Six-pack abs may steal the headlines, but when it comes to being a great runner (or simply just living a healthy, functional, pain-free life), your pelvic floor muscles really should be getting more attention.
"If you have a pelvic floor, you can have pelvic floor issues — and everyone has a pelvic floor," Sara Reardon PT, DPT, board-certified pelvic floor physical therapist and owner of NOLA Pelvic Health in New Orleans, tells LIVESTRONG.com. (That's right, whether you have a uterus or not, you still have a pelvic floor.)
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What Is the Pelvic Floor?
Your pelvic floor is the set of muscles and ligaments that act like a sling to support the organs in your pelvis, including the bladder, rectum and uterus or prostate. The pelvic floor's primary role is to support your body's bowel, bladder, reproductive and sexual function. It also works closely with your diaphragm and deep core muscles to help control and stabilize your pelvis and spine.
So it's pretty important. And thanks to the intricate balance and coordination between all of these muscles, any weakness or over-activity can cause a dysfunction of the entire system.
Symptoms of Pelvic Floor Dysfunction
- UTI-like symptoms
- urinary leakage
- long-term constipation
- unexplained lower back or tailbone pain
- pain during sex
Here's the good news: If you experience these symptoms, you're not alone. Even better? Your symptoms are treatable.
"One of the most pervasive myths about the pelvic floor is that pelvic floor symptoms are just an expected part of pregnancy, postpartum recovery, menopause and aging, and that there's nothing that can be done about it," Rebecca Maidansky, PT, DPT, an experienced pelvic floor physical therapist and the owner of Lady Bird PT clinic in Austin, Texas, says.
"It's so common for athletes to stop moving when they develop pelvic floor symptoms because the message they receive is that these symptoms are just part of life and we don't have treatment options, but that's not the case."
Reardon agrees. "There is still a lot of stigma around pelvic health issues, especially in the athletic community. But if staying active or continuing to run is your goal, working on your pelvic floor is key to that."
Tight vs. Strong: What’s the Goal?
While there are so many resources now that weren't available 5 or 10 years ago — search "pelvic floor" and you'll get thousands of articles, or pop onto social media and see hundreds of pelvic health therapists — we still have a long way to go.
"Many folks don't know the female pelvic floor has three openings and the male pelvic floor has two," Reardon (who is better known as The Vaginal Whisperer on social media) says. "So first it's education and awareness — learn what it does, what's normal and what's not — and then it is really about tuning in and self-assessing."
One of the biggest areas of confusion is whether your pelvic floor should be tight or strong. A "tight" pelvic floor and "strong" pelvic floor are often confused for one another, and while they're related, they are two very different things, says Maidansky.
Tight Pelvic Floor
"A tight pelvic floor describes a lack of flexibility or a situation where the pelvic floor muscles are held in a constantly contracted state," she says. In this scenario, your pelvic floor has a tough time relaxing. If that tension continues for an extended period of time, your pelvic floor muscles become shortened and lose access to their full range of motion. This creates more tension, and the cycle continues.
"Imagine clenching your fist for a week and then imagine how hard it would be to fully open that fist afterward. You'd experience pain, stiffness, and you wouldn't be able to use that hand very well in the short term until flexibility returned. That's what a tight pelvic floor is like."
Strong Pelvic Floor
A strong pelvic floor, on the other hand, is able to fully contract and fully relax. It's not stuck in a constantly contracted state. Imagine your fist hasn't been clenched for a week.
"You're able to fully open and fully close it. You're strong enough to lift a heavy dumbbell, but also have enough dexterity to unclasp a necklace because your hand isn't tight," Maidansky says. In this situation, your hand is both strong and flexible.
"For a pelvic floor to be strong, it has to be flexible. It has to be able to fully relax and fully contract so that it can do all the things we need to do without causing pain or other symptoms."
While a strong pelvic floor is better than a tight one, what matters most is its function. "There has always been a focus on pelvic floor strength, but what's ideal for these muscles — like any other muscles in our body — is their function," Reardon says.
"You want them to contract when you need them to contract (during a cough or jump to prevent leakage), to relax when needed (during bowel movements, bladder emptying, birth and sex) and be coordinated throughout the day."
Does Running Ruin Your Pelvic Floor?
Running, as with all high-impact activities, exerts more stress on your pelvic floor than if you were just standing around. That's because your pelvic floor muscles, along with your deep core, are responsible for managing both ground impact forces (from every step you take) as well as changes in your intra-abdominal pressure (from every breath you take) to keep your internal organs supported and your torso stable. That's a big job!
But stress doesn't equal bad or off-limits. In fact, Maidansky says that healthy stress leads to positive adaptations in the body, like strength gains and improved fitness.
"The general rule of thumb for the pelvic floor (and all forms of exercise) is this: If your strength, endurance, flexibility and muscular control is good, exercise will support your pelvic floor. Your muscles will become stronger and more resilient," she says.
"But if your strength, endurance, flexibility or muscular control is impaired, exercise can further stress your pelvic floor, exacerbating underlying symptoms."
Just like any other muscle group, your pelvic floor muscles should adapt and build endurance to running over time. If you're symptom free on the run and after, there's not much to worry about as long as you're following a balanced running program that includes strength training and adequate recovery. But if someone is already experiencing pelvic floor symptoms, like leakage, prolapse symptoms or pelvic pain, continuing to run can exacerbate these symptoms and injuries.
