Pelvic floor morphofunctional characteristics in female rugby players beyond the tackle. Pelvic floor muscles in high-impact sports

Abstract

Rugby is a high-impact sport that may impose substantial mechanical demands on the pelvic floor muscles (PFMs) and has been associated with stress urinary incontinence (SUI). This cross-sectional study assessed pelvic floor morphofunctional characteristics in 27 nulliparous female rugby players using digital palpation, 2D transperineal ultrasound, and surface electromyography (sEMG) in supine and standing positions, both at rest and during tonic contractions. Ten players presented an anteroposterior diameter of the levator hiatus (LH (ap)) > 4.5 cm in supine, which was significantly larger in standing (p < 0.001), especially in those with SUI (p = 0.010). Variations in electrical activity were associated with levator hiatus dimensions, suggesting possible functional adaptations. Incontinent players showed higher activation percentages (p = 0.029), while continent players showed greater amplitude during MVC. A larger LH (ap) under load was observed particularly in players with SUI, who also showed a pattern of greater myoelectric excitation, potentially reflecting increased muscular demand during effort. Pelvic floor function in athletes exposed to repeated high-impact loading may depend on the balance between structural support and muscular activity, supporting the relevance of targeted evaluation and preventive strategies. Given the cross-sectional design, these results should be interpreted as associative