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PELVIC FLOOR CONSIDERATIONS A POTENTIAL GAME CHANGER FOR WOMEN’S FOOTBALL? Pelvic Health Physiotherapist BSc (Hons) MCSP HCPC Affiliated POGP Private Practice, Physiomum, Surrey, UK
FEATURE / EMMA BROCKWELL FIFPRO, the organisation which works as a trade union to unite the voice of professional footballers and their national unions produced a report in 2020 which highlighted that ‘players are the most valuable resource for all football teams and that the athlete is central to the existence of the sport’1. Therefore, for the sport to reach its full potential the player’s potential must be fulfilled. One way of doing this is to identify and implement the best practices in health, safety and performance of the players2. Female footballers, and all those working with them are keen to make this a reality with informed, evidence-based information3. However, females remain significantly underrepresented in sport and exercise science research,4,5 and certain areas remain “wholly underappreciated”, even hidden within sports medicine. One such area is the pelvic floor and its connected structures and conditions that can result when dysfunctional. Sitting at the base of the pelvic outlet, these structures uniquely serve multiple roles; organ support, sphincteric, lumbopelvic motor control, sexual and sump pump. When this area is not optimally working Pelvic Floor Dysfunction (PFD) can occur. Conditions of PFD include:
population and not necessarily the ‘athletic female’ population. Whilst it is true that females present with higher prevalence of PFD during these key transitional periods of life, females of all ages who participate in sport / exercise have 3 times the risk of experiencing urinary incontinence for example compared to a non-athletic female6. In fact, amongst female athletes, PFD is one of the most common concerns over the lifespan of female athletes7 and yet it is not considered within key documents that support female athletes’ health8. But, what if, consideration, prevention and management of PFD could optimise and unlock the true potential of all female footballers, see them return to football postpartum better than ever before, future proof their health and in doing so empower
and inspire girls and women who follow football to take their pelvic health more seriously? The Pelvic Floor Muscles - an overview There are many overt differences between males and females and the pelvic floor is a great example of this. The male pelvic floor is invaginated by two openings and therefore less compromised than the female’s pelvic floor, which is invaginated by three, the urethra, vagina and anus. The pelvic floor complex sits within the bony pelvis and includes muscular tissues of the pelvic floor, their neural connections, and the fascial layers surrounding the pelvic floor muscle fibres/fascicles9. The following muscles in the table below are considered to be those that make up the perineum and pelvic floor10:
Muscles of the pelvic floor complex Anterior Urogenital triangle
Bulbosponginosus Bulbocavernosus Ischiocavernosus Superficial transverse perinei External Urethral Sphincter
• Emptying disorders of the bladder and bowel •Sexual dysfunction • Chronic pelvic pain • Urinary Incontinence • Anal Incontinence • Pelvic Organ Prolapse
Deep transverse perinei Posterior (anal) triangle
External anal sphincter
Levator Ani
Pubococcygeus (which includes puborectalis, pubovisceralis, pubovainalis) Iliococcygeus
Typically, PFD has been thought to only affect the perinatal and menopausal
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Ischiococcygeus / coccygeus
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