Runners are no strangers to the world of physical therapy and its many benefits. But pelvic floor therapy is either totally unknown or taboo—in both scenarios, runners, particularly female runners, might be missing out on important injury prevention and rehab opportunities.
Pelvic floor therapy is a type of physical therapy that focuses on, well, the pelvic floor. Because of the nature of treatment, pelvic floor physical therapists go through additional training for certification, explains Lauren Garges, P.T., W.C.S., director of the women’s health program at St. Luke’s University Health Network in Bethlehem, Pennsylvania. In fact, less than 1 percent of physical therapists in the U.S. are certified as a pelvic floor specialist, she says.
What is pelvic floor therapy?
To understand pelvic floor therapy, it’s important to understand what the pelvic floor actually is. Essentially the pelvic floor is a group of interlacing muscles that span the distance between the tailbone and the pubic bone, explains pelvic floor specialist Paul Tulikangas, M.D., director of urogynecology at Hartford Hospital. These muscles support the bowel and bladder in men and women, and the uterus and vagina in women.
Because humans are upright, the strength and tone of the pelvic floor muscles are imperative in keeping the organs in place, Tulikangas explains.
Pelvic floor therapy is a type of physical therapy that can treat issues related to the pelvic floor, including incontinence in men and women, painful intercourse in men and women, pelvic pain, overactive bladder, including frequency and urgency, and organ prolapse, in which the bladder, uterus, or rectum can drop or press into the vagina.
Tulikangas works closely with his team of pelvic floor physical therapists and says that physical therapy is used to treat most conditions he sees as a physician. “It’s made a difference for our patients,” he tells Runner’s World.
What is a pelvic floor therapy appointment like?
A pelvic floor therapy appointment is unlike your typical physical therapy session. It’s in a private room, for one, due to the sensitive nature of the appointment. Garges tells Runner’s World that a pelvic floor therapist will spend 75 percent of an initial appointment just talking to a patient to learn about sleep habits, nutrition and hydration, exercise, symptoms, goals of treatment, and stress.
“There are so many systems in this small area of the body,” she says.
Patients—men and women—should be prepared for an internal examination, intervaginal for women and interrectal for men. The purpose of this exam is to assess the muscles’ abilities to contract and fully relax, Garges explains, and to determine the strength and tone of these muscles. Muscles that are too strong or tight, for example, can cause pain.
Garges says that most of her female patients say her exams are more comfortable than their gynecologic exam. “We don’t use a speculum, swabs, stirrups, and we don’t take samples,” she says.
For men, a pelvic floor specialist appointment may take longer than a prostate exam, Garges says, because therapists are paying more attention to the muscles and tailbone area.
What are the benefits of pelvic floor therapy?
Pelvic floor therapy can treat a host of problems that affect runners of all types, particularly women. Because running is a high-impact sport that causes the pelvic organs to jostle around, having a strong (but not too strong) and toned pelvic floor can keep women, especially, running pain-free.
“A lot of people have said to me, ‘Why didn’t anyone tell me about pelvic floor therapy sooner?’” Garges says. “More than other forms of physical therapy, you really learn about your anatomy with pelvic floor therapy and how things function.”
Not only is pelvic floor therapy extremely effective in treating conditions like urinary incontinence and pain during intercourse, it is part of total-body strength, Garges says. That’s means it can target and treat problem spots notorious for runners, including the hips and glutes.
In Garges’ experience, orthopedists, for example, who are treating someone with an injury—say of the hamstring or hip—might not think about the pelvic floor. “But when patients bring it up themselves, most medical professionals say, that’s not a bad thought,” she says.
Types of Pelvic Floor Therapy
A pelvic floor therapist has a variety of treatment methods and tools, depending on the nature of the problem.
Biofeedback is a way for a therapist and a patient to gauge muscle strength and the muscles’ ability to relax. Garges points out that pelvic floor muscles that are too tight can cause pain and that is exacerbated by doing too many kegel exercises or not doing them correctly.
During a biofeedback session, electrodes are placed on the skin and a probe is placed internally to show when muscles are contracting and relaxing (often while performing kegels), and how those muscles coordinate with other muscles like the hips and abdomen.
Soft Tissue Work
Pelvic floor muscles are muscles, which means they have trigger points and myofascial tissue that might need a release, just like your quads or calves. Internal soft tissue work directly on the pelvic floor muscles and external soft tissue work on muscles outside the pelvic floor can also address the iliotibial (IT) band, hips, adductors, and abdominals.
