The Performer’s Pelvis: Managing Pelvic Floor Dysfunction in Dancers and Artistic Athletes

Overview

Dancers and artistic athletes have unique movement and training demands involving repetitive impact, extreme ranges of motion, intense artistic expression, and quick adaptation to physical environments/performance spaces. Pelvic floor dysfunction is common in these high-level athletes, and there is a need for more clinicians who can understand their performance demands as well as deliver high-quality care for pelvic floor concerns like incontinence, pain, and prolapse. This course bridges pelvic health with musculoskeletal practice and performing arts medicine, with a focus on external and functional/movement training to address pelvic floor concerns in dancers and artistic athletes. 

Join this course for a 9-week dive into all things pelvic floor and performing artist. You will enhance your knowledge of pelvic floor anatomy and function and how this integrates into breathing, pressure-management, movement demands, health concerns, and orthopedic issues commonly found in this population. You will develop skills to assess and treat the pelvic floor from head to toe, integrating pelvic concerns with orthopedic perspectives and consideration for the overall health and well-being of the dancer/artistic athlete. 

Come learn new skills for management of the artistic athlete’s pelvic floor with Brooke Winder, physical therapist and Expert with Pivot Dancer, a knowledge-sharing platform that provides improved access to evidence-based content to the dance community. 

Learning Objectives: 

Upon completion of this course, participants will be able to:

• Understand and explain pelvic floor anatomy, function, and dysfunction as it relates to the unique movement and training demands of dancers and artistic athletes.
• Screen for and (externally) evaluate pelvic floor dysfunction in performing arts settings.
• Recognize common breathing and intra-abdominal pressure-control deficits in dancers and artistic athletes, and design exercises and interventions to address these deficits and offload the pelvic floor.
• Recognize specific movement demands of dancers and artistic athletes, including repetitive impact and extreme ranges of motion, and their relationship to pelvic floor function and dysfunction.
• Prescribe exercises to address overall movement dysfunction and load attenuation to optimize pelvic health in dancers and artistic athletes.
• Screen for general health considerations relevant to this specific population, including autonomic nervous system dysregulation, digestive dysfunction, RED-S, menstrual dysfunction, and hypermobility, and explain how these issues impact the pelvic floor.
• Implement management techniques to optimize digestive and nervous system function within a performing artist’s demanding training and performing schedule.
• Implement exercise and self-care interventions to specifically address pelvic floor muscle coordination, strength, and mobility deficits in performers.
• Identify key orthopedic intervention strategies for the neck, low back, hip, and foot/ankle that can address pelvic floor dysfunction from an effective whole-body perspective.
• Demonstrate patient-centered communication strategies to best address sensitive concerns that often surround the pelvic floor.
  Sessions:

Outline of this 9-Week Live Online Course

WEEK 1: Pelvic Floor Anatomy, Function, and Feel for Dancers and Artistic Athletes 

In this session, you will be introduced to pelvic floor anatomy, pelvic floor function, and the anatomic connections between the pelvic floor, trunk/spine, and hips relevant to the unique movement demands of dancers and artistic athletes. Experiential learning will help you build awareness of pelvic floor activation and relaxation and understand how shifts in alignment, positioning, movement cues, breath, and tension can affect the pelvic floor.

You will learn common signs, symptoms, and risk factors involved in pelvic floor dysfunction, which risk factors are more prevalent in dancers and artistic athletes, and basic screening/evaluation tools for pelvic floor dysfunction that can be used in typical performing arts settings. Current research relating to pelvic floor dysfunction in dancers and artistic athletes will be shared. 

WEEK 2: Breathing and Intra-Abdominal Pressure: Efficiency for Performing Artists

In this session, you will explore the breathing and pressure management system by diving into the anatomic and functional relationship between the glottis, diaphragm, and pelvic floor.

You will gain improved understanding of how vocal and breathing strategies can impact the pelvic floor, as well as how to address common breathing habits in dancers and performing artists that can lead to non-optimal pelvic floor function. Interventions to improve breathing variability and efficiency for artistic athlete demands, including thoracic cage and upper quarter mobility exercises, breathing exercises, and self-mobilization techniques, will be demonstrated. You will also be introduced to the basics of intra-abdominal pressure management and its importance in pelvic floor health for dancers and artistic athletes.

