How Not to Pee Your Pants While Running (Part 3: Exercises to Strengthen Your Pelvic Floor)

Part 3: Exercise Recommendations (with Videos) to Strengthen Your Pelvic Floor

In this 3-part blog series, we’ve been addressing how to strengthen your pelvic floor so you can enjoy running without leaking or experiencing pelvic pressure or pain. Blog 1 gave us an overview of the pelvic floor, and blog 2 delved more into running and pelvic floor dysfunction. If you haven’t done so yet, please read both of these articles, as they will lay the groundwork for the exercises we are discussing in this blog.

Now that you understand the pelvic floor's importance and its connection to running, it’s time to discuss specific exercises you can do to strengthen your pelvic floor and optimize running performance.

The Importance of Safe and Effective Pelvic Floor Strengthening for Running

Pelvic floor health plays a pivotal role in optimizing running performance and preserving pelvic health. As runners pound the pavement with each foot strike, the pelvic floor muscles act as a vital support system, maintaining stability and reducing the impact of ground forces on the pelvic region. Strengthening and stretching these muscles enhances the ability to provide support to the bladder, uterus, and rectum, reducing the risk of urinary incontinence and potential pelvic organ prolapse. 

Addressing the pelvic floor within a proper core and leg strengthening program improves the alignment of the pelvis, hips, and spine during the dynamic movements of running. This will not only reduce the incidence of leakage but will also promote optimal running form and performance. In addition to its biomechanical advantages, pelvic floor conditioning also extends its impact to overall pelvic well-being. The increase in blood flow and improved muscle flexibility promote tissue health, reducing the risk of post-run discomfort or pain.

Respiration & Regulating Intra-Abdominal Pressure

Proper breathing plays a vital role in pelvic floor health for runners. Engaging the diaphragm and coordinating your breathing pattern with the pelvic floor helps regulate intra-abdominal pressure, minimizing excessive strain on the pelvic floor during high-impact activities. Runners who master diaphragmatic breathing techniques can enhance their pelvic floor's coordination to support and stabilize the pelvic region while preventing urinary incontinence.

Core Stabilization

A strong and stable core is essential for optimal running form and posture. The pelvic floor is an integral part of the core musculature, working in unison with the deep abdominal and back muscles. Strengthening the pelvic floor contributes to improved core stability, which, in turn, helps runners maintain proper alignment, reduce energy wastage, and prevent overuse injuries.

The Difference Between Core Strength vs. Core Stability

Core strength and core stabilization are two distinct but interconnected functions of the body's core musculature. Understanding the difference between these concepts is essential for runners because both play critical roles in maintaining efficient running mechanics, preventing injuries, and optimizing performance, especially as it relates to the pelvic floor.

Core strength refers to the ability of the muscles in the core to generate force. It involves the muscles' capacity to produce a maximal contraction against a resistance or load. This includes muscles such as the rectus abdominis (front of the abdomen), obliques (sides of the abdomen), and erector spinae (lower back muscles). Exercises that focus on core strength typically involve movements that move the spine through its range of motion, such as crunches, sit-ups, russian twists, or back extensions.

Core stabilization, on the other hand, refers to the muscle's ability to maintain stability and control during movement, especially dynamic and functional movements. This involves the deeper muscles of the core, including the transverse abdominis, multifidus, and pelvic floor muscles. These muscles stabilize the spine, pelvis, and hips to provide a solid foundation for movement. Core stabilization is crucial for maintaining proper alignment, balance, and control during activities like running, where the body is subject to repetitive forces and higher impacts.

Hip Strength & Stabilization

Healthy hip function is critical for efficient running mechanics. The pelvic floor muscles play a role in stabilizing the pelvis, ensuring proper alignment and movement of the hip joints. Strengthening the pelvic floor can enhance hip stability, reducing the risk of imbalances and compensatory movements that could lead to discomfort or injury during running.

Shock Absorption

Running generates considerable impact forces that travel up the leg from initial contact into the hip, pelvis, and spine. In fact, 2-6 times your body weight needs to be absorbed while running. Crazy to think, right?

A flexible pelvic floor aids in shock absorption by acting like a trampoline, helping to dissipate these forces and reduce the strain on the lower body. Runners with well-conditioned pelvic floor muscles are better equipped to manage the repetitive impact of each stride, potentially reducing the risk of leakage and musculoskeletal injury to the tendon and bone.

