Training Through Pregnancy and Back — What Nobody Told You About Your Pelvic Floor

Women's Health · 2026 · Muók Boxing · 8 min read

Training Through Pregnancy and Back — What Nobody Told You About Your Pelvic Floor

Leaking, pressure, pain, and not knowing if you can train. You don't have to accept any of it as normal. Here's what's actually going on and what to do about it.

Written by the Muók Boxing coaching team in collaboration with Dr. Lorrainne at Root Physical Therapy — Doctor of Physical Therapy and current orthopedic residency candidate pursuing board-certification. Lorrainne leads pelvic health care on-site at Root Strength Georgetown, same building as Muók. She has extensive experience working with active women and athletes before and after pregnancy. If you're pregnant, recently postpartum, or figuring out how to get back to training, book an assessment with Lorrainne — she's right next door and she's seen exactly what you're dealing with.

If you've been training at Muók Boxing while pregnant, or you're thinking about coming back after having a baby, you're dealing with a set of questions that most gyms aren't equipped to answer. Can I still train? What's off-limits? Why does it feel weird down there? Is it normal to leak when I skip rope? Am I supposed to just wait six weeks and then jump back in?

The short answer on that last one: no. The six-week OB clearance is real, but it's not a green light to go straight back to full training. And the stuff that feels "normal" — leaking, pelvic pressure, not being able to do a sit-up without something doming out of your stomach — isn't something you just have to accept as part of having had a baby.

Here's what's actually happening with your pelvic floor, what the research says about managing it before and after delivery, and what getting back to Muay Thai training actually looks like when you do it right.

• 01
  What your pelvic floor is and why it matters for training

  It's not just about Kegels. Your pelvic floor is a performance structure — and it takes a significant hit during pregnancy and delivery.
• 02
  What's actually happening during pregnancy

  Why things change as early as the first trimester, and what that means for how you should be training.
• 03
  The signs you shouldn't ignore

  Common symptoms that are normalized but are not normal — and what they're telling you.
• 04
  What the research actually says about training through pregnancy

  The evidence on pelvic floor training before and after delivery has moved significantly in the last few years. Here's what it says.
• 05
  The real return-to-training timeline

  Not a date — a set of criteria. What you should actually be able to do before you come back to sparring, bag rounds, and heavy lifting.

What Your Pelvic Floor Actually Does

Your pelvic floor is a hammock of muscle and connective tissue across the base of your pelvis. It supports your bladder, uterus, and bowel. It's responsible for keeping you continent — meaning you don't leak urine when you cough, jump, or get kneed in the stomach. It coordinates with your diaphragm and deep abdominal muscles to manage pressure when you lift, kick, or take impact. And it needs to both contract and fully relax to do its job — which is why "do more Kegels" is not always the right advice. This is exactly why our team at Root Physical Therapy always begins with a proper assessment before writing any exercise program.

For Muay Thai specifically, your pelvic floor is under a specific kind of load that most sports don't create: impact absorption from checked kicks, repeated abdominal bracing during clinch, explosive hip extension during teeps and roundhouses, and the body rotation involved in every technique. A pelvic floor that isn't coordinating properly will affect performance long before it causes obvious symptoms.

30–47%

of women experience stress urinary incontinence in the first year postpartum — normalized everywhere, not inevitable

37%

reduction in postpartum urinary incontinence with structured pelvic floor training — 2025 British Journal of Sports Medicine

8×

more likely to fully resolve stress incontinence symptoms with pelvic floor PT vs. no treatment

What Happens During Pregnancy

Pregnancy changes your pelvic floor starting in the first trimester — well before there's any visible belly. A hormone called relaxin, which peaks early in pregnancy, increases laxity in your connective tissue and ligaments throughout the pelvis. This is necessary for labor — it allows the pelvis to open during delivery — but it also means the support structures around your pelvic floor are working differently from very early on.

As your pregnancy progresses, the increasing weight of your uterus adds sustained downward load on your pelvic floor. Your posture shifts — most women develop increased lower back arch and rib flare, both of which change how pressure moves through your trunk during movement. By the third trimester, your pelvic floor is doing significantly more work than it was before you got pregnant, under different mechanical conditions, often without any specific preparation.

