Pelvic Health for Runners - Workshop Recap
Dr. Katie Zhong (Photo courtesy of Ascent Physical Therapy)
In July, Katie Zhong, PT, DPT (she/her) of Ascent Physical Therapy presented a workshop on Pelvic Health for Runners (all-gender inclusive) for PPTC. The workshop explored the anatomy, biomechanics, and training strategies that can keep the pelvic floor healthy and strong. Below is a summary of the workshop written by Dr. Zhong.
What is the Pelvic Floor?
Figure 1. Anatomical illustration of the pelvic floor viewed from above (Image courtesy of Vivid Women’s Health)
The pelvic floor is a group of muscles and connective tissue that span from the pubic bone to the tailbone - literally forming the floor of your pelvis. These muscles play a huge role: they support your organs, contribute to core stability, help with continence, and even influence your sexual health.⁶ They’re active all day long, responding automatically (as part of reflexes) or voluntarily (like when you actively contract them), and work in sync with your breath and pressures within the trunk.⁶
How the Pelvic Floor Works When You Run
Figure 2. Running gait cycle diagram showing the phasing of initial ground contact, mid-stance, and toe-off as part of the full stride. (Image courtesy of ResearchGate)
The pelvis connects the spine and hips, acting as both a shock absorber and force transmitter. Every stride involves two main phases:
Stance phase – Pelvis must remain stable to avoid excess motion.
Swing phase– Pelvis rotates to allow proper leg movement.
Studies using surface and intravaginal EMG (Electromyography) suggests that the pelvic floor muscles (PFMs) cycle through different activation levels:¹-⁶
Pre-landing: Contract in anticipation of ground impact.
Initial contact: Peak activity to absorb forces.
Mid-stance: Maintain stability while transferring load.
Toe-off: Gradually relax as the leg swings forward.
This reflexive action is vital for resisting downward forces from impact and for working in harmony with the diaphragm, core, and hip stabilizers. PFMs are never fully "off" during running, they cycle through dynamic contraction/support and relaxation.¹³
Pelvic Floor Dysfunction in Runners
Figure 3. Illustration above highlighting what symptoms someone can have that is experiencing pelvic floor dysfunction (Image courtesy of Rosanna Physio)
When the pelvic floor isn’t functioning well, runners may experience:
Urinary leakage or urgency
Constipation or difficulty voiding
Heaviness/bulging (poor pressure management or possible prolapse)
Pelvic, hip, or low back pain
Pain with sexual activity
If PFM activation is delayed, the pelvic floor can’t counter the pressure from landing efficiently, which may lead to leakage or decreased support for the pelvic organs. If it’s too shortened or has a high tone, there’s not enough recoil at toe-off. This reduces efficiency, disrupts synergy with your glutes and core, and can even cause pain.¹-⁶
A well-functioning pelvic floor is about timing, reflexes, and coordination.
Key Exercises for Pelvic Floor Health
The following are practical exercises to build pelvic floor awareness and strength:
Anterior & Posterior Pelvic Tilts: for improving pelvic motion, awareness, and control
Starting Position: Sit comfortably on a chair or physioball with feet grounded on the floor or lay on your back with knees bent
To do anterior pelvic tilt, think about arching your tail bone behind you while rotating your pelvis forward.
To do a posterior pelvic tilt, think about tucking your tailbone underneath you while rotating your pelvis backwards.
Kegel - Relaxation - Bearing Down Practice: for improving pelvic floor coordination, awareness, and strength
Starting Position: Sit comfortably on a chair or physioball with feet grounded on the floor
Step 1: Kegel (Contraction)
Kegel is the first step to strengthening pelvic floor muscles, improving continence, and supporting the bladder, uterus, and rectum.⁶
Inhale gently, then as you exhale, contract your pelvic floor as if you are “picking up the blueberry with your vaginal canal” or “bringing your nuts to your guts”
Imagine lifting the muscles upward and inward.
Hold ~ 3 seconds as you continue to exhale
Step 2: Relaxation
Relaxation is crucial for deregulating our neuromuscular and pain system and assisting in voiding and defecating.⁶
Release the contraction fully on the inhale.
Imagine your sit bones widening and pelvic floor sinking back down from the kegel.
Rest for 5 -10 seconds to reset
Step 3: Bearing Down (Lengthening)
Bearing down is crucial for assisting in labor delivery and managing bowel movements.⁶
On your next exhale, gently bear down - like starting to pass gas or initiating a bowel movement.
Keep it light and try not to hold your breath, you should feel your floor having more surface contact on the chair or physioball
Hold 2–3 seconds, then return to neutral
Frequency & Practice:
At first, don’t worry too much about reps - focus on quality, motor control, and coordination. Try setting aside 15 minutes each day in a quiet space to practice each exercise. Once the movements start to feel more natural, you can weave them into daily life. For example, doing a few kegels while waiting at a stoplight/watching TV, or practicing relaxation and bearing down when you are performing a slightly bigger bowel movement.
Final Note:
These exercises can feel tricky at first, so be patient with yourself. It takes time to build awareness and coordination in the pelvic floor. If you’ve been experiencing pelvic floor dysfunction for more than 4 weeks, don’t wait - reach out to a pelvic floor therapist to get personalized guidance and support.
References:
¹ Williams AR, Johnson MK, Smith LT. Characterizing pelvic floor muscle activity during walking and jogging: An EMG study.J Appl Biomech. 2022;38(3):215-224.
²Sampson KM, Chen SH. Evaluation of pelvic floor muscle activity during running in continent and stress urinary incontinence women. Neurourol Urodyn. 2021;40(5):1295-1303.
³ Thompson PD, Nguyen EA. Coactivation of the pelvic floor and gluteus medius while walking and running. Sensors (Basel). 2023;24(5):1356.
⁴Davis RJ, Patel MN. Mechanisms of pelvic floor muscle training for managing urinary incontinence: A scoping review. Int Urogynecol J. 2022;33(8):2001-2014.
⁵Lopez VH, Ramirez FC. The acute effects of running on pelvic floor morphology and function. J Womens Health Phys Ther. 2023;47(2):95-102.
⁶Bø K, Herbert R, eds. Evidence-Based Physical Therapy for the Pelvic Floor. 2nd ed. Elsevier; 2015.
Editor’s Notes:
The above is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem, condition, or disease, and those seeking personal medical advice should consult with a licensed professional.
Ascent Physical Therapy is an official race sponsor of PPTC.
Non-endorsement disclaimer:
We are grateful to Dr. Zhong for generously giving us her time and providing us with information. The information provided by Dr. Zhong and this post does not constitute or imply an endorsement or recommendation by PPTC.
Introductory text by Linda S. Chan
All other text by Katie Zhong, PT, DPT
Produced by: Linda S. Chan
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