Feeling like you’re going to leak urine during a run (or actually leaking)?
Are you experiencing pelvic pain or a sensation of heaviness down there? Do you have achy hips or lower-back soreness that doesn’t seem to go away?
If you’ve ever experienced these symptoms, there’s a good chance your pelvic floor could use a tuneup. It’s important to realize this is common and treatable. Studies show that up to one third of women are affected by pelvic floor dysfunction, which refers to a number of issues ranging from the frequent urge to urinate to dropped pelvic organs (prolapse).
Symptoms may become more noticeable during running due to the added stress upon impact, says Julie Wiebe, a Los Angeles–based physical therapist who specializes in treating female athletes. “These symptoms can respond to care, but won’t just go away if ignored and could lead to musculoskeletal fallout and affect performance,” she explains.
Your pelvic floor forms a sling at the base of your pelvis. It is part of a team of core muscles that, Wiebe says, “are shown to anticipate a movement challenge and prepare for it by helping anchor your body at its center.”
New moms, take note: During pregnancy and childbirth, these anticipatory core muscles and other postural muscles go through many changes. Women should aim to restore communication and balance between these muscles before returning to running. Wiebe recommends following the three-prong strategy here as well as seeing a women’s health physical therapist if you are experiencing any pelvic or musculoskeletal symptoms.
Your anticipatory core muscles learn to work together again best when you are in a neutral alignment. In running, this neutral positioning also helps reduce forces upon impact, by keeping your center of gravity over your heels as you land (versus landing with your foot out in front of you). Use the ski jump exercise to find neutral:
- Stand with feet at about hip-width, with arms at your sides.
- Lean forward from your ankles and feel your weight shift to your midfoot/forefoot.
- Allow your rib cage to lean in as if you are running against a strong wind. Note that your bum gently untucks.
- Allow responsiveness in your belly so you can breathe like an umbrella. Notice movement of your rib cage and abdomen as you breathe from your belly, not shoulders.
Practice the first two tips together three times a day to help wake up your core muscles and find good alignment.
Find your pelvic floor muscles and reestablish their relationship with your transverse abdominus (deep ab muscles) and diaphragm (breathing muscle).
- In proper alignment from #1, place one hand on your lower rib cage and the other on your lower abdomen. Inhale through your nose, letting your rib cage expand in all directions, like an umbrella opening. Allow your belly to relax and gently rise.
- Exhale through pursed lips and gently lift your pelvic floor. Imagine you are picking up a kidney bean with your vagina. Feel your abdomen move inward in response. Notice your rib cage return to a closed position.
- Again, inhale through your nose as you soften your abdomen and relax your pelvic floor, imagining you are letting go of the bean.
- Continue for 3 breaths. Then shift your weight back to mid-foot while maintaining the relative alignment between ribs and hips.
- Continue breathing here for about 1–2 minutes, alternating between letting go and lifting of the bean on each corresponding inhale and exhale.
Before running, warm up with the first and second tips and then do two sets of the exercises in the third.
Training the dynamic, automatic response
The pelvic floor automatically engages before our first heel strike in running. But this does not mean it remains uniformly engaged throughout the run. It actually goes through a range of motion (excursion) as you move your trunk over your foot.
“To prepare the pelvic floor for a demand like running, we have to ask it to do things that match that demand,” says Wiebe. “The following exercises train the pelvic floor to be responsive, go through a range of motion and engage in larger body movements, and be involved in a functional pattern that translates into running.” Modify an exercise or position if it causes pain or leakage. If pain or leaks persist, discontinue.
Bridge with pullover
- Lie on your back with your knees bent. Place a folded blanket, towel or pillow under your head and shoulders to prevent your ribs from jutting out.
- Hold a light weight (start with 5 pounds) in both hands and raise your arms toward the ceiling. In this position, inhale and relax your pelvic floor.
- Exhale and lift your pelvic floor, then continue to exhale and stay engaged as you press through your heels to lift your hips while maintaining ribs aligned with hips. Still engaged, pull your straight arms to your hips.
- Inhale, relaxing your pelvic floor as you reverse the motion, returning the weight and your hips to the starting position.
Perform this sequence 8–12 times.
Lateral pull with cross-body chop
- Secure a light resistance band to a surface that’s at least a foot taller than you. Hold the band in your left hand with your arm out to your side, and take a few steps laterally until you feel slight tension.
- Stand with feet at hip-width, and place your right foot on a small towel.
- Keeping your weight in your left foot, inhale as you slide your right foot away from your body.
- From this position, exhale and lift your pelvic floor. Continuing to maintain the tension, pull the towel back toward your other foot. At the same time, pull the resistance band across your body, toward your right hip.
- Inhale and relax to reverse the motion with the towel and band.
Perform the sequence 8–10 times on each side.
- Stand with feet hip-width apart, then step your left foot back and place the ball of your left foot on the ground. Keep your front shin vertical and maintain your center of gravity over your front foot.
- Inhale as you bend both knees and lower your body until your left knee hovers above the ground.
- Exhale and lift your pelvic floor, then continue to exhale and stay engaged as you drive through your right heel and rise to standing.
Perform the sequence 8–12 times on each side.
- Start in a plank position with hands directly under shoulders and feet at hip-width. Modify this exerciseif you have diastasis recti by placing hands on an elevated surface, like a step or a table.
- Inhale and allow your pelvic floor to gently soften.
- Exhale and lift your pelvic floor, then continue exhaling and stay engaged as you jump your feet out wider. Repeat inhale/exhale and then jump back to the starting position.
- Inhale and relax your pelvic floor between reps.
- Progress the movement by exhaling through one whole cycle of out and in. Then speed it up with quicker, shorter inhales/exhales and pelvic floor lowers/lifts. Then switch to inhaling/softening as you jump wide and exhaling/engaging as you jump narrow.
Perform for 20–30 seconds.