Exercise, The Female Athlete, and the Pelvic Floor


Fiona McMahon PT, DPT

In honor of National Women’s Health and Fitness Day ,September  28, we are exploring the benefits of regular exercise for women as well as addressing some pitfalls (pelvic floor included), that female athletes can fall into too. It is far too often that women find themselves sidelined from their favorite sports and fitness routines secondary to issues like orthopedic or sports-related pain or incontinence. Although all the issues outlined in this blog can occur to both genders, many of these conditions are more likely to happen to females, secondary to their pelvic structure and physiology.


Exercise and Its Benefits



The benefits of exercise are too numerous to discuss every single one here and span the physical to the emotional. There are a number of conditions that have profound effects on the health of women nationwide. Let’s explore some of exercise’s specific benefits for these conditions together.

Heart Disease

According to the American Heart Association, Heart disease is the number one killer of women in the US and is responsible for 1 in 3 female deaths.  Exercise and a healthy lifestyle have been shown to reduce the risk of heart disease by 80%. The American Heart Association recommends 150 minutes of moderate activity or 75 minutes of vigorous activity to stave off heart disease.


Osteoporosis is unfortunately a common affliction among white and asian urban dwelling females.  It is characterized by reduced bone density, which causes bones to be fragile and increases the risk of fracture in individuals that have osteoporosis. Exercise has been shown to be helpful in both reducing the risk of osteoporosis as well as improving the bone mineral density of those who already have osteoporosis.

Other benefits of regular exercise include:

  • Reduced risk of diabetes
  • Reduced risk of colon cancer
  • Improved psychological well being
  • Maintenance of healthy body weight

Remember, it is important to consult with a trained healthcare professional before commencing a new fitness routine.


The Female Athlete Triad- Aka the Downside

All things in moderation. Although exercise is beneficial it is easy to over do it. It becomes easier to slip into an unhealthy relationship with exercise, especially in women who are training at elite levels, have eating disorders, or body dysmorphia issues.

The  female athlete triad consists of three disorders that can have severe health consequences in both the near and long term. The three disorders that compose the female athlete triad are:femaletriad

  1. Disordered Eating
  2. Ammenorrhea (absent periods or periods that are irregular)
  3. Osteoporosis

The female athlete triad is often attributed to the expectation that women keep a slender appearance. Girls and women who have body image issues may be at greater risk. The female athlete triad is dangerous and has the potential to be deadly. Osteoporosis can result  in fractures and eating disorders can seriously impact fertility, or even throw off the delicate balance of electrolytes in their system, putting them at serious risk for a cardiac event.

Warning signs of the female athlete triad include:

  • Yellowing of skin
  • Stress fractures
  • Rapid fluctuations in weight
  • Development of baby hair over skin
  • Daily vigorous exercise to an excessive level


The female athlete triad requires a multidisciplinary approach from medical, to psychological to nutrition.  It is important for someone who is suffering from the female athlete triad to seek help in order to safeguard their health and emotional well being.


Athletics and The Pelvic Floor

d14e2-tipsforahappyandhealthyvaginaLike any muscle, the pelvic floor can get fatigued, strained, or even go into a painful muscle spasm. The thing about the pelvic floor muscles, is that they have to work in almost every athletic pursuit. They work in partnership with the multifidus of the back, the transverse abdominus of the belly, and the diaphragm to stabilize and protect your spine. They also contract with every step during running activities to prevent your pelvic organs from dropping down in your pelvic cavity and to prevent urinary and or fecal leakage. Things can go wrong when the pelvic floor or other core muscles don’t function properly. Athletes’ pelvic floors can become tight and restricted, preventing closure of sphincters and support of pelvic organs. They may go into spasm from working too hard to stabilize the spine, if one of the other core muscles is failing to pull its weight.

Recently there has been more work to investigate the link between athletes and pelvic floor dysfunction. A recent study found that self identified female triathletes suffer from urinary and fecal incontinence at rates as high as 37.4% and 28.0%, respectively. Similar results were also found on a group of runners. Of the triathletes studied, nearly a quarter of them fit the criteria for female athlete triad, discussed earlier in this post.

Does this mean you have to give up your penchant for running? NO! (hellooooooo the author of this post is a runner), but if you find yourself experiencing incontinence, pain, constipation, and or painful sex, something is wrong and you must intervene in order to protect your long term health and your ability to participate in your favorite sport. At Beyond Basics Physical Therapy we combine orthopedic and pelvic expertise to help return athletes to their sports in a more functional and less painful condition. We relax tight muscles of the pelvic floor, train the core, including the pelvic floor if needed, to do its fair share, and return normal postural and structural alignment to our patients. We work one on one with you to develop a home exercise plan to help you reach your goals and prevent a reoccurrence of your pelvic floor or core disorder.


