Why High-Performing Athletes and Stressed Professionals Are at Highest Risk for Overactive Pelvic Floor
There's a particular kind of person who arrives at pelvic floor physical therapy expecting to hear that their floor is weak. They exercise regularly — often intensely. They're disciplined, physically capable, and accustomed to the idea that more strength and more effort produce better outcomes. The last thing they expect to hear is that their pelvic floor is too active.
And yet, this pattern shows up consistently in clinical practice: the highest-output individuals are frequently the ones with the most chronically overactive pelvic floors.
Why Athletes Are Particularly Vulnerable
High-intensity exercise modalities — CrossFit, Olympic lifting, intense Pilates, competitive athletics — share a common characteristic: they demand sustained abdominal and pelvic bracing throughout training sessions. Breath-holding during heavy lifts, core engagement cues that emphasize constant stability, and the high-impact forces of jumping and landing all create conditions where the pelvic floor is recruited heavily and frequently.
The problem is that training culture in these environments rarely addresses the release side of the equation. Athletes are coached to brace, engage, and stabilize. They are almost never coached to decompress, lengthen, and release. Over time, the pelvic floor adapts to this pattern of demand by maintaining a higher resting tone — and the muscle's ability to fully lengthen between contractions gradually diminishes.
The resulting floor is not functionally stronger — it's functionally shorter. And a muscle that cannot fully lengthen cannot fully contract, cannot coordinate properly with breathing and movement, and begins to produce the symptoms associated with overactivity rather than strength.
The TMJ Connection
One of the more surprising clinical correlations in pelvic floor research is the relationship between temporomandibular joint dysfunction — jaw clenching, grinding, and TMJ pain — and pelvic floor overactivity. Patients presenting with TMJ dysfunction have a statistically elevated likelihood of concurrent pelvic floor overactivity.
The mechanism is likely related to systemic tension patterns driven by the autonomic nervous system. Chronic stress activates the sympathetic nervous system — the "fight or flight" branch — which produces generalized increases in muscle tone throughout the body. The jaw and the pelvic floor are both areas where this chronic sympathetic activation manifests as sustained, low-level contraction that the person may be entirely unaware of.
This is the clinical basis for the observation that people "hold stress in their pelvic floor." Research supports that the pelvic floor is actually one of the primary sites of stress-related muscle tension in the body — arguably more so than the commonly cited shoulders and neck. For someone who grinds their teeth at night, clenches their jaw during the workday, and holds their shoulders near their ears — the pelvic floor is almost certainly doing something similar, without any of the conscious awareness.
What This Means for Treatment
For the high-performing individual with an overactive pelvic floor, treatment requires a significant reframe. The instinct to "work harder" at pelvic floor rehabilitation is counterproductive. The therapeutic goal is not to build more strength — it's to restore the full range of motion of the muscle: the capacity to fully lengthen before and after contraction.
This often means stepping back from high-intensity training temporarily, learning diaphragmatic breathing as a foundational reset tool, and developing body awareness around pelvic floor tension that has often been present for years without recognition.
The irony is not lost on us: for the CrossFitter, the Pilates instructor, the driven professional — the prescription is, in part, to do less. And to do it on purpose.
📞 Call 314-252-0345 to schedule an in-home pelvic floor PT assessment.