Running into the Realm of Pelvic Rehabilitation

Over the past 28 years, my pelvic floor has endured at least 20,000 miles of running, including racing on the collegiate level and then completing 10 marathons. Add to the high-impact sport two 8.1 pound natural childbirth deliveries 26 months apart, and you can imagine why I accepted the invitation to blog for this well-respected institute. One of my elderly patients once told me my uterus was going to drop out from so much running (which, thankfully, has NOT happened); however, I have to admit, urinary stress incontinence and frequent urination were unwelcome enough consequences! On the positive side, it all initiated my journey to understanding the pelvic floor.

In 2014, Poswiata et al used the Urogenital Distress Inventory (UDI-6) to assess how prevalent stress urinary incontinence may be among elite female skiers and runners. Of the 112 female athletes in the study, 50% reported leaking a small amount of urine. Coughing and sneezing provoked leakage for 45.54% of those women, indicating stress incontinence, and 58.04% of the women in the study reported frequent urination. Are those acceptable statistics? I would have to say no.

Research results can be comforting so athletes can be told they are not alone regarding a quite personal aspect of their lives. When I could supposedly empty my bladder, stand to wash my hands and have to go again, walk down the hall to put on my sneakers and go once again before heading out the door for a run, it was nice to know someone else was probably experiencing the same issue that morning. Just because it is common, though, does not make it “normal.” We are not meant to leak just because we stress our bodies beyond normal ADLs.

A very recent study by Luginbuehl et al (2015 July 21), just published online, attempted to explore the electromyography (EMG) activity of pelvic floor muscles with variable running speeds (7, 9, and 11km/h) over 10 steps. The highest pelvic floor muscle activity was recorded at 11km/h, which would sensibly suggest the muscles produce a greater contraction the faster someone runs. If a runner has developed a decreased ability to activate the pelvic floor muscles, stress urinary incontinence will likely become a highly irritating problem with fast running speeds over time. But how do they know, and where do they go?

Without health practitioners trained in rehabilitation of pelvic floor dysfunctions, consider how chronic an issue urinary stress incontinence would be for a large athletic population. So many women (and men) do not even recognize their leakage or frequent urination as treatable “issues” and never mention them to anyone. Often times, we are treating an athlete for a hip or lumbar injury and purposefully yet discretely have to ask the right questions and then educate the patient how some of their symptoms are secondary to pelvic floor deficits. Someone has to explain what is normal, and, better yet, someone HAS to make an effort to fix what is “broken” and restore the pelvic floor to a higher level of function. With the proper training, perhaps that someone can be you.

References:
1. Poświata, A., Socha, T., & Opara, J. (2014). Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes. Journal of Human Kinetics,44, 91–96. doi:10.2478/hukin-2014-0114.
2. Helena Luginbuehl, Rebecca Naeff, Anna Zahnd, Jean-Pierre Baeyens, Annette Kuhn, Lorenz Radlinger (2015 July 21). Pelvic floor muscle electromyography during different running speeds: an exploratory and reliability study. Archives of Gynecology and Obstetrics. doi: 10.1007/s00404-015-3816-9.