Please come see us so you can return to your sport in a better and more optimal condition than when you started: http://www.beyondbasicsphysicaltherapy.com/




American College of Sports Medicine. Information on … the female athlete triad. https://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf. Accessed September 19, 2016


American Heart Association. Facts About Heart Disease in Women.  2016. https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed: September 6, 2016


Bø, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine, 34(7), 451-464. 2004.


Illinois Department of Public Health: Women’s Health. Facts about  women’s wellness exercise . http://www.idph.state.il.us/about/womenshealth/factsheets/exer.htm Accessed: September 13 2016


Loyola University Health System. “Female triathletes at higher risk for pelvic floor disorders.” ScienceDaily. ScienceDaily, 23 August 2016. <www.sciencedaily.com/releases/2016/08/160823165743.htm>.


Stampfer M, Hu F, Manson J, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England Journal of Medicine. 2000; 343(1). 16- 22
Todd J, Robinson R. Osteoporosis and exercise. Postgrad Med J. 2003; 79:320-23

Beyond Basics’s Pro-Bono Clinic for PT Day of Service!


Victoria LaManna, DPT

October is around the corner! And a busy month for many. Whether you are getting back into the swing of school or work after summer vacation, preparing your Halloween costume or getting ready for all the upcoming holidays right around the corner – there is a lot going on!
This time of year is also an opportunity to do good and give back. October is National Physical Therapy Month, where physical therapists celebrate their amazing field of healing and getting people back to optimal function. In addition, many of the PT’s throughout the U.S. give back to their communities during this month. This year we are taking it up a notch. Physical therapists WORLDWIDE are getting involved for the second annual Global PT Day of Service Saturday, October 15th. Whether it is by hosting a pro-bono clinic, serving in a soup kitchen, participating in a 5k for a cause, or cleaning up a community garden – physical therapists globally as a profession are coming together to make a positive impact on the world around them.
At Beyond Basics, we have decided to host a pro-bono clinic Saturday, October 1st to give back to those in the New York City area who may not have insurance or access to physical therapy. We are providing 30 minute one-on-one evaluations and recommendations for home programs to up to 30 participants. For more information and to sign up please visit: http://signup.com/go/Nu1T4Q
You can also check out PT Day of Service here and follow on twitter (#PTDOS) to see how the day unfolds! http://ptdayofservice.com/
The American Physical Therapy Association (APTA) is also involved in hosting National Physical Therapy Month. This year the APTA’s focus is on it’s national public awareness campaign, #ChoosePT. This campaign lets consumers know about the risks of opioid use and that physical therapy is a safe, non-opioid alternative for managing pain.
I encourage you to check out educational resources provided by the APTA (www.apta.org) and Move Forward PT (http://www.moveforwardpt.com/Default.aspx). Learn all about how physical therapy can help you overcome pain without the use of opiods, improve mobility and maintain independence throughout your lifetime.


The Things We Put “Up There”, Part I

By Fiona McMahon, DPT

This might seem like an odd topic to post about, but when you think about it, there seem to be more and more products on the market for you to use on or in your vagina. These products promise a range of different benefits from pelvic pain relief, to making your vagina smell like a spring meadow in bloom. For any woman, especially one with pelvic pain, it can be difficult to navigate this marketplace and find products that are not only safe, but deliver on their promises. This post will serve as a brief introduction to vaginal products and their respective risks and benefits.

When I first started this blog post I thought it would be a brief blow by blow of different products, their intended uses, and their side effects. Little did I know that the politics, history, and business interests surrounding vaginal and intrauterine devices could fill a whole book, let alone a measly little blog post. I opened Pandora’s Box. In an effort to highlight the story behind these objects, beyond the what and how, I will be making this blog a multipart series. So, if you don’t see your favorite device, despair not, dear reader. It may be coming in a future post. So for now let’s explore the first two devices in our line up: pessaries and tampons. Onward.

Source: http://www.aafp.org

Pessaries are devices that are inserted into the vagina that provide mechanical support for the pelvic organs when the muscles of the pelvic floor are not strong enough to support them. They basically do the work of the pelvic floor and can be used to treat stress incontinence (urinary leakage with increased abdominal pressure, like coughing laughing or sneezing), pelvic organ prolapse, ( a condition where the bladder, uterus, or rectum drops down in the pelvic cavity and causes increased pressure and discomfort).

Pessaries are a good option for women who do not want surgery. Women who have short vaginas, large vaginal openings, or prior repair of hernias may not be successful with finding an appropriately fitting pessary.

Pessaries acts like a little a buttress to hold up the organs of your pelvic floor to improve continence. Because we all come in different shapes and sizes, pessaries must be fitted by a trained professional to do their job correctly.

