Tag Archives: Fitness

Is Running Bad for a Woman’s Pelvic Floor?

As some of you may know, I recently completed my second half-marathon. To make it even better, I completed it with my amazing and wonderful husband Andrew:

4 miles in to our first half marathon!

4 miles in, and feeling great!

This was my second half marathon in 1 year, and my third *big* athletic event—the other two being the Disney Princess Half Marathon and the Ramblin’ Rose Sprint Triathlon. I started out 2013 with the goal of being healthier and developing strategies for life-long fitness, and I really am proud to say that as I approach the end of 2014, I am well on my way to better fitness.

Disney princess half

Disney Princess Half Marathon with my awesome sister, Tara and wonderful colleague, Jenna

After completing my last half-marathon, I received the following question from a previous patient of mine,

“Ok, I have to ask, after seeing your race pictures,

isn’t running bad for a woman’s internal organs??”

My initial thought was to respond quickly with a, “Not always, but sometimes…” type of response. But then it got me thinking, and inspired me to really delve into the issue with a little more science to back my thought—although honestly, the gist will stay the same.

So… Is running bad for the pelvic floor? Let’s take a look.

When someone initially looks at the issue, there may be the temptation to respond with a resounding, “YES!” We initially think of running and think of “pounding the pavement,” identifying large increases in intra-abdominal pressure and assuming that this pressure must make a woman more likely to experience urinary incontinence and/or pelvic organ prolapse.

But, what does the research really show?

1. Urinary incontinence during exercise is common and unfortunate.

  • Jacome 2011 identified that in a group of 106 female athletes, 41% experienced urinary incontinence. However, they also found that UI in those athletes seemed to correlate with low body mass index.

2. High impact athletes often may require more pelvic floor strength than non-athletes.

  • Borin 2013 found that female volleyball and basketball players had decreased perineal pressure when activating their pelvic floor muscles compared to nonathletes which they concluded placed these women at an increased risk for pelvic floor disorders and especially UI.

3. Over time, physically active people are not more likely to have urinary incontinence or pelvic organ prolapse that non-active individuals.

  • Bo 2010 found that former elite athletes did not have an increased risk for UI later in life compared to non-athletes (although she did find that women who experienced UI when they were younger were more likely to experience UI later on in life).
  • In another study, Bo (2007) found that elite athletes were no more likely to experience pelvic girdle pain, low back pain or pelvic floor problems during pregnancy or in the postpartum period compared to non-athletes.
  • An additional study by Braekken et. al. 2009 also did not find a link between physical activity level and pelvic organ prolapse. However, they did find that Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP.

Is your head spinning yet?? Let’s make some sense of this research…

First, it does seem like UI is a common problem in athletes—the cross-fit video that had all of my colleagues up in arms identified this problem really well—and honestly, runners are no exception to this. Every week, I work with women who experience urinary leakage when they run or may have even stopped running due to leakage, and I can assure you this causes a huge impact to these women’s lives. I also can assure you that there are many women out there dealing with leakage during running or other exercises who suffer in silence, too embarrassed to get help or somehow under the impression that leakage with exercise is normal.

With that being said, I am not ready to throw away running or really any other form of exercise all together (other than sit-ups…let’s never do those again). Running has amazing benefits—weight control, cardiovascular improvements, psychological improvements/stress reduction—and these should not be cast aside due to a fear that running could cause a pelvic floor problem.

As a pelvic floor physical therapist working in a predominantly orthopedic setting, I see many men and women enter our clinics with aches and pains—and injuries—that began while starting or progressing a running program. Often times, our amazing PTs identify running gait abnormalities, areas of weakness, or biomechanical abnormalities which can be contributing to hip/knee/foot/etc. pain with running. Improving those movement patterns and improving those individual’s dynamic stability seems to make a huge difference in allowing the client to participate in running again without difficulty.

To be honest with you, I see pelvic floor problems in runners the exact same way. When a woman comes into my office complaining of urinary leakage during running, I look to identify running gait abnormalities, areas of weakness or biomechanical abnormalities which are impacting her body’s ability to manage intra-abdominal pressure during running. I also make sure I am managing other things—identifying pelvic organ prolapse when it may be occurring and helping the woman with utilizing a supportive device (tampon, pessary—with collaboration with her physician, or supportive garment), managing co-existing bowel dysfunction or sexual dysfunction, and making sure the patient has seen her physician recently to ensure she is not having hormonal difficulties or medication side effects which could worsen her problems.

