When the Pittsburgh Pirates finally broke through their 21 year losing streak and made the playoffs, I used this expression. 

"I'm so excited I peed a little."

When I deadlifted a personal best 275lbs last December, I was only half-kidding....

In 2013 there was a video made during the Crossfit Games asking women whether or not they pee themselves during workouts. In fact, at the beginning of the video, which you can watch here, many women confess that they pee during a double under, which is a form of jumping rope. 

Dustienne Miller.

Pelvic floor dysfunction is far from funny, despite the jokes we make, usually to make ourselves feel better. It affects women of all ages, some of whom have had children and some who haven't. Jumping jacks have some women running to the bathroom and others who are just like...um...no. None of those for me thanks. I have to pee just watching you do those. 

In an effort to better understand what's really going on and what women can do about it, today's guest post comes from Dustienne Miller, a board certified women's health clinical specialist and yoga teacher based in Boston. Her physical therapy practice, Flourish Physical Therapy, emphasizes the importance and of pelvic and orthopedic wellness. 

KL: Thank you so much for shedding more light on this topic Dustienne. Let's start with the basics: what is pelvic floor dysfunction?

Dustienne: Hi Kim! This is a great question and thank you for bringing attention to this topic. A lot of women I work with believe that leaking during workouts is normal, especially after having a baby. While this is a common experience, it is not normal. It is a sign that the core is compromised.

Our bodies are wildly complex with hormones, menstrual periods, pregnancies, and deliveries. Tack on to that a prior hip or back injury and the body has to work even harder to stabilize the pelvis.

No woman should feel ashamed for leaking during workouts. If she is comfortable wearing a pantyliner, that’s fine, but there is another option: to rehabilitate and feel more in control.

KL: What causes it?

Dustienne: We look at the core as a canister where all walls must activate for optimal stability. The human “canister” is made up of the:

• abdominal wall

• diaphragm (even up to the vocal cords)

• multifidi (deep segmental back stabilizers)

• pelvic floor 

Leakage occurs when the physical demand of the exercise or activity is more than the system can handle. Some common symptoms of compromised stability are:

• If you lose support in the abdominal wall, you might have a diastasis recti.

• If you lose support in the back, a disc herniation may occur.

• If you lose support in the pelvic floor, you might experience urinary leakage or pelvic organ prolapse. 
   

A simple way to practice supporting the pelvic organs is lifting the pelvic floor muscles up and in while sneezing, coughing, and lifting. This movement is referred to as a kegal exercise. Pelvic floor muscle contractions are enhanced when coordinating with the breath as explained in this video about pelvic floor movement with the breath. When performing a squat, inhale on the descent. As you push through your feet, legs, and glutes to come back upright, exhale and pull your lower abdomen and pelvic floor muscles in towards the spine. This same principle can be applied to lifting grocery bags and children.

Kim: Are there specific exercises you can do to help prevent the leakage? We tend to use PRI drills at Spurling, such as the one below. We try not to do them with the full foam roller like I did in this video though, because that just looks awkward: 

This is a very brief explanation of a version of the 90/90 hip lift; concentrate on full inhales and full exhales doing five breaths.

Dustienne: Doing breath work in different positions, like the 90/90 Hip Lifts, are great. Once you understand the concept of coordinating your breath using your pelvic floor, you can integrate it into your workouts and you'll strengthen your pelvic floor as you strengthen your other muscles. 

Any exercise that strengthens the hip external rotators also strengthens your pelvic floor via the obturator internus muscle. The clamshell exercise is one example. 

Lay on your right side with your knees bent. Engage your lower abdomen. Keep your trunk and pelvis still as you lift your left knee up towards the ceiling. Repeat 30 times and switch sides. For more load, loop a resistance band around the thighs.

Dustienne: Your core is key; fellow physical therapist Julie Wiebe has an informative post about strengthening your core. It's written for runners, but you don't need to be a runner to see it's benefits. 

(Note from KL: These posts I did on core exercises here and here might also come in handy.)

Lastly, yoga has proven to significantly reduce urinary incontinence. One study showed over a 50% reduction in leakage. Anyone looking for a yoga based pelvic floor strengthening program can check out my DVD on optimizing bladder control and strengthening your pelvic floor.  

KL: Is there anything in particular women can do during exercises such as jumping jacks or jump rope to help prevent this?

I look at core activation with lower load tasks to predict where someone is losing stability. 

For example, if someone demonstrates poor hip stability in one legged stance, they will have less stability as the load increases with jumping. 

Rather than trying to fix the problem during a high level activity, look at breaking the task down. Retrain motor programs so that the body automatically fires the deepest muscles of the core. You can start with single leg weight shifts and test your balance. If you demonstrate poor hip stability with your trunk leaning off to one side, there could be even less control as you increase the demand of jumping and running. 

KL: Where can women go to find more information?

Physical therapists with special training in pelvic health can offer individualized evaluation and care. We evaluate your spine, pelvic girdle, hips, pelvic floor…the whole system to make sure you are firing muscles optimally.