Pessaries are taking on an amazing new role in developing countries with reduced health care infrastructure. Pessaries can be used to prevent pre-term birth in mothers who may not have access to advanced Western-style neonatal intensive care units. In a study published in the Lancet, the use of pessaries spontaneously reduced the rate of preterm delivery. The implication of this finding is profound and far reaching. With the use of a $50 device,  women who do not have access to proper medical care are more likely to carry their infants to term and deliver healthier babies. It’s really amazing.

As amazing as pessaries can be, they aren’t correct for all people. If you suffer from pelvic pain, the pressure from the pessary can increase pressure on the pelvic floor muscles (usually culprit for pelvic pain), and make your pain worse. Although this is disappointing, pelvic floor physical therapy is helpful to help reduce your painful trigger points in your pelvic floor as well as strengthening your pelvic floor muscles to reduce your degree of prolapse.

Tampons are familiar to most of us. They are thin cylinders that are inserted into your body to capture menstrual blood before it escapes the body. But, oh boy, are tampons and the social politics surrounding them complex.


Source: Pinterest

Tampons come from the rather crude French word, tampion meaning plug or stopper. Tampons have been around in some form or another since well before the common era. Things such as rolled papyrus, and ferns have been used since ancient times to staunch the flow of menstrual blood.

The first modern tampon appeared in the US around 1933 by the Tampax corporation. It is estimated the American women use approximately 11,400 tampons in their lifetime and spends 6 to 7 years of their life menstruating (total bummer).

With that kind of use and ubiquity the safety of tampons is certainly a concern for women and parents of adolescent girls who have begun their cycle. In the United States, tampons are considered a grade II medical device, meaning they a subject to regulation by the food and drug association to ensure they are not only effective, but safe. Prior to 1976 tampons were not classified the way they are today and were not as rigorously tested to ensure that they were safe to use.

Anyone who has opened a box of tampons is probably aware of the little slip of paper that contains information on how to use tampons as well as Toxic Shock Syndrome (TSS). TSS is usually a result of the overgrowth of a nasty little bug, who goes by the name Staphylococcus aureus (S. aureus). S. aureus is carried in about 20% of people. These little microbes can cause a multitude of ailments from pimples, rashes, and food poisoning.

TSS is characterized by high fever, a drop in blood pressure, flaky skin, rash and muscle pain. It was first classified in 1978 and received a more precise definition in 1980. What is really fascinating about TSS is that it was found across the population at the time of its classification, in men and children (clearly, not regular tampon users).

The link between TSS and tampons came to light during the late 1970’s and early 1980’s. The tampon market ( an extremely lucrative and competitive industry) was entering a phase known as the “absorbancy wars”. In the mid 70’s and 80’s there were huge market pressures to produce a tampon that was not only cheaper to make, but also highly absorbent to compete with a market already saturated (sorry), with inexpensive and highly effective products.

In the mid 1970’s Proctor and Gamble released a highly absorbent tampon called “Rely”. This tampon was extraordinarily absorbent and distinct in its design from its competitors. The tampon contained synthetic gelling materials that absorbed  massive quantities of menstrual blood. While this designed allowed the wearer security and protection from unintentional menstrual leaking, the gelling substance provided a great environment for bacteria to grow and flourish. Furthermore, the gelling substance was manufactured in cube shape which increased the surface area for S. aureus to multiply.

A new tampon put on the market today would qualify as a class II medical device and would be under much stricter regulation by the Food and Drug Association (FDA). Rely, however, debuted on the market before such regulation was in place, and therefore was under less rigorous testing.

All tampons on the market today have won approval by the FDA and should be considered safe, but there are a few common sense recommendations to keep in mind when using these convenient little pieces of cotton. Always make sure you are inserting your tampons with clean hands, whether or not you are using tampons with applicators, or digital (applicator-less tampons). Use the lowest absorbency to do the trick. Tampons that are too absorbent  for your flow can dry and irritate the vagina, (not to mention a dry tampon is never a pleasant experience to remove). Change tampons regularly, and remove old tampons before inserting new ones. Remember tampons are only meant to be used during your period, if you feel like you are having discharge that needs to be absorbed, see your doctor as it may be a sign of infection.

That will do it for “Thing we put up there: Part 1”. Stayed tuned for our next edition. Ever hear of a pelvic wand or wonder what is the deal with douches? Well, put on your scuba gear, dear reader, we will be diving into those topics and more in future editions.


