Confessions of a CrossFitting Pelvic Floor Physio
I have decided it's time to officially come out of the closet. I, Lori Forner, a passionate physiotherapist helping women (and men) with pelvic floor dysfunctions, am a... CrossFitter. I have been doing it for over a year and... I like it...a lot. Please don't stop reading. As funny as it sounds, I have been worried about the negative opinions my fellow colleagues might feel, worried about whether my professional referrers will discredit me and not want to send me patients, and worried some of my patients might think I will try to convert them. Crazy? Maybe. But I was one of them before this journey.
Years ago I lectured to boxes about pelvic floor dysfunctions. I had teaching about pelvic floor in the bag. I love to educate about this stuff, but I was really skeptical as I had just seen a video glorifying stress urinary incontinence in CrossFit. But I felt compelled to teach what I knew, and maybe convince some of them to quit.
I started to see some CrossFit clients and decided I needed to enter a stealth pursuit as an underground pelvic health physiotherapist to spy on these unsafe, high-fiving, muscly, high-sock people. I needed to see how "bad" it really was, because in my profession, we were all talking about the stupidity and dangers of it. Yes, I am just that type of professional who feels the need to really experience what my patients do so I can properly understand how to help them. Yes, even if it means learning about "boxes" and "snatches"...but come on, that was already a part of my job, right?
At the start of this pursuit, I was surprised by the principles behind their "fundamental movements" - generally bodyweight, functional things I had done before (squats, pushups, overhead press, pulling). We did a "strength" session for 15-20mins, then a "conditioning" session for 12 minutes. That is all! 12 minutes of hard, but safe, work. I just took my time, worked perfectly on my technique because I am oddly perfect that way, and did all the easier modifications that I thought were pretty adequate scaling options - which surprised me given they were directed from the coaches who were not physios or even exercise physiologists (which in my mind meant they should know nothing - sorry, I was wrong). So far this was much more safe and fun compared to some of the 60-minute-non-stop-bootcamp classes I have tried and did not like.
Over the next 6 months, I was taught some new moves (and not getting any of the names right...hang power clean, squat snatch, man maker...wtf) and these were repeated here and there but on the whole I don't think I have done the same workout twice (except for certain workouts that are used as a means of objective testing - and of course they also have names. No, really. They have names...like Fran, Cindy, Karen (ugh.....). I kept my weights light, more from fear than from my physical abilities, and learned over time how amazingly adaptive my body is and how amazingly fearful my brain is. What if I was causing pelvic floor issues? We don't know enough about this type of exercise. I decided to trial different vaginal support pessaries that I was using on my patients for possible internal pelvic organ support (more on this another time...). Pessaries gave me confidence but we still don't know enough about them with regards to prevention of pelvic floor dysfunctions in the first place or prevention of symptoms worsening over time (ie. leaking and prolapse), however in some people they can help when they already have symptoms.
I continued my 3/week workouts and kept waiting for that session I could say "see, this is crap and not healthy for women" but each time I came close to thinking a movement was unsafe, I was shocked to find out there was a way to modify it to make it pass my test. And I was strangely having fun working out ways to modify and teach different movements or workouts to suit my patients. How I could modify skipping with alignment or breathing or timing. We won't get into my mild rhabdo experience, let's just say it had more to do with my poor (alcoholic) behaviour and events following the gym workout than it had to do with CrossFit.
Fast forward another 6 months and somehow someone MADE me sign up for some competitions (you know who you are). I figured if I am really going to understand the psychology behind why people engage in these competitions and push themselves past what their bodies should do, I might as well test this also. How can I help people if I don't know why they do things? I also thought it would be an interesting venture into whether or not I would push myself beyond perfect technique, even though I know my body's limits. Who does that, right? Well, it was a learning experience. I did push myself more than I would have normally, lost some technique when fatigued, had delayed onset muscle soreness and a sore back from over doing it...but I survived and had a great time in a supportive, social environment! But now I get it. Competition mentality. But I don't blame CrossFit. It's the same when I pushed myself to finish a marathon with a tendonopathy. I think certain sports draw certain personalities and I am sure CrossFit is one of those...lots of ex-athletes and people who like to challenge themselves. Just like triathlons and IronMan and Ultra-marathons.
To get to the point...would I recommend my patients to do CrossFit? Yes and No. It depends on the person in front of me as well as the coach. I think the awareness of pelvic floor dysfunctions in CrossFit coaches (and most fitness or health professionals) is minimal to none, which is what I want to change. But I understand now the beautiful community support and psychosocial aspects, not to mention the great physical aspects, of CrossFit and how I can help my patients make better choices if they are safe to continue with a pelvic floor issue. Like my runners, I am hesitant to pull them away from their friends and community they so love and I will strive to help them continue as best as I can. Yes, no doubt there will be some patients who just may not be able to continue, but I feel that may be more so because of an inability to let go of the need/want to push themselves harder, rather than the inability of an exercise to be scaled and adapted to their needs. It's easy enough to tell a runner or a CrossFitter to swim or do yoga or pilates, but that probably won't work and it's more detrimental for them to stop all activity and do nothing. We have enough obesity and chronic illnesses because of inactivity. And I have also seen many women with prolapse and incontinence who are not physically active and their issues were not caused by activity. I have seen women do all of the "right" things and get worse. I have also seen women push themselves too hard, too fast and do make things worse - and guess what? It wasn't CrossFit. Not saying it won't happen, but there are plenty of programs and trainers out there that do inappropriate training so people need to stop blaming CrossFit. (But we can blame them for poor prize choices at the CrossFit Games) :).
So today, I find myself with my first pair of CrossFit shoes, bigger calluses on my hands than before, pull-up straps, whip marks from double unders (and a stupid, broken rope), a muscle-T and an eye on booty shorts.With all that being said, I am still working it out for myself and for my women with pelvic floor issues...but I am having a blast doing it.
If you made it to the end here...good on ya and thanks!