Stop Pushing Down Into Your Belt

Leaking on a heavy squat can feel isolating, but the numbers tell a different story: pelvic floor symptoms show up in a huge share of resistance-trained athletes. We walk through what bracing actually is, how the “core canister” works, and why your pelvic floor is supposed to join the brace automatically rather than being forced on with constant kegel cues. We also explain what tends to change once you cross higher intensities, why breath holding and Valsalva show up above roughly 80% for most lifters, and how breath strategy can change intra-abdominal pressure without turning your lift into a fragile, overcontrolled routine.

From there, we get specific about what drives symptoms like urinary incontinence, heaviness, and pelvic discomfort in the gym. We call out one of the most common coaching mistakes we see in female athletes: “big inhale and bear down,” especially when someone is told to push hard into a weightlifting belt. Instead of spreading pressure evenly through the trunk, those cues can send pressure down into the pelvis, creating a coordination problem that shows up as leaking or loss of support when the load gets real.

We also dig into new pelvic floor research on a 5x5 heavy squat protocol using ultrasound, what the findings do and do not mean, and why normal pre to post “effort changes” are not the same thing as damage. Finally, we share practical belt guidance (fit, tightening on an exhale, keeping the same brace from warmups to top sets) plus postpartum considerations and realistic timing for returning to breath holds and belt use. If this helps, subscribe, share it with a lifting friend, and leave a review so more moms and athletes can train with confidence.

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Transcript

Welcome And What We Cover

SPEAKER_00 0:07

Hello everyone and welcome to the Barbell Mamas Podcast. My name is Christina Prevett. I'm a public school physical therapist, researcher in exercise and 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 gonna 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 excited. Hello everyone, and welcome to the Barball Mamas podcast.

Bracing Basics For Real Life

SPEAKER_00 1:12

Christina Previtt here, and today I am going to be doing a whole podcast about bracing, lifting, and the pelvic floor. I've done a couple of podcasts about this over the years in the past. We are getting new information, which is super exciting. Our ideas are evolving. We're getting more data on women. And so I kind of wanted to do this big all-encompassing episode, especially after a paper was recently published by Lori Fourner and her colleagues that was looking at what happens to the pelvic floor and vaginal wall support when individuals participated in a five by five heavy lifting paradigm. So, first let's kind of talk about what bracing is, kind of the fundamentals of bracing, then we'll layer in this like pelvic floor leaking before you've had kids, during pregnancy, after you've had kids, and kind of try and pull this all together. Bracing is the coordinated core contraction of our core canister that is done in anticipation of and in response to effortful movement. That means the core canister is our anterior core wall, and that is not just our TA, that includes our obliques, our chest wall, our lumbar musculature, our low back musculature, like our erectors and our maltifidae, and then our pelvic floor. So when we are doing anything effortful, and I say effortful because that is a relative term to the fitness of the person who is moving, you have this co-contraction that happens of all four sides. They respond off each other. So it works as a system and it creates stiffness in your spine that causes pressure to go up. That's how we generate this stiffness. And then it allows us to move our arms and legs. So consider this stiff midsection as like a launching pad for you to jump off of. If you have a launching pad that is stiff and rigid and held in place, you can bounce off of it. But if it's like a lily pad that you use in the water and it's a little bit loosey-goosey and you're trying to jump off of it, you really don't get a good jump into the water. So we want that stiffness to occur. When I say effortful movement, this can be lifting heavyweight, right? We see this in our strength training athletes who are lifting, moving heavyweights, whether that's the Olympic lifting movements, whether that's bodybuilding movements. As soon as we get into effortful, moderate to high intensity strength training, we're absolutely in that need and more necessity to brace zone. But this is also what is happening when we're going from rock walking to jogging to running. If anyone has ever done a sprint workout and they hadn't been to the track for a while, you probably are gonna feel your obliques, your core wall the next day, because they're absolutely getting a really good workout in when you are going from walking to jogging to sprinting. And so that coordinated contraction of all those sides of the core canister happen in endurance sport as well. Outside of sport, this also occurs in daily life. If you're picking up a couch, you're bracing. If you are somebody who is struggling with muscular strength, like some of my older adults that are more frail, they're gonna be bracing hard going from sitting to standing. They're gonna be bracing hard trying to push a grocery cart around their grocery store. That could also be why their public floor uh can struggle and things like having a toot going from sitting to standing is common in some of our older adult populations. You also have to brace in order to cough well, right? If you think about if we are choking, if we are coughing and we're trying to get stuff out, we use this coordinated co-contraction to create stiffness in our belly, in our chest, in order to get our phlegm out, in order for our cough to be productive. And with our older adults, right, sometimes that lack of productive cough, which a part of that is weakness of the belly, can make it so that they can develop pneumonia because their cough isn't as clearing as it