We know that intra-abdominal pressure is higher when running. A poster presentation at the International Continence Society in 2012 identified that running does in fact increase intra-abdominal pressure compared to walking—but not as much as jumping, coughing or straining (Valsalva). And not as much as sit-ups…which I hate.

Kruger et. al. ICS Poster Presentation, "Intra-abdominal pressure increase in women during exercise: A preliminary study." 2012

Kruger et. al. ICS Poster Presentation, “Intra-abdominal pressure increase in women during exercise: A preliminary study.” 2012

As you know by now if you follow my blog posts, I do not believe that the pelvic floor is the only structure involved in controlling intra-abdominal pressure increases in the body. (This is why I get so annoyed with all of the studies trying to look at the effectiveness of pelvic floor muscle exercises used in isolation in treating pelvic floor dysfunction). The most current anatomical and biomechanical evidence supports the idea that the pelvic floor muscles work in coordination with the diaphragm, abdominals, low back muscles as well as even the posterior hip muscles to create central stability and modulate pressures within the pelvis. In order for a runner to not leak urine or not contribute to prolapse or pelvic floor dysfunction when she runs, she needs the following(well really, more than this…but let’s start here):

  • Properly timing, well-functioning, flexible pelvic floor muscle group.
  • Properly timing diaphragm—that is used appropriately as she runs so she is not participating in breath holding during her exercise
  • Strong and adequately timed abdominals and low back muscles to assist in stabilizing her spine/pelvis and assist in controlling IAP.
  • Flexible and appropriately firing gluteal muscles to support her pelvis during each step as she runs
  • Appropriate shoes to support her foot structure and transfer the loads through her legs
  • A great sports bra to help her use good posturing while running

Now, is there a time when a woman shouldn’t run?

Yes, I do actually think there are times when running does more harm than good and it may be advantageous for a woman to take some time off from running to restore the proper functioning of structures listed above.

  • If a woman has pelvic organ prolapse, for example, she may need to take some time off from running and participate in other exercises emphasizing functional stability with less of an increase in IAP prior to resuming an exercise program. Some women can return to running in the meantime using a supportive device like a pessary or tampon to help support her organs; however, this may not ultimately mitigate the harm if a person is not stabilizing properly as she runs.
  • I also recommending taking a break from running if a woman is leaking significantly during running or experiencing pain with running. I generally believe that once these structures are appropriately restored to function, women can return to running with less difficulty.
  • The other time I will often recommend waiting is when a woman is further along in her pregnancy or early post-partum. At this time, the increased weight on the pelvis as well as the loss of stability occurring due to hormonal changes places a woman at a higher risk for pelvic floor dysfunction. This, of course, varies based on the individual, but in many cases it may be helpful for these women to choose alternative exercises until after they deliver their children.
  • And lastly, I do recommend a woman holds off on running immediately after gynecological surgery (no-brainer here folks). The research does not indicate that said woman should never return to running—but again, I do think she should allow her body to heal and build up the appropriate strength and coordination needed to support her organs and her pelvis when running.

This post got a little longer than I originally anticipated… so to sum it up… is running bad for your female organs? Not always… but sometimes.

Many of my colleagues have some fantastic blog posts regarding exercise and pelvic floor dysfunction. Check out a few of them below:

Vlog by Julie Wiebe providing an alternative to running:

https://www.juliewiebept.com/video/integrative-programming-for-female-runners-with-incontinence/

Safe exercise for those with pelvic pain:

http://www.pelvicpainrehab.com/pelvic-floor-physical-therapy/2058/pelvic-pain-and-exercise-general-fitness-tips/

Tracy Sher, “Pelvic Guru” on Leaking during exercise:

http://pelvicguru.com/2013/06/22/dear-crossfit-and-crossfit-gynecologist-im-appalled-theres-help-for-peeing-during-workouts/

Seth Oberst’s 4-post series on the Diaphragm:

http://www.sethoberst.com/blog/category/breathing

What do you think? Let me know in the comments below!

Written by: Jessica Reale, PT, DPT, WCS

References:

Bo K, Backe-Hansen KL. Do elite athletes experience low back, pelvic girdle and pelvic floor complaints during and after pregnancy? Scand J Med Sci Sports. 2007 Oct;17(5):480-7. Epub 2006 Dec 20.

Bo K, Sundgot-Borgen J. Are former female elite athletes more likely to experience urinary incontinence later in life that non-athletes?

