

What The Data Suggests

Why Breath Beats Pre-Kegels

Postpartum Coordination And Progression

Rehab Like A Cranky Shoulder

Study Gaps And Future Directions

Closing Thoughts And Questions

SPEAKER_00 0:07

Hello everyone and welcome to the Barbell Mamas Podcast. My name is Christina Fruit. I'm a public school physical therapist, researcher, and exercise in pregnancy, and a mom of two who has competed in prostitutes, powerlifting, or weightlifting, pregnant, post-partum, 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 everyone and welcome to the Barbell Mamas podcast. Christina Previtt here, and today we are going to be doing a deep dive and tackling the concept of kegling with strength training. This is actually a pretty hot topic in the pelvic health world with two very different camps. One camp that is saying essentially that you should be doing a kegel to prime your pelvic floor every time you are doing strength training. Others are not, and saying that it is not necessary. We actually just had a brand new study that talked about this in pre-release. I had a print in the International Eurogynecology Journal, which I had posted about on my Instagram account. So I really want to dive into this topic, get into the weeds of it, and hopefully make some conclusions by the end of this episode. First, when we think about the problem and we put this into context, whether you have had kiddos or not, 30 to 50% of those who participate in heavy barbell lifting can leak with their sport. This is often under your heaviest loads, at least initially, when it shows up, which happens to be most common in the squat, the deadlift, and the clean, which are the three movements where we see individuals are lifting the heaviest amount of weight. When we are considering bracing, and I've talked about this a lot on the podcast, individuals are often told, in my opinion, to brace incorrectly, where they are told to inhale nice and big and then bear down into their belly. When I am looking at a person's pelvic floor and I ask them to do that, when they're used to that strategy of bearing down, I see more downward movement of the walls of the vagina and it puts more strain on the pelvic floor. The pelvic floor is a really important part of our bracing mechanism, our force transfer mechanism, where we have our pelvic floor, our abdominal wall, our chest wall, and the muscles of our low back that all have this coordinated co-contraction that increases interabdominal pressure. That pressure is important because it increases spinal stiffness and rigidity through the trunk, which allows for force transfer. Because of that, as you lift more weights, interabdominal pressure increases as a result of that co-contraction. As you go faster and you go from slow walking to sprinting, you also see this linear increase in interabdominal pressure because of that increase in co-contraction of the core canister. When you add in pregnancy and postpartum, that causes an increase in strain on the pelvic floor, low back, abdominals, and glute muscles, and the desire to return to high strength training or high load strength training activities in the postpartum period. There now is a lot of conversation around the best way to brace, breathe, co-contract potentially or prime the pelvic floor, and then what that return postpartum looks like. When we are thinking about urinary incontinence, right? And we're thinking about stress incontinence in particular, where we see individuals who leak with activities of higher interabdominal pressure. And in non-athletic populations, this tends to be coughing, sneezing, laughing really hard, or vomiting. Then what is often taught is a maneuver called the neck, which essentially is a squeeze before you sneeze, where you prime the pelvic floor or do this pre-contraction of the pelvic floor. And what that does is it essentially braces the pelvic floor against that increase in inner abdominal pressure to potentially help reduce your amount of leaking. And our evidence today does show that it can significantly help with leaking and helps prevent too much downward movement of the urethra that attaches to the bladder and the vaginal walls. All of this context means that when thinking about those who have urinary incontinence or other pelvic floor symptoms in the strength training space, this idea of priming the pelvic floor essentially like a knack for a brace or a barbell or a squat or a bar uh deadlift with a barbell, what the idea is is like if it works for the cough or sneeze, maybe it will work for this lifting. So it does have a really solid reason why individuals are suggesting it. Okay. Let's kind of speak to this component. When I speak to pelvic floor muscle training, I aim to expand our definition to look at the strength, the relaxation, and the coordination of the pelvic floor. The knack is a coordination mismatch. When I am thinking about helping to teach that squeeze before the sneeze, that knack maneuver, I 1000% use it in practice. When I am thinking about a sneeze versus a heavy deadlift, a couple of things are required to nuance this topic out. And this is not in the pregnancy and postpartum context. I'll add that layer in in a second. When I am under a heavy barbell, the risk, I say risk very tentatively, but I hope you all are following me, in terms of injury, not peeing injury is higher if not if I'm not paying attention than with a sneeze. When I am going for a max deadlift, my focus should be on my points of performance. And one of the things that I'm always