Q: Is there ever a situation where leaks with lifting is okay? Asking for a friend
A: Short answer: A very contextualized yes. Long answer: Keep reading.
The CrossFit Open always brings these questions to my inbox, and DMs. I get sent links to reels and tiktoks either downplaying it, accepting it, celebrating it, or laughing about it. We get viral videos of women peeing during lifts, or cleaning up the aftermath. I will continue to hope that the culture around this will continue to evolve. I waiver between asking “are we really still here?” and knowing how the landscape has changed for the better. We do have a lot of counter-programming posts and videos offering support and guidance-new messages are out there. But clearly there is still a need to reframe the leaks with lifting conversation and provide tools. Information and education is our path forward to bring that change.
Leaks with lifting is something we can and should coach.
Let’s discuss a few scenarios- when is it okay and when is it a signal we need to listen to?
If leaks with lifts ONLY happen when an athlete is attempting a PR (personal record), a new max effort, that’s good. This might indicate that the central control system, pelvic floor (PF) included, was able to manage the gradual progression of loads all the way up to the PR load. Then that new level of max effort tipped the scales to a leak. The leak doesn’t necessarily represent a ‘failure’ of the PF, but perhaps a brief overwhelm of pressure + load in that max moment. The PF is otherwise healthy and responsive in the rest of their workouts, daily life, bowels and sex are all good? Yes? Cool.
Here’s why we might not be overly concerned: Consider that same scenario but instead of a leaks with lifting insert shoulder pain with lifting. If they had shoulder pain with an overhead lift PR, but otherwise the shoulder was good and healthy we might keep an eye on it. It happened once, and then the body/brain managed to sort it out and the pain never repeats with that same lift? Yes? Cool.
But if that repeats every time they hit that load, I would suggest that we should and would look at the clients form, strategy, capacity (range?), etc. We should coach something to allow the athlete to perform that load without pain. Pain signals us that something needs to change. Leaks do too.
Let’s Flip the Script
I advocate that we have the same thought process we have for pain, for leaks with lifting in athletes. It is a signal, like the shoulder pain, that something needs to change to allow them to participate without leaks. And it can. Let’s figure that out for them. The thought process for interventions for leaks are the same as they are for pain – Ex: Is the athlete accessing a higher IAP strategy to help them hit a max because of a lack of posterior chain support for the lift? Then lets focus on posterior chain, so they don’t have to use all IAP to get that bar overhead. Less pressure, less leaks, AND more glutes. Or lets see if there is a form tweak that allows them to access more posterior chain while under the load. This would also allow them to utilize a less intense IAP strategy.
Are leaks occurring in submax lifts, more frequently or within a variety of athletic activities (like impact too)? Or in daily life outside the gym? Yes? Not so cool. Let’s coach that.
Rather than ignore it, or assume it will just get better with time/or load progression. Let’s coach it by normalizing the integration of pelvic floor strategies as a part of lifting for females. There may be a need to strengthen the pelvic floor, and build it’s capacity. However, we likely need to create opportunities to help coordinate it with the rest of the central system and integrated into the lift or in impact activities. So increasing load tolerance for the pelvic floor doesn’t always just happen, we often need to be sure it is actually cued to participate. Coupled that with a similar approach as above, we can also look at form, capacity, strategies….Can we reduce impact through form changes (double unders for example)? Can we reduce IAP through some coaching for a better lift strategy? Is this a postpartum athlete? Or someone who has never had a baby? These represent different types of needs, and need targeted approaches.
In addition, we need to start considering more than load, and strength as our only way of thinking through pelvic floor needs. Training the PF for speed, or power for example will help us support lifts, performance and help to control an impact. Cool?
Let’s coach this. Let’s change the culture around this. Let’s keep talking.