Why Sports Physical Therapists Should Add Pelvic Health to Their Clinical Toolbox

Sports physical therapists are experts in athletic movement.

We analyze biomechanics, optimize performance, guide return to sport, and help athletes recover from injury. We understand that efficient movement depends on strength, coordination, mobility, and the seamless integration of multiple body systems.

So why should the pelvic floor be any different?

The pelvic floor is an important component of the athletic movement system, yet pelvic floor symptoms and dysfunction may be overlooked in sports rehabilitation.¹⁻³ By developing foundational pelvic health knowledge, sports physical therapists can better evaluate the whole athlete, improve clinical decision-making, and identify issues that may otherwise affect participation, comfort, training, or recovery.

The Pelvic Floor Is an Athletic Muscle Group

The pelvic floor is more than a group of muscles responsible for bladder and bowel control.

The pelvic floor functions in coordination with the diaphragm and abdominal and trunk musculature and contributes to continence, intra-abdominal pressure regulation, and lumbopelvic control.¹ During athletic activities such as running, jumping, and lifting, pelvic floor demands change in response to the forces and increases in intra-abdominal pressure associated with exercise.¹

Like any other muscle group, pelvic floor muscles can demonstrate weakness, altered activation or coordination, increased activity, or pain.

For the sports physical therapist, understanding pelvic floor function provides another component to consider when evaluating the athlete as a whole.

Many Athletes Experience Pelvic Health Symptoms

Pelvic floor symptoms are common in athletic populations. Research has identified urinary incontinence and other pelvic floor symptoms across a variety of sports, with urinary incontinence particularly well documented among female athletes.²⁻⁵

Athletes may experience:

• Urinary leakage during running, jumping, or lifting

• Pelvic pressure or heaviness

• Pelvic or perineal pain

• Tailbone pain

• Abdominal wall dysfunction

• Difficulty coordinating breathing and intra-abdominal pressure during activity

• Postpartum challenges returning to sport

Pelvic floor symptoms are not exclusive to one sport, competitive level, age, or gender. Recent research among elite youth track and field athletes found pelvic floor dysfunction symptoms in both female and male athletes.⁵

Importantly, these symptoms may remain undisclosed in athletic settings. In a study of 325 athletes participating in the 2024 World Athletics U20 Championships, 43.7% reported at least one pelvic floor dysfunction symptom, including 53.7% of female athletes and 29.3% of male athletes. Only 29.2% reported awareness of pelvic floor health, 88% had never undergone pelvic floor screening, and most athletes experiencing symptoms had neither disclosed them nor sought specialized care.⁵

A few thoughtful screening questions may therefore uncover clinically relevant information that would otherwise not become part of the sports rehabilitation evaluation.¹^,⁵

Pelvic Health Isn't Just for Bladder Leakage

One of the biggest misconceptions about pelvic health physical therapy is that it primarily serves pregnant and postpartum individuals.

While these populations are important, sports physical therapists routinely encounter active individuals who may experience pelvic floor symptoms, including athletes participating in running, weightlifting, gymnastics, dance, cycling, swimming, and field and court sports.²⁻⁵

Pelvic health knowledge may also be relevant across different stages of an athlete's life—from adolescent and young adult athletes through pregnancy and postpartum recovery to masters athletes maintaining lifelong physical activity.

Understanding pelvic health principles can therefore enhance a sports physical therapist's ability to recognize pelvic floor concerns across the lifespan and determine when intervention or referral may be appropriate.

When Progress Plateaus, Consider the Pelvic Floor

Sports clinicians often encounter athletes who have completed strengthening programs, mobility work, and progressive loading but continue to struggle with symptoms.

Perhaps the runner still leaks despite improving hip strength.

The athlete experiences urinary leakage during heavy lifting.

The athlete has pelvic or perineal symptoms that interfere with training.

The postpartum runner cannot comfortably return to impact training.

The answer isn't always another exercise.

For some athletes, considering pelvic floor symptoms and function may identify an additional factor relevant to rehabilitation. Pelvic floor muscle training has demonstrated benefit for urinary incontinence in female athletes, although the available evidence remains limited and continued research is needed.⁶

Better Clinical Reasoning Leads to Better Outcomes

Learning pelvic health doesn't simply expand your treatment options—it can broaden your clinical reasoning.

Pelvic health education provides an opportunity to develop a deeper understanding of:

• Lumbopelvic function

• Regional interdependence

• Breathing strategies

• Intra-abdominal pressure management

• Neuromuscular coordination

• Pelvic health considerations during return to sport

• Communication about sensitive health concerns

• Screening and appropriate referral

These concepts complement many of the skills sports physical therapists already use every day.