The thing most people miss — it's not always weakness

The cultural narrative about pelvic floor problems during and after pregnancy is that the pelvic floor is "weak" and needs Kegels. That's sometimes true. But it's also fairly common — especially in athletes — for the pelvic floor to develop elevated resting tension, what clinicians call hypertonicity. A hypertonic pelvic floor can't fully relax and coordinate properly. It can cause pelvic pain, painful intercourse, difficulty with certain movements, and — paradoxically — leaking, because poor coordination causes dysfunction even when the muscles aren't weak. Doing Kegels on a hypertonic pelvic floor makes things worse, not better. This is one of the reasons a proper assessment by a Doctor of Physical Therapy at Root Strength matters — an assessment tells you which direction the dysfunction is actually running. Just as our team approaches shoulder injuries from pad work or head impacts in sparring with a proper clinical assessment before recommending any intervention, the same applies here.

Signs That Are Common But Not Normal

This is important: common means a lot of women experience it. Normal means it's acceptable and expected with no need for intervention. These are not the same thing.

Signs That Warrant a Pelvic Health Assessment

Any leaking of urine when you cough, jump, skip rope, or get hit. A feeling of pressure, heaviness, or bulging in the vagina. Pelvic pain that affects your training, daily life, or sex life. Pain around the pubic bone or tailbone during or after training. An inability to do a sit-up or crunch without something doming or coning visibly out of your abdomen (this is diastasis recti). Ongoing perineal or C-section scar pain past 8 weeks postpartum. Any of these, at any point during pregnancy or postpartum, is a reason to get assessed at Root Physical Therapy — not something to wait out.

Leaking when you train is not a badge of effort. It's a signal. The pelvic floor is telling you something isn't coordinating the way it should — and that signal responds well to treatment.

What the Research Actually Says

The evidence on pelvic floor health during pregnancy and postpartum has improved significantly. Here's what it actually shows, without the usual oversimplification.

Training your pelvic floor during pregnancy helps — and the earlier the better

A 2024 systematic review published in a major obstetrics journal found that structured pelvic floor muscle training during pregnancy — started in the first or second trimester — reduces the likelihood of urinary incontinence in late pregnancy. Women who started earlier consistently saw better outcomes than those who started in the third trimester or waited until after delivery. A separate 2024 analysis found that the same training reduced the duration of the second stage of labor — a pelvic floor that has been specifically trained to contract and relax is mechanically better prepared for delivery.

Postpartum pelvic floor training has strong evidence behind it

A 2025 meta-analysis in the British Journal of Sports Medicine, analyzing data from seven randomized controlled trials involving nearly 2,000 women, found that structured pelvic floor muscle training reduced the odds of postpartum urinary incontinence by 37% and also reduced pelvic organ prolapse. This isn't soft evidence — it's the kind of consistent finding across large trials that supports clinical recommendation. Pelvic floor PT is the first-line treatment for postpartum incontinence. Not a supplement to treatment — the treatment itself. For the full clinical breakdown of the evidence, including the specific trial data and assessment tools, see our detailed PT guide at Root Strength.

Complete rest postpartum is not the recommendation

The evidence here mirrors what we've seen in concussion management: extended complete rest is not better than thoughtful progressive activity. Just as the Amsterdam Consensus Statement on concussion moved away from "dark room until symptoms resolve," the postpartum evidence supports early pelvic floor reconnection and light activity within the first week or two after delivery. The goal is graduated, symptom-guided return — not waiting for everything to feel perfect before doing anything. The same principles that govern return to training after any injury apply here.

Diastasis Recti — What It Is and What It Means for Training

Diastasis recti abdominis (DRA) is a separation of the two sides of the rectus abdominis — the "six pack" muscle — at the midline. It occurs in the majority of pregnancies to some degree, because the growing uterus simply creates the space. A diastasis that leaves the connective tissue at the midline unable to transfer load properly is the clinically relevant version, and it affects how you should approach abdominal loading when you return to training.

