How To Fix Lifting Incontinence

Correct core activation is an area of lifting that is very regularly overlooked, with exercises such as crunches still being incorrectly programmed and performed as primary 'core strengthening exercises.'

Similarly, a large number of individuals still think specified core training isn't needed at all, as according to them, bracing for major lifts is adequate enough.

Although you may not have any apparent injury issues, optimising your core strength directly, can only improve your lifting, not hinder it.

Learning how to correctly brace and activate your deep core muscles, as well as directly strengthening them, is key to remaining injury free and ideally establishing a long and healthy lifting lifespan, across both men and women.

---

---

Apart from a one in a million lift where you let things go the wrong way, or you have a prolapse, this absolutely should not happen and there are methods through training that can dramatically improve or reduce it from happening (Clark, 2008).

Commonality does not equal acceptability!

As you can see from this image, the bottom layer of our core is called the Transverse Abdominis, or TVA for short, which is the main muscle we use to help establish trunk and pelvis stability. In both men and women, this muscle is also directly connected to our pelvic floor muscles, as well as to our internal hip flexors and a muscle that runs up alongside our spinal column in our lower back called the Multifidus (Manocchia, 2010).

Your TVA is a key stabilising muscle and is critically important in movements where trunk activation is of high importance.

There are several ways to learn how to correctly activate this muscle, however, it is important to not that if you have just had a baby or suffer from specific dysfunction in this area like a hernia, activation control will be different then to someone who is without injury.

If you have a prolapse/hernia/incontinence or are in the initial Post Natal stages, the best way to learn how to re-activate this area properly is to draw in the area of your stomach around the waistband of your pants.

Imagine sucking in the lower part of your tummy, by bringing your belly button closer to your spine.

If you are unsure of whether you are doing it correctly, place your fingers just inside your iliac crest, which is at the front of your pelvis and you should be able to feel a small contraction where the 'V-line' of your abdominals follows towards your groin.

Still not sure?

Cough while your hands are touching the V-line of your abdominals and you will feel your TVA rise and fall each time you cough, and then try and mimic this by drawing in your belly as explained above. 

Progressing from here, or if you have normal abdominal function, activating your core requires your thoracic region (your torso) to have a slight amount of extension in order for the diaphragm to be able to engage correctly and activate your core.

Now, how many people reading this actually brace their core by collapsing their sternum into their diaphragm and crunch over?

Well, I'm sorry to say, this is the incorrect way to activate your core properly.

Instead, the sternum should stay slightly raised at all times if you are trying to engage correct stability.

Now let's get back to the problem at hand and discuss how we can prevent incontinence during training.

The most common causes of lifting incontinence are:

• Poor posture
• Poor activation technique (crunching down when bracing instead of bracing out)
• Weak TVA and pelvic floor (due to injuries, childbirth etc) (Kenway, 2009)

Incorrectly bracing for either a squat or a deadlift will at some stage result in you bearing down instead of bearing outwards, which is part of the reason why lift incontinence occurs. In doing so, incorrect over  activation of the rectus abdominus during 'crunching' occurs and you are left with decreased activation of the muscle you are actually trying to use, which is the TVA.

Continuing to lift with an incorrect technique like this, will over time as we get older, potentially create a bladder prolapse, which will then require specific physio and potentially surgery.

So how do we strengthen this muscle now you have learned how to locate it?

1. Remove any kind of torso flexion exercises, such as crunching, from your training as they are mostly pointless and can actually cause neck and back issues when done poorly.
2. Strengthen your trunk stabilisers.

To correctly strengthen your trunk stabilisers you need to be doing exercises that encourage just that, stabilisation.

Some good examples of exercises that achieve this are:

• Planks (high, normal and side)
• Bird dogs
• Leg lowers
• Deadbugs
• Heel slides (Kenway, 2009)

If you are already doing these and wish to make them more difficult, try increasing the angle or adding in further resistance such as kettlebells to improve your progression.

Remember, it's not all about the prime movers!

Taking the time to learn how to strengthen and stabilise these deep core muscles will not only help current or potential incontinence in the future, they may also help prevent hip issues and lower back issues as well.

For a measly 5-10 minutes of work, the benefits are well worth it.