Breath, Valsalva, And Pressure

SPEAKER_00 6:00

needs to be. So bracing is an incredibly important skill. What we need to think about is that as we get over 80% of our one rep max, and again, this is going to be relative, it could be at 100 pounds for some people, 150 pounds for others, 15 pounds for others. But as soon as we get over 80%, what happens as weight gets heavier and heavier and heavier, our inhale breath, our inspiratory volume increases and we stop breathing. Okay, we stop breathing. And so with that, our inspiratory breath, our inspiratory volume goes off and we close our hole, our glottis hole, or cl or hole in our throat. Ideally, we're also closing our pelvic floor holes, but in this case, I'm talking about the throat. This happens for everyone, whether you are trained or untrained, as soon as you go above 80%. Okay. Our brace and our breath are different. They work together, absolutely they do. But we also have to think about them as two separate concepts. And when we think about them as two separate concepts, they're different things that we can manipulate and talk about. Okay. So we have our breath and then we have our brace. One of the things that you are not going to see me talk about often is to keagle while you are bracing or cue the keagle. The reason why it's not my first go-to, I do use it in some instances, and this is where the nuance comes in, is because when you brace well, your pelvic floor should kick on automatically to the amount of activation of the other sides. What I mean by that is that if you're bracing at 50%, because your body is responding to a 50% load, you're not consciously doing that. You are bracing and your body is kind of telling itself how much it needs to brace based on what it's feeling from a load perspective, then your body's automatically going to kick pelvic floor on, ideally, to 50%. If we try and kegle, because what we can do is we can take that pelvic floor and put it under our own control outside of the system, doing it automatically, then it may be working at 100% and everything else is working at 50%. Or if we don't have very good control compared to the strength of our pelvic floor, then we may contract at 50% and everything else is contracting at 100%. So because of that, I will cue how to brace first and ensure that that's being done well. And then I will cue the breath. So I I will have these two things as something different. Knowing that going over 80% is going to cause at least some closure of our throat hole because we need it for our ability to complete that movement. A lot of times in the pregnancy postpartum pelvic health space, people talk about a coordinated breath strategy, more specifically an exhale on exertion. With that, people are either inhaling on the easier part of the movement, exhaling on the harder part of the movement, or they are holding their breath on the easier part and exhaling on the hardest part of the movement, usually the concentric part of the movement, which for the deadlift is off the floor, for the squat is out of the hole. There are two kind of thoughts as to why you might want to do that. When we look at our breath and the pelvic floor, when we inhale, our pelvic floor relaxes slightly, slightly, and when we exhale, it contracts. And so people will kind of use this idea of this inhale breath, right? The chest is expanding, pelvic floor is going down. When you exhale, everything's kind of coming back, which when we're doing a pelvic floor contraction, our pelvic floor is going towards our head or it's going cranially. And when we are relaxing, it's going towards our tail, aka our tailbone, it's going towards our butt. I do not believe that this exhale is kicking the pelvic floor on extra by by marrying our breath to what our pelvic floor is doing. My belief is that when you exhale, you are essentially like taking air out of an overfilled balloon, right? We know that there's a big difference in interabdominal pressure in from free breathing to Valsalva of like two to three X. And so you are manipulating that relationship when you are changing your breath strategy as you are lifting, right? So I believe it's more that you're bringing pressure down rather than you're trying to kick the pelvic floor on more with your breath. That's

