Pelvic Health and Running: When to suspect that your pelvic floor may be involved in your running injury

As the newest member of the team here at Precision Performance and Physical Therapy, I am excited to integrate my passion for pelvic health physical therapy into our runner’s clinic! Many people think that pelvic health PT is only needed by those who are pregnant or postpartum, and yes, I see a lot of those folks. But pelvic floor dysfunction can be a sneaky player involved in running injuries as well. Many providers don’t know the direct and indirect connections that the pelvic floor has to other regions of the body, or they may be aware that it exists and could be a factor, but they don’t know how to assess it or address it, and therefore they just skip it in your treatment. Not here at Precision!

Read on to learn more about the pelvic floor and how to know when it’s time to get it checked out.

What is the pelvic floor?

First, let’s dive into what the pelvic floor is and what it does for our bodies. 

The pelvic floor is a group of muscles that looks a bit like a hammock sitting within the pelvic bones. There are 14 muscles that make up this “hammock,” and its main functions can be described as the 5 S’s: Sphincter control, Sexual function, Stability, Support of pelvic organs, and Sump pump. In other words, these muscles help control urination and bowel movements; fill with blood during sexual arousal and contract with orgasm; help stabilize the bony pelvis and hips; provide support below the pelvic organs; and act with the diaphragm to form a “pump” system that helps fluid flow throughout the body. I think most would agree that these are pretty critical functions! We should all give our pelvic floors more credit! 

Let’s take a moment to elaborate a bit on the “Stability” component of the 5 S’s. Yes, the pelvic floor helps stabilize the structures directly adjacent to it, but it also plays a special role with other muscles in the body to help stabilize more than just your pelvic bones. The pelvic floor is part of what we call your deep core. Your deep core consists of four muscle groups that all work harmoniously to stabilize and support our entire body during movement. The four muscle groups of the deep core are:

• Transverse abdominis: the deepest layer of your abdominal muscles that acts as your body’s built-in corset to help stabilize between your ribcage and pelvis

• Multifidus: muscles that run along the entire spine from the base of your skull to your tailbone to help stabilize your spine

• Diaphragm: often thought of as just a muscle for breathing, this muscle forms a dome under your ribcage and works with the other deep core muscles to adjust abdominal pressures which helps stabilize your torso and spine

• Pelvic floor: as I mentioned above, your pelvic floor muscles help stabilize the bony pelvis, but they also move dynamically with your diaphragm to manage abdominal pressure and provide structural support to your torso and spine

Phew! My pelvic floor is tired just thinking about all the work it has to do throughout the day. The good news is that all of these postural muscles are designed to be working for extended periods of time and contract or relax appropriately to the loads placed upon them.

Do females AND males have a pelvic floor?

Yes! Contrary to popular belief, males do in fact have pelvic floor muscles along with females. Male and female pelvic floors are essentially comprised of the same muscles, just organized differently. Some of the key differences are that the male pelvic outlet is narrower than the female pelvic outlet, meaning the “hammock” of muscles can be relatively smaller in males; the male pelvic floor has more support in the middle whereas the female pelvic floor lacks support in the same region due to the presence of the vagina; and for those who have undergone pregnancy and/or childbirth, the pelvic floor structures have been disrupted to at least some extent but may impact some folks more than others. Due to these anatomical differences, the female pelvic floor muscles are less efficient than their male counterparts, meaning their muscles have to work harder to accomplish the same tasks. As a result, females are at higher risk of pelvic floor dysfunction. However, this scoping review found that male athletes may have higher risk of lower urinary tract symptoms such as urinary incontinence than males of the same age in a non-athletic population. That’s why it’s important that we screen for pelvic floor symptoms in all our patients at Precision, not just females!

What symptoms could indicate that my pelvic floor may be involved in my running injury?

Remember that some of the main functions of the pelvic floor are Sphincter control, Sexual function, Stability of bony pelvis, and Support of pelvic organs. In order to screen for possible pelvic floor issues, it is important that we ask you questions about your bladder, bowel, and sexual health along with questions about your hip or back pain.

This evidence-based screening tool can be used to quickly identify possible pelvic floor dysfunction. Take a look at these questions. If you check three or more circles, the research indicates that you likely have pelvic floor dysfunction. Even if you check one of the circles, you should consider getting evaluated by a pelvic floor physical therapist because all of the symptoms on this list are things that may be able to be addressed through physical therapy!

How can a PT assess my pelvic floor to determine if there’s something going on?

Pelvic floor muscle function can be evaluated through a pelvic exam. The pelvic exam often includes an external component and an internal component to assess for tension, pain, strength, and coordination of the pelvic floor. During an internal exam, your PT would use a gloved finger in the vagina or rectum to feel what the muscles are doing. We can determine a lot about your pelvic floor externally if you are not comfortable with an internal assessment. This may include external palpation around the pelvic region to see if there’s any tenderness, along with assessing movement of the tailbone to observe pelvic floor activation. This can be done over clothes. I work together with clients to determine which assessments will be most appropriate for them based on their preferences, symptoms, and goals for physical therapy.

What do I do if my pelvic floor isn’t functioning optimally?

How we treat the pelvic floor will depend on what we find in the pelvic exam, the physical assessment outside the pelvis, and your unique goals and preferences. You may have heard of or even practiced kegels (pelvic floor contractions), and sometimes these can be an appropriate first step in treatment. However, treating the pelvic floor is not as simple as doing 100 kegels per day. We need to make sure that your pelvic floor has good strength, range of motion, endurance, and neuromuscular control to contract appropriately in conjunction with the other muscles of the deep core. This means your treatment may include doing kegels of many varieties such as repeated contractions, holds, or combining kegels with other exercises; or your treatment may not include doing any kegels at all while we work on reducing tension and improving the range of motion of the pelvic floor. It’s common to find pelvic floor tension or overactivity in runners, which makes sense when you consider how much work the pelvic floor has to do during running. It is not only working to help stabilize the pelvis, but it is also absorbing the impact from the ground, actively supporting your pelvic organs, and eccentrically contracting with each inhale (this means it’s lengthening in a contracted state rather than lengthening in a relaxed state like a stretch).

There is no one-size-fits-all approach to managing pelvic floor symptoms, especially when we combine the pelvic floor findings with things we found outside the pelvis in the low back or hips, diaphragm or ribcage, posture, foot control… the list goes on! The bottom line is – work with an expert to determine the best course of action for YOU.

The pelvic floor can unfortunately be a “black box” to some PTs when addressing musculoskeletal injuries. By this I mean that they may not have a strong understanding of the structure and function of the pelvic floor and therefore skip it altogether when considering root causes or contributors to your pain. Here at Precision Performance and Physical Therapy, all of our clinicians are trained to identify when the pelvic floor could be playing a role in an injury, we have the staff to assess it, and we know what to do with the findings! I will be offering pelvic health physical therapy in both our Atlanta and Serenbe offices, so if you think you may have pelvic floor dysfunction or have any questions, please don’t hesitate to email me at perrin@precisionpt.org or give us a call at 404-343-3314. 

Your pelvic health nerd,

Dr. Perrin Clavijo, PT, DPT

Precision Performance & Physical Therapy in Atlanta and Serenbe