Guest blog By Dr. Carrie Pagliano DPT, OCS, WCS
Have you ever had the feeling someone is hiding something from you? It’s happened to me several times now, so I know it’s not a fluke.
You see, I’m a pelvic health physical therapist — yep, the kind that helps you when you have abdominal separation after pregnancy, when you experience pain during sex, and when you have urinary or bowel incontinence. Patients confide in me, sharing things they wouldn’t tell their closest family and friends, so you can imagine my confusion when I realized some patients were hiding something from me.
I can say with certainty that some of my patients have been afraid to tell me they do CrossFit. Once they’ve finally told me, what has happened next has usually been the most surprising — my confession to them.
Yes, I’m a CrossFitter, too.
Typically, they respond with a sigh of relief that seems to say, “Thank goodness. I thought you were going to tell me to stop and take my happiness away, and I don’t know what I would do without it.” After that conversation, we move on with a bit more ease to discussing urine leakage when doing double-unders or box jumps or when running.
Are Physical Therapists Really Against CrossFit?
No. Absolutely not. Where did this idea that physical therapists don’t like CrossFit originate? A little history is warranted here — and full disclosure, there was a time that I wasn’t a fan, probably around 2013 when this video about how “normal” it is to pee during workouts came out and went viral in my field.
In the video, an athlete interviewed at a CrossFit event introduced her gynecologist (also a CrossFitter) who declared it was OK to pee yourself during workouts. Of course, this set off a collective groan across the pelvic physical therapy community. Today there is much more understanding on both sides, training and physical therapy. However, the stigma is still there. Why? It comes down to something to which we can all connect: fear. We fear what we don’t understand.
I get the fear part. I’ve been an athlete all my life — running, nordic skiing, swimming, yoga, pilates, and yes, some weight training at one point, too. I have two kids, ages four and six, and I’ve needed to adjust my exercise habits and time management accordingly (a polite way of saying that my kids rule the roost).
I was intimidated by the idea of going into a gym full of massive weights and what I imagined would be a group of “muscle heads” blaring music, throwing around terms I didn’t understand like metcon and WOD, and flailing at the bar (my understanding of kipping at the time). However, the happy, quiet zen of my runs and mommy-baby yoga were not helping me get my body and mind where I wanted them to be.
If I stepped foot into the CrossFit box would that mean that I accepted leakage as the norm? Would my pregnancy souvenirs (diastasis recti, a few pelvic floor issues, and pain from a hip surgery) keep me from being able to do anything? Did I belong there?
To my surprise, this strange place meshed well with what I knew as a physical therapist.
As a mom, I am not broken, and there’s a lot I can do. Movement is scalable. The body craves adding load intentionally.
Now, when I walk into my local CrossFit box, my gym friends are there — moms and dads from my neighborhood, their kids in the childcare area — and we chat about the day’s workout and how each of us is going to scale for that day. The music is still blaring but there’s no fear, just promise.
As a mom, a physical therapist, and a CrossFitter, here’s some of what I’ve learned and share with my patients.
Find a Good Coach That You Trust
My shift away from fear came only with the help of well-trained, intuitive coaches who met me where I was and who continue to guide me safely through the journey. I trust that they understand what’s going on with me, that they will not put me in harm’s way knowingly, and that they are willing to work with me in the context of what I can do right now while I work toward what I want to be able to do.
If your car is leaking oil, you take it to the mechanic. If your body is leaking urine during jumps, get checked out. The most beautiful thing about CrossFit is that scaling movement is a normal part of the culture. Just because you leak now doesn’t mean CrossFit is over for you. It means that it’s time for your coach to assess your form and your breathing and work with you to identify where the breakdown is. If you can’t figure it out, it may be time to expand your movement team to include a pelvic health physical therapist familiar with CrossFit. All states in the U.S. (and some other countries) have some form of direct access, meaning you can seek care from a physical therapist without having to see a physician first.
Knowledge Is Power (So Is Understanding)
There can be a lot of reasons for Stress Urinary Incontinence (leaking urine when you lift, jump, bend, and so forth). Fortunately, we’re in a time when most clinicians, trainers and athletes understand that the solution doesn’t always lie in doing Kegels or strengthening alone. Someone with overactive pelvic floor muscles (as a result of birth trauma or sub-optimal movement strategies, for example) may have difficulty coordinating muscle activation and relaxation strategy well enough to counteract increased abdominal pressure occurring with these activities. In many cases, looking at technique, breath, and movement strategies and retraining pelvic floor muscle relaxation can result in reduction or elimination of urine leaks with activity.
Get Help From Someone Who Supports and Understands What You Want to Do
As much as it pains me to say, not every coach will tell you that leaking should be addressed and not every physical therapist will be able to help you scale your double unders instead of advising you to stop CrossFit. That said, spend a little time doing research to find a coach or physical therapist whose approach aligns with you as an athlete and patient. If you leak, something needs to be addressed. Not all leaks can be “fixed” with physical therapy or coaching, but in most cases, the right care team can help you make improvements.
Back in 2013, when the infamous “pee during workouts” video went viral, there weren’t many options and most medical professionals weren’t willing to talk about how to treat urinary leakage without taking someone completely out of their workout. Five years later, it’s time to move on.
Wouldn’t it be so much nicer if we could move fear aside, communicate more openly, and work together to find a solution that doesn’t take us away from the movement that our bodies and minds want?
Connect with a coach who acknowledges that leakage is common but not normal. Make an appointment with a physical therapist who can help you find the underlying cause of your leakage, and work with them both to scale your training toward what you want to be able to do while respecting what you can do right now.
No more “true confessions” on either side. Let’s just get back to our workouts!
Note from GGS: To find a pelvic health physical therapist in your area, search one of the following websites.
If nothing comes up in your area, a general Internet search using one of the following terms: pelvic health, pelvic floor, women’s health physical therapist, or women’s health physiotherapist and the name of the city will provide some leads. In the U.S. use the term physical therapist. Outside of the U.S., use the term physiotherapist.
About The Author: Dr. Carrie Pagliano
Dr. Carrie Pagliano is one of Lauren’s super talented, physical therapy school classmates. She has agreed to let us share her blog to give hope to all those Cross Fit women out there. Hope you enjoyed her insight!
Dr. Carrie Pagliano has been a women’s health physical therapist for nearly 20 years. She lectures nationally in the areas of pre-natal and postpartum health, pelvic pain and women’s health education. She is double board certified in Orthopaedics and Women’s Health. Dr. Pagliano is President of the Section on Women’s Health of the American Physical Therapy Association and owner of Carrie Pagliano PT, LLC, a concierge women’s health physical therapy practice in Arlington, VA. She is an active wife, mom of two, runner, yogi & CrossFitter. You can follow Dr. Pagliano on Twitter and Instagram.