If you’re working with a female population in rehabilitation, fitness, and sports performance, it’s imperative to understand the Chain Reaction® of female biomechanics. Dysfunction in the Pelvic Core Neuromuscular System can profoundly change a woman’s life. However, with the right tools, a movement professional can help their female clients or patients identify the real causes of their dysfunction and regain control.

At Gray Institute®, we’re committed to improving lives with Applied Functional Science® (AFS). That’s why we’ve turned our attention to women’s unique biomechanics and the Female Chain Reaction. In this blog, we explain how AFS can give you the comprehensive ability to evaluate, provide rehabilitation and exercise prescription that is unique to the female pelvis, neuromuscular system, and female pelvic bowl organs.

Understanding the Pelvic Core Neuromuscular System

The Pelvic Core Neuromuscular System (PCNS) is defined as the respiratory diaphragm at the top, the abdominal muscles at the front and sides, the back and hip muscles at the back and sides, and the critical pelvic floor muscles at the bottom of the pelvic bowl. This also includes the nerves, proprioceptors, joint motion, fascial tissue, and lymphatic system that are associated with the aforementioned muscle groups. All systems must work together as a team to avoid pelvic floor dysfunction (PFD).

Common symptoms of pelvic floor dysfunction include the following:

  • Hip pain
  • Low back pain
  • Pelvic pain with urination or bowel movements
  • Pelvic pain with intimacy
  • Pelvic pressure
  • Bladder or bowel leakage with coughing, sneezing, laughing, jumping, or impact in which the intra-abdominal pressure increases
  • Bladder or bowel urgency and frequency

These issues can dramatically and negatively impact women’s quality of life and physical performance.

RELATED: Pelvic Floor Dysfunction: What Physical Therapists Need to Know

Using Applied Functional Science to Address Stress Urinary Incontinence

Now, let’s explore how movement professionals can use Applied Functional Science to address pelvic floor dysfunction. Stress urinary incontinence (SUI) may be as high as 50% among recreationally active women. It’s a profoundly difficult and life-changing issue, but traditional treatment protocols aren’t always effective.

A study in the Journal of Women’s Health Physical Therapy evaluated hip angles, joint movements, and muscle activity during gait in women with and without self-reported stress urinary incontinence. Biomechanical gait analysis explored the sagittal, frontal, and transverse planes that occur at the hips throughout the gait cycle. The study found that women with stress urinary incontinence demonstrated altered hip biomechanics throughout the stance phase of gait, primarily in the transverse plane. Hip adduction and hip internal rotation motor control strategies in the group with SUI were impaired as compared to the group without SUI.

In Applied Functional Science, we evaluate six Vital Transformational Zones to determine the mobility at the hips in six directions, as well as the stability or motor control strategies of the hips in six directions. Using a comprehensive movement analysis system, like 3DMAPS®, you can assess the Pelvic Core Neuromuscular System and determine what may be contributing to a woman’s pelvic floor dysfunction.

Excessive hip internal rotation and hip adduction while evaluating the transverse and frontal plane, respectively, may demonstrate overreliance on the gluteus maximus muscle group due to deficits within the obturator internus and levator ani groups. The levator ani contributes to continence by reducing downward movement of the bladder neck. When the levator ani is unable to prevent this downward movement, incontinence may occur. 

The pelvic floor muscles contribute to a support system for the pelvic bowl organs. The pelvic bowl organs include the bladder, the uterus, and the rectum. The female pelvis tends to be oriented towards a more anterior tilt position. This orientation towards an anterior tilt provides a skeletal support system to the pelvic bowl organs. The pubic symphysis is oriented under the bladder, the uterus stacks on top of the bladder, and the rectum stacks against the posterior side of the uterus. This stacking mechanism is also part of the support structures via fascial tissue and ligamentous support. Understanding the parts of the female chain reaction biomechanics, female pelvic mechanics, and female pelvic bowl organs and anatomy will enable you to treat and train the female comprehensively for health, fitness, and sports performance.

Ready to Learn More? Enroll in Female Chain Reaction

In our Female Chain Reaction specialization, we take a global approach to assessing local mobility or stability deficits to restore global female chain reaction biomechanics and continence. If you would like to learn more about how Applied Functional Science can improve your female clients’ or patients’ outcomes, contact Gray Institute today.

Be in the know and start your journey through the Female Chain Reaction!



Bonis M., Lormand J., Walsh C., Immediate Effects of Exercise and Behavioral Interventions for Pelvic Floor Dysfunction. JWHPT. 2020;44(2):54-62.

Hartigan E., et al, Hip Angles, Joint Moments, and Muscle Activity During Gait in Women With and Without Self-reported Stress Urinary Incontinence. JWHPT. 2020;44(3):107-116.

McKenzie S., et al, Stress Urinary Incontinence is Highly Prevalent in Recreationally Active Women Attending Gyms or Exercise Classes. Int Urogynecol J. 2016;27(8):1175-1184.