By Natalie Grant, PTA

In the second blog in the Unsolved Mysteries Series, we learned that the nature of dance itself can create rather “choppy waters” for the pelvic floor, our Atlantis deep within all of us, yet undetected and mysterious to many (check out the first blog in the series for a little more context). The diverse physicality required of an artistic athlete alone can create the “perfect storm” to have dysfunction here – not to mention the myriad of mental, cultural, and emotional influences ever present in dance. We’ve also discovered through this series that if a dancer is experiencing symptoms possibly pointing towards pelvic floor dysfunction, hypertonicity is the common culprit... 

*A quick recap on hypertonicity*

A hypertonic pelvic floor is a strange combination of being “tight yet weak.” Range of motion is limited by hypertonic states in that a muscle at rest has excess tone and essentially exists in a constant semi-contracted state. With a loss in range of motion comes a loss in power, or force production. If we think of a rubberband that is too tight, too rigid, and cannot get stretched enough, we understand it cannot be slingshot across the room. In other words, the rubberband here cannot build enough potential energy (stored energy) to then produce kinetic energy (energy of motion). It is tight yes, but it is also weak in that it cannot produce force. Same goes for the pelvic floor! To have the strength to resist gravity, endure petite allegro, or control leakages, it needs a healthy elastic relationship. 

How might hypertonicity show up in the body? Here are some of the common symptoms to be on the lookout for: 

• Incontinence (bladder or bowel leakage, even gas!) 

  • This can be due to urgency, “stress” like coughing jumping (allegro!) or laughing; functional (are you not allowed to take restroom breaks until class is over but you’ve been needing to go since tendus at barre?), or some combination of these. 

• Urgency or frequency   

• Pelvic or tailbone pain 

  • Can feel deep inside and/or can be difficult to localize or describe 

• Persistent hip or back pain 

  • The pelvic floor can refer to surrounding areas, as well as share structures with surrounding areas (remember obturator internus? That muscle in the hip and part of the pelvic wall?)  

• Pain with intercourse 

  • Or problems like difficulty achieving orgasm 

• Pain during gynecological exams 

• Difficulty using a tampon or period cup for folks with a vulva 

• Constipation (fecal, urinary, or again even gas!) 

  • Or just difficulty to start emptying 

Do any of the above resonate with you? What about several? It is common to live with multiple symptoms at once. While there are many reasons for this, one of the most prevalent is that these issues can feel awkward, embarrassing, or even shameful to discuss; and thus people don’t. 

BUT! Pelvic floor dysfunction is extremely common. Research published in the International Urogynecology Journal studied elite AFAB (assigned female at birth) athletes in eight different sports, including ballet. They found that 43% of ballet dancers experienced urinary leakage! With that number, you’d think this would be much more of a hot topic in the dance community… 

So, what can you do for yourself if you…

1) believe you might have a hypertonic pelvic floor? And/or 2) you’re hoping to prevent dysfunction knowing just how much dancers are prone to dysfunction here? Essentially, anything that helps you relax, lengthen, and reduce stress:  

• Spend time in positions that encourage pelvic floor relaxation & elongation  

  • Happy baby pose, deep yoga squat, child’s pose 

• Deep intentional breathing

  • This requires relaxing your abdomen and allowing movement into your belly and entire rib cage 

  • Pair this with the positions above! 

• Relax your abdomen 

  • Worth repeating, it gets its own bullet point ;) 

• Meditation, mindfulness, and/or stress management 

  • Truly anything to help you calm your nervous system and quiet the mind – research has shown that mindfulness or meditation has a positive effect on urinary urgency and pain. 

• Incorporate neutral/parallel positions into your daily life 

  • If your dance style’s primary residence lives in turnout, try spending time in non-rotated positions outside of the dance studio. This means walking in parallel, using stairs in parallel, cross-training in parallel (yoga or weight training for example), standing in parallel, etc. 

  • Go even further, literally, by performing internal rotation exercises to truly balance yourself out. 

If your symptoms change or worsen, if you feel like “finding Atlantis” is just not happening for you, or if you want professional insight, reach out to a pelvic health PT team! Dr. Brianna Durand, PT, DPT and Natalie Grant, PTA of Empower Physiotherapy are both pelvic health certified PT professionals. You can also check out this video here from our YouTube Channel to learn a little bit about what a pelvic floor PT session with us might look like. 

For the sake of long careers and happy humans, ensure that your pelvic floor is as resilient as you are in all that you do! 

Are you a dancer or dance professional with a pelvic floor? 
*cough* yes, everybody and every body has one ;)

Are you a PT Professional, pelvic health speciality or not, treating artistic athletes?  

Just curious?

GREAT! 

Keep an eye out for future blogs, share with your  friends and colleagues, and give us a visit! Book an appointment here. 

References

Adelstein, S.A., Lee, U.J. The Role of Mindfulness in Urinary Urgency Symptoms. Curr Bladder Dysfunct Rep 11, 38–44 (2016). https://doi.org/10.1007/s11884-016-0348-5 

Thyssen, H., Clevin, L., Olesen, S. et al. Urinary Incontinence in Elite Female Athletes and Dancers . Int Urogynecol J 13, 15–17 (2002). https://doi.org/10.1007/s001920200003