A few of our SW members shared stories or asked questions about the pelvic floor and leaking while running, or when exercising. One of our members reached out to Dr. Foley, who graciously supplied some useful information and techniques, see her inputs below:
Leaking while running is very common for many women. It can happen after having children, or and in some cases it happens to female athletes. Unfortunately, finding a treatment for the problem of leaking while running is not simply found through doing one or two exercises. The top four approaches I recommend to decrease leaking while running are: 1) relaxing the abdominals; 2) posture; 3) strengthening the gluteus medius; and, 4) retrain the system with breath to accommodate the load of running.
There are many contributory factors that cause leaking during physical activity. First, one must identify when they experience leaking- does it occur at the beginning or end of the run? Does it happen while running downhill or only when running fast? Does leaking happen during the entire run, or only after the run? Does leaking occur while jumping?
A few often helpful strategies are to change one’s posture and to change how one engages the abdominals. I’ve seen many patients who held in their abdominals all day long, and even more during higher levels of activity. Studies have shown that women with incontinence can have good activation of the pelvic floor, but over stabilization of the external oblique. People do not need to pull in their abdominals all the time and definitely do not need to be doing it more with higher level activity. There is a pressure system from the diaphragm to the pelvic floor. This system must have the pressure distributed evenly or the system will fail. The diaphragm sits underneath the rib cage, while the pelvic floor is at the bottom of the torso. What is in between the two? The abdominals. If there is constant activation of the abdominals, it will increase the pressure towards the pelvic floor. A good way to see if this is happening is to simply look at the abdominals. There may be a kink in the upper abdominals, pushing out the lower abdominals.
Leaking while running is very common for many women. It can happen after having children, or and in some cases it happens to female athletes. Unfortunately, finding a treatment for the problem of leaking while running is not simply found through doing one or two exercises. The top four approaches I recommend to decrease leaking while running are: 1) relaxing the abdominals; 2) posture; 3) strengthening the gluteus medius; and, 4) retrain the system with breath to accommodate the load of running.
There are many contributory factors that cause leaking during physical activity. First, one must identify when they experience leaking- does it occur at the beginning or end of the run? Does it happen while running downhill or only when running fast? Does leaking happen during the entire run, or only after the run? Does leaking occur while jumping?
A few often helpful strategies are to change one’s posture and to change how one engages the abdominals. I’ve seen many patients who held in their abdominals all day long, and even more during higher levels of activity. Studies have shown that women with incontinence can have good activation of the pelvic floor, but over stabilization of the external oblique. People do not need to pull in their abdominals all the time and definitely do not need to be doing it more with higher level activity. There is a pressure system from the diaphragm to the pelvic floor. This system must have the pressure distributed evenly or the system will fail. The diaphragm sits underneath the rib cage, while the pelvic floor is at the bottom of the torso. What is in between the two? The abdominals. If there is constant activation of the abdominals, it will increase the pressure towards the pelvic floor. A good way to see if this is happening is to simply look at the abdominals. There may be a kink in the upper abdominals, pushing out the lower abdominals.
Letting this tension go and relaxing the abdominals will allow the pelvic floor to function the way it is meant to be used. For example, at heel strike, the pelvic floor moves down and forward- if there is already pressure on the pelvic floor due to gripping the abdominals, the addition of the heel strike impact (while running) could lead to leaking.
The second most important thing to focus on is posture.
The second most important thing to focus on is posture.
The rib cage and the pelvis must be in alignment in order for the pressure system to be used effectively. The first picture (above, left) features rounded shoulders which brings the rib cage behind the pelvis while the pelvis moved forward. This increases the pressure through the system. With running one needs to bring the rib cage and pelvis in alignment, but also lean slightly forward to distribute the impact of running. Leaning forward can also improve hip extension which powers of our movement. Rotation is the other important part of movement with running. During pregnancy, women adopt compensatory strategies for movement; oftentimes, this results in a side-to-side movement rather than rotation due to the baby growing in the abdomen. When women lose that rotational movement, it may take retraining the brain and body to get this movement back. Women must ensure they rotate at the trunk with walking and running. When running, women want to concentrate on landing softer with the feet, making sure there is space between the legs, rotation in the arms and trunk, and while leaning forward (similar to leaning into a strong wind).
Third, to support the pelvis, you need to have strong gluteus muscles. To test if your gluteus muscles are strong and supportive, one can perform a single leg squat. If the knee moves inward, this indicates that the gluteus medius is not helping to support that activity. During running, each time one takes a step there is impact upon a single leg. If the glutes are not supporting this activity, pressure is placed on other areas such as the knee or pelvic floor. To strengthen this, one can perform a single leg squat in front of a mirror while holding onto a countertop for support. In doing this, one can perform the squat at different depths and with different levels of assistance, i.e. holding on with a whole hand versus a finger for extra support.
Sometimes one needs to change how the brain is working instead of strengthening the pelvic floor. The way to do this is through breath and with graded exposure to the activity of difficulty. If the activity is jumping, then one must unweight that activity and focus on breath. For example, start with plank jumps to improve jumping jacks, or even heel strike without leaking. First, start with a slow plank jack with an inhale, then exhale and jump both feet out. Then, move to inhale jump, exhale jump, and from there one can increase width between the feet, or increase the speed. The breath connects the brain and the activity. From the plank jack, one can perform a supported plank jack on a chair or couch, and then ultimately perform an actual jumping jack. As one transitions the from a plank jack to a jumping jack, they change the load on the pelvic floor. Then most important things to consider are when there is leaking it is a sign that the system needs a new strategy and running cannot be effective with a stiff pressure system.
If you have additional questions, seeking advice from a pelvic floor physical therapist would be a good resource to help get back to the activity you love.
Third, to support the pelvis, you need to have strong gluteus muscles. To test if your gluteus muscles are strong and supportive, one can perform a single leg squat. If the knee moves inward, this indicates that the gluteus medius is not helping to support that activity. During running, each time one takes a step there is impact upon a single leg. If the glutes are not supporting this activity, pressure is placed on other areas such as the knee or pelvic floor. To strengthen this, one can perform a single leg squat in front of a mirror while holding onto a countertop for support. In doing this, one can perform the squat at different depths and with different levels of assistance, i.e. holding on with a whole hand versus a finger for extra support.
Sometimes one needs to change how the brain is working instead of strengthening the pelvic floor. The way to do this is through breath and with graded exposure to the activity of difficulty. If the activity is jumping, then one must unweight that activity and focus on breath. For example, start with plank jumps to improve jumping jacks, or even heel strike without leaking. First, start with a slow plank jack with an inhale, then exhale and jump both feet out. Then, move to inhale jump, exhale jump, and from there one can increase width between the feet, or increase the speed. The breath connects the brain and the activity. From the plank jack, one can perform a supported plank jack on a chair or couch, and then ultimately perform an actual jumping jack. As one transitions the from a plank jack to a jumping jack, they change the load on the pelvic floor. Then most important things to consider are when there is leaking it is a sign that the system needs a new strategy and running cannot be effective with a stiff pressure system.
If you have additional questions, seeking advice from a pelvic floor physical therapist would be a good resource to help get back to the activity you love.
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Dr. Courtney Foley, PT, DPT, PRPC is a pelvic floor physical therapist who is currently practicing in Charlotte, NC. Thank you for taking a moment to provide some helpful advice to the Stroller Warriors® community!
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