Designing an Individualized Pelvic Floor Strength Training Program

In this section, we’ll demonstrate strengthening exercises commonly used to address musculoskeletal impairments contributing to urinary incontinence while running. Please assess your current training plan for potential areas you may be missing, or use these videos to ensure you are performing each exercise correctly.

By no means should you complete every exercise listed below. We highly recommend scheduling an appointment with a pelvic floor physical therapist to narrow your focus to the specific exercises that will be the most beneficial for you.

1. Diaphragmatic Breathing Exercises

Diaphragmatic breathing exercises involve deep inhalations that expand the abdomen and engage the diaphragm, while exhaling allows a gradual release. This technique enhances pelvic floor function by creating a dynamic interplay between the diaphragm and pelvic floor muscles. As the diaphragm descends during inhalation, the pelvic floor simultaneously lengthens and relaxes, promoting improved coordination and circulation and decreasing overactivity within the pelvic region.

In this video, we demonstrate crocodile breathing, hooklying breathing, and supine 90/90 breathing.

2. Core Stabilization Exercises

The dead bug, side plank, and pallof press are fundamental exercises utilized for their positive impact on core stabilization. The dead bug challenges coordination between the limbs and core muscles, promoting balanced engagement and enhancing pelvic floor awareness. The side plank not only strengthens the lateral core muscles but also encourages optimal pelvic alignment, enhancing pelvic floor support. Meanwhile, the pallof press, with its anti-rotational focus, improves deep core stability, synergistically reinforcing pelvic floor function.

In this video, we demonstrate dead bug, side plank, and pallof press.

3. Hip Strengthening Exercises

Hip exercises such as sidelying hip abduction, hip bridge, and adductor slides form a comprehensive arsenal for enhancing hip strength and optimizing pelvic floor function. Sidelying hip abduction targets the gluteus medius muscle to create control and connectedness between the hip & pelvis. The hip bridge not only strengthens the glutes but also reinforces the pelvic floor's role in maintaining a solid foundation during hip extension & push-off. Adductor slides improve inner thigh/groin strength, while tying in flexibility and core stabilization.

In this video, we demonstrate sidelying hip abduction, hip bridge, and adductor slides.

5. Single Leg Stabilization Exercises

The step up, single leg hip hinge, and single leg squat exercises require a high degree of stabilization which intricately connects the pelvic floor and lower limb. With running being purely a single leg activity, creating coordinated movement between the pelvis and leg is paramount for successful running form and injury prevention.

In this video, we demonstrate step up, single leg hip hinge, and single leg squat.

6. Plyometric & Shock Absorption Exercise

Plyometric and shock absorption exercises play a pivotal role in enhancing pelvic floor function by developing strength, control, and resilience during high-impact activities. While emphasizing controlled landings and force distribution, the drop squat and medial to lateral jumps further contribute to pelvic floor health by training the muscles to manage impact, reducing the risk of strain or dysfunction, and promoting optimal pelvic support for a wide range of activities.

In this video, we demonstrate drop squat, drop squat to 1-leg stick, and medial to lateral jumps.

7. Cross Training

For individuals suffering from urinary incontinence and pelvic floor dysfunction, cross training provides an opportunity to maintain and/or enhance fitness levels while safeguarding pelvic health. This approach serves a dual purpose by allowing more variety to workout routines, it not only improves cardiovascular fitness and muscular endurance but also minimizes the high-impact strains that can exacerbate pelvic floor concerns. 

Engaging in cross training activities such as cycling, swimming, rowing, and elliptical training offers a myriad of benefits. These modes of cardiovascular fitness elevate the heart rate and enhance lung capacity without imposing the jarring impacts that often trigger pelvic floor discomfort. Furthermore, by incorporating activities that challenge different muscle groups and movement patterns, cross training promotes overall muscular endurance and strength, creating a more well-rounded and safe training plan compared to running alone. This multifaceted approach mitigates the risk of undue pressure on the pelvic floor, enabling individuals to pursue their fitness goals with confidence, minimize discomfort, and lay the groundwork for better running.

In Conclusion

Now that you have a multitude of exercises to target your pelvic floor, it’s time to get to work. What’s important to remember is that you may not need every exercise discussed in this article. That’s where working with a trained pelvic floor physical therapist can narrow your focus to help save time and energy.

Start simple and progress over time. Rather than selecting the hardest exercise and struggling to properly activate your pelvic floor or breathe, put yourself in a position for success by adopting a quality-over-quantity mindset. Once you master the basics, begin adding more repetitions, harder variations, and so on to gradually develop the capacity to run without leakage. This could take weeks, months, or even years! However, the end result will be worth the effort.