Episode #48: Functional Anatomy of the Core & Pelvic Floor in Barbell Training with Dr. Breanne Maruca, PT, PRSCC, CLT, WCS

Episode #48: Functional Anatomy of the Core & Pelvic Floor in Barbell Training with Dr. Breanne Maruca, PT, PRSCC, CLT, WCS

The core and pelvic floor are often forgotten areas of the body when it comes to addressing injuries and issues in powerlifting. This area of the body is not visible and symptoms associated with dysfunction of the inner core and pelvic floor can present themselves as poor training progress or injuries in the back or limb before a direct issue presents itself. 

Why does this happen? Well, most people are completely unaware of their pelvic floor and inner core because we don’t see them, feel them, or typically think about them. Additionally, their functions are anticipatory and automatic when it comes to movement and posture. 

In this episode of the PRS Podcast, PRS Clinical Coaches, Drs. Rori Alter and Breanne Maruca discuss the functional anatomy of the pelvic floor and core and the role they play in barbell training. 

This episode is an educational experience for barbell trainees, powerlifters, Crossfitters, weightlifters, and other strength lifters to deeply understand their core and pelvic floor to optimize their training and technique to either address their symptoms or reduce the risk of injury in the future. 

If you’re a chiropractor, physical therapist, medical doctor, strength coach, or student clinician, this episode is a great review and application tutorial regarding the core and pelvic floor and barbell training.

In this episode we discuss:

  • The layers of the anterior core musculature and how they function in daily movement and barbell training exercises

  • The role of the transverse abdominis and how it functions are your inner weightlifting belt

  • Why you don’t necessarily need to do isolated abdominal exercises

  • How the anterior core muscular contribute to the mechanism of the Valsalva Maneuver

  • Pelvic floor function and how the muscles contract and relax relative to the diaphragm, movement, and barbell training

  • Proper functioning of urination and defecation and why it shouldn’t happen when you lift

  • A brief introduction to Powerlifting Urinary Incontinence and resources for that

Resources Mentioned In This Episode:

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GET IN TOUCH WITH THE SHOW!


Dr. Rori Alter, PT, PRSCC, SSC: [00:00:00] All right, Welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Rori Alter, head clinical coach here at Progressive Rehab & Strength, with another lovely clinical coach here at Progressive Rehab & Strength. Many of you who have been listening to the podcast are very familiar with Alyssa and John, both doctors of physical therapy and clinical coaches here at Progressive Rehab & Strength. But we are joined here today and for the next couple of episodes with Dr. Breanne Maruca, a clinical coach here at Progressive Rehab & Strength and physical therapist who specializes in pelvic health. So what we're going to be doing this month is we are going to be talking about all things related to the core, the inner core, the pelvic floor, and types of dysfunction that people experience outside of training and inside of training. But those things outside of training certainly relate to the inside training. So without further ado, Bre, can you just give us a short introduction as to who you are, what your certifications and background are, and then, we'll dive into the functional anatomy of the inner core and the pelvic floor.


Dr. Breanne Maruca, PT, PRSCC, CLT, WCS: [00:01:10] Yeah. So Rori, thanks for, of course, having me. I mean, obviously, being a part of your team, but especially on the podcast that we get to let people know and discuss these important topics because, gosh, just because something is normal and you will hear this throughout all the episodes this a million times.


Dr. Breanne Maruca, PT, PRSCC, CLT, WCS: [00:01:28] Just because something is normal or sorry, just because something is common does not mean it's normal. So, um, this is where, you know, I really feel like the inner core pelvic floor and all things kind of surrounding it. There's a lot of things that we might not fully understand or there's a lot of misunderstanding about it or buzzwords and things that people just like hop on the bandwagon and say, This is what everyone should do or this is how you should do it. And it's like it just depends. So anyway, thank you, you know, for having me here, But, um, first off, as Rori said, I am a doctor of physical therapy. I continued on with my education and did a residency program through the University of Pittsburgh Medical Center. Um, it was about two years longish, and that was to become a board-certified pelvic health physical therapist. So not only in this residency did we work, did I work with a lot of pelvic-related conditions and different populations. So I worked with men, women, children, um, of all different ages, of all different backgrounds with all different diagnoses and surgeries. And it just, it was amazing, honestly, like the best experience ever. But, and I learned so, so much, especially from all of my mentors. After completing the residency then, and actually while I was in my residency, that's how Rori and I met. We were at a conference both presenting, um, regarding long special cases related to pelvic floor pelvic health. So we met and since then I've been working with men, women, and children back in my hometown in the clinic, as well as with Rori, through doing virtual pelvic rehab coaching and barbell coaching and barbell training. So kind of getting a little mix of everything. Um, and yeah, so that I guess I don't know if there's more, more about me.


