On Lingering Pelvic Floor Musculoskeletal Injuries in the Postpartum Athlete: Are We Adequately Addressing Them?

Although vaginal birth has the highest risk of musculoskeletal injury per hour of exposure of any natural human activity, the resulting injuries often go unrecognized - sometimes for decades. The types of tissues injured during a difficult vaginal birth are similar to those involved in other musculoskeletal injuries. It is not widely appreciated that multiple structures can be injured, including pubic bone stress fractures, injury to the nerve innervating the right or left levator ani (LA) muscle, stretch injuries of the LA muscles themselves, and/or passive tissue stretch injuries to the perineal body (PB), perineal membrane (PM), and endopelvic fascia. Complicating the issue further is the possibility that each structure can be injured to differing extents, and the injuries can occur in a variety of combinations. As a contribution to the existing literature, the relevant information is tabulated for the first time in a pelvic floor musculoskeletal injury classification system, supported by illustrations for easy reference. Because early identification and interventions can help reduce, and even prevent, long-term symptoms, it is important to screen postpartum athletes and refer them to pelvic health specialists when appropriate. This will help benefit these athletes by fostering appropriate interdisciplinary collaboration with their sports medicine care team.