If you are wanting to lift weights and have pelvic organ prolapse, you may have come across discussions about breathing. Here is a short blog about 4 different breathing strategies and when to use them.
But first, here’s a little bit about why we start with the breath. As you can see below, from the image by Burrell Education the importance of the relationship between the diaphragm (breathing muscle) and the pelvic floor.
Breathing Strategy #1 - No change to breathing
Not changing your breathing strategy is itself a breathing strategy! For many tasks, particularly those happening on autopilot, you don’t need any change to your breathing strategy. For example, lifting something light, grabbing your car keys from the side, walking up the stairs.
The pelvic floor has a reflexive and anticipatory response and at light loads, it activates without needing prompting.
Breathing strategy #2 - Exhale before or on exertion
This is probably the most common breathing strategy when it comes to pelvic health. In its simplest form, it’s an exhale (sometimes alongside a voluntary contraction of the pelvic floor) just before, or on the hardest part of a movement. In lifting terms, the exhale would happen just before or timed to coordinate with lifting at weight.
One of the aims of rehab is to elicit an automatic response from the pelvic floor. Without the need for a voluntary lift of the pelvic floor muscles. So, once you are able to elicit this pelvic floor response via your exhale, there is less need to activate the pelvic floor. However, at heavier loads, activation may still be useful and perhaps protective for the pelvic floor.
Breathing Strategy #3 Breath hold with exhale to let off pressure
For heavier loads, where there is more intra-abdominal pressure created, and where there is more need for stifness (to be able to lift). I like to cue an inhale into the ribs or lats (versus cueing a brace which often directs pressure downwards), a short exhale (as if to let off a bit of pressure), maintain this as a breath hold for the lift, and then the rest of the exhale as you come out of the lift. This may feel like it has many component parts but is a great tool for female lifters and once mastered is super useful to manage heaier loads.
Breathing strategy #4 Bracing (without bearing down)
At max lifts (or for competitive female lifters during competitions) bracing can be useful. The aim of ‘bracing’ is to protect the spine under very heavy loads.
It is often cued as a pushing out of the stomach and then flexing stomach in whilst you press against your abdominal wall. Whilst I don’t often cue bracing in this way, for female lifters, I would replace the cues around stomach to the lats or ribs, which would help bring pressure away from the pelvic floor.
3 final considerations for lifting with prolapse
- Utilise the breathing strategy that best meets both the load and your own ability/function e.g. a light load for one person may feel heavy for another
- The pelvic floor needs to be able to meet the demands placed upon it so consider some pelvic floor muscle training as part of your training programme. This isn’t just about strength but coordination and responsiveness.
- Avoid bearing down (or other habits such as sucking in tummy or always contracting the pelvic floor) and generating more pressure downwards. This may mean lifting some lighter loads and then progressing into heavier loads once you’ve perfected your breathing (not bearing down) strategy.