How Not to Pee Yourself While Running - Part 3: Exercise Recommendations to Strengthen Your Pelvic Floor

Part 3 of this blog series is written by Garrett McLaughlin.

The previous articles in this series provided an Overview of the Pelvic Floor & Running with Pelvic Floor Dysfunction. If you haven’t done so yet, please read those articles as they will lay the groundwork for the exercises introduce in Part 3.

Importance of Safe and Effective Pelvic Floor Strengthening for Running

Pelvic floor health plays a pivotal role in optimizing running performance and preserving pelvic health. As runners pound the pavement with each foot strike, the pelvic floor muscles act as a vital support system, maintaining stability and reducing the impact of ground forces on the pelvic region. Strengthening and stretching these muscles enhances the ability to provide support to the bladder, uterus, and rectum, reducing the risk of urinary incontinence and potential pelvic organ prolapse. 

Addressing the pelvic floor within a proper core and leg strengthening program improves alignment of the pelvis, hips, and spine during the dynamic movements of running. Not only will this reduce the incidence of leakage but promote optimal running form and performance. In addition to its biomechanical advantages, pelvic floor conditioning also extends its impact to overall pelvic well-being. The increase of blood flow and improved muscle flexibility promotes tissue health, reducing the risk of post-run discomfort or pain.

Respiration & Regulating Intra-Abdominal Pressure

Proper breathing plays a vital role in pelvic floor health for runners. Engaging the diaphragm and coordinating your breathing pattern with the pelvic floor helps regulate intra-abdominal pressure, minimizing excessive strain on the pelvic floor during high-impact activities. Runners who master diaphragmatic breathing techniques can enhance their pelvic floor's coordination to support and stabilize the pelvic region while preventing urinary incontinence.

Core Stabilization

A strong and stable core is essential for maintaining optimal running form and posture. The pelvic floor is an integral part of the core musculature, working in unison with the deep abdominal muscles and back muscles. Strengthening the pelvic floor contributes to improved core stability, which, in turn, helps runners maintain proper alignment, reduce energy wastage, and prevent overuse injuries.

The Difference Between Core Strength vs. Core Stability

Core strength and core stabilization are two distinct but interconnected functions of the body's core musculature. Understanding the difference between these concepts is essential for runners because both play critical roles in maintaining efficient running mechanics, preventing injuries, and optimizing performance, especially as it relates to the pelvic floor.

Core strength refers to the ability of the muscles in the core to generate force. It involves the muscles' capacity to produce a maximal contraction against a resistance or load. This includes muscles such as the rectus abdominis (front of the abdomen), obliques (sides of the abdomen), and erector spinae (lower back muscles). Exercises that focus on core strength typically involve movements that move the spine through its range of motion, such as crunches, sit-ups, russian twists, or back extensions.

Core stabilization, on the other hand, refers to the muscles' ability to maintain stability and control during movement, especially dynamic and functional movements. This involves the deeper muscles of the core, including the transverse abdominis, multifidus, and pelvic floor muscles. These muscles work to stabilize the spine, pelvis, and hips to provide a solid foundation for movement. Core stabilization is crucial for maintaining proper alignment, balance, and control during activities like running, where the body is subject to repetitive forces and higher impacts.

Hip Strength & Stabilization

Healthy hip function is critical for efficient running mechanics. The pelvic floor muscles play a role in stabilizing the pelvis, ensuring proper alignment and movement of the hip joints. Strengthening the pelvic floor can enhance hip stability, reducing the risk of imbalances and compensatory movements that could lead to discomfort or injury during running.

Shock Absorption

Running generates considerable impact forces that travel up the leg from initial contact, into the hip, pelvis, and spine. In fact, 2-6 times your body weight needs to be absorbed while running. Crazy to think, right?

A flexible pelvic floor aids in shock absorption by acting like a trampoline, helping to dissipate these forces and reduce the strain on the lower body. Runners with well-conditioned pelvic floor muscles are better equipped to manage the repetitive impact of each stride, potentially reducing the risk of leakage and musculoskeletal injury to the tendon and bone.

Designing an individualized pelvic floor strength training program

In the following section, we’ll demonstrate a series of strengthening exercises that are commonly used to address musculoskeletal impairments contributing to urinary incontinence while running. Please assess your current training plan for potential areas you may be missing or use these videos to ensure you are performing each exercise correctly. By no means should you complete every exercise listed below... We highly recommend scheduling an appointment with a pelvic floor physical therapist to narrow your focus to which exercises will be the most beneficial for you.