The visible sign of a poorly managed diastasis during exercise is coning or doming — a ridge or peak that appears at the midline of the abdomen when you do a sit-up or crunch. That's not a core activation you want. It's a sign that the tissue isn't managing the load appropriately, and exercises that cause it consistently should be avoided until the system is more functional. The good news: diastasis responds well to physical therapy at Root Strength, and most women who receive proper rehab and appropriate loading progression recover full function. The measure of a well-managed diastasis is not the width of the gap — it's whether you can generate tension and transfer load through the midline without coning.

The Real Return-to-Training Timeline

This is not six weeks and you're cleared. The six-week OB appointment is important — but it does not include a pelvic floor assessment, and "cleared for activity" does not mean "cleared for Muay Thai." The return to sparring, bag rounds, clinch, and skipping is a graduated process with specific criteria at each stage. Here's how our PT team at Root Strength Georgetown frames it. You can also read the full clinical version of this framework in our Root Strength pelvic health guide.

• 01
  Weeks 0–2: Reconnect, don't load

  Gentle pelvic floor awareness and breathing coordination — not strengthening. The goal is neuromotor reconnection. The pelvic floor can be temporarily impaired after delivery, especially if you had an epidural or significant perineal trauma. Light walking as tolerated. No abdominal loading, no impact, no weights.
• 02
  Weeks 2–6: Build the foundation

  Structured pelvic floor training — endurance holds and quick contractions. Hip and glute activation. Basic stability work coordinated with breathing. Walking progression. C-section scar mobilization begins around 6–8 weeks if your scar has closed. Get your PT assessment during this phase — don't wait for symptoms to develop.
• 03
  Weeks 6–12: Progressive loading

  Resistance training returns — squats, deadlifts, pressing — at reduced load from your pre-pregnancy baseline. Core work progresses from stability to anti-rotation and anti-extension. Hip strength is critical here: your glutes and hip abductors are load-transfer partners for your pelvic floor. No running, no impact, no bag work with full body rotation until you can pass the impact criteria below.
• 04
  Week 12+: Return to impact — when criteria are met

  Return to skipping, running, and bag work begins when: you can single-leg hop without leaking or feeling pelvic heaviness; you can do 10 rapid pelvic floor contractions; your hip stability is solid under single-leg loading; and you have no prolapse symptoms with exertion. These are criteria, not a date. Some women meet them at 12 weeks. Some take longer. The timeline varies.
• 05
  Return to sparring

  Sparring is the final stage. It requires all of the above, plus the physical readiness to absorb and deliver contact without your pelvic floor failing under load. At Muók, return to sparring after postpartum is something we approach collaboratively — with our coaching staff and the PT team at Root Strength — not something you just jump back into when you feel ready. The goal is a return that holds up, not one that creates a setback three weeks in.

The athletes who manage this well are the ones who take the return seriously. Not because they're being overly cautious — but because they understand that a solid eight-week foundation is what lets you train hard for the next eight years without issue.

Training During Pregnancy — What to Modify and When

Continuing to train through pregnancy is generally safe and beneficial, with modifications. The research supports exercise during uncomplicated pregnancies, and maintaining conditioning through pregnancy significantly reduces the recovery timeline postpartum. But the modifications matter, and they change as your pregnancy progresses.

First trimester

Most of your normal training is appropriate, with attention to hydration, overheating, and fatigue — which tends to be significant. If you're feeling any pelvic pressure, pubic bone pain, or lower back pain, that's a signal to reduce load and get assessed at Root Physical Therapy. These symptoms are not something to push through; they're the pelvic floor and lumbopelvic system telling you the load isn't being managed well.

Second trimester

As the belly becomes visible, supine exercises (lying flat on your back for extended periods) may need modification due to vena cava compression. Begin reducing lumbar flexion loading — sit-ups, crunches, heavy deadlifts with spinal flexion — and replace with stability-based alternatives. Clinch work and sparring are typically discontinued as the pregnancy progresses — the risk of contact to the abdomen and the mechanical changes to your base make these inappropriate.

