Running is an outlet for so many things. It can remind you how strong you are, give you a sense of accomplishment, and the endorphin rush at the end is an added bonus. It requires no equipment, no social interaction, and no membership fees. It is something many of us start doing at a young age that feels like an inherent skill we can pick back up whenever we want. As our bodies evolve and change with age, how easy and what that feels like when we pick that skill back up changes.
A story from Jenn:
This October our clinician Jenn ran a half marathon with her dad. She had done one before a couple years ago and it poured the whole time. By mile 11, her hamstrings were not happy and making themselves known. Once your sneakers are wet, they lose 50% of shock absorption; which, by my assumption, means that her hamstrings were working overtime.
On her most recent training session, she made sure to do strength training, and give her hamstrings extra love and attention. But by mile 10.5, Jenn was feeling SI pain and later found out she leaked a little. As a PT herself, Jenn could see the trend; at around that 10 to 11 mile mark her shock absorption system breaks down.
A couple days later I assessed her pelvic floor muscles in standing. We found that those muscles were much weaker and had much poorer endurance compared to when they were assessed lying down. Needless to say, I gave her some homework to start working on pelvic floor muscle endurance.
So Why Am I Leaking?
One of the most common things that people come to see us for is urinary incontinence. Female athletes are three times more likely to have urinary leakage than male counterparts. A recent meta-analysis showed that almost 40% of female runners experience urinary incontinence.
These statistics are both averages across women who have had babies and who have not had babies. So why are women leaking?
Several factors can contribute to urinary leakage, but we are going to dive into one area in particular: shock absorption.
One of our pelvic floor’s major functions is shock absorption from those ground reaction forces our body experiences in any weight bearing activity. Running is essentially glorified hopping, which means that on every step as we are landing ground reaction force is being transmitted and absorbed starting at our foot, traveling up our leg, to our hip, pelvic floor, and lumbar spine. When everything is working in tip-top shape that force is transmitted up the leg, absorbed by our pelvic floor and dispersed with our trunk’s rotation.
Our pelvic floor needs to act like a trampoline, it needs to be soft enough to absorb the energy and force but not so soft it has trouble reacting in time. Our pelvic floor needs to be more than just strong enough to absorb that force, it needs to be quick, and it needs to have the endurance to do it repeatedly for the duration of your run.
Where this gets tricky is it is often not as simple as only our pelvic floor muscles are weak and they need to be stronger. Our pelvic floor muscles do not work in isolation when it comes to shock absorption, the strength and mobility of our feet, legs, hips, core, and spine are all part of that picture of how force is translating up our body.
So What Do I Do About It?
The answer isn’t necessarily kegels. A weak core or hips can be contributing to that difficulty and break down with shock absorption - sometimes because other things are weak the pelvic floor is being asked to do too much! Here are some things to check in on and get a sense of what might be happening in your body:
Try to balance on a single leg. Does one leg feel harder or more wobbly than the other? Do you consistently lose your balance to one side?
Try hopping on one leg. Is it hard to get off the ground? Do you land hard? Is it easier on one side? Can you do it quickly? Does it make you feel like you might leak?
Try to stand up from a chair on one leg and then sit back down, all while staying on one leg. Are you able to get up on one leg? Do you lose your balance? Are you able to sit down with control or do you plop back onto the chair? Is it different from side to side?
This a good starting point as these compound functional movements screen several components: strength, balance, coordination, power, and shock absorption. All things that are needed to be able to run. All things that are needed to not leak when you do run.
Are these movements challenging but you need clarification as to why that is? Or need better and more running-specific exercise progressions? That is when you come see us and we can do a comprehensive screen of not just pelvic floor function but also core and hip strength, spinal and hip mobility, and breathing mechanics. Once we figure out what part (or parts!) are breaking down, we can then give you running specific exercises that incorporate your pelvic floor and deep core.