hesitant about with the pelvic floor squeeze is that there is a chance that individuals are focusing more on their pelvic floor contraction than their points of performance. And I am hoping that the pelvic floor comes on board when points of performance are solid. When I am teaching strength athletes with pelvic issues, the first thing I tackle is the brace. Can I get the right coordination of the pelvic floor? And with that, I often focus on the abdominals first before I focus on the pelvic floor first. If I cannot clear it up, if the abdominals and I'm giving external cues and I'm still seeing this bear down, then I can or will cue the pelvic floor contraction and to get individuals to understand or feel what that system is like. Under a barbell with bracing, the thing that we see though is that our automatic system allows all the muscles of the core canister to turn on to the right amount at the right time when the system is working appropriately. What I mean by that is if you are under a 50% load, then your core canister, all the sides of it, are going to respond to that load and activate at 50%. This is something that your body does automatically. When you take over and you do volitional control of your pelvic floor muscles, meaning that you do a contraction or a keagle, what we are starting to see from an EMG data perspective is that we are really bad at grading that contraction. Meaning if you have a 50% squat, you are not contracting your pelvic floor at 50%, you're contracting your pelvic floor at 100% because it seems to be this I am contracting my pelvic floor or I am not. And that is some of the work from Linda McLean's lab looking at EMG. And she did this in a group of pelvic physios who know their pelvic floor in that system very well. And she showed a lot of inaccuracies and a lot of haziness in the data when asking individuals to contract at 30% versus 60% versus 100%. It basically turned into this it's on or it's not. When we are overriding that core bracing system and pre-priming the pelvic floor, then what can happen is now we can have this mismatch of our pelvic system where our pelvic floor is contracting at 100% and everything else in the core canister is contracting at 50%. For that reason, I do not do the pre-contraction normally in practice. Up until now, we did not have any data that was looking at this maneuver and does it work? Insert this new study came coming out of Kari Bo's lab that was evaluating this on a pilot test kind of level. It had 11 individuals who were in it, out of 26 that were screened, which is interesting, and I'll talk to that with the data. Of those 11, 10 were noliprous, so had never given birth. One had given birth before. Most individuals either had no symptoms of pelvic floor dysfunction with heavy lifting or had minimal symptoms. So less than once a week, they were experiencing some amount or a small amount of urine loss. And there's a lot of conversations of what is the threshold at which this becomes a dysfunction versus some variability, like a twinge in the shoulder versus a shoulder injury kind of thing. With that, what they did was they put in a device called the FemFit, which is an intravaginal probe where it can measure interabdominal pressure and EMG in millimeters of mercury of the pelvic floor. What they were trying to look at was inner abdominal pressure with the squat, deadlift, uh leg press and uh curl, and what the pre-contraction of the pelvic floor did to that inner abdominal pressure. What they showed was, or and what they were asking is does the femme fit one accurately assess these things? And two, does the pressure of the pelvic floor closure now exceed inner abdominal pressure when we prime it versus when we don't? What they saw was that when you prime the pelvic floor specifically on or on any, let's talk more broadly first. When you prime the pelvic floor, it does not seem to significantly increase or place the contraction of the pelvic floor above interabdominal pressure. The second thing was when we did this in the deadlift, pelvic floor contraction went up, but so did interabdominal pressure. And it went up to about the same degree. Why this matters or why this becomes a discussion in the pelvic space is that often what we think about is that the contraction of the pelvic floor is insufficient to maintain urethral closure. So we can't close the holes in the presence of higher interabdominal pressure. When you can't do that, you leak. Rather, it's gas, vaginal flatulence, or uh stool or gas, anal gas. When you have insufficient urethral closure, insufficient hole closure, because interabdominal pressure is higher, you end up having symptoms. So what they were seeing was that this doesn't seem to impact symptoms. Now, there's so much to unpack here. And there's a lot that I wish this study would have had. Um, but I understand that it's a pilot study. And first and foremost, they had to test the femme fit. From a research perspective, one of the things that has been very difficult, and I have explored this at a very cursory level, knowing that there are other people way smarter than me in the EMG and sensory space, is that whenever you are doing something really dynamic, all of the movements of your abdominal contents, like literally your organs moving around, your muscles changing, direction, et cetera, with something like a squat or a deadlift, there is so much haziness, or we call it artifact, in the recording that it makes the recordings almost useless. And so people who have tried to do some