Why Lifters Leak And Feel Heaviness

SPEAKER_00 11:20

just my belief system. We still have a lot of research to do there. Okay, so that's kind of like bracing 101. Where the understanding of the pelvic floor has to come in is that what we see is that between 30 and 50 percent of our resistance-trained athletes have pelvic floor symptoms. That is usually peeing, especially with the squat and the deadlift, uh, and sometimes the clean, or feeling heaviness symptoms, symptoms that are often um kind of associated, like this bulging sensation that's associated with pelvic organ prolapse, or that that access and vaginal wall movement or range of motion that your body becomes very sensitive to. And then there's also this discussion around pain because you can have tightness in your pelvic floor, tightness in your hips, tightness in your low back, and that can that area of injury is more, I don't want to say more common because our rates of injury and resistance training are not in excess of other sports, but a common area where we see injuries in lifters is kind of low back hip, and then potentially the pelvic floor comes in there. For my male lifters, this is where hemorrhoids and hernias can come in, um, especially if if bracing is not done well. And so 30 to 50% is an absolutely massive number, right? With FIFA going on, uh, or with the the current, like, you know, everyone's kind of talking about soccer around FIFA. What we are talking about in the female side of things is around ACL injuries. I was like, the presence of pelvic floor dysfunction is even higher than our like differences sometimes when we think about, you know, our our other orthopedic injuries. And so this to me is very much a coaching issue in female athletics. And it's something that we have to be thinking about for us who are coaching athletes. And then, of course, rehab is gonna respond, right? That is okay. We want to do that, but ideally, I'm not having 50% of my lifters having some sort of incontinence or pelvic floor issue, right? Because it's embarrassing, it affects performance, all of these things. And so when we are thinking about that pelvic floor issue, to me, that that lends itself to there's something going on with our coaching. And so one of the cues that I see most commonly that leads to or precipitates leaking in my female athletes is they get told to inhale nice and big and bear down into their pelvis. And when they add a belt, they say to push out against their weightlifting belt. And what that does is it creates this excess pressure instead of like kind of this co-contraction. Sometimes we can have this leaking of pressure, pun intended. Um, and it hits a point where now our pelvic floor can't close our holes and we're starting to fart or pee when we don't want to be. And so when we have that going on, right, what is happening? The question has become like, what is happening at the pelvic floor? What do we see is happening in the pelvic floor before and after lifting? And this question, this big question has been like, what is the relative risk for our female athletes? Because we