Therapists might also treat issues with scar tissue massage (which involves both actual massage and other techniques), especially if a patient has had surgery, including a C-section.
Many women who experience pelvic floor concerns require stretching. That can be done manually or with dilators—tube-shaped devices that come in a range of sizes—which Garges says is a good way for a patient to be involved with their treatment. Dilators can serve a few purposes, including helping the muscles lengthen and relax, as well as desensitizing the area to allow for stretch and movement.
Stretching can help alleviate issues like pain or an overactive bladder. “Some runners may not be able to run more than 20 minutes due to muscle dysfunction,” Garges says, and if tightness is the issue, stretching the pelvic floor muscles can help.
Although runners often think of stretching when something is tight or stiff, Garges looks at it as reducing tension in the tissue, which includes muscles and connective tissue.
“[Reducing tension] can include manual techniques by the therapist to gently lengthen tense or tight pelvic floor muscles, gentle massage to increase blood flow, or specialized pressure techniques to reduce trigger points, or knots,” she says.
Traditional stretching is effective, too. Garges recommends moves like happy baby and child’s pose to stretch the pelvic floor.
Who can benefit from pelvic floor therapy?
More often than not, therapists will see women after childbirth who have complaints of pain during intercourse or incontinence. “[These issues are] very common but not normal,” Garges says.
A woman’s likelihood of experiencing incontinence goes up with every pregnancy. After all, each full-term pregnancy and delivery takes a toll on the pelvic floor and it requires proper strength-training (a goal of pelvic floor therapy!) to restore that strength and tone.
Runners who’ve had children, especially, can benefit from pelvic floor therapy after delivery, vaginal or C-section; the high-impact nature of running adds further stress to the already weakened pelvic floor. Therapy can help build back strength and tone before you start logging miles again.
Often, there isn’t much guidance for women who are looking to get back to running postpartum, and just because a six-week postnatal exam checks out (doctors may not even do a physical exam), doesn’t mean women’s bodies and muscles are ready for the high-impact sport of running, Garges says.
“Therapists who are trained in [pelvic floor therapy] can guide women in a step-by-step way to get back to running safely,” she says. “An exam might include how posture has changed during pregnancy and postpartum.”
Garges also explains that a pelvic floor therapist can assess diastasis recti, or ab separation, which happens in 100 percent of pregnant women. With the help of a therapist, you can easily treat it.
When should you see a doctor instead?
Because pelvic floor therapy isn’t (yet) mainstream, patients often turn to their doctors to address their symptoms. It’s common for people, especially women, to assume a condition like incontinence is normal with childbirth or age and avoid bringing it up with physicians. But it’s not normal, Garges and Tulikangas emphasize. And there are ways you can address it, especially if you see a pelvic floor PT.
But for symptoms related to infection, like discharge and fever related to vaginitis after childbirth, for example, a doctor can prescribe antibiotics, Tulikangas says, and that’s why you’d want to see a doc first before a PT. Some types of urinary incontinence are also caused by a fistula, which requires surgery and cannot be treated with pelvic floor therapy.
“Physicians are a common entry point and then we can connect patients with a pelvic floor therapist,” Tulikangas says. So it’s never a bad idea to see your doctor, but it’s also smart to ask about pelvic floor therapy.
Who should avoid pelvic floor therapy?
In rare cases, women who have severe organ prolapse should avoid pelvic floor therapy, Garges says. While pelvic floor therapy can help strengthen the floor, if prolapse is advanced, surgery might be the only option. Garges notes that this is more likely to happen in older women.
Is at-home pelvic floor therapy an option?
Depending on the nature of the problem and the type of therapy needed, there are exercises people can do from the comfort and privacy of their own homes. The widespread taboo of discussing pelvic floor-related conditions juxtaposed with the potential difficulty of booking an appointment are two reasons Brianne Grogan, P.T., D.P.T, started a YouTube channel to discuss pelvic health.
“There is a massive lack of information,” Grogan tells Runner’s World. “That’s why it’s essential to take matters into our own hands. People can and should take ownership of their own pelvic health, and I want them to feel empowered to learn more about their pelvic floor.”
That said, Grogan recommends seeing a professional in person for an initial evaluation before starting at-home therapy with her online videos. “At-home pelvic health education is a great thing to do while waiting for your first appointment or between sessions,” she says.