Why Your Pelvic Floor is the Key to Injury Prevention and Performance in Midlife
Up to 50% of women in midlife experience some form of pelvic floor dysfunction, yet the vast majority suffer in silence or assume it’s just a normal part of aging. The nagging low back pain, stubborn hamstring strain, or accidental leak while jumping or running downhill isn't just a random nuisance—it’s a direct distress signal from your body's true core foundation.
Knowing your body is no longer optional. If we want to treat midlife as our peak performance era, we have to start talking about the muscle group that holds it all together: the pelvic floor.
On this week's episode of Fuel with Erin, I sat down with Dr. Rachel Selman, a physical therapist, strength and conditioning coach, and author of the upcoming book Floor It.
Rachel shattered the myth that pelvic floor care is only for the immediate postpartum period, explaining how this critical powerhouse dictates our orthopedic health, tendon resilience, and overall athletic longevity in midlife.
What is the Pelvic Floor, Really?
Forget the vague definitions (I call it an undercarriage :). The pelvic floor is a highly coordinated group of 9 to 13 muscles that spans like a hammock from your pubic bone in the front all the way to your tailbone in the back.
"Your pelvic floor sits like a hammock at the bottom of our pelvis and it has really big jobs like holding up our organs, managing pressure. It helps support the hips and the core and the back." — Dr. Rachel Selman
For hybrid athletes and active women, the pelvic floor acts exactly like a trampoline. When you run, lift, or jump, the springs of that trampoline need enough give to absorb force, and enough recoil to bounce back up. If the springs are permanently locked up and too tight, the force gets jarred directly into your hips, low back, and discs.
The Sneaky Connection: Pelvic Floor & Chronic Injuries
Many women over 40 assume their nagging injuries are just signs of "getting older." However, Rachel points out that an uncoordinated pelvic floor often causes a domino effect of orthopedic issues:
Recurring Low Back & Tailbone Pain: Three major pelvic floor muscles attach directly to your tailbone. If your tailbone or lower back is constantly aching despite traditional PT, the pelvic floor might be the missing link.
Stubborn Tendon Strains: Chronic glute tendinopathy, high hamstring strains, or groin tweaks are frequently caused by a pelvic floor that isn't absorbing its share of the force.
The Perimenopause Factor
To make things more complicated, our tendons are directly under attack by changing hormones during perimenopause—the 10-year transition phase before menopause.
"Tendons have estrogen receptors. And when our estrogen starts to fall, we do see a decreased quality in tendon health. And so it's actually now called the musculoskeletal syndrome of menopause." — Dr. Rachel Selman
When estrogen enters a chaotic up-and-down pattern, multiple tendons can flare up at once. To combat this, Rachel recommends heavy isometric holds (holding an immovable load for 30 to 45 seconds), which act like "wringing out a wet sponge," pumping out the cellular gunk and forcing the frayed tendon fibers back into alignment.
How to Assess Your Pelvic Floor at Home
You don't necessarily need to run to a clinic to start building a connection with your body. You can perform a simple self-check using 360-degree diaphragmatic breathing.
The "Sit on Your Hands" Test
Sit tall on a hard surface with your hand placed directly under your pelvis.
The Inhale (Reverse Kegel): Breathe deeply into your belly and pelvic basin (visualize a pufferfish expanding). You should feel a distinct lengthening, opening, and downward drop against your hand.
The Exhale (Kegel): Blow out air like you're blowing out a candle. You should feel the core brace and the pelvic floor muscles lift up and close, moving away from your hand.
The Midlife Athlete Trap: Rachel notes that most active women aren't actually weak; rather, they are stuck in a constant contraction (a perpetual Kegel). If your pelvic floor cannot fully relax and lengthen, it cannot absorb shock when your foot hits the pavement or when you drop into a heavy squat.
Tangible Takeaways to Implement Today
1. Coordinate the Pelvic Floor in Your Deadlifts
Stop overthinking it on every rep, but take one workout a month to lower the weight and match your breathing to your movement mechanics:
On the way down (The Hinge): Your glutes, hamstrings, and pelvic floor should all naturally lengthen together. Think about a gentle, open reverse Kegel as you lower the bar.
On the way up (The Stand): As your glutes and hamstrings shorten to bring you to a standing position, perform a conscious concentric contraction (the lift) of your pelvic floor to fully support your spine.