Third trimester

Focus shifts to maintaining conditioning without provoking symptoms. Coning during any abdominal exercise means the exercise should be modified or stopped. Impact and rotational loading should be reduced. Pelvic floor coordination, breathing mechanics, and hip mobility become the training priority. Talk to your coach and get a PT assessment at Root Strength if you haven't already — this is the window where preparation for delivery has direct value. Our team works with members of Muók Boxing's classes specifically to build trimester-appropriate training plans.

From the Muók coaching team

We've had pregnant members train with us through their second trimester and beyond, safely, with appropriate modifications. We've also had members who needed to step back from contact work at week 12 because of pelvic girdle pain that wasn't being managed. Every pregnancy is different. We work with what you're actually dealing with — not a generic template. And when it comes to the pelvic floor piece, Dr. Lorrainne is right next door at Root Strength. She's a Doctor of Physical Therapy, she specializes in exactly this kind of care, and she works directly with our coaching team on return-to-training plans. Come talk to us, then go see Lorrainne — or do it the other way around. Either works.

A Note on "Bouncing Back"

There's a cultural pressure on postpartum women — especially athletic ones — to return to training quickly, to look like they never had a baby, to "bounce back." We're going to be direct about this: that pressure is not coming from the evidence, and acting on it is how you end up with injuries, persistent incontinence, or prolapse symptoms that follow you into your forties. The athletes who return to Muay Thai training successfully after pregnancy are almost universally the ones who slowed down enough to do the foundational work — the breathing, the pelvic floor rehab, the graduated loading — before jumping back into bag rounds and sparring.

That's not weakness. That's how you train for the long game.

Pregnant or Recently Postpartum?

Dr. Lorrainne sees patients on-site at Root Strength Georgetown — same building as Muók. She's a Doctor of Physical Therapy with extensive experience in pelvic health and postpartum rehabilitation for active women. No referral required. Most major insurance accepted.

Book with Lorrainne →

Keep Reading — Muók Boxing

Concussion in Muay Thai — What Every Athlete Needs to Know Shoulder Injuries From Pad Work and Clinching — What's Going On and How to Fix It Shin Splints From Muay Thai Training — What's Happening and What to Do Muay Thai for Fitness in Seattle — What Happens to Your Body Muók Boxing Classes — Georgetown Seattle About Muók Boxing

Root Strength & Physical Therapy

Full Clinical Guide: Pelvic Health Before and After Birth → Concussion — Assessment, Management & Return to Sport → Return to Training After Injury — What Most People Get Wrong → Shoulder Pain — Why It Happens and How to Fix It → Shin Splints in Athletes — Injury Mechanism & Rehab Protocol → Root Physical Therapy — On-Site Assessment → Book an Appointment →

Sources

1. Beamish NF, Davenport MH, Ali MU, et al. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. British Journal of Sports Medicine. 2025;59(8):562–575.
2. Zhang R, et al. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and perineal tear. Acta Obstetricia et Gynecologica Scandinavica. 2024;103:1015–1027.
3. Woodley S, Dumoulin C. Pelvic floor muscle training for preventing and treating urinary incontinence during pregnancy and after childbirth: A Cochrane Review. Cochrane Database of Systematic Reviews. 2024;(1):CD012279.
4. Maximizing recovery in the postpartum period: a timeline for rehabilitation from pregnancy through return to sport. International Journal of Sports Physical Therapy. 2022.
5. Return to running for postpartum elite and subelite athletes. PMC. 2025 May–Jun.
6. Donnelly GM, Moore IS, Brockwell E, et al. Reframing return-to-sport postpartum: the 6 Rs framework. British Journal of Sports Medicine. 2022;56(5):244–245.
7. APTA Pelvic Health Division. Pregnancy & Postpartum Physical Therapy — Evidence Highlight. 2025. aptapelvichealth.org
8. Santos AC, et al. Effectiveness of group aerobic and/or resistance exercise programs associated with pelvic floor muscle training during prenatal care for the prevention and treatment of urinary incontinence. Neurourology and Urodynamics. 2024;43(1):205–218.

← Concussion in Muay Thai Muay Thai for Fitness →