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Keep on Moving: Running and your Pelvic Floor

I often get asked “can I run if I have pelvic floor problems?”

“When can I get back to running after having a baby?”

My answer to these, as with all pelvic floor problems, is: it depends.

I often get told:

“I can’t run because I leak”

“I’ll never run again, it’s too high impact”

My answer to these is: Not necessarily – in fact, I believe with the right individualised plan, you CAN.

Remember that any leaking of urine is NOT NORMAL. It’s a sign of a struggling pelvic floor, and it can be helped! But most women don’t leak every time they run, even if they do have incontinence issues. Why is this? How can we start to tip the balance towards continence and happy running?

How much impact is too much?

Running is an impact exercise, no question. But how much impact? It really can vary, and you can use this fact to adjust your running style and reduce the impact on your body.
We are designed to move, in fact we are designed to move much more than the average person moves nowadays. We were designed to run, to climb, to jump out of trees, to lift, pull, and push. Sure, impact can be too much for us – we were never designed to drive cars, or be hit by them, for example. But running? I’d suggest it’s far more about HOW you run than WHETHER.

There’s a perception that running is damaging to your body – again it’s a case of HOW you run. At its best, running is a fantastic form of exercise – 6 times more challenging than cycling, it’s brilliant for cardio work, endurance, mobility and mental health. All in a 30 minute workout from your front door.

Adjust your Style

Running with a ‘soft’ style removes excess jarring from the joints and muscles, and allows them to flex and spring in harmony, and allows the diaphragm and your breathing muscles to power you through. Running should feel smooth and almost as if you are falling forwards into it, gathering momentum rather than hefting along.

Heel striking, despite the inches of rubber in modern trainers, still loads the joints in an unhelpful way, puts out bodyweight behind our centre of gravity and effectively brakes our stride.

See the pictures below. In the first one, I am running downhill, leaning slightly back to control my descent, my heel out in front to ‘brake’ me. This is a typical, understandable pattern of running, especially if you’re not a fast runner, as rushing downhill feels a bit scary, so we brake. However this may be counter-productive, as it will jar the joints all the way up the leg into the pelvis, and naturally the muscles there will have to take the hit, preventing them from contracting and relaxing optimally.

In the second picture, my body is above my feet, equivalent to leaning slightly down the hill, gathering momentum, but much softer in my landing. My stride is slightly shorter and therefore far less ‘clumpy’ than a longer, slower stride. This dramatically reduces the jarring from heavy landing, and my pelvic floor is far happier.

I’ve helped lots of women who become really nervous on a downhill, telling me they feel ‘weaker’ or ‘less secure’ in their pelvic floor (and continence). A simple tweak of leaning forwards down the hill from the ankles (not bending at the hips) eliminates this feeling, and empowers these ladies to run again.

Take a look at the video here, showing the full run. Compare the first half to the second – a soft landing is faster, smoother, easier… overall a much more enjoyable run – and a happier pelvic floor!

How much running?

Again, this depends. What kind of running is your body used to? What have you achieved before? How often, how far? I often find that ladies have high goals, but because these seem so far off it’s a struggle to start. Obviously start small, and build up gradually, just like any exercise programme. After giving birth, and after your 6-week check, a programme like a couch-to-5k is perfect – even if you’ve run for years before. It will give you body a chance to gather strength and get used to the load again.

If it feels easy, then great! You will gain confidence. But never underestimate the massive effects of giving birth, your changing hormones and lack of sleep. Please be gentle with yourself, you will benefit in the long term.

How much, specifically, again depends on the problem. Both a weak pelvic floor and a hyper-active pelvic floor will fatigue if asked to run over a certain distance (this benchmark is different for everyone – again a great thing to measure!) and we will need to work around this to ensure you can run, but also to respect and support your pelvic floor by not asking too much of it.

What changes can I make to my running plan to help my pelvic floor?

Typically, those with incontinence can tweak their training to take advantage of their better days:

  • Run in the morning, rather than the evening, as the pelvic floor will have rested overnight and not be tired from a day of rushing about
  • Chart your monthly cycle – often a dysfunctional pelvic floor struggles in the week before your period as the womb is heavier and hormonal changes can affect the connective tissues. If this is typical pattern for you, then focus on less impactful exercise that week, such as yoga, pilates or swimming.
  • If hills are a problem (because they are more effort, or because you struggle to alter your running style as above) stick to the flat so you can still get some miles in but be more relaxed.
  • If you have been diagnosed with a weak pelvic floor, try doing your pelvic floor exercises just before you go out – this can ‘fire them up’ and support you better during your run.

How do I know which tips are best for me?

Try them and see what works for you, everyone is different. Gathering stats of your own situation – frequency, duration, time of day, distance-to-leaking, make notes of how secure you feel, can all give you information to start trying different techniques and making a difference to your confidence.

However, there’s no better option than getting a pelvic floor internal and external assessment. I know it sounds sales-y, but honestly, how can you fix a problem if you don’t know exactly what the problem is?

Incontinence is not the problem, it’s the symptom. The problem is a dysfunctional pelvic floor, and this comes in many forms. Your muscles may be dysfunctional due to weakness, tension, scarring, pain, hip weakness, hip tension, lower back restrictions, ankle or foot problems, to name just a few. Often the pelvic floor can be valiantly over-working to compensate for issues elsewhere in the pelvis, and you need a proper assessment to work out what your individual issue is.

Finally, it’s crucial to reiterate that any leaking of urine is NOT NORMAL. It’s a sign of a struggling pelvic floor, and it can be helped! Please try the above tips and adjust your running, but book yourself in with a Pelvic Health Physiotherapist to get yourself properly assessed. It can change your running, and your life, for the better!