Many questions arise when it comes to running and the pelvic floor muscles: Is running bad for the pelvic floor? Am I causing harm to my pelvic floor muscles if I run with pelvic floor dysfunction? These are questions that researchers and clinicians are increasingly trying to answer. While researchers and clinicians have a ways to go before truly understanding the dynamics within the pelvic floor muscles (PFM) during running, the take home message= don’t stop running altogether! Simply train differently.
Resistance and cardiovascular exercises are supposed to be good for us, and clinicians are increasingly encouraged to not create fear avoidance in these activities. With that said, there might be a better way to train in order to run/jog so as not to overload the PFM. While running and resistance training may not be bad for the PFM, it’s important to note that there may be certain levels of weakness within the PFM that make the PFM unable to resist intraabdominal pressure or even gravity. If you experience leakage while running, then consider several things: What can be done to decrease the leakage? How can the activity be modified? More personally, how much is one willing to tolerate in order to continue running?
One key principle that helps inform the decision to run or not to run, is the overload principle. When we work out, we want to work our muscles to their point of fatigue (or for some high-level athletes, to failure). The PFM, especially when in a weakened state, will reach their overload point more quickly and urinary leakage occurs. In order to nudge the threshold of this early overload point, we can use a specific graded exercise approach in order to withstand various intraabdominal pressures as well as gravity. In other words, we start with small/simple exercises and progress into more complex/dynamic as the muscles regain their optimal function. We eventually use impact exercises as a stimulus for this tissue adaptation, which includes jumping, squatting, lunging, hopping, use of varied surfaces, etc. After all, even for non-runners, the PFM have to learn how to adapt to impact on a daily basis (examples: sneezing/coughing, moving boxes, doing heavy loads of laundry, housework, chasing/lifting children, etc). When we know our body’s thresholds, we can encourage muscle work up until we are hovering just below the point of fatigue, and then we slowly nudge that threshold by gently challenging the muscles so the tissue can adapt over time. The good news: it works! The bad news: it takes time and patience (sometimes up to 3 months and beyond).
Because impact affects us daily whether we are runners or not, it’s important to train our muscles to act and react as well as work voluntarily and involuntarily. This is why going beyond the traditional kegel is important. Kegels are often static and performed only on voluntary basis. However, recent research has shown that the pelvic floor muscles have a reflexive component during the running cadence. In other words, for a very brief moment in time (we’re talking milliseconds) prior to every heel strike, the PFM experience a downward displacement that researchers are still trying to figure out1. While the details are still TBD, the clinical take home message is that only teaching the PFM to kegel (or squeeze/lift up and in) on command is selling the PMF short on it’s overall function. Once someone can easily perform PFM contraction (squeeze + lift) more easily in different positions, then it’s time to move them along their PFM training as noted in the paragraph above. This involves training the PFM along with other muscle groups to behave as a coordinated unit.
The processes involved with PFM adaptation varies for everyone and are most often guided by a pelvic health physical therapist. This all starts with assessing the baseline of the PFM (What is Pelvic Health?). The pelvic health PT and the patient will then decide as a team what dosage and intensity is right for the individual to train at. Other things to consider: what’s in a person’s medical/personal history and what are their running goals? Everyone’s journey and goals are unique, and training and/or rehab should be no different. Whether you are training for your first marathon or simply hoping to chase your children around with more ease, the benefits of learning to specifically train the pelvic floor muscles are far-reaching.
If you are still wondering if YOUR PFM is ready for running, call today to schedule a consult with a pelvic health physical therapist!
