How Do I Protect My Pelvic Floor While Running?
Despite popular belief, running isn’t inherently bad for your knees or your pelvic floor. With that said, the way you run can significantly alter the amount of stress placed on your pelvic floor muscles. In this piece, we’ll dive into whether running is good or bad for your pelvic floor, how your pelvic floor is impacted by running, exercises and drills you can incorporate into training to support your pelvic health and ways to modify running form to protect yourself while you run.
Is running good or bad for my pelvic floor?
Running itself is neither good or bad for your pelvic floor, but the status of your pelvic floor while you run can influence whether running is strengthening or stressing these muscles. Here’s a simple rule of thumb to help you determine whether running is helpful or stressful for your pelvic floor: If you don’t experience any pelvic floor related symptoms like leakage, heaviness in your pelvis or pelvic pain and your pelvic floor has good strength, endurance and muscular control, running may help make you stronger. If you do experience pelvic floor symptoms, particularly if those symptoms are aggravated by running, or if you have underlying weakness or control deficits, running may not be the best option for you, for now.
If someone is already experiencing pelvic floor symptoms like leakage, prolapse symptoms or pelvic pain, continuing to run can exacerbate symptoms and injuries. This may be a contributing factor to why female athletes are more likely to experience urinary incontinence than their sedentary counterparts. I generally don’t recommend running through these symptoms unless you've been told otherwise by your healthcare provider.
No pain no gain is not the mantra for a healthy and happy pelvic floor. If you’re experiencing any of the symptoms listed above, start by addressing the underlying cause of the symptom before resuming training.
How does running impact your pelvic floor?
Running, just like all high impact exercise, exerts increased forces through your pelvic floor. Fortunately, your pelvic floor has evolved to absorb this stress.
One role of the pelvic floor is to support your internal organs from below. Your pelvic floor forms the bottom of your core. When you land while running, a force known as ground reaction force travels through your foot, up your leg into your pelvis. As you land, ground reaction forces of 2.4 to 3.9 times the body weight travel through your pelvic floor muscles. In reaction to this expected increase in force, your pelvic floor muscles have evolved to automatically activate prior to landing during running and high impact activities. Or at least that’s what they’re supposed to do.
In folks with underlying pelvic floor muscle weakness or coordination deficits, this automatic muscle contraction might not occur. This increase in ground reaction force paired with a lack of automatic activation explains why running and other high impact activities can trigger urinary leakage and prolapse symptoms that aren’t present at rest.
For someone with a healthy pelvic floor, this increase in ground reaction force is not problematic. As a pelvic floor physical therapist, I am a huge fan of running for exercise. The benefits of cardiovascular fitness, time spent outdoors, positive impact on bone density and functional strength are too amazing to give up due to fear of increased forces through the body.
For someone with pelvic floor impairments, it’s important to address those underlying areas of weakness so that you can continue to run without increased likelihood of injury. This is no different than someone returning to running after an ankle sprain. If you sprain your ankle and return to running without rehabbing your ankle, running will be bad for your ankle and may result in further injury. If you take the time to rehab your ankle and allow your tissue to heal, running may once again be an excellent exercise for your body. The pelvic floor is the same.
5 ways to modify running form to protect your pelvic floor
While running will always trigger an increase in ground reaction force through the pelvic floor, running form can significantly increase or reduce forces through your pelvic floor. Modifying running form in a way that reduces excessive force through the pelvic floor can reduce common symptoms like urinary leakage, pubic bone pain and vaginal heaviness.
It's important to note that there is no one ideal way to run. Every person has a different physical make up with different strengths, weaknesses, injuries and dispositions. As a result, form modifications that feel good for one individual may not feel as good for another. In health and fitness, there’s never one way that’s the right way for all. Working with a pelvic floor PT can help you better understand your individual strengths and weaknesses while creating an individualized plan to get you feeling your best.
With that said, there are a number of common form modifications that have been shown to help reduce forces through the pelvic floor and can help reduce common pelvic floor symptoms.
Common running form errors which lead to increased ground reaction force include:
Keeping a abdominal wall stiff or engaged as you run
Lifting chest and rib cage up (think nipples pointing to the sky)
Swinging arms instead of rotating the trunk
Landing with your feet in front of the body
Landing heavy, particularly when fatigued
If any of these sound like you, don’t stress! Though form can be challenging to change, practice makes perfect.
