S4, E4: Pelvic Health Considerations for Climbers – Sam Lemminger

If you would like to listen to the entire interview with Sam Lemminger, check out the podcast. If you want to watch the interview, click the YouTube link or any of the timestamps above. If you would like to read a concise recap of key interview topics and questions, check out the excerpt from the interview below.

Pelvic Floor and Rock Climbing: What Every Climber Needs to Know
With Sam Lemminger, PT

Pelvic floor health is a topic most climbers never think to connect to their sport — yet it plays a direct role in force transfer, core stability, and performance on the wall. Sam Lemminger, a pelvic floor and orthopedic physical therapist at Onward in Fort Collins, Colorado, breaks down what the pelvic floor is, how to assess it, and why every climber — regardless of gender or injury history — should understand it.

Can you tell us a little about yourself?

I’m a physical therapist treating both pelvic floor and orthopedic conditions. I think it’s really difficult to treat someone orthopedically if you’re ignoring an entire region of the body, so having both lenses has been invaluable. I work at Onward, a cash-based clinic in Fort Collins that focuses on performance beyond just pain and injury. Outside of the clinic, I climb, hike, and spend a lot of time in the gym — it’s hard to recommend exercise to patients if you’re not doing it yourself.

Who has a pelvic floor, and why should climbers care?

Everyone has a pelvic floor — men and women alike. You don’t need to be pregnant, postpartum, or experiencing obvious dysfunction for it to be relevant. The pelvic floor is a group of layered muscles that sits like a bowl at the base of the pelvis. Its functions include sexual function, supporting the organs above, and — most relevant to climbers — facilitating force transfer between the lower and upper body. If the pelvic floor is coordinating well, you can be more dynamic and explosive. Most people just don’t know how to connect with it.

Most of what I cover in the clinic is foundational body awareness that we probably should have been taught as children — it just happens to be for a part of the body nobody talks about.

Are there differences between male and female pelvic floors?

The muscles are essentially the same, just oriented slightly differently due to anatomy. The functions are identical. Women tend to be more commonly affected by issues like leakage because the female pelvis is wider, requiring those muscles to work over a larger zone. But men are absolutely not exempt — pelvic floor dysfunction shows up in men too, often in different ways.

What does the pelvic floor actually have to do with core training?

There’s something called the core canister — a closed pressure system made up of four walls. The pelvic floor sits like a bowl at the bottom. The diaphragm sits like a dome at the top, underneath the rib cage. The abdominal wall forms the front, and the spine stabilizers form the back. When you take a deep breath in, the diaphragm flattens, the canister fills with pressure, and the abdominal wall and pelvic floor should expand and relax with it. When you contract your core by drawing up and in, the pelvic floor should reflexively engage with it.

So when a climber is training core with planks and sit-ups, they may or may not be getting pelvic floor engagement — it depends on the individual. Core and pelvic floor should contract and relax together, but if that happened automatically in everyone, I probably wouldn’t have much to treat. The goal is to understand what the muscles are and how to connect with them so you don’t have to consciously think about it when you’re executing a hard move.

What does pelvic floor dysfunction actually look like in a climber?

Most people assume weakness is the main issue, but in practice — especially with athletes — the far more common problem is a hypertonic, or overactive, pelvic floor. Think of someone who holds all their tension in their traps and neck when stressed. The pelvic floor does the same thing. We’re in a state of constant gripping and bracing throughout the day, and climbers are especially prone to this.

Signs of dysfunction during climbing can include leaking urine during hard moves, passing gas on an exertion, or developing a hernia. These seem unrelated on the surface, but they’re all pressure management problems. Think of it like a biceps curl — if your arm is always stuck in a contracted position, you won’t be able to generate force through the full range when a big demand comes in. When the pelvic floor is chronically overactive, it can’t respond appropriately under load. Pressure takes the path of least resistance, and that’s where symptoms appear.

Pain is also common: hip pain, low back pain, and abdominal pain can all have a pelvic floor component that goes unaddressed for years. I regularly see climbers who have been through multiple rounds of PT for hip pain, and when we do an internal exam, that’s exactly where the symptom is reproduced.

How do you assess the pelvic floor as a clinician?