Postpartum return to sport provides a particularly good example. International consensus recommendations emphasize individualized assessment and progression when returning to running after childbirth, including consideration of pelvic health symptoms, musculoskeletal symptoms, exercise history, physical capacity, and other biopsychosocial factors.⁷^,⁸

Expand the Care You Can Provide

Athletes benefit from clinicians who understand the demands of sport while addressing the whole person.

Adding pelvic health knowledge allows sports physical therapists to:

• Screen for pelvic floor symptoms that may otherwise go unrecognized¹^,⁵

• Recognize when pelvic health concerns warrant additional assessment or referral

• Integrate relevant pelvic health principles into rehabilitation

• Improve interdisciplinary collaboration with sports medicine physicians, orthopedic surgeons, urogynecologists, urologists, and other healthcare professionals

• Expand services for athletes across the lifespan

For many clinicians, pelvic health knowledge can become another valuable component of sports rehabilitation—not necessarily a separate specialty.

You Don't Have to Change Your Practice—Just Expand It

Adding pelvic health doesn't mean you must immediately build a dedicated pelvic health clinic.

Many sports physical therapists can begin by learning how to:

• Screen for pelvic health symptoms¹

• Recognize when referral or more specialized pelvic floor assessment is appropriate

• Provide comprehensive, multidisciplinary care of the athlete with ongoing surveillance for pelvic floor disorders¹

• Incorporate breathing and pressure-management principles into rehabilitation

• Understand pelvic floor considerations during athletic movement

• Build confidence discussing topics athletes may otherwise never mention

As knowledge and experience grow, clinicians may choose to expand their pelvic health skill set even further.

Invest in Your Athletes—and Yourself

The future of sports rehabilitation increasingly emphasizes whole-person care.

Athletes deserve clinicians who recognize the multiple factors that may influence participation, performance, injury recovery, and return to sport—including pelvic health concerns.

By expanding your pelvic health knowledge, you can strengthen clinical reasoning, broaden your treatment options, and better serve athletes striving to return to the activities they love.

Ready to Expand Your Practice?

Whether you're interested in helping runners manage urinary leakage, supporting postpartum athletes returning to competition, understanding pressure management during strength training, or providing more comprehensive care for athletes with lumbopelvic concerns, pelvic health education provides evidence-informed knowledge that complements your existing sports physical therapy expertise.

The pelvic floor isn't separate from the rest of the movement system. Understanding its function—and knowing when to screen, intervene, or refer—can help sports physical therapists provide more comprehensive care for the athletes they treat.

References

1. Giagio S. Surveillance, screening, and athlete profiling for pelvic floor dysfunction. In: Donnelly GM, ed. Sports Medicine and the Pelvic Floor: Science to Practice. Elsevier; 2026:151-165. doi:10.1016/B978-0-443-32986-9.00020-5

2. Pires T, Pires P, Moreira H, Viana R. Prevalence of Urinary Incontinence in High-Impact Sport Athletes: A Systematic Review and Meta-Analysis. J Hum Kinet. 2020;73:279-288. Published 2020 Jul 21. doi:10.2478/hukin-2020-0008 

3. Rodríguez-López ES, Calvo-Moreno SO, Basas-García Á, Gutiérrez-Ortega F, Guodemar-Pérez J, Acevedo-Gómez MB. Prevalence of urinary incontinence among elite athletes of both sexes. J Sci Med Sport. 2021;24(4):338-344. doi:10.1016/j.jsams.2020.09.017 

4. Teixeira RV, Colla C, Sbruzzi G, Mallmann A, Paiva LL. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J. 2018;29(12):1717-1725. doi:10.1007/s00192-018-3651-1 

5. Giagio S, Adami PE, Bermon S, et al. Nearly half of 325 athletes reported pelvic floor symptoms: a cross-sectional study at the Lima 2024 World Athletics U20 Championships. BMJ Open Sport Exerc Med. 2025;11(3):e002564. Published 2025 Jul 25. doi:10.1136/bmjsem-2025-002564 

6. Demeco A, Bartocci G, Astore N, et al. The efficacy of pelvic floor rehabilitation in the treatment of urinary incontinence in female athletes: a systematic review. Sports (Basel). 2024;12(12):338. doi:10.3390/sports12120338.

7. Christopher SM, Donnelly G, Brockwell E, et al. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. Br J Sports Med. 2024;58(6):299-312. Published 2024 Mar 13. doi:10.1136/bjsports-2023-107489 

8. Deering RE, Donnelly GM, Brockwell E, et al. Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. Br J Sports Med. 2024;58(4):183-195. doi:10.1136/bjsports-2023-107490.