Female Runners: Nagging injuries and your Pelvic Floor — Is There a Connection?

Female Runners: Nagging injuries and your Pelvic Floor — Is There a Connection?

The female runners I have worked with are so dedicated to their running, they have typically endured some level of pain prior to seeking treatment.  Passion is good but pain is speaking a message and it’s time to take a closer look … Be gone with those nagging injuries— Hamstring strains, plantar fasciitis, shin splints, ITB band syndrome, knee pain, hip pain … Most women connect the pelvic floor to incontinence or leaking during running.  But there’s more to the floor…

“It has been argued that there is a biomechanical link between poor core stabilization and injuries such as posterior tibial tendonitis, medial shin splints, chondromalacia patellae, plantar fascitis, hamstring tears and other musculoskeletal injuries (especially during functional lower extremity movements.”(Ryan E et al)

Nagging Injuries and your Pelvic Floor — Is There a Connection?

Well, first we must understand a little bit more about the pelvic floor and how it functions in our day to day tasks and during high body demands such as running. The pelvic floor muscle is a key part to core stability. The core is the area bounded by your diaphragm, pelvic floor, abdominal wall and lower back.  The pelvic floor is a part of our deepest core muscles or “inner core” along with the diaphragm, transversus abdominis and multifidus.  The inner core both functions to stabilize and support the body during movement as well as in anticipation of movement.  These muscles work together; dynamically and synergistically with coordinated breath.

All these pieces have to be working properly AND together to provide us with the core stability we need, especially during the high demands of running.  If not, we may see nagging injuries pop up elsewhere, as our body tries to compensate for instability. Adding this piece to orthopedic rehabilitation can improve the restoration of function, performance and prevent injury.

Integrating the pelvic floor and inner core to a functional rehabilitation program for our female athletes and runners
What NOT to Do

Adding more burpees or overdoing pelvic floor strengthening exercises is not the answer.  A stronger pelvic floor does not necessarily equate to a well-functioning one.  And doing more burpees without a properly functioning inner core lacks the foundational stabilization required for performance and injury prevention. Also, women with urinary leakage during running should not compensate by abdominal or pelvic holding...this will limit diaphragmatic movement, strain breathing and is counterproductive in stabilizing the spine. Try it, tighten your abs and breathe in.  Can you feel how this limits rib cage expansion and your ability to take a full breath? This is not how our body is designed to work and may create additional dysfunction and injury.

“The diaphragm, a component of core stability, plays a role in respiration and trunk stability by controlling intra-abdominal pressure and reducing the stress on the spine through cooperative action with the abdominal and pelvic floor muscles.” (Eunyoung et al)

What To DO

See a Physical Therapist who specializes in both pelvic floor and manual orthopedics.

  • Pelvic Floor/Inner Core Evaluation and Treatment: There are many reasons our pelvic floor/inner core can become dysfunctional: pregnancy, difficult childbirth, trauma, pain, posture, surgery, pelvic unleveling or bladder/bowel conditions.  A physical therapist will provide the correct treatment based on objective findings. See more on pelvic floor evaluations and what we look for in determining treatment in my previous post, To Kegel or Not to Kegel.
  • Orthopedic Evaluation and Treatment: There are many intrinsic and extrinsic factors to running injuries aside from pelvic floor dysfunction. Forces from running are attenuated through the body tissues, muscles and joints. Evaluating muscles, joints, posture and running biomechanics is essential.
  • Retraining of Inner Core Musculature: Each muscle will need to be functioning properly, both contracting and relaxing; and in synergy with each other. Treatment involves hands on facilitation by your physical therapist to correct deficit patterns as well as educating you to feel for and activate the right contraction with coordinated breath. Again, you may have developed compensatory strategies including breath holding, muscle substitution, postural changes or pelvic unleveling. Your physical therapist will cue you in on how to watch out for these substitutions.
  • Integrated Core Exercise Patterns and Core Strengthening Exercises: The goal of physical therapy is to restore FUNCTION and get you back to the things you LOVE.  So once your muscles of the inner core are working properly individually, your physical therapy program can progress to strengthening and functional integration of core exercise patterns....and Burpees TOO!
A Deeper Feel of Your Inner Core

Close your eyes and feel the movement of your body as you relax and breath… Feel how your inner core works in synchronicity.

Diaphragmatic Breathing Exercise:

Inhalation: Breath in, our rib cage expands and diaphragm descends; the transversus abdominis lengthens (belly expands outward) and the pelvic floor descends and lengthens.

Exhalation: Breath out, the diaphragm relaxes upwards and transversus abdominis and pelvic floor recoil

Did You Know

"Approximately 30 million Americans run for recreation or competition. The rate of injury is significant. Each year between 1/4 and 1/2 of runners will sustain an injury that is severe enough to cause a change in practice or performance."(Novacheck, NF)

Here's to Getting You Back to the things You LOVE!



Ryan E, Lopez R Jacobs P. Running Injuries and Core Stability: Florida International University, Miami, FL

Eunyoung K, Hanyong L. The Effects of Deep Abdominal Muscle Strengthening Exercises on Respiratory Function and Lumbar Stability. J Phys Ther Sci, 2013,:25(6): 663-665 [PubMed]

Hodges PW, Gurfinkel VS, Brumagne S, et al. Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration. Exp Brain Res, 2002, 144: 293–302 [PubMed]

Hodges PW, Eriksson AE, Shirley D, et al.  Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech, 2005, 38: 1873–1880 [PubMed]

Richardson C, Jull G, Hodges PW, Hides JA. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach. 1a ed. Sydney: Churchill Livingstone; 1999.

Bliven Huxel KC, Anderson, BE.  Core Stability Training for Injury Prevention: Sports Health, 2013, 5(6): 514-522 [PubMed]

DISCLAIMER: The content on the blog for Evoke Physical Therapy and Wellness Center, LLC is for educational and informational purposes only, and is not intended as medical advice. The information contained on this blog should not be used to diagnose, treat or prevent any disease or health illness. Any reliance you place on such information is therefore strictly at your own risk. Please consult with your physician or other qualified health care professional before acting on any information presented here.
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