Could Your Performing Arts Athlete’s Pain Actually Be a Pelvic Floor Issue?

By: Sara Gagliano, PT, DPT, CLT-UE, Sydney Stevens, PT, DPT, PRPC, and Rebekah Hibbert, MS, ATC

August is Pelvic Floor Dysfunction (PFD) Awareness Month, but when most people hear pelvic floor they tend to think of pregnancy or postpartum recovery. They don’t necessarily think of a dancer, gymnast, musical theater performer, or other artists.

What people may not know is that PFD shows up in performing artists and athletes far more often than most people realize, and it can hide behind all kinds of symptoms that don’t seem connected to it at all. If your performing athlete has ongoing pain, discomfort, or something that’s been written off as “just part of the sport,” it may be worth a second look.

What Is the Pelvic Floor, and How Does It Affect Performing Arts Athletes?

The pelvic floor is a group of muscles at the base of your pelvis. It is a group of 14 muscles in 3 layers. It works together with your diaphragm, deep abdominal muscles, and low back muscles as part of your core, not as some separate, disconnected system. Every time a performing arts athlete lands, holds a position, or pushes through a lift, the pelvic floor is doing its part. Like any other muscle group, the pelvic floor needs to be both strong AND able to fully relax.

Examples of Pelvic Floor Dysfunction in Performing Arts Athletes

As clinicians, we often see performing arts athletes come in for what looks like one thing, only to find the pelvic floor is playing a role. Examples include a dancer whose tailbone still hurts months after a fall, a gymnast who experiences leakage when she lands a jump, or a musical theater performer with low back pain that keeps flaring up during long rehearsal days. In cases like these, the pelvic floor is often part of the reason those symptoms are sticking around.

PFD Affects Both Female and Male Performing Arts Athletes

Research on performing artists has found urinary incontinence in roughly half of female performing arts athletes, along with high rates of anal incontinence and pain with intercourse. Long-standing groin pain in female athletes has also been linked, in some cases, to untreated pelvic floor dysfunction.

Male performers are affected too and often know even less about it. Research on male athletes broadly has found that a large majority are unaware that the pelvic floor muscles exist, or that they can be trained at all. Male dancers and performers fall into that gap as well.

When pelvic floor dysfunction symptoms are left unaddressed, the discomfort can be enough to make an athlete step back from their sport altogether, which makes it important to address early.

What Can Cause Pelvic Floor Dysfunction

Pelvic floor dysfunction isn’t caused by one single thing, and it isn’t a sign that someone did anything wrong. A hard landing, a fall onto the tailbone, or an injury elsewhere in the body can throw off how the pelvic floor moves and functions, even when the original injury itself seems to heal.

Other contributors include muscle imbalances or joint dysfunction elsewhere in the body, tissue restrictions, nerve irritation, and hypermobility, which is common among dancers and gymnasts given the flexibility their sport demands.

Symptoms Worth Mentioning to a Physical or Occupational Therapist:

• Leaking urine with jumping, coughing, sneezing, or laughing
• A frequent or urgent need to urinate
• Constipation or a sense of incomplete bowel movements
• Pain in the low back, hip, groin, or tailbone that hasn’t responded to typical treatment
• Pain with sitting for long periods
• Abdominal or pelvic pain without a clear cause

Any one of these on its own might be minor. Several together are worth a conversation.

How Physical Therapy Can Help

A pelvic floor therapist can evaluate your pelvic floor and build a plan that addresses the root cause of symptoms rather than just the pain. Treatment might include retraining breathing mechanics, hip and core strengthening, and hands-on treatment to help an overly tense pelvic floor relax or a weak one engage more effectively. Not sure what a session actually looks like? Read what to expect from a pelvic floor physical therapy visit in “What Is Pelvic Floor Therapy, and What Does a Session Actually Look Like?“. The goal is to help your dancer or athlete move, train, and perform with less pain and more confidence in their body.