The gold standard is an internal exam — a single gloved, lubricated finger inserted vaginally or rectally — to directly feel the resting tone of the muscles, check for pain referrals, and observe what happens with different breathing and bracing strategies. It’s always performed with full informed consent, and patient comfort is the priority throughout.

We can also assess externally by palpating near the sit bones, or simply observing movement between the sit bones during breathing. Assessment in standing and functional positions is often more revealing than lying flat, since that’s where symptoms actually occur. We can get creative — a high step or a squat position, for example, tells us a lot more than a table.

For those who prefer not to do an internal exam, external palpation and guided breathing exercises can still give us useful information. Sometimes just working through the basics — learning to relax and learning to brace correctly — tells us what we need to know.

What should a climber do if back or hip pain hasn’t responded to standard PT?

My approach is always to meet the patient where they are. If someone comes in with back pain, I look at the back first. But if someone has been through multiple courses of PT with no lasting change, the pelvic floor is a stone worth turning over. The internal exam is not the first thing I reach for — we go through the standard orthopedic workup first, look at the hip, and try treatments. If nothing explains it, then we can have that conversation. There is one stone we haven’t yet turned over.

Once dysfunction is identified, how do you treat it?

Treatment is staged. I always explain this upfront so people know where they are in the process and can see progress along the way.
Stage one is simply understanding what the pelvic floor is and what it does. Stage two is learning to connect with it — knowing whether you’re actually contracting or relaxing correctly. Stage three is translating that into exercise. Stage four, if needed, is building capacity.

The starting point is almost always diaphragmatic breathing, lying flat on your back. Place one hand on your chest and one on your belly. Breathe so that the lower hand rises and the upper hand stays relatively still. Most people are so chronically stressed that they’re breathing with their chest and accessory muscles without realizing it.

Once that’s established, shift attention to the space between your sit bones. On the inhale, there should be a subtle expansion and elongation — not a push, just a release. A cue I love: yawn your butthole. You’ll never forget it, and it gets exactly the right response. On the exhale, there’s a natural passive recoil. From there, we add an active contraction — drawing up and in, like you’re trying to stop a stream of urine. For most people, the core and pelvic floor will engage together, which is exactly what we want.

What if someone can’t feel anything in the lying position?

We try other positions. Yoga poses like happy baby, child’s pose, or puppy pose naturally open the pelvis and can make it easier to connect. If that’s still not working, tactile feedback helps — hook your fingers on the inside of your sit bones and feel for subtle movement during breathing, or roll up a towel and sit on it lengthwise on a firm chair and notice whether you feel pressure change as you breathe and contract. Usually one of these cues works. Sometimes it just takes a few days of repetition.

The first phase — building that connection — is the hardest part. We’re asking someone to detect a couple of millimeters of movement in a part of the body they’ve been taught to ignore their entire lives. It takes time, and that’s completely normal.

How does this progress into climbing-specific training?

Once the coordination is established lying down, we move quickly into functional positions — squats, hip thrusts, step-ups, single-leg work, impact. The exercises often look identical to standard strength training; what’s different is the internal awareness. We also get on the wall as soon as possible. If a climber is struggling with compression moves, we’ll practice exactly that and focus on what the core is doing during the engagement.

The goal is not to think about your pelvic floor at the crux. It’s to build the habit so that coordination becomes automatic — like learning to ride a bike. Deliberate at first, unconscious eventually. A shakeout at a rest position is a good time to check in. The actual hard move is not.

Is there anything else climbers should be aware of?

One factor that doesn’t get enough attention is energy availability. The body doesn’t prioritize pelvic floor function when it’s in a caloric deficit. Even if someone is doing everything mechanically correct, if they’re underfueled, those muscles won’t have the resources to do their job. We see this in gymnastics populations frequently, and I think it applies to climbing as well. It’s worth considering as a foundational piece alongside the mechanics.

There’s a lot more to cover — pregnancy, for example, is a whole other conversation — but even a basic understanding of what the pelvic floor is, how it connects to the core, and how to start building that awareness can make a real difference. There’s something in this topic for every climber.

Where can we find more information?

To connect, you can reach Sam via Instagram @samlemm.