What Changes After Hard Effort

SPEAKER_00 14:50

know that female athletes have higher rates of pelvic floor issues than our general population does. Right. And so I had done a uh reel and I did a substack actually that was looking at morphology changes to the pelvic floor before and after running. And what we saw was that the bladder neck was lower and the opening of the vagina was slightly larger in our runners pre- to post run. When I start talking about these morphology changes, it's very easy for us to get concerned about these, right? But if you want to rep max your squat and then you try and retest the strength in your legs, what you're gonna notice is that your quad is tired. And so your quad isn't going to look the same pre-to-post run. And, you know, that's not necessarily, or pre to post lift rather, that's not necessarily a bad thing. Understanding what that physiology is gives us an idea of what could be happening when people do have pelvic floor issues. We have to know what's a normal pre-post change. So then we can go into clinical populations of those who are having pelvic floor issues and see if there's a difference in that cohort. And so that's kind of what Linda McLean's lab in Ottawa has been doing with running and seeing the difference in those with stress urinary incontinence with runners and those without. And they've shown that those with stress urinary incontinence have a lower pre-run position of their bladder neck. So that there should be, or there could be rather some anatomy shifts in our incontinent runners versus not. And then that led them to this intervention trial that they're doing with pessaries, which is cool, right? That's kind of what we're hoping to see happening in the pelvic floor space with our lifters. And so Lori Fourner and colleagues started this initiation so that we could start to have some of this discussion. When it comes to pelvic floor changes, what we also have to take into account is confounding variables. What I mean by that is that the pelvic floor of somebody who has never been pregnant and particularly never given birth vaginally is going to be different than someone who is Paris, who has given birth in the past. So we have some like preliminary data that was looking at muscular strength out of Kari Bow's lab, I believe, in Christine Scoggs. Don't quote me on the authors. I'm just trying to pull that off the top of my head, but that was looking at niliparus, never given birth groups and showed that their muscular strength didn't really change pre to post lift. Lori's group, Dr. Fourner's group, was looking at Paris women. So those who feel comfortable in resistance training are resistance training, and they did a five by five at 80% squat paradigm looking pre-to-post. And they did some strength measurement, um, but they also did real-time ultrasound to look at changes or shifts in anatomy that may have been present. This was not in a symptomatic group. This was very much

New 5x5 Study On Pelvic Support

SPEAKER_00 18:10

exploratory so that we have an idea of what our understanding of the physiology of lifting is. And so, in this, what she saw was that there was no drastic change in pelvic support. So, this idea around having lower or an increase in range of motion of the vaginal walls pre to post-lift was not supported on our averages in this small pilot study. Great news. Most of her variables were the same pre-to-lifting. There was a couple of things that she noticed that was a little bit different from pre-deposed that did hit statistical significance. One being the opening of the vagina was slightly larger post-lift, and two, the position of the bladder neck on a pelvic floor contraction was slightly lower. So showing that our body did some exertional type of exercise. With that response, it is almost the same. Or it is starting to show parallels to what we are seeing in the running space that our anatomy shows signs of effortful movement. And that in and of itself, like I said, when we compare it to the quad under a heavy squat, is not a bad thing. It is not.

Testing Coordination In Pelvic Exams

SPEAKER_00 22:00

About bracing. And this is gonna go into like evaluation and stuff like that. When I evaluate somebody for pelvic floor dysfunction, and we teach this in our pelvic courses through the Institute of Clinical Excellence, we have taken a very functional lens to pelvic floor assessment. Okay. So I get you to contract your pelvic floor, I get you to bear down and try and push on a relaxed pelvic floor. And what that does is essentially gives me like your vagina's range of motion, right? Similar to me asking you to flex your elbow and extend your elbow to see how much your elbow moves. I'm essentially trying to do the same thing with your vagina. And then I'm gonna ask you to brace. And what I can see in some of my symptomatic lifters is that their brace and their relaxed bear down can look the same. And how we conceptualize this is that there's a coordination issue. So instead of this nice strong co-contraction of our pelvic floor that's being distributed all around the core canister evenly, we're having extra pressure going down into our pelvis. That our pelvic floor is trying to maintain closed holes against. And then sometimes it can't. And so if your brace and your bear down looks the same, it usually triggers me that there's some sort of change or will work on your coordination with your bracing. What that can help with, right, is to keep your pelvic floor having as much support as it needs to meet the demand of the task we are trying to do. And so in Lori's study, this is the five by five squat. With that, right, now if we're doing this brace well, then we're probably not putting extra strain on our vaginal walls and we may not, or we may be less likely to see that difference between pre and post. And so what I would be super fascinated to do is to see what that coordination looked like on those people with the biggest pre-post differences, and to see if that coordination was off in those humans and was not there, was not a big change, or they didn't look the same. The brace and beardums didn't look the same in the people that didn't have a change in movement. That study by Lori and colleagues gives us a great first step. And now where I'm hoping that we're gonna go is into a bit more intervention work. We've done a lot around describing pelvic floor dysfunction, what is happening, et cetera, in our resistance training populations. And now we have to kind of go into intervention. Just to kind of like as a side to that, I know it can be really frustrating if you're looking at the research, being like, okay, now what do we do about it? Like, why don't we have these studies? Getting funding for this type of interventional study is hard, right? We're in a place where it's difficult to get funding in women's health in general. But then also like these studies are way more expensive than you think. There's a lot more equipment that's involved. You know, like there's just it is more, it's more in-depth than we think. And then it takes a long time, right? Like if you think about a study from getting the funding to finishing it is like two or three years, plus it can take an extra six to eight months to get it published. The timelines are just so much longer than you think. And so being in research has given me a newfound understanding for just how long it can take. And then if you're working with moms who are early postpartum, postpartum's hard, being able to commit to a research study is harder. And so, recruitment, like you know, there's just so many things that are involved. When