Lamers, B.H., Broekman B.M., et al; Pessary treatment of pelvic organ prolapse and health-related quality of life: a review. International Urogynecology Review. 2011. 22(6), 637-44

Goya M, Pratocorona L, Merced C, et al. Cerivical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. The Lancet. 2012. 379(9828): 1800-06

Viera A, Larkins-Pettigrew. Practical Use of the Pessary. Am Fam Physician. 2000 1;61(9):2719-26

Tampons for menstrual hygiene: modern products with ancient roots. October 28,2014

Vostral S. Rely and toxic shock syndrome: A technological health crisis. Yale Journal of Biology and Medicine. 2011. 84: 447-59

29 Things Everyone With a Vagina Should Know

As Thanksgiving beckons, we wanted to send you off into the holiday weekend with some enlightening fun. Here, from Buzzfeed’s Carolyn Kylstra, is “29 Things Everyone With a Vagina Should Definitely Know.”

We love the way Kylstra’s writing is forthright and informative, and there should definitely be more sexual health writing out there like this! Read the article to learn more about vaginal tenting, G-spots, the vagina after birth, hymens, and much more. Remember, too, that vaginas come in all shapes and sizes and they’re all beautiful!

And, as always, never be afraid to discuss your body with your partner or with your healthcare professional. If you have any problems or questions, we at BBPT are always here to help, too.



This holiday season, love yourself and your vagina!

Irritant Information

By Riva Preil

On June 9, we posted a fantastic YouTube video on our website entitled “Detox the Box”, a parody on a popular Justin Timberlake song from Saturday Night Live.  This entertaining and informative video encourages viewers to request that Tampax, Always, and Procter and Gamble remove irritants from their feminine hygiene products by signing a petition.

As a pelvic floor physical therapist, I STRONGLY AGREE with their message.  Vaginal irritants can cause vulvar and pelvic floor muscle irritation and pain. Natural-fiber pads and unscented products are healthier for the pelvic floor than scented products. Tampons appropriate for a particular menstrual flow should be used (rather than “playing it safe” with a larger than necessary tampon).

While on the topic of vaginal irritants, allow me to take this opportunity to mention several other DOs and DON’Ts


  1. Wear loose fitting underwear that does not restrict blood flow to the groin (due to tight fitting elastic)
  2. Sleep without underwear
  3. Use fragrant free detergents
  4. Use Dove bar soap, Neutrogena, or Basis
  5. Use soft, white, unscented toilet paper
  6. Wear loose/baggy sweatpants during exercise


  1. Don’t wear girdles or support stocking pantyhose– they restrict blood flow to the perineum and limit necessary circulation
  2. Don’t use a douche. EVER. Not pelvic floor friendly, to say the least
  3. Avoid extremely hot water on the vulva
  4. Never use a blow dryer on pubic hair
  5. Avoid toiletries with fragrances, propylene glycol, and sodium lauryl sulfate
  6. Avoid scrubbing the vulva while bathing
  7. Refrain from wearing Spandex, thongs, and wet bathing suits

A happy pelvic floor contributes to a happier YOU!  Have you discovered any unique or helpful products on your quest towards vaginal health?  Please feel free to comment and share any thoughts you have about products that have contributed your pelvic floor health.  The comment that receives the most “likes” on Facebook will receive a prize!  And on behalf of your fellow females, please sign the petition to “Detox the Box”!

Let’s Review: Pelvic Floor Muscles


By Mary Hughes, PT, DPT

Urogenital Triangle

Primary Sexual Function: Obstructs venous return and maintains erection of clitoris

Primary Sexual Function: initiates erection of the clitoris, also functions as a vaginal sphincter in females

Superficial Transverse Perineum: Stabilizes and strengthens the perineum

Levator Ani: functions as a unit.
Deep Pelvic Floor Muscles: Pubococcygeus,  Iliococcygeus, Puborectalis
Supports Pelvic Organs, assists with core stabilization, assists in orgasm in both men and women, moves the tail bone.
Inappropriate length tension relations or strength between any or all of these muscles can lead to pain, bladder/bowel dysfunction and or sexual dysfunction.

How Clean is Too Clean?

By Riva Preil

Believe it or not, people sometimes overdo it with regards to vaginal hygiene.  This is especially true with regards to individuals with vulvar disorders (ex. eczema, lichen sclerosis, urinary tract infections, or yeast infections).  A common misconception is that the disorder is a result of inadequate cleansing of the vulva, thereby leading to itching, irritation, and pain.  However, over scrubbing of the perineum and vulva may actually exacerbate vaginal irritation.  It is important to gently cleanse the vagina without using irritating chemicals.  Most scented soaps, scrubs, powders, and detergents are detrimental to vaginal health; instead, one should opt for unscented products.  Furthermore, gentle fingertip cleansing should be performed rather than using a washcloth.

In addition, it is important to be mindful of clothing, because lower extremity garments often affect vulvar irritation. Tights pants and jeans, thongs, spandex, and pantyhose are often the culprits of triggering a flare up.  When possible, one should wear cotton underwear, loose pants (ex. sweatpants while working out instead of leggings), and thigh-highs or knee-highs to prevent pain.  Hopefully, incorporation of these minor tips can create a major improvement in one’s quality of life.