Borin L, Nunes F, Guirro, E. Assessment of pelvic floor muscle pressure in female athletes. PM R. 2013 Mar;5(3):189-93. Scand J Med Sci Sports. 2010 Feb;20(1):100-4

Jácome C, Oliveira D, Marques A, Sá-Couto P. Prevalence and impact of urinary incontinence among female athletes. Int J Gynaecol Obstet. 2011 Jul;114(1):60-3.

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Pilates: What’s in it for me?

Today’s blog post comes from a wonderful colleague, Blair GreenPT, MPT, OCS, CSCS, who practices at One on One Physical Therapy (an amazing clinic!) in Atlanta, GA. Blair is an excellent clinician, and is an expert at integrating pilates into clinical practice. We are so honored to have Blair write for our blog, and we know you will enjoy her fantastic writing! 

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Fitness trends seem to come and go in the blink of an eye. However, Pilates seems to have stuck around for several years, defying conventional beliefs. Perhaps that is because Pilates is not just a fad but rather a method that has been proven over time to be beneficial for many individuals with a variety of health and fitness goals.

Pilates began back in the early 20th century when a man named Joseph Pilates developed a system of exercise to improve and maintain health.  He named his method Contrology and even wrote 2 books about it.  Those who learned from him passed on his method and changed the name to Pilates in his honor.

 What is Pilates and how will it benefit me?

Pilates is a method that embodies whole body health. It is based on several principles, including breath, control, precision, and whole body movement.  It is a system of specific exercises that are designed to improve strength, flexibility, endurance, posture, alignment and balance.  It emphasizes the deep core muscles, which include the transverse abdominus, diaphragm and the pelvic floor.  When these muscles are at their best, the whole body works more efficiently.

 Do’s and Don’t’s of Pilates

1. Don’t assume that all Pilates instructors are created equal.

The training to become a Pilates instructor is a long process.  Most comprehensive training programs can last one full year so that trainees can learn all of the apparatus and the mat work, and practice in their own bodies as well as on others.  The professional association for Pilates instructors is the Pilates Method Alliance (www.pilatesmethodalliance.org).  You can find a list of certified instructors and more information on types of training on their website.

2. Do ask the following questions before you get started:

How many people are in your mat classes?

If the answer is more than 10, know you may not get the attention you need to improve in your movement

What training did you have?

See above regarding instructor qualifications

I’m injured, what should I do?

Most instructors should know how to modify workouts for injury and/or have a good relationship with a physical therapist who is familiar with Pilates.  The answer should never be “we can just skip …”   Some studios will have particular instructors and classes that cater to individuals with injuries.

3. Don’t expect a workout where your heart is racing and you feel like you’ve just run a marathon.

Pilates focuses on the deep core muscles. These muscles are endurance muscles and they function to stay active over long period of time. These muscles hold you up when you are doing other activities; they turn on before you perform other movements.  You may find yourself doing more thinking than exerting; this is okay!  Pilates is about efficient movement, not burning calories.  It is meant to compliment other types of sport activity and exercise.

4. Do expect it to be a process that improves over time.

Again, Pilates is training movement strategy.  Remember the principles: breathing, precision, control, centering.  Pilates is not meant to be mastered in a week or a month. Many people practice for years and are still refining and fine-tuning the process.  Working with a qualified instructor will help you find the movements and exercises that are most beneficial to you.  And keep in mind, these may change over time as well.  Once you have built awareness and you are familiar with the apparatus or the mat exercises, the emphasis moves from doing the exercises to doing them well.

5. Don’t work through pain – tell your instructor!

Again, most qualified instructors are familiar with injury and can refer you to a physical therapist who will help you get back to Pilates.  If the movement or exercise does not feel right to you, stop and get help.  The old adage of “no pain, no gain” does not apply in Pilates.  In order for muscles to work well, the movement needs to be pain-free.  If you experience pain or other symptoms the best thing you can do is let someone know.  Exercises can be modified so that you can continue.

6. Do have fun!

Pilates is a method of exercise that is appropriate for all people at all ages.  It may be hard work but it pays off.  Remember, it has been around for nearly 100 years.  It has stood the test of time, and the fitness industry.  Go out and enjoy it!

 

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Blair Green PT, MPT, OCS, CSCS
PMA Pilates Certified Teacher

 

Blair Green is a physical therapist and partner at One on One Physical Therapy and Back 2 Motion Physical Therapy in Atlanta, GA.  She is comprehensively trained in Pilates through Polestar Pilates and is a PMA Pilates Certified Teacher.  Her practice focuses on women’s health, including pre- and post-natal health and pelvic floor dysfunction.  She is Board Certified in Orthopaedic Physical Therapy and a Certified Strength and Conditioning Specialist.

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