2. Fix Your Running Posture and Cadence
If you suffer from minor leaks while running down technical trails or roads, try these simple athletic tweaks:
Incorporate Hill Repeats: Running uphill forces your body into a slight forward lean, which automatically fixes a flared rib cage and unclinches your glutes, making it significantly easier on the pelvic floor.
Shorten Your Stride: Check your smartwatch data. If your cadence is low (around 160), you are overstriding and braking with every step, forcing a highly stretched pelvic floor to take massive impact. Increase your cadence by 5 to 10 beats per minute to land your feet directly under your center of mass.
3. Steer Clear of Gimmicks
Beware of expensive "stay dry" electronic stimulation chairs popping up in wellness spas. Rachel warns that these chairs only target the surface-level Type 2 muscle fibers (which make up only 30% of the pelvic floor) and can actually make overactive, tight pelvic floors significantly worse. Save your money and invest in an evaluation with a performance-minded pelvic physical therapist instead.
4. TRY Pelvic Floor Weights
If you are a hybrid athlete dealing with a minor leak when running down technical trails, or feeling intense pressure during heavy lifting sets, you might assume your pelvic floor is weak. But according to Dr. Rachel Selman, the exact opposite is usually true for highly active individuals—your pelvic floor is likely overactive, clenched, and tight.
When you hit the ground running downhill, a rigid pelvic floor can’t move dynamically, meaning it can't absorb the force of your stride, and something has to give. This is where progressive overload comes in.
"We have been very hesitant to prescribe weights for clients who we feel like have overactive pelvic floors... Now we realize it's not the muscle being short. It's the nervous system saying we don't have the capacity because we're not strong enough. And so when you teach it to be stronger with something like weights, then it understands, 'Okay, that's what you're asking of me. I can handle that.' ...Strength gives permission to soften." — Dr. Rachel Selman
How to implement this: Dr. Selman recommends using high-quality pelvic floor weights, specifically noting that the brand Intimate Rose is designed by a pelvic PT and made with clean, body-safe materials. (Skip the sketchy, unverified options on Amazon!)
The Shower Routine: You don't need to carve out extra hours in your day for this. Insert the weight back toward your tailbone so it rests on the hammock of your muscles. While in the shower, perform functional movements like calf raises to practice holding and lifting the weight, or gently tug on the string and practice resisting that pull. Training the muscles with weight teaches the nervous system that it is capable, allowing the pelvic floor to finally relax, absorb impact, and stop leaking.
Knowing When to Seek Professional Help
While at-home awareness, proper breathing, and targeted training tweaks are incredible starting points, there are times when your foundation requires a dedicated mechanic. Rachel emphasizes that while she loves giving women the tools to understand their own bodies, one-on-one nuanced care is still the gold standard if you are struggling with persistent symptoms.
If you are tracking your symptoms and notice that your self-assessments or scores aren't improving over time—or if you are experiencing complex signs like pain with intercourse, chronic constipation, difficulty emptying your bladder, or severe pelvic pressure—it is time to loop in a professional.
However, as active women and hybrid athletes, Rachel issues one massive warning when choosing your care team: make sure your physical therapist actually matches your athletic lifestyle.
"There's a lot of pelvic PTs out there who do not integrate athletic performance. If you've tried pelvic PT, didn't get good results, and you're a very active individual, but don't feel like your PT was bridging the gap between that, find someone who's more performance-minded. Because kegels on a table, reverse kegels on a table is not going to translate to trying to qualify for the Boston Marathon, right? Those are two very different goals. So you have to have someone who can get you from point A to point B and that takes some of that orthopedic understanding." — Dr. Rachel Selman
If your provider's only solution is telling you to stop lifting or to quit running the trails you love, it’s time to find a provider who looks at your body through a performance lens. Your pelvic floor doesn't exist in a vacuum; it has to function at high speed and under heavy loads. Find an orthopedic-minded pelvic health specialist who wants to help you build capacity, not shrink your life.
To get your hands on the comprehensive symptom questionnaires and training protocols discussed in today's episode, you can pre-order Rachel’s highly anticipated book, Floor It.
Tune into the full episode of Fuel with Erin on Apple Podcasts, Spotify, YouTube, or your favorite player to dive even deeper into midlife peak performance!
