Midline stabilization is heralded as the foundation of safe and successful weightlifting. But have we been ignoring a part of the “core”? The pelvic floor is a topic that tends to be avoided. Most people do not casually discuss urinary frequency over coffee or admit to their coach that they pee every time they perform double-unders. Men- if you think this one is just for the women, stick around!
I only realized the prevalence of leakage after CrossFit HQ posted a video following regionals. All of these women were saying “It’s ok, I pee during workouts too. It’s normal!” Please do not confuse normal and common. Urinary incontinence may be common in certain populations, especially of heavy lifters, but it is absolutely not normal.
The pelvic floor includes a group of muscles that attach from your coccyx (tail bone) and sacrum to your pelvic ring.
These muscles are important for bowel and bladder function, organ support, and stability of the pelvis. Although pelvic floor dysfunction (PFD) was thought to be largely a problem of women, it is becoming apparent that men have similar issues. The pelvic floor may seem very foreign and uncomfortable to discuss, but when it properly functions it can improve your workouts. Here’s how:
I like Mary Massery’s description of the core as