Author: Laura Plankis, PT, DPT
Imagine the feeling of lacing up your favorite running shoes to step outside and realize it is the perfect cool summer morning. You head towards your favorite path, lined with green trees and the occasional vibrant wildflower. There is a slight breeze, just enough to cool you down as you start increasing your speed. Your mind starts wandering, remembering good events from the day before. You feel strong. You feel empowered. You remember all the reasons you fell in love with running in the first place. Then, all of a sudden, your bladder decides to be in control of your running route. Urinary urges start increasing, becoming more and more powerful with each stride forward. You look for a restroom … port-a-potty … even a bush. Urinary urgency is just one of the signs that you may be experiencing pelvic floor dysfunction. This blog will provide you with insight on common signs and symptoms of pelvic floor dysfunction in runners – whether you are a weekend warrior, marathoner, or working on completing your first mile.
- Urinary and/or Fecal Urgency
Planning a run around restroom or port-a-potty locations can limit running locations and ultimately take some of the joy away from the run itself. Even more frustrating is stopping in the midst of the run to use the restroom, only to find that very little urine is actually voided. So what is causing this urgency? Research suggests that myofascial trigger points within the pelvic floor muscles can lead to urgency by triggering neurogenic bladder symptoms. A study published in the Journal of Urology found that manual therapy to release these myofascial trigger points resulted in significant improvement, or full resolution of urgency-frequency symptoms in 83% of both their male and female participants.8 While out on a run, your pelvic floor may develop active trigger points, or knots in the muscle fibers, which can subsequently lead to both urinary and fecal urgency.
- Urinary and/or Fecal Leakage
A study in 2016 found that 41% of female athletes have experiences urinary incontinence.3 This may vary from a few dribbles on a pantie liner to moisture seeping down your leggings to your knees. Regardless of the amount of leakage, urinary and/or fecal leakage are signs that your pelvic floor is not tolerating the task at hand – in this case running. Leakage is associated with pelvic floor muscle dysfunction. This may include trigger points or muscle spasms, muscle weakness, decreased coordination, or a combination of factors. Trigger points can cause a poor firing pattern of the muscle fibers, leading to overall decreased muscle activation. Muscle weakness may present as decreased endurance, power, or both. Poor coordination results in inadequate timing of the muscle contractions. In other words, the muscle can not “turn on” quickly enough to prevent the leakage from occurring. If dysfunction is present, the muscles are not healthy enough to adapt to the forces being applied with running – while also continuing their role of maintaining continence.
- A Feeling of Heaviness or Pressure
The sensation of heaviness and/or pressure in the pelvis is a sign of potential pelvic organ prolapse. Pelvic organ prolapse is the downward descent of one or multiple of the pelvic organs.1 Most commonly, this involves the uterus, bladder, and/or rectum. In order to maintain proper support of the organs against increases in intra-abdominal pressure, there needs to be healthy muscles and connective tissues. Running causes increased intra-abdominal pressure, requiring a strong and supportive pelvic floor to combat this change in forces being placed on the organs. It has been documented that running on level ground at a pace of 8-9.7 km/hr cause an average maximal intra-abdominal pressure of 66.5 cmH2O. 6 For comparison purposes, the same study found transitioning from standing to sitting and jumping resulted in an average max pressure of 31.9 cmH2O and 91.2 cmH2O, respectively. 6 If the pelvic floor muscles are not healthy, more force will be placed on the ligaments and connective tissue. Overtime this force can lead to failure, or prolapse. Therefore, it is important to make sure your muscles are healthy enough to withstand the forces which may be placed upon them.
Many runners have experienced muscle pain during or after runs. They may grab a foam roller to work through their muscular knots, or use ice to decrease generalized inflammation. Runners are commonly familiar with stretches to maintain flexibility of their quadriceps and hamstrings, as well as techniques to maintain adequate hip mobility for running. However, it is fair to say that pelvic floor stretches are not a common component to a pre-workout routine or post-run cool down.
As previously discussed, the pelvic floor muscles can develop trigger points in the same way other muscle groups do. These trigger points commonly refer pain into the lower abdomen, mimicking abdominal cramping, feeling of GI distress, and/ or bladder pain. 5 Coccygeus and obturator internus, two of the deep pelvic floor muscles, can also refer pain to the hip, buttock, and posterior thigh. 5 Pelvic pain while running may be stemming from the pelvic floor muscles themselves, from surrounding musculature, or both. For instance, the adductor muscle group, among other muscle groups recruited for the act of running, can refer pain to the pelvis. 7 It is important to maintain appropriate muscle flexibility, as well as strength, throughout all the muscles involved in running – and yes, this includes the pelvic floor, to decrease risk of pain or tissue injury.
- Core instability and weakness
When discussing core, it is important to remember that the core goes way beyond rectus abdominis – or that optimal “6 pack muscle”. The core can be separated into the “local core” and the “global core”. The global core includes muscles such as obliques, hip adductors, and latissimus dorsi. These muscles contract during a direction dependent motion. 2 They are notorious for being overused, and can contribute to pain responses. The “local core” includes transverse abdominis, multifidus, pelvic floor muscles, and the diaphragm. These group of muscles help stabilize our bodies by contracting prior to a movement and regardless of direction. 2 Therefore, they help prepare the system for the upcoming task.
As a part of our local core system, the pelvic floor is functioning throughout all phases of running. During the flight phase, the pelvic floor is going through an eccentric or lengthening contraction.4 Then during strike or impact, the pelvic floor rebounds and goes through a concentric contraction to shorten. 4 Therefore, the pelvic floor needs to be strong and healthy throughout its full range of motion for optimal mechanics while running. Additionally, the local core system needs to be in sync. So for instance, if diaphragmatic breathing is limited while running, the pelvic floor muscles may be limited in their function as well. If the local core system is not functional at an optimal level, instability arises which can lead to pain and tissue injury. Training your local core stability system as part of your running program can help prevent injury, improve stability, and aide you in reaching your next PR!
At N2 Physical Therapy we are passionate about both pelvic floor health and running! We would love to see you at one of our 4 locations to aide in improving your pelvic floor muscle health and activation of the local core system to improve your overall running mechanics.
- Barber, M. Pelvic organ prolapse. British Medical Journal (online). 2016. doi:10.1136/bmj.i3853.
- Hodges P. Neuromechanical control of the spine. PhD thesis. 2003. Karolinkska Institutet, Stockholm, Sweden.
- Leitner M, Moser H, Eichelberger P, Kuhn A, Radlinger L. Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study. Neurourology and Urodynamics. 2016;36(6):1570-1576. doi:10.1002/nau.23151.
- Luginbuehl, H., Naeff, R., Zahnd, A., Baeyens, J., Kuhn, A. and Radlinger, L. (2015). Pelvic floor muscle activity during different running speeds—an exploratory and reliability study. Physiotherapy, 101, pp.e910-e911.
- Pastore EA, Katzman WB. Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2012;41(5):680-691. doi:10.1111/j.1552-6909.2012.01404.x.
- Shaw JM, Hamad NM, Coleman TJ, et al. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. Journal of Sports Sciences. 2014;32(12):1176-1185. doi:10.1080/02640414.2014.889845.
- TRIGGER POINT DRY NEEDLING: an Evidence and Clinical-Based Approach. S.l.: ELSEVIER HEALTH SCIENCES; 2018.
- Weiss JM. Pelvic Floor Myofascial Trigger Points: The Journal of Urology. 2001:2226-2231. doi:10.1097/00005392-200112000-00045.