Dr. Rori Alter, PT, PRSCC, SSC: [00:03:35] Why don't you tell us just a little bit about your background in strength and conditioning and exercise, your athletic background basically, and how you, how, how we really came to connect on barbell training.


Dr. Breanne Maruca, PT, PRSCC, CLT, WCS: [00:03:49] Yeah. So I mean, I guess going way back, I've been involved in sports and being active and outdoors and all of that since I was really little. I danced, I think starting at three years old and then got into softball, basketball, volleyball, I don't know, you kind of name it, I either tried it or really loved it. So and kept and continued with it. So all throughout high school, I, you know, continued those sports and then getting into college, I still kick myself in the butt. I wish I would have played college softball, but, uh, that's whatever. Let bygones be bygones, I guess. Um, but yeah, I focused on my studies. I was definitely a person who needed to study a lot, so I focused on my studies to that. Yes. Yeah. It was just like, okay, um, softball or, you know, a career. And that's kind of where the route went. But, um, so, but I stayed involved in intramural sports and summer sports and things like, you know, summer leagues and things. But overall, I got into barbell training specifically a littlebit more related to Olympic lifts with CrossFit. And I'm now a level one CrossFit certified coach. Um, but that's kind of where we got into where I was starting to get into more, into barbell training. Um, and when Rori and I met, it was just like, oh, there's so much more to this than you're ever taught in general playing sports and growing up in the athletic realm. But then especially in school, I'm like, okay, well, did we ever really learn how to squat optimally? Did we ever really learn how to like hip hinge and deadlift? And you know what all of this means related to not only people barbell training, but, um, you know, any population how we can tie this all into function inside and out of the gym and symptoms inside and out of the gym. And we just dive deeper and deeper and go down all these good rabbit holes. Not in a bad way, but. 


Dr. Rori Alter, PT, PRSCC, SSC: [00:05:55] No, no, it's so much fun. Honestly, this month of podcasts might be really long episodes. Guys we apologize. Yeah.


Dr. Breanne Maruca, PT, PRSCC, CLT, WCS: [00:06:02] Not only do we just like, are we super passionate about this, but it is kind of interesting even when like as we start getting into these conversations that we start to like, our brains start to turn and we're like, Oh yeah, like great point. And like, it's just ties things together more and more. And I think that's why I love, like, specializing in this area so much because it's kind of the central missing link of a lot of things and it just pulls pieces together. So yes, I specialize in the pelvic area, abdominal area, but it's almost like, well, you need that, at least my thought process is like, you almost need that piece to connect hip problems and then shoulder problems. Like there's all these, you know, it kind of starts at the core and we'll get into that more.


Dr. Rori Alter, PT, PRSCC, SSC: [00:06:50] But yeah, so just to touch on how you and I actually met, and what we're talking about when we say like we can just talk for hours. Yeah. So we were at the American Physical Therapy Association combined sections meeting, which is an annual conference that they have where all the different sections of Physical therapy- So pediatrics, sports, neuro, oncology, like everything, ortho or pelvic health, geriatrics, there are so many more that like don't even know about, but they all come together and there's large presentations and short presentations, research being presented, round tables and case studies. And so in 2019, you and I presented in the complex cases for pelvic health, and I brought a case that I had been working on about urinary incontinence and powerlifting and presented it was a 20-minute case study presentation. And then Brie presented on one of her clients as well. And we just really connected after that. And they asked. They were. The panel was very interested in learning more about powerlifting, urinary incontinence and how I, as a physical therapist who does not have an educational background in pelvic health, like I didn't do the residency. I'm not a board-certified pelvic health specialist, you know, I'm an ortho sports PT, How did I treat this person? And they wanted me to go deeper into that and present a two-hour presentation. And I was like, Oh dear gosh, I can't do this without Bre. And Bre had come up to me after that presentation and we really just connected because of your background in CrossFit, and you were just like, I want to know more about this. Yeah, like, this is awesome. Yeah. So then we just became friends from that, you know? And I said, you know, Bre, they want me to present on this. Would you be my co-presenter? So we spent the entire next year, literally, it was a full year of gathering research. I had already done this research because we have with my husband, John, at Adelphi University, we had already done a study, collected data for a study on powerlifting urinary incontinence, which maybe one day we'll actually write up a paper and submit it. And we really should because there's been so many more. We did that in 2017 and there's just been so much research that has come out since then on the topic of pelvic health issues in resistance training and barbell training. Um, but anyway, you and I spent the next year really diving into that research even further, putting together a presentation and really defining what powerlifting urinary incontinence was or is. And then we presented it together and then COVID happened and right away, like COVID happened literally.