How can the load capacity of the pelvic floor be determined?

Load capacity, sometimes referred to as load tolerance, refers to the ability of a structure to manage the load it is exposed to (Gabbett and Oetter, 2025, Gabbett, 2023). In terms of pelvic floor load capacity, this means its ability to tolerate body weight, impact (from the ground, body to body contact, a fall, etc) and rises in intra-abdominal pressure.

This means that the level of pelvic floor function required is likely to vary from individual to individual and depend on the type of sport, activity and lifestyle that they engage in. For example, faster movements and lifting heavier weights will likely elicit higher intra-abdominal pressures than slower movements and lifting lower weights (Shaw et al., 2014). Sports such as rugby, which involve speed, exertion and resistance, may expose female athletes to their load threshold sooner than sports such as swimming or cycling. 

There is currently no validated approach to determining adequate load capacity at the pelvic floor (Kennaway et al, 2026). Two approaches commonly used by clinicians is described by Kennaway et al (2026) and includes:

1. Load until you leak – where the athlete continues training in an activity or task that provokes symptoms until the moment of symptom provocation. For example, if someone leaks urine on the 6th repetition of box jumps, they do sets of 6.
2. Load to 1 repetition in reserve – where the athlete continues training in an activity or task that provokes symptoms until the repetition before they can feel symptoms will be provoked. If someone leaks urine on the 6th repetition of box jumps, they do sets of 5.

Choice of approach will be athlete and practitioner-led and depend on the perceived experience of symptoms. As training progresses and an athlete engages in focused pelvic floor muscle training and wider pelvic health advice, it is expected that the load capacity of the pelvic floor muscle will improve and that the repetitions to symptoms will increase. If not, signposting to a specialist pelvic health physiotherapist is recommended.

The benefit of utilising approaches like the two outlined above is that the presence of pelvic floor dysfunction symptoms need not mean an athlete has to stop training or participation. Similar to other areas of rehabilitation, it simply indicates where modifications may need to be put in place. What modifications are needed will depend on the individual athlete’s presentation and circumstances.