Leaking With Running: Beyond Pelvic Floor Strength
You just went through the miraculous process of birth. You have given yourself time to heal and you are ready to return to the activities you love. Running is one of these activities, but once you start you notice some leakage. You take a break and try again, but the leakage continues to happen. You may have even already seen a pelvic physical therapist for a standard 6 week check up and gotten leakage with sneezing and coughing under control with some strengthening exercises. So why do you keep leaking with running?
In order to more comprehensively treat the pelvic floor, we must assess and treat the whole body and apply it to the specific activity that is dysfunctional. Too often “kegels” (or as I prefer to say: pelvic floor muscle contractions) are prescribed for leakage without taking a more individualistic and movement oriented approach. There is a time and place for strengthening, but as movement specialists pelvic physical therapists can and should still provide a holistic and multimodal treatment.
One of the first things to consider when leakage occurs primarily with running is the mechanics of running itself. Unlike walking where shock can be distributed through both feet, running is a relative single leg activity where only one foot is making contact with the ground at any given time. When considering pelvic health, it is important to understand that the pelvis is a central are of shock absorption and translation. If we have inefficiencies in shock absorption down the chain, aka at the feet, the pelvis and pelvic floor can secondarily suffer and lead to dysfunction.
One of the first things I look at as a pelvic physical therapist is your center of mass, or where you weight is primarily on your feet. For various reasons attributed to the unique story of your nervous system, we can take on different weight bearing patterns. Very commonly with postpartum people, there can be a noticeable shift of the weight into the heels.
Take a moment to experience this:
Stand up and feel your weight in your heels. Now try to perform a pelvic floor contraction. Just notice without judgment what you feel.
Now try to shift your weight forward from the ankles, keeping your heels down. Perform a pelvic floor contraction again. Notice if you felt anything different.
In the average person (and your experience might be different and that is ok), most people feel more of the rectal part of the pelvic floor contract when the weight is in the heels. When you shift forward, you may have felt more of the vulvar (or base of the penis if you are a penis owner) area contract. This simple difference is profound because it dictates what part of our pelvic floor can be activated depending on where our weight is in our feet.
Shifting out of a heel dominant pattern can be significant because it allows us to have more connection and coordination with our anterior pelvic floor. The anterior muscles are the ones that play a larger role in keeping us continent. There are muscles called the urogenital triangle that either compress or release the urethra, which is the little tube we ultimately release urine from.
Understanding that leakage comes down to not just muscle strength, but quality of shock absorption and efficient muscle coordination can be a game changer in your experience with leakage with running.
Taking this concept and then applying it to specific and individualized exercises is ultimately what leads to sustainable change in the nervous system. There is no textbook treatment because you must work within your systems boundaries and honor your unique experience. This is where working with a pelvic physical therapist focused on movement patterns and nervous system retraining can be invaluable. Taking the time to invest in mindful movement retraining for the short term can create sustainable and pleasurable movement patterns for the long term.
At Bodyful Physical Therapy and Wellness, our goal is always to help you return to the movements and activities that bring you joy. We are comprehensive in our assessments and dynamic in our treatment styles. Consider booking an appointment if running with leakage is something you are struggling with- you can absolutely make a change and we would be honored to facilitate that change alongside you!