By Dr. Amanda Olson

Pelvic Floor Implications in Running Athletes

Running is a complex biomechanical process which can be derailed by pelvic floor dysfunction (PFD). This is pertinent to health care providers and fitness professionals who interact with runners due to the popularity of running. In the USA, running is the most common moderate-vigorous physical activity in adults, with 13% of the nation reporting regular participation (Katzmarzyk 2017). In Canada, the typical Canadian runner is a “white female, around 40 years old, who runs alone in the morning,training about 40k/week to run a 24:40 5k, or equivalent 10k or half-marathon” (Statistics Across Candada 2017).

PFD presents with a myriad of symptoms under the broad categorizations of overactive and underactive pelvic floor muscle dysfunction. Overactive pelvic floor dysfunction can result in pain and in some instances incontinence due to lack of mobility of the pelvic floor during impact activities. Underactive pelvic floor dysfunction can result in urinary incontinence, pelvic organ prolapse (POP), and aberrant running mechanics.

Pelvic Floor Muscle Activity and Impact on Running

Recent studies show that running appears to trigger pelvic floor pre-activation before and reflex-activation after heel strike in both continent and incontinence women (Leitner 2016). The authors suggest that running training stimuli may serve as beneficial and complimentary to PFM training to address symptoms of urinary incontinence. Similar findings demonstrate that PFM involuntary EMG activity was 40% higher while running (8 km/h) than during standing voluntary contraction. In this study, mean maximal PFM EMG activity was 124.3% within 214 milliseconds after heel strike suggesting involuntary and reflexive PFM activity during running impact loads. (Luginbuehl 2013). An additional study demonstrates that EMG activity of the pelvic floor increases with increased running speed (Shaw 2018).

The Impact of Running on the Pelvic Floor

Conversely, the impact of running can result in pelvic floor dysfunction and injury to the pelvic floor muscles. Runners have unique physical, nutritional, and psychological needs that require special attention from pelvic floor physical therapists and other healthcare and fitness professionals. Runners often present to orthopedic specialists with knee and hip injuries that do not resolve as expected due to the presence of pelvic floor impairments that are missed by orthopedic physical therapists. General injuries resulting from running are estimated to be between 19.4% and 92.4% (vanGent et al 2007). The popularity of running is on the rise, resulting in more runners presenting as injured to healthcare clinics. Novice runners have estimated 17.8 injuries per 1000-hr of running, while on the opposite end of the spectrum, ultra-marathon runners have estimated 7.2 injuries per 1000-hr of running (Videbaek 2015).

What Healthcare and Fitness Professionals Must Know

Pelvic floor and orthopedic practitioners can provide necessary treatment to address issues and work in tandem with other professionals for optimal rehabilitation of runners with pelvic floor dysfunction.

The goals of treatment for an injured runner are to:

• Address patient centered concerns and goals such as distance, speed, frequency
• Regain control, balance, and symmetry of running gait
• Educate the patient on principles of maintenance and future injury prevention
• Achieve pain free movement

It is therefore important that healthcare and fitness professionals in the orthopedic realm understand screening techniques for pelvic floor dysfunction, identify patients that will benefit from consult with a pelvic physical therapist, and refer them for consult. Conversely, it is important that Pelvic Physical therapists understand the role of foot, knee, hip, and running mechanics as it relates to the pelvic floor and running impairments. This includes common running specific injurie, unique goals of runners, and when to refer for orthopedic physical therapy consult for higher level running training.

References

• Katzmarzyk, Peter T., et al. “Epidemiology of physical activity and exercise training in the United States.” Progress in Cardiovascular Diseases 60.1 (2017): 3-10
• Luginbühl, Helena, et al. “Intra-session test–retest reliability of pelvic floor muscle electromyography during running.” International urogynecology journal 24.9 (2013): 1515-1522.
• Statistics Across Canada Road Running Report. (2017)
• Van Gent, R. N., et al. “Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.” British journal of sports medicine 41.8 (2007): 469-480.
• Videbæk, Solvej, et al. “Incidence of running-related injuries per 1000 h of running in different types of runners: a systematic review and meta-analysis.” Sports medicine 45.7 (2015): 1017-1026.