evaluation, it has been very difficult to find a sensor that does not get a lot of background signaling from other muscles, from other movement, et cetera, to make the data useful. What this study did was show some preliminary evidence that maybe the femme fit is going to be the answer for that. And if it is, I would love it because it's such a needed area, which is really exciting. The second thing they were looking at was this relationship between interabdominal pressure and pelvic floor activation. And here they didn't really show that pelvic floor exceeded interabdominal pressure, which when you're thinking about leaking and the high interabdominal pressure being something that is often the cause or trigger for their symptoms, this became relevant. Where I teach often, and if you follow me on the professional side of things with our courses when I teach with the Institute of Clinical Excellence, we teach to manipulate breath first versus pelvic floor muscle priming or pre-contraction first, because what we know is that breath significantly drops inner abdominal pressure. And so if you are having a hard time keeping your holes closed when pressure is higher, like with a closed breath, closed glottis brace, like the valsalva, if we change and bring your breath into an exhale on exertion strategy, we can often make you asymptomatic and then build you back up to that valsva maneuver because it's really important for your top loads. With that, we have a predictable and consistent drop in inner abdominal pressure. So if pelvic floor muscle contraction stays the same and inner abdominal pressure drops, then we can help individuals change their symptom burden. And then there's also a performance side to having freedom or changes to breath strategy so that you can use the balsalva when you need the balsalva, you can use the exhale or coordinated breath strategy when you need that as well. Now, what people will say, well, what about pregnancy or more specifically returning postpartum? This is an interesting thought because individuals are thinking about motor reprogramming after delivery, particularly after vaginal birth, that stretch injury and doing pelvic floor muscle strengthening to get that group of muscles that had an injury back up to strength, um similar to the strength they had in pregnancy and post um pregnancy or pre-pregnancy rather, is important and can be helpful. And we do have consistent research that doing pelvic floor muscle training in the postpartum period is helpful for the management, mitigation, and prevention of different pelvic floor complaints. It makes sense then that people would want to do that pre-contraction to retrain that core coordination in that postpartum period. Again, I tend to go breath first and low load first. But if I do have clients who are having trouble with that relearning of coordination postpartum and priming the pelvic floor helps, I can also go there. However, what this is, is more like neuromuscular exercise, where I'm trying to retrain that coordination rather than a consistent strategy that I am going to leverage. Where this gets misinterpreted or I think overly utilized is when trying to get pelvic floor back into core canister coordination postpartum turns into every time I lift a barbell, I'm keegling. This is where I think we shift too far. And if we start with pelvic floor contractions voluntarily, volitionally, where I cue it on my own versus I let it go automatically. As your provider, the thing that I need to do is DC it or discharge it. Once we have that coordination, right? If I do decide to use that pre-contraction, then I will tell you, okay, we got your coordination under control. Now I just want you to focus on your points of performance. I do not need you to hyperfixate on that pelvic floor piece. If you notice that your symptoms are coming back, maybe we'll get you back doing a couple of sessions where you are focusing on that contraction again, and then we'll DC it. Similar to an injury that you've had, where you do your therapeutic exercises, eventually you don't need to do them anymore, or you've adapted to them. You go on about your merry way, you do all of the things, and then you have if you have a little of twinginess or a bit of a flare-up in symptoms again, you can return to those exercises. They are always there to serve you. The same can be true in the pelvic health space. And so if we start thinking a lot more about rehab, postpartum, or in the presence of pelvic symptoms, the same way you would for a cranky shoulder, it can really clarify a lot of our thought processes in our pathways and frameworks for return and for our strategies in the presence of pelvic floor symptoms and with postpartum return to strength exercise. All right. I hope you all found that helpful. I really loved that the that study came out. I think it's so important. I know it's a pilot. I really wish they would have done stuff with ultrasound and looked at the vaginal wall range of motion and where the bladder neck is, et cetera, things that we've seen in some of our running research. We are not there yet, but maybe it's in the works. I really hope so. Um, but more and more data like this coming out is really gonna change the game and give us a lot more information of strategies to use and how to. To approach rehab in both um athlete populations that have never birthed children and those that have. If you have any other questions, comments, concerns, please let me know. Otherwise, I will see you all next week and have a good one.