WEEK 3: The Pelvic Floor in a Larger System—Pressure Management, Impact, and Extreme Ranges of Motion

This week will begin with a review of intra-abdominal pressure management and current related research. We will explore the commonly-developed habit of “over-tensioning” the pressure system in dance and artistic athletic endeavors—including understanding typical teaching strategies that can perpetuate these habits.

You will learn how to educate dancers that “drawing abs up and in” cannot be their only strategy for stabilization, and be able to show them why through movement and exercise interventions. This session will also dive into repetitive impact loading and extreme ranges of motion required of dancers and artistic athletes, and how to address these demands with a focus on optimal loading and/or offloading of the pelvic floor. 

WEEK 4: General Health Considerations and their Impact on the Pelvic Floor: Nervous system and Digestive Health for Performers

This session will focus on the impact of the autonomic nervous system (both parasympathetic and sympathetic) on the pelvic floor.

You will discover why dancers and artistic athletes may experience uniquely high levels of stress that can influence pelvic floor symptoms via nervous system sensitization and disruption of the HPA-axis, as well as how to calm the nervous system through specific techniques. Secondly, this session will address how digestive health impacts the pelvic floor (as well as the nearby low back and hip).

Relevant gastrointestinal system anatomy and function will be introduced. We will discuss strategies to help dancers and artistic athletes optimize digestive function through movement, self-mobilization, daily and bowel/bladder habits, and adapting to unpredictable travel and performance schedules. 

WEEK 5: General health considerations and their impact on the pelvic floor: RED-S and Hypermobility

What is RED-S (Relative Energy Deficiency in Sport), why are dancers and artistic athletes at high risk for RED-S, and how does it impact the pelvic floor? In this session, we will discuss fueling considerations and concerns in performing artists, including the relationship to menstrual dysfunction and other hormonal concerns.

Screening methods and appropriate referrals for RED-S and overtraining syndrome will be included. This session will also cover pelvic floor concerns commonly associated with hypermobility, a frequent presentation in dancers and artistic athletes, and what we can do to help. 

WEEK 6: Pelvic Floor-Specific Training for Performers

This week we will return to a specific focus on the pelvic floor muscles and how to train them. Sample cases involving both hypertonic and hypotonic pelvic floor dysfunction will be discussed. Interventions (external) and exercises will be presented to address both hypertonic and hypotonic pelvic floor dysfunction, including examples of integrating this training into higher-level athletic function in dancers and other performers. 

WEEK 7: Treating from Head to Toe to Help the Performer’s Pelvis

This week will focus on integrating knowledge from an orthopedic perspective into the management of pelvic floor dysfunction in dancers and artistic athletes. You will learn how approaching problems at the neck, low back, hips, and feet can have a huge impact on dancers and artistic athletes struggling with pelvic floor symptoms.  

Research and clinical perspectives will be shared linking the pelvic floor to common orthopedic presentations. Exercises and strategies to address key joints above and below the pelvic floor will be explored with a focus on optimizing function in performing artists. 

WEEK 8: Communication Considerations in Treating the Pelvic Floor

This week will focus on developing basic skills to build a truly patient-centered environment for treating the pelvic floor in dancers and performing athletes.

Topics will include:

• Age-appropriate education and exercise to optimize pelvic floor function in pediatric or adolescent dancers and artistic athletes,
• Common considerations for dancers who are pregnant and post-partum (note, this is not a comprehensive pre- and post-natal course)
• The basics related to trauma awareness and gender inclusivity in pelvic floor care.

WEEK 9: Pulling It All Together

This week will involve final case studies and a discussion of how to pull together the information for efficient use in the clinical setting. Discussion and Q&A time will allow participants to explore further questions and ideas related to what they learned in weeks 1-8.

This session will finish with a one-hour movement class where you become the participant and experience a conditioning session that integrates breath, pelvic floor function, and pressure-management strategies into a flow of whole-body exercises.

Audience:

This course is perfect for physiotherapists and other rehabilitation professionals who have an interest in the pelvic floor, dancers, and artistic athletes. Previous experience in pelvic floor assessment and treatment is not needed.