Here are 5 ways to modify your form in order to reduce pelvic floor symptoms:
Relax your abdomen while you run: Are you constantly sucking in? Do you feel like you’re keeping your abs intentionally or unintentionally rigid as you run? Your abdominals function as shock absorbers and keeping a stiff core limits their ability to absorb shock on impact. Let your belly relax as you run and see how it feels through your hips and pelvis!
Point your nipples to the ground 20 feet ahead of you: A common habit of runners, particularly pregnant and postpartum runners, is to point their chest up to the sky. This stretches the abdominal wall and creates a slight back bend, making it harder for your core to function effectively. Stacking your ribs over your pelvis allows your pelvic floor, abdominals and diaphragm to work together to support you.
Rotate through your shoulders instead of your elbows to increase trunk rotation: Have you ever seen someone running, pumping their arms but keeping stiff as a board through their trunk? I can’t be the only person who watches runners on the trail. Thoracic rotation, not just arm swing, is an important part of running form. Rotating through your upper body as you stride allows your body to effectively use momentum and fascial lines to propel you through space. As you stride forward with one leg, bring your opposite shoulder forward. Alternate with each step.
Tits over toes: Land with your chest over your feet, not behind them. When you land with your feet in front of your body, your hamstrings are forced to pull you forward through your stride. When you land over your feet, your ankles, knees and hips can effectively absorb ground reaction force and your glutes and quads can work together to push you forward.
Landing soft: This one is often easiest for folks to incorporate. Land quietly. If you can hear yourself thumping on the ground, you’re creating more force than if you were quietly landing and more effectively absorbing that force. Make your landings as quiet as you can.
Pelvic floor exercises and drills for runners
Exercise and drills for a healthy pelvic floor is about so much more than kegels, particularly for runners. Working on hills, trunk rotation, single leg stability and landing drills can help reduce stress on your pelvic floor while you run. If you're experiencing leakage, pain or heaviness in the pelvis, I always recommend beginning with an evaluation with a pelvic floor PT. The drills and exercises below are not meant to take the place of personalized medical advice.
4 things to incorporate into training to support pelvic health as a runner:
Add hills into your workout: This is particularly beneficial if you’re experiencing any of the symptoms discussed in this piece. Running uphill and walking downhill as a warm up or as training can help increase intensity of training efforts without increasing stress on the pelvic floor. Running uphill reduces force through the pelvic floor and gives your body a chance to build strength and endurance without stressing your pelvic floor. Running hills also helps folks practice some of the form changes discussed above, like keeping your chest over your toes and increasing rotation. These adaptations occur more naturally when running on incline.
Incorporate trunk rotation exercises: Adding thoracic rotation into running form can feel really unnatural, particularly for folks with stiffness through the mid back (looking at you desk workers). Exercises to promote thoracic rotation can help improve ease of rotation while running. Mobility drills like threading the needle and open book are a good place to start.
Single leg stability drills: Single leg drills are an effective way to improve balance and strength in the hips, core and pelvic floor. Single leg drills are a better way to build functional strength than exercises like kegels. Try exercises like single leg squats from any height, single leg russian dead lifts, bulgarian split squats, lunges and step ups.
Plyometrics: Running is basically a single leg jump over and over, alternating from side to side. If you never practice plyometric training, you’re not training for your sport. Exercises like jump squats, single leg hops, ladder drills and box jumps are a few examples of plyometric drills.
As online resources grow in numbers, it's important to remember there's no replacement for one on one care. Pelvic floor symptoms have a number of underlying causes, and working with a qualified health professional can help you understand the why behind your symptoms so you can effectively treat them and ensure they don’t return in the future.
Online resources are a powerful tool to share information and education in order to help people betterunderstand their bodies and symptoms better. Pelvic health care is still largely inaccessible both geographically and financially, which I hope to see change in the near future. But if you’re having symptoms while running and you have the ability to access a pelvic floor PT, I’d recommend starting there.
Contact us here to schedule a consultation with one of our pelvic floor physical therapists.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.