Running and the Pelvic Floor

By Natalie Sterner, PT, DPT

Running is a common activity that many women and men enjoy daily. Frequent runners typically have a pre and post workout regime consisting of stretching for hip and knee musculature, foam rolling, and even icing in order to reduce pain and inflammation in various joints or muscles. One thing that is often left out of these routines is the pelvic floor – a vital component in core stabilization and injury prevention with exercise, particularly running. Many runners will seek out treatment for common orthopedic issues – plantar fasciitis, hip pain, ITBand dysfunction – which may be stemming from the pelvic floor and will not see complete results with therapy due to only being given “core” exercises without addressing the pelvic floor as well. Statistics show that at least 1 out of 4 women report having one or more pelvic floor related disorders such as urinary/fecal incontinence, pelvic pain, and pelvic organ prolapse (POP). A study by Thyssen in 2002 found 44% of young female athletes leaked during sports.

The pelvic floor is just as important as our other external musculature in proper running mechanics. The pelvic floor is part of the deep core muscles which are our anticipatory muscles. They stabilize our body by contracting prior to movement. Other muscles in this group are the transverse abdominus, multifidi, and diaphragm. The pelvic floor works during both phases of running. During the flight phase it works eccentrically or lengthens. During heel strike of the stance phase the pelvic floor and deep core muscles work concentrically meaning they shorten to allow for stability. Thus we need the full range of the pelvic floor for optimal mechanics during running.

Pelvic floor dysfunction can present in various signs/symptoms. Some common dysfunctions found in athletes/runners are listed below:

• Urinary/fecal urgency: This symptom is often caused by myofascial trigger points within the pelvic floor muscles which triggers neurogenic bladder symptoms. These trigger points can become active during running and lead to the feeling of immediate voiding! This can be extremely frustrating for runner who may limit their paths or routes to make sure a bathroom is close by or even needing to stop mid-run to not lose urine or feces.
• Urinary/fecal incontinence: Urinary or fecal leaking can be a very common occurrence with runners. In a study by Leitner in 2016, it was found that 41% of female athletes have experienced urinary leaking with running. This can range from a small dribble to fully soaking through leggings and running down legs. Running is very stressful on the pelvic floor muscles that work to support all the pelvic organs while maintaining continence. If leaking occurs, the pelvic floor is not able to tolerate this pressure. This could be caused by myofascial trigger points, muscle weakness, and/or decreased coordination.
• Pain: The pelvic floor muscles work just like any other muscles – they contract and relax and can become tight or weaken. Pelvic floor muscle trigger points can develop as well if not allowing lengthening to occur in the muscle. Common pain referrals from the pelvic floor are the lower abdomen, hip, buttock, posterior thigh. Pain may also be coming from external hip muscles as well. The adductors, our inner thigh muscles, can also refer pain to the pelvis. It is important to have both strength and flexibility in all of these muscle groups.
• Heaviness or pressure: This can be a potential sign of pelvic organ prolapse (POP) which is the downward descent of the pelvic organs. This can involve the uterus, bladder, and/or rectum. The pelvic floor muscles need to provide enough support with the increase of intra-abdominal pressure that occurs during running. If there is weakness and not enough support, this can lead to pulling on the ligaments and connective tissue leading to possible prolapse.

What can we do to ensure that the pelvic floor is working appropriately to reduce the risk of these symptoms? Breathing is the first step. When exercising we want to ensure that the diaphragm is moving properly. When we inhale the diaphragm should move down into our abdominal cavity allowing the rib cage to open and the belly to expand rather than just breathing using our chest. This will allow the pelvic floor and transverse abdominus muscles to lengthen. During our exhalation the diaphragm moves upward as the pelvic floor and transverse abdominus return to their prior position. The diaphragm and pelvic floor muscles move in tandem like a piston and generate good tension in the trunk which creates more stability while we run. Coordination of this is important.

Try not to hold/grip the abdominals or pelvic floor. This will limit trunk rotation and the ability to use the abdominals effectively. Same with the pelvic floor – there needs to be some absorption of pressure and holding can lead to overactivity of the muscles. We want all of the deep core muscles to work together in balance.

Posture is important for running as well. Proper running posture consists of leaning over so that your rib cage is on top of your pelvis in order to keep your head looking forward. This will allow better mobility through the hips and will keep your body over your heel as you land reducing the pressure through the body. Increasing your cadence, the number of steps you take per minute, can also decrease the forces through your body leading to less impact through the pelvic floor as well.

Making sure that your body is taken care of while doing what you love to do is important so that you can keep doing it! The demands of running are intensive and repetitive. It is important to specifically train the pelvic floor to meet these demands just as you would strengthen your back, hip and knees for fitness. If you feel you are having any of these issues the pelvic health therapists at Pelvic Health Solutions can assess you individually and work with you to continue with the sport that you love to do!

Resources:

Thyssen HH, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunction. 2002;13(1):15-7.