There seems to be equal parts mystery and misinformation surrounding the pelvic floor. One of the most common misperceptions is that “pelvic floor issues” are a “woman problem,” that doesn’t affect men. In truth, while women in general and runners in particular, are at higher risk of developing pelvic floor dysfunction, especially if they are postpartum, men are also at risk for developing pelvic floor problems. So it’s important for everyone to pay attention to pelvic floor health—and that includes incorporate pelvic floor workouts into your routine.
To understand why pelvic floor issues develop, how to identify them, and why strong pelvic floor health is generally so important for runners, let’s start with a quick anatomy lesson.
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What does a healthy pelvic floor feel like?
First, let’s state the obvious: both women and men have a pelvic floor with some even more obvious differences. “The pelvic floor is a group of muscles that close off the base of the pelvis in both men and women. It is part of ‘the core,’” says Kim Vopni, certified personal trainer and author of Your Pelvic Floor: A Practical Guide to Solving Your Most Intimate Problems. In women, the pelvic floor manages three openings, as compared to two in men, and the pelvic, sacrum, and pelvic outlet (where the muscles attach) are all wider on women, Vopni tells Runner’s World.
These anatomical differences, in addition to carrying and birthing babies, are what put women at a higher risk for developing pelvic floor dysfunction and core stability challenges, Vopni explains.
“The roles of the pelvic floor are to support the internal organs, maintain continence, contribute to pelvic and spinal stability, and as well as sexual response,” she tells Runner’s World.
If you lack pelvic floor stability, which can be due to the muscles of the pelvic floor being either too weak or too tight, you could experience symptoms like pain in the low back, pubic joint, or tailbone, painful sex, urinary or anal incontinence, or more serious cases, organ prolapse (when one or more of the pelvic organs moves from their normal position), Vopni tells Runner’s World. Additionally, studies suggest that lack of pelvic floor function can contribute to erectile dysfunction in men.
The pelvic floor connection to low back pain, diaphragm function, and breathing mechanics often comes as a surprise to people. “A tight pelvic floor can cause low back pain in a number of different ways,” says Melissa Oleson, D.P.T., physical therapist who specializes in the pelvic floor. “When we inhale, the diaphragm descends, helping the pelvic floor to lengthen, and when we exhale the diaphragm contracts and comes back up with gentle activation of the pelvic floor and abs. When the diaphragm isn’t able to descend all the way like it wants to, it causes too much pressure. Because of where the pelvic floor attaches onto the pelvis and how the pelvis moves, this can affect your back.” A tight pelvic floor can not only be connected to back pain, but tight hips too.
How do you know if you have a weak or strong pelvic floor?
“You can tell if you have weak pelvic floor if you are having any symptoms like constantly feeling like you have to run to the bathroom, [or conversely] constipation; coning, doming, or bulging out of lower abs during core workouts, and not being able to feel connection between your core and pelvic floor,” Dr. Oleson says.
On the flip side, one way you can tell whether you have a strong pelvic floor is by how strongly you feel muscle activation and recruitment during movements that call for core stability—which essentially includes all dynamic movement. “[You should be able to] feel both the lengthening and activation of the pelvic floor with your breath and are able to feel glutes and core when doing specific exercises,” Oleson explains.
The goal, according to Oleson, is to optimize how this system works by learning how to manage the pressure in your abdomen. “Certain things, like holding your breath, chest breathing, [and] sucking your abs in all day are a few of the things that can increase the pressure,” she explains. “An increase in abdominal pressure can lead to issues like leaks, pains, prolapse, ab separation (diastasis recti), and decreased performance. To build true pelvic floor stability is to learn how to manage the pressure—and it all starts with breathing, positioning, and how you are moving.”
To understand how intra-abdominal pressure is created, imagine how the entire core functions as a unite when we breathe. The shape of the diaphragm muscle somewhat resembles a domed mushroom cap, and when we inhale, it flattens to expand our ribcage, which in turn allows the lungs to fill with air. In addition to expanding the rib cage, this action also pushes the organs in our abdomen down towards our pelvic floor.
When our pelvic floor is functioning optimally, it lengthens and expands during our inhales in tandem with the diaphragm flattening to make room for our organs. When our pelvic floor is dysfunctional, this expansion during our inhales doesn’t happen as much as it ideally should, and the pressure on the organs essentially has nowhere to go.
What role does pelvic stability play in running?
In addition to the contributing factors that increase abdominal pressure mentioned above, there’s a big one at the top of the list that’s of particular concern to runners: the act of running itself, Vopni explains.