Weightlifting Belts And Postpartum Timing

SPEAKER_00 26:00

we are now thinking about our weightlifting belt, right? And we're kind of adding in this final layer. I am very pro-weightlifting belt. I am looking for what the size and look of your weightlifting belt is and how you are using it. Okay. So, my bias is that your weightlifting belt should be the same size all the way around. You shouldn't have a bigger back pad and a more narrow front because I want even distribution of that support around your entire body. Your weightlifting belt should about come to approximating or touching the each side. So you don't want it too big, you don't want there to be too much overlap. And I teach tightening the weightlifting belt on an exhale. So I tighten it, it should feel tight. And then when you take that big inhale breath, you'll really feel the support of the belt against your sides. Then your brace should not change, right? And what other areas are you gonna? So if I didn't have a weightlifting belt, that would be like me warming up with a brace one way, and then on my heaviest deadlift, suddenly changing it. My warmups and my heaviest sets, my warmup is leading me to my heavier set. I shouldn't be changing my strategy. So when you add a weightlifting belt, I don't want you to change your strategy. Tighten on an exhale, big inhale breath, brace the exact same way. With that, when you use your weightlifting belt, it should not be a crutch, right? I see this so often postpartum, where women feel like their middle doesn't feel as strong as it did before. And so they use a weightlifting belt early. Uh-uh. Not in my books, right? In my books, you have to earn that weightlifting belt. And you can't skip the foundations of re-strengthening and re-coordinating your abdominal wall in the postpartum period. In my cross-sectional research study, we asked people when they returned to holding their breath and bracing and using their weightlifting belt. And for them, on average, it was four and a half to five months for holding their breath and lifting, and about five and a half to six months for using their weightlifting belt on a standard progression postpartum. That really makes a lot of sense to me. So that kind of is information. Some people are gonna be faster, some people are gonna be slower, some people aren't aren't gonna want to use their weightlifting belts anymore. But just to give kind of some buoys for you around when you're kind of returning to that type of um of bracing. And so adding in that weightlifting belt, then once you've earned it, at 80% of your lifts are in your heaviest sets, is usually when I use it. I had a um coach say something to me though that was really interesting, and I haven't really noodled on it, that there's also a line of thought in powerlifting to use it a bit earlier so you don't fatigue your midline for your heavier sets. I'm gonna have to noodle on that a little bit. I feel like that would be very niche to my very elite level athletes, and I wouldn't apply it to everyone, but it is something interesting to think about if you want to leverage it early. I don't know. Um, I love that, you know, people challenge me and makes me kind of uh noodle on different lines of thinking. But the the big point though is don't use it as a crutch, right? We want to to build resiliency, make sure our brace is solid, and then use it as a performance aid rather than um a crutch

Key Takeaways And Closing

SPEAKER_00 29:50

that we're we're leveraging too much and too often. All right. I hope you found that helpful. Totally did a very big overarching overview on bracing. If you have any questions, please let me know. Otherwise, we will see you all next week.