Written by Brianna Irion, PT, DPT, OCS
Here’s why your pelvic floor muscles may need a little extra attention before you do
It is a well-known fact that running is a high impact sport. But how high impact? It has been reported that running at a moderate pace can lead to ground reaction forces up to 1.6-2.5 times your body weight. Of course, this increase in forces can lead to a significant strain through your joints creating the potential for injury. Most runners are aware of this increased strain and react accordingly by strengthening their muscles and training appropriately to minimize injury. The same concept can be applied for your pelvic floor (PF).
Your pelvic floor muscles play a significant role in supporting your trunk and hips during movement, particularly when running. It has been found, in females with a history of urinary incontinence, that there is a 4.59 fold increased risk of pelvic floor dysfunction with high impact exercise compared to low impact exercise. During pregnancy, there is an increased load on your pelvic floor from the weight of the baby which makes these muscles tired and overworked. The abdominal muscles also lengthen to accommodate for a growing baby. The female body is amazing in its ability to adapt to a growing baby. The ab muscles remain strong while you are pregnant because of the tension on them from the baby. Now think about birth. As soon as you deliver the baby, it’s like popping a balloon, the tension is gone and these muscles have a very hard time contracting at first. In the case of vaginal delivery, the pelvic floor muscles are designed to lengthen to allow your baby to safely get through the birth canal. This lengthening can lead to muscle trauma similar to if you sprained your ankle or twisted your knee. The injury will improve. Your body just needs time to go through the natural phases of healing. Your pelvic floor is not completely spared with cesarean delivery either and your body will need a similar amount of time to heal from surgery.
The risk of dysfunction is amplified in postpartum women simply due to the involvement of the pelvic floor during pregnancy and delivery. With the high impact of running, intra-abdominal pressure increases, creating increased strain through the pelvic floor. If the PF muscles do not have the strength to support the increased pressure caused by running, dysfunction may occur. Your pelvic floor, abdominal and hip complex muscles need time to recover after pregnancy and delivery before returning to such a high impact sport. Many women who return to running too quickly or without doing the proper strengthening first, find themselves injured.
We recommend that all women have a full musculoskeletal assessment after delivering a baby as it is physically demanding and often leads to imbalances. If you plan to return to running or other type of sport, the importance of a full assessment is magnified.
Preparing your pelvic floor muscles to return to running postpartum is a very similar process to rehabilitating any other running injury.
Here are a few helpful tips to begin working towards achieving your goal of returning to running:
● Strengthen. Strengthen. Strengthen. Gentle strengthening can be started soon after delivery and will progress in intensity over time. This is key for a healthy return to run program. Talk to your physical therapist for a more in-depth strengthening program.
● Test Yourself. Once you have worked on your strength for at least 6 weeks, try these movements as a guide to see if your body is ready to start a gradual return to run program. If you feel any pain, heaviness or dragging in your pelvic floor stop and call a pelvic floor PT.
● Be patient. It is recommended that a return to run program be initiated 3-6 months postpartum and only if you do not have aggravation of symptoms with the initiation of the program. Returning to your prior level of running will take time, but you will get there faster if you give your body time to heal and take the appropriate steps to ensure a strong injury-free return.
● Start small. Starting with short periods of running followed by a slightly longer walking time is often a good way to ease back into running. The reality is, you are unique and will likely need a specific program based on your prior level of function and current impairments. Contact a pelvic floor physical therapist for help in creating an effective running program that is best suited for you.
Listed below, are some keys to think about to recognize if you are experiencing any pelvic floor dysfunction. If you notice any of these symptoms along your return to run journey, stop and take 1 step backward in your program. Work at that level for a while before trying to progress further. Call Advanced Rehab’s Women’s health team for specific advice to your condition.
1. Do you leak urine or fecal contents during daily activities or when you attempt to run?
2. Do you feel a heaviness, pressure or bulging in your pelvic floor region?
3. Do you experience pain in your pelvic floor region during daily activities or intercourse?
4. Do you feel like you can’t engage your core or your pelvis feels “loose”?
If you said yes to one or more of those questions, you have a very common treatable condition. You do not have to live with these symptoms forever. And, guess what? We can get you back to running and the other activities you enjoy.
The pelvic floor muscles are heavily involved in how effectively you are able to run, particularly postpartum. This post is just the start of better understanding your pelvic floor and the needs you may have to re-initiate high level activities. The time taken to allow these muscles to heal and return to their optimal function will allow you to get back to the level of running you desire. Call Advanced Rehabilitation Services for more information or an in-depth evaluation regarding pelvic floor dysfunction.