Diaphragmatic Breathing Exercises

Diaphragmatic breathing exercises involve deep inhalations that expand the abdomen and engage the diaphragm, while exhaling allows a gradual release. This technique enhances pelvic floor function by creating a dynamic interplay between the diaphragm and pelvic floor muscles. As the diaphragm descends during inhalation, the pelvic floor simultaneously lengthens and relaxes, promoting improved coordination, circulation, and decreasing overactivity within the pelvic region.

Crocodile Breathing

Hooklying Breathing

90/90 Breathing with Stabilization

Core Stabilization Exercises

The dead bug, side plank, and pallof press are fundamental exercises utilized for their positive impact on core stabilization. The dead bug challenges coordination between the limbs and core muscles, promoting balanced engagement and enhancing pelvic floor awareness. The side plank not only strengthens the lateral core muscles but also encourages optimal pelvic alignment, enhancing pelvic floor support. Meanwhile, the pallof press, with its anti-rotational focus, improves deep core stability, synergistically reinforcing pelvic floor function.

Dead Bug

Side Plank

Pallof Press

Hip Strengthening Exercises

Hip exercises such as sidelying hip abduction, hip bridge, and adductor slides form a comprehensive arsenal for enhancing hip strength and optimizing pelvic floor function. Sidelying hip abduction targets the gluteus medius muscle to create control and connectedness between the hip & pelvis. The hip bridge not only strengthens the glutes but also reinforces the pelvic floor's role in maintaining a solid foundation during hip extension & push-off. Adductor slides improve inner thigh/groin strength, while tying in flexibility and core stabilization.

Sidelying Hip Abduction

Hip Bridge

Adductor Slides

Single Leg Stabilization Exercises

The step up, single leg hip hinge, and single leg squat exercises require a high degree of stabilization which intricately connects the pelvic floor and lower limb. With running being purely a single leg activity, creating coordinated movement between the pelvis and leg is paramount for successful running form & injury prevention.

Step Up

Single Leg Hip Hinge

Single Leg Squat

Plyometric & Shock Absorption Exercise

Plyometric and shock absorption exercises play a pivotal role in enhancing pelvic floor function by developing strength, control, and resilience during high impact activities. While emphasizing controlled landings and force distribution, the drop squat and medial to lateral jumps further contribute to pelvic floor health by training the muscles to manage impact, reducing the risk of strain or dysfunction, and promoting optimal pelvic support for a wide range of activities.

Drop Squat to Stick

Drop Squat to 1-Leg Stick

Medial to Lateral Jumps

Cross Training

For individuals suffering from urinary incontinence and pelvic floor dysfunction, cross training provides an opportunity to maintain and/or enhance fitness levels while safeguarding pelvic health. This approach serves a dual purpose by allowing more variety to workout routines, it not only improves cardiovascular fitness and muscular endurance but also minimizes the high-impact strains that can exacerbate pelvic floor concerns. 

Engaging in cross training activities such as cycling, swimming, rowing, and elliptical training offers a myriad of benefits. These modes of cardiovascular fitness elevate the heart rate and enhance lung capacity without imposing the jarring impacts that often trigger pelvic floor discomfort. Furthermore, by incorporating activities that challenge different muscle groups and movement patterns, cross training promotes overall muscular endurance and strength, creating a more well-rounded and safe training plan compared to running alone. This multifaceted approach mitigates the risk of undue pressure on the pelvic floor, enabling individuals to pursue their fitness goals with confidence, minimize discomfort, and lay the groundwork for better running.

Conclusion

Now that you have a multitude of exercises to target your pelvic floor, it’s time to get to work. What’s important to remember is that you may not need each and every exercise listed in this article and that’s where working with a trained pelvic floor physical therapist can really narrow your focus to help save time & energy.

Start simple and progress over time. Rather than selecting the hardest exercise and struggling to properly activate your pelvic floor or breathe, put yourself in a position for success by adopting a quality over quantity mindset. Once you master the basics, begin adding more repetitions, harder variations, and develop the capacity to run without leakage. This could take weeks, months, or even years, however, the end result will be worth the effort.

Thank you for reading this 3 part series! If you have any questions, please don’t hesitate to contact myself or Dr. Lauryn & Dr. Caroline of Pelvic Health & Wellness in Milwaukee, Wisconsin.