Hi! I’m Katie Peters, one of the physical therapists at Klein PT in Denver, CO.
Katie Peters, DPT (that’s me!)
As some of you may know, I love working with athletes and that’s something I was so excited to bring to Klein PT. Even more than working with athletes… I LOVE working with runners.
Coming from a long history of running myself, I easily feel connected to this population. I love introducing simple principles to these athletes that can change their sport so quickly, help them finally accomplish a pain free race; and now, help the female runner complete her morning jog around the park without any pelvic floor dysfunction.
(If you haven’t heard, I too am now treating pelvic floor patients and I am thrilled to bring my two interests together.)
Enough about me. I’m here today to tell you how you can be a better runner. I want to share with you my knowledge and the current research on how to be faster, stronger and more efficient. And finally, I’m going to share with you how the pelvic floor works and supports you during your run.
One of the most common questions that I get from runner’s is “how do I become a better runner?” Well, that depends… What does “better” mean to you? Faster? More endurance? Perhaps more efficient or decreased injury? The answer is: all of these things are achievable if you train your body properly.
Let’s start by talking about speed. Running faster isn’t as simple as just taking quicker steps.
The world record for cadence is between 180-200 steps per minute. You and I could do that if we had a metronome- but not for very long because this would require so much energy and effort on our part. Speed ultimately comes down to power. If you want to be faster, you must generate more force through the ground with each step that you take→ more force through the ground equals more power and more power equals more air time.
Confused yet? Keep reading, and I promise this will start to make sense. Something I hear from patients all of the time (no matter what their endurance sport) is “I run x number of miles per week, I’m already strong!” The truth of the matter is running doesn’t actually put a high demand on your muscle fibers. So as a runner progresses, they actually start losing the ability to access different groups of muscle fibers.
Don’t worry, I’m going to tell you how to start recruiting those muscle fibers to provide your body with more power and stability; but first I want to dive into why runner’s are at such a high risk for injury. I’ve been that person, you may have been too or at the very least have known someone who has trained for an endurance race, gotten injured mid training and pushed through anyway. So why is running such a “high risk” sport? Every step you take while running is 2.5x your body weight and just so you understand what that means… that’s 250% more impact than walking.
With such repetitive activity, that’s a lot of stress through our bodies! How do we minimize that increased stress level while at the same time improving performance? The answer is reducing your loading rate AKA where your foot lands in relation to your body and having the stability and strength to absorb impact. An article from the Journal of Orthopaedic & Sports Physical Therapy shows that individuals with patellofemoral pain demonstrated 26% less hip abduction strength and 36% less hip external rotation strength than their matched controls. What does that have to do with anything? I’ll give you a hint- your hip abductors and external rotators are where you get all of your stability!
Okay, so you’re probably wondering when I’m going to start giving you some useful tips. Well here it is. To be a better runner, you need to develop STABILITY and POWER.
This is done through form training exercises, developing strength in your proximal hip musculature and creating power through explosive movements. My advice to my running population is that you need to include 1-2 leg specific strength days in your routine per week; yes this means you shouldn't run EVERY day. Include a variety of exercises from traditional lifts such as deadlifts and squats to form training specific movements such as a Running Man to explosive movements such as squat jumps.
A systematic review in 2016 concluded that a strength training program which included low to high intensity resistance exercises AND plyometric exercises performed 2-3 times per week is an appropriate strategy to improve running economy in middle to long distance runners.
So now you know why you need to strength train… but is that going to stop urinary leakage from happening? Not necessarily. Although hip strength and stability absolutely have to do with our pelvic floors, there could be many more contributing factors to why a person can’t jog a mile without needing to wear a pad.
At Klein PT, we see a lot of moms, and I think something we hear frequently is that they leak the “normal” amount during a run for a mom. I’m here to tell you that any leakage during a run (or any activity) is not “normal”. Okay, if it’s not normal… why is it so common? An article from 2011 looked at a group of 106 female athletes and found that 41% of those women had urinary leakage. Another article from the Journal of Human Kinetics established that over 40% of elite female runners experience urinary incontinence during running or other high impact activities.
We know that running increases our intra-abdominal pressure. In other words, during a movement (this could be running, coughing, sneezing, jumping on the trampoline), there are forces that go through our abdomen and pelvis and our body has to work to disperse these forces. In order to disperse these forces, we need a properly timed, coordinated and strong inner core.
Oftentimes, dysfunction in our inner core (whether it be a weak transverse abdominis or pelvic floor, dysfunctional breathing patterns, poor posture, etc), can lead to poor dispersal of these forces leading to leakage with impact. Intra-abdominal pressure isn’t the only contributing factor however.
The following are some things we need to take into consideration when we experience urinary incontinence while running:
Flexible, strong and properly timed gluteal musculature
Proper breathing patterns (i.e. holding of breath, timing with the rest of inner core)
Posture (are you leaning backwards, slumped forwards, is your sports bra providing the support you need?)
Appropriate footwear
Strong, well timed inner core (abdominals, back muscles, pelvic floor).
So, to sum it up… urinary incontinence during running (or any activity) is not normal and can be changed with the proper training.
So… Want to Be a Better Runner?
Schedule an appointment with me at Klein PT!
Studies and Resources:
Bo K, Backe-Hansen KL. Do elite athletes experience low back, pelvic girdle and pelvic floor complaints during and after pregnancy? Scand J Med Sci Sports. 2007 Oct;17(5):480-7. Epub 2006 Dec 20.
Poświata, Anna, et al. “Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes.” Journal of Human Kinetics, vol. 44, no. 1, 2014, pp. 91–96., doi:10.2478/hukin-2014-0114.
Davis, I et al (2003). Hip strength in females with and without patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy, 2003 Volume:33 Issue:11 Pages:671–676 DOI:10.2519/jospt.2003.33.11.671
Balsalobre-Fernández, C, Santos-Concejero, J, and Grivas, GV. Effects of strength training on running economy in highly trained runners: a systematic review with meta-analysis of controlled trials. J Strength Cond Res 30(8): 2361–2368, 2016