"This may be a contributing factor to why female athletes are more likely to experience urinary incontinence than their sedentary counterparts," Maidansky says. "I generally do not recommend running through symptoms like these unless you've been told otherwise by a qualified healthcare provider."
Like any injury, it pays to not be stubborn and seek help early. (This is especially important for pregnant people. Running isn't bad for your baby, but the extent to which the pregnancy and running combo strains your pelvic floor is very individual and will continue to change and evolve over the weeks and months of your pregnancy.)
"It's really challenging to tell a runner to stop running. As a former long-distance runner, I know first hand it's likely not to happen when it's their ankle, knee or pelvic floor that's injured," Reardon says. "The goal for runners from a pelvic health perspective is how we can optimize their pelvic floor function to help them run. So a runner may not have to avoid running if it causes leakage, but they may have to modify their running to work on their leakage."
Your goal should be to not think about your pelvic floor while you run. (For some, that can actually make you tense up and stress the muscles even more.) Only when you're experiencing symptoms — leakage, prolapse symptoms or pelvic pain — is it time to change what you're doing.
Check Your Running Form
If you experience urinary leakage, pubic bone pain or vaginal heaviness while running, it could have something to do with the way you run. A person's running form can significantly increase or decrease stress on your pelvic floor (and thus, your pelvic floor symptoms) while running, explains Maidansky.
"Symptoms like these are common causes for people to stop running altogether," she say.s But in many cases, tweaking form can make a big difference allowing people to continue training and racing or just running for fun and fitness."
It's important to stress that everyone is different — and running form can (and should!) vary from person to person. But a few common form patterns that lead to increased pressure through the pelvic floor include:
- Keeping your abdominal wall stiff
- Thrusting your chest and rib cage up to the sky
- Swinging your arms without any trunk rotation.
While working with a pelvic floor PT should be considered the gold standard, Maidansky says there are a number of tweaks folks can try to reduce stress on their pelvic floor while running.
"Though these changes may feel strange to start with, try relaxing your belly, tucking your rib cage so it sits over your pelvis and increasing trunk rotation, not just arm swing," she says. "These changes allow you to use your glutes, quadriceps and abdominals to push and propel yourself effectively, leading to a more efficient movement with less stress on your pelvis."
3 Training Adjustments to Make
In addition to tweaking your form, modifying your training and adding pelvic floor rehab exercises to your weekly routine can help keep you running while supporting a healthy pelvic floor, says Maidansky. Here are a few things you can incorporate into your training to help support pelvic health as a runner.
1. Head for the Hills
"If you're having symptoms like leakage, pain or heaviness while running, consider running uphill and walking downhill as a warmup or as training," Maidansky says. "Running uphill reduces force through the pelvic floor and gives your body a chance to build strength and endurance with less stress. Running uphill also helps folks practice keeping their chest over their toes instead of tilted up to the sky."
2. Do the Twist
Add in exercises that promote mid back rotation, recommends Maidansky. "Stiffness through the mid back, or thoracic spine, will limit a runner's ability to rotate as they stride. Exercises to promote thoracic rotation can help." Mobility drills like threading the needle or other T-spine stretches are a good place to start.
3. Shore Up Your Stability
Single-leg stability drills help strengthen the hips, core and pelvic floor, according to Maidansky. These can include exercises like front and lateral step ups, single-leg Russian deadlifts and single-leg bridges.
"This is a better way to build functional strength than exercises like kegels," she says. "Progressing your single-leg drills to include impact [such as hopping and jumping] should be the goal."
When to Seek Help
As online resources grow, it's important to keep in mind that there's no replacement for personalized care. "There's no one way to treat pelvic floor dysfunction. Symptoms can have a number of underlying causes and thus a number of treatment approaches," Maidansky says. "Pelvic health care is still largely inaccessible both geographically and financially, making online information a game changer for a lot of folks."
But if you're experiencing pelvic floor symptoms and you have access, an evaluation with a pelvic floor PT trained in working with athletes will provide you with the most personalized and effective approach.
And remember: While the pelvic floor conversation tends to focus on women (specifically women who have birthed children), that's just the tip of the iceberg in terms of who can benefit from treatment.
"Most people end up seeing a pelvic floor therapist after birth, bladder surgery or if they are directly instructed to do some following surgery," pelvic floor physical therapist Oluwayeni Abraham PT, DPT, owner of Triggered Physical Therapy, says. "What people often do not know is that pelvic floor therapists can see patients in childhood for bed wetting, help pain with periods for folks with endometriosis, manage issues associated with infertility and even support gut and chronic bowel diseases."
What's more, in most states in the United States people do not need a referral to access this kind of care — and you might find the best options out of network, Abraham says: "Private, cash-based care is on the rise and becoming the best standard of care to provide folks with one-on-one care, quicker healing and improved access."
Can’t find a pelvic floor therapist in your area? Look for providers that offer virtual appointments to get that one-on-one help remotely. You can also try online programs from certified experts like Reardon to help address pelvic floor weakness, tension or coordination.
Finally, keep in mind that like any muscular injury, healing pelvic floor issues will take time.
"Your symptoms may not improve right away," Reardon says. "These issues have likely been ongoing for some time before you decide to address them. It may take two to three months to see improvement, and you will have to continue to work on this even as symptoms get better."