       You can find someone in your location here:

• APTA Women’s Health Section physical therapist locator

• Herman & Wallace practitioner directory

About our guest: Dustienne Miller is a board certified women’s health clinical specialist and yoga teacher based in Boston. Her physical therapy practice, Flourish Physical Therapy, emphasizes the importance of pelvic and orthopedic wellness. She is passionate about using yoga as a holistic treatment modality. Check out her blog at www.yourpaceyoga.com.

Last summer, I learned that in England, the time-frame leading up to the election of the Prime Minister is one month. 

One. Month. 

Without getting into politics, I think we can all agree that shortening the lead up to the Presidential Election by three years and 11 months would be awesome. 

I digress. The one think I dislike about as much as listening to political pundits and ads, is planking. 

The plank position (think push up position but with your forearms flat to the ground) is an often used core exercise, ideal for people of all fitness levels. 

And I'll tell you what, planking is about as much fun as sliding down a razor blade into a pit of salt. Because unfortunately, as useful as the exercise is to improve core strength, it can also be brutally boring. 

And when you get bored, you think about other things. And when you think about other things, you forget about form. And breathing. And when you forget about form and breathing, you hang on your lumbar spine (lower back) and eventually face plant in to the turf because you quit breathing 90 seconds ago. 

So in the interest of keeping your face and lower back happy, here are a couple of anterior core (front of your stomach) options that include the plank position, but with a little variety that might cut down on the boredom.

I won't say fun. That's overstating it. 

Or you can also try this variation, performed with sliders (or paper plates under your feet), and a couple of dumbbells. 

So how do you know if it's time to progress to one of these variations? If you are able to plank with good form (hips not too low, but not too high) for five breaths, then you're probably ready to add some variety to the exercise. 

Ok, I'm totally guilty of using this title for click bait, but if you clicked on it then, ohla! It worked. :)

Seriously though, whether your goal is performance based or fat loss motivated, the deadlift is one of the best all around compound movements you can add in to your training. 

If you've read my about me page or seen any of my social media posts, you'll know that I'm a hyoouuuuuuge fan of the deadlift. And I'll be totally honest, I love it because it came naturally to me. Which is why I openly boycott the bench press in my training, where I have yet to hit triple digits. 

This lift itself can feel very intimidating, especially when you see someone like this guy lifting 500 plus pounds. If you're not a bald-headed muscular dude, it can be hard to see yourself doing the same kind of lift.

So where do you start?

Well, first thing's first, shave your head. 

Kidding. I mean unless you want to. Then that's cool.

Second of all, start with a PVC pipe or broom handle of some sort. And then do this:

What are we doing here besides finding an additional use for a broom handle and/or light saber? We're introducing the hip hinge pattern, which basically means sitting back with minimal bending of the knee and then snapping forward, which is engaging the entire posterior chain. (Posterior chain is a fancy term for using all of the big muscles groups on the back of the body; hamstrings, glutes and lower back). 

The key to the deadlift is maintaining a neutral spine throughout the movement, but you have to have a context of what that looks like. I'll have a client do the above exercise for five or six reps before moving on to the actual deadlift itself. The key coaching cue for the exercise above is to maintain contact with the stick at the butt, upper back, and head. Initiate the movement by sitting back with your butt. Imagine someone has a rope tied to your waist and is pulling back. 

But what if I have back pain?

Chances are you have back pain because your glutes are weak and your hamstrings are tight. As Dean Somerset says "deadlifts train the spine to remain stable while exposed to stupidly high shear forces, thus making you Superman." I'd say Captain America, but tomato tomato.

As a side note, I'm always a little mystified when people say they don't want to deadlift or squat because they are afraid of injury, or their knees hurt or whatever. Every time you bend down to pick up a child, or air conditioner or bag of groceries, you are, in fact, dead lifting weight off of the ground. And every time you sit down on a chair, your bed, the toilet or your niece's "Frozen" big wheel cycle, you're squatting. Both the deadlift and the squat are patterns from your activities of daily living. Anywho, mini-rant over. 

Kettle bell deadlift

Almost everyone begins with the kettle bell deadlift, and I like this variation for a couple of reasons.

First of all, the kettle bells are more available than a trap bar. Second of all, the weight selection starts fairly light. This is a movement you don't want to load up until you have the technique down. Third of all, most gyms have a selection of kettle bells.

Key coaching cues:

1. Elevate the surface where you rest the kettle bell. In the video below I'm using a couple of plates. Use a step or whatever flat surface you have available to raise the surface a few inches, otherwise you'll find yourself squatting the movement, which is what we DON'T want.

2. Think of closing a door behind you with your butt - I heard this on a podcast somewhere and it works. Instead of just bending down to pick up the kettle bell, slide your butt back to close that door and grab the kettle bell.

3. Try to bend the handle of the kettle bell - Pretend your Superman and you're trying to actually bend the handle of kettle bell. Think of splitting a piece of wood in half with your bare hands. This engages the lats (that area under your arm pits and back).

4. Push your feet into the floor - Do it!

5. Squeeze your glutes at the top. Like trying to crack a walnut. You're welcome for that image. :-)

I haven't spent a ton of time encouraging comments below, but if you have any questions about exercises like these, or general nutrition questions, please post them below. 

Give this deadlift variation a try and let me know what you think.