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Running and incontinence

Running and incontinence Like lots of our clients, we love running! We also know that many women avoid running out of fear of leaking if they do. At The Physiotherapy Clinic in Cammeray, Bondi Junction and the shire (Woolooware) we are passionate about helping women run well, pain free and without incontinence.


So why do you leak and how can you stop it from happening?

Oftentimes your pelvic floor is solely blamed for incontinence, however we know this isn’t actually always the case! In simple terms, Stress Urinary Incontinence occurs when too much pressure is sent down onto your bladder, with not enough pressure pushing back up. So yes, you need good strength at your pelvic floor to help support your bladder, but you also need to know how to move well and in a way that doesn’t put undue pressure down onto your bladder in the first place.


Things that commonly send pressure downward include your thorax and your abdomen via stiffness and bracing. In our clinic in Cammeray we often treat the thorax to help it move better and often cue women to let go of their stomachs or any bracing patterns.


We also want to make sure you are absorbing force well from the ground up. We know that shock absorption begins at the foot and if we can opitimise your landing mechanics by making sure the foot is moving well and the calf complex is strong and resilient, then we can decrease force transmission up the chain and into your bladder.


There are lots of contributing forces but ultimately, It’s all about pressure management and how you regulate pressure in YOUR body. It’s also why women often get fed up with pelvic floor exercises; because after months of diligent pelvic floor rehab they don’t see any improvement in their incontinence and throw in the running shoes altogether, when the issue might not be an isolated pelvic floor issue at all.


So we know that pelvic floor strength and full body pressure management are important, but there are two more important considerations in your incontinence. You need consistent, full body strength training. There is no point having an absolutely perfect, strong, coordinated pelvic floor if the other muscles surrounding your pelvis aren’t strong too. We also know that strength training can reduce overuse injuries by up to 50% (Lauerson, 2013) by increasing tissue capacity (the ability of tissues to withstand the loads that running places on the body).


The muscles on your running checklist are your glutes, quads, hamstrings and most importantly, your calf complex. The calf is often neglected however it absorbs 6-8x your body weight every step. So if your calves fatigue, where will that force go? Surrounding joints and your pelvic floor.


The final piece in the incontinence puzzle is your running technique. Running biomechanics plays an important role in injury prevention and management. Running technique has been linked to certain injuries and also to your risk of pelvic floor dysfunction.


There are some things we commonly look for in your running technique when treating running induced incontinence. These include stride length (cadence), overstriding, aggressive heel striking, vertical oscillation, increased ground contact time and your knee angle at midstance.


All of these terms might sound technical or scary but they make a lot of sense when you break them down!


An ‘overstride’ occurs when your foot lands in front of you, beyond your center of mass at initial contact. Overstriding has been correlated with various boney injuries and it makes sense that landing in front of your body instead of underneath your hip will also increase pelvic floor load, because it is a suboptimal position for your muscles to contact in.


So how do we stop this? We often cue your cadence (step rate) to encourage shorter, faster steps. This helps bring your landing foot closer to your body where your muscles can absorb force well, and decreases contact time with the ground and subsequent impact in the body.


As you can see, incontinence with running is a broad and multifaceted problem that needs to be addressed from various angles. Our women's health physios in the shire (Woolooware), Cammeray and Bondi Junction may start with your pelvic floor strength and coordination but this is only the start! Your running technique, your lower limb strength and your ability to transfer pressure are often equally as important.


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