We also need to factor in the increased ground reaction forces that have been reported to be between 1.6 and 2.5 times your bodyweight when running at a moderate speed of about 6.8 mph. With all this force, “it’s essential that the pelvic floor muscles have the capacity to react quickly and with enough strength and endurance to maintain the roles of organ support, continence, and stability during high-impact activities,” Vopni adds.
Plus, studies also suggest that activation of the pelvic floor muscles increases substantially as our running pace gets faster. So you need a work out the pelvic floor muscles in order for them to handle the activation on the run.
“The mechanics of what happens at the pelvis affects everything down the chain all the way to our feet. So if something is not working optimally it’s going to have an impact somewhere else,” says Dr. Oleson. “Pelvic floor dysfunction can impact your balance and stability, especially on one leg, and while running you are constantly on one leg.”
What does an effective pelvic floor workout look like?
When people experience some or all of the symptoms we’ve talked about, or are told they have a weak pelvic floor, the standard recommendation is typically to start doing kegels exercises in which you contract, lift, and release the pelvic floor muscles, according to Vopni. But kegels alone often won’t cut it, and can sometimes even exacerbate the problem if the pelvic floor is actually too tight.
The reason you don’t want “tight” pelvic muscles: “We need muscles that can generate enough force to control movement and the transfer of loads through joints,” says Vopni. “Tight overactive muscles create rigidity and can inhibit our control. The goal is a balance between effort and ease.”
Instead of focusing on kegels for pelvic floor strength, look to your core. “The pelvic stability team members include your diaphragm (breathing muscle), pelvic floor, abs, and back muscles,” Dr. Oelson says.
To release tightness, plus to learn to connect and activate your pelvic floor muscles during movement, it comes down to an ABC approach, Vopni says. “Alignment (posture work), Breathing (the pelvic floor works in synergy with the diaphragm) and Coordination (kegels combined with whole body movement),” she explains. “In order to optimize pelvic stability it is important to first release tension and then build strength and endurance.”
Below are some of Vopni’s and Oleson’s favorite pelvic floor stability exercises for runners, combined for a full pelvic floor workout that releases and connects your breath to your pelvic floor muscles. Keep in mind, if you find you do have issues with pelvic floor stability, a physical therapist who specializes in pelvic therapy can also help you address the issue.
How to use this list: Practice these moves daily, following the timing and reps listed below. Natascha Grief, certified personal trainer, demonstrates each exercise so you can learn proper form. You don’t need any equipment for these moves, but an exercise mat and stability ball are optional.
Posterior Pelvic Floor Release
Sit on floor, legs extended, chest tall, shoulders down and back, and spine neutral. Place a lacrosse ball or tennis ball in middle of left glute. Relax muscles and breathe deeply. The goal is to let the muscles release. Hold for at least 30 seconds and then repeat on the other side. Perform this release 1 to 2 times per day.
Happy Baby Variation
Lie faceup. Bring knees into chest, grab feet on the outside, and then gently pull knees out to the side, as though trying to tuck knees into armpits. Connect to pelvic floor by feeling pelvic floor lengthening during inhale in synergy with diaphragm expanding rib cage, then gently pulling inward as you exhale. Stay in this pose for 1 to 2 minutes, breathing deeply. If it feels more comfortable, place a pillow under the hips.
Sit on a stability ball with chest tall, shoulders down and back, and spine neutral. Place one hand on belly and the other hand on the side of rib cage. Inhale deeply and expand ribcage laterally while feeling only a slight overflow of breath into the belly. As you exhale, feel the rib cage moving laterally back toward center line. Slowly and mindfully continue this breathing, focusing on pelvic floor. As you exhale, draw the pelvic floor up in tandem with out breath. Then, when you inhale, expand the pelvic floor towards the stability ball. Visualize trying to gently push sit bones apart during inhale using pelvic floor to help you get the hang of it. This may take time to get the hang of, especially if connection to pelvic floor is weak, so stick with it. Once you feel like you’ve mastered core breath, add the exercise below.
Core Breath with Glute Bridge
Lie faceup with knees bent and feet flat on the floor about hip-width apart. Keep pelvis neutral and low back grazing the floor. Add the core breath: inhale to expand, exhale to engage. On your next exhale/engage, lift hips off the floor without losing neutral pelvis or arching low back. Inhale/expand as you lower hips back down. Repeat slowly and mindfully for 10 reps. To advance this variation, lift one leg off the floor.
Start on all fours with knees under hips and hands under shoulders. This is your starting position. Lift and extend left arm and right leg, reaching from left fingertips through right heel. Avoid shifting weight to one side; the goal is to stay centered while activating core and pelvic floor to stabilize. Hold for 10 seconds while you perform core breath, then lower limbs to starting position. Repeat on the other side. Do 5 reps per side.
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