When skipping postpartum (or otherwise), its normal to leak right? I just wear a pad and change my pants after the workout. I’m a Mum, it’s just what I have to deal with now.
Urinary incontinence or leaking pee (or even feeling a heaviness and like you need to go to the toilet) when you do double unders postpartum is very common – I’m talking one in three women who ever had a baby wet themselves but that does not mean it is normal.
This blog post will look at:
- What is “normal” pelvic floor function
- Working with a Women’s Health / Pelvic Health Physiotherapist – their role, cost and a self assessment checklist as to whether you could benefit from seeing one
- Coaching cues that can help with eliminating or decreasing any symptoms you may be experiencing when you double under
“Normal” pelvic floor function
The normal function of our pelvic floor muscles are to: “Give you the ability to control the release of urine (wee), faeces (poo) and flatus (wind) and to delay emptying until it is convenient.” – sourced from the Continence Foundation of Australia. Therefore, our pelvic floor muscles are not functioning as they should if we are losing our ability to control the release of urine when we double under (or in any other movement). There could be a number of reasons as to why you may be experiencing urinary incontinence. Sometimes if the symptom is just happening in specific movements it can be as simple as changing your positioning, tension in the movement and sometimes it just isn’t that simple. In most cases, by working with both an experienced Coach and a Women’s Health Physio, together you can tackle your approach to double unders (and any other movement that you may be experiencing urinary incontinence with) to work towards doing these with little to no symptoms.
What is a Women’s Health / Pelvic Health Physiotherapist
The role of a Women’s Health Physiotherapist (WHP) or a Pelvic Floor Physical Therapist (PFPT) has expanded over time to a rather broad scope but originally focused on the pelvis and pelvic floor. The scope of practice has now increased to include all health concerns of women surrounding incontinence, pelvic or vaginal pain, prenatal and postpartum pain, osteoporosis, rehabilitation following breast surgery, lymphedema, education prevention, wellness and exercise. All females across the life span, from the young athlete, the childbearing woman, the menopausal and elderly woman receive benefit from physical therapy.
Choosing your Women’s Health / Pelvic Health Physiotherapist
Just like a Doctor or a midwife, you want someone that you can gel with. Ideally, you want to find a Women’s Health Physio that understands the demands of your life and your chosen area/s of athleticism. You want someone that watches how you move and helps you to find strategies to keep you doing what you love, rather than just restricting you. It is also important that your physio understands not just the biomechanics behind your symptoms but also the other factors that can impact your symptoms. To do that they need to understand who you are and what you want to do. Your session/s should leave you feeling heard and understood, empowered and confident that you are working with someone who respects your values, priorities and ultimately, your autonomy.  Guidance on determining the right Women’s Health Physio for you sourced from @rxphysio Teresa Waser.
How much will it set me back?
Here is the downfall – in New Zealand in most cases it is a private medical expense. Unless it falls under the small scope of ACC guidelines. The initial session will hit you back somewhere between $140-180. However, subsequent visits are around half to two thirds the initial session and you generally don’t need to see your Women’s Health / Pelvic Health Physiotherapist more than a handful of times. Here at CrossFit Central Wellington we off our postpartum athletes returning to training a $50 subsidy to see a Women’s Health / Pelvic Health Physiotherapist, should they wish, in the hope of making it a little more accessible and allowing us to better support our athletes. How do I know if I should see one? Below is a link to an assessment tool that you can work through to determine whether you could benefit from a visit with a Women’s Health Physiotherapist. Assessing whether I need to see a Women’s Health Physio
Some Coaching cues that can help with eliminating or decreasing any symptoms you may be experiencing when you double under
Sometimes a change in your double under strategy can help you manage or alleviate symptoms such as leaking or a feeling of heaviness.
Antony Lo can often be quoted telling women about “tension to task” that is, applying the right tension to the task at hand. In order for our double unders to be efficient, they should be using the right amount of tension. With the double unders – in order for you to be efficient as possible and for these to use less energy in a workout we want to work towards these using a very limited amount of tension.
Next time you double under try: Relaxing through your shoulders and butt, allowing the flick of the wrist and spring of your jumps to be the driving forces behind your double unders.
- The “Power Jump”
The height we want for our doubles is more than that of a single skip but we want to jump with the same efficiency as a single jump by driving the balls of our feet. Here we also want to think about staying light on the feet and driving off our big toe and the balls of our feet.
- The legs – what are they doing
It is also worth seeing what the legs from the knees down are doing – are you kicking your feet forward into a dish or donkey kicking them behind? Play around with this with single jumps – do some kicking them forward, do some flicking behind and see if this makes your symptoms better or worse?
- Considering your threshold
As you are rebuilding your pelvic floor you might find that you just have a volume threshold. Consider getting to just below the threshold and slowly work towards increasing this symptom free. Eg, you leak when there are more than 50 double unders, then just decrease the number and do part double unders, part bike or another cardio in the interim as you keep regaining pelvic floor strength.
- Rebuilding the foundations
When changing the way you do any movement its always worth bringing it back to basics – light single skips, light single “power” (same as before but working to generate more height) jumps, then single single double working to make sure that the double skips are using limited more effort than the single skips, then low volume double sets to allow you feel out what is working and what isn’t.
Other things to consider:
Many other factors can impact symptoms such as fatigue (generally and in the workout – volume considerations), stimulants (coffee, excess fluids), beliefs (I suck at double unders, they are so hard), the list goes on!
Early postpartum we suggest our athletes take time before returning to impact movements (usually around the 10-12 week mark). That doesn’t mean a lot of preparation and strength work isn’t done in the interim! Experiencing one of the above symptoms in double unders and still after some more support? If you feel comfortable then talk to your Coach at your local Affiliate or reach out to us here! CrossFit Central Wellington has a diverse team of Coaches that are all eager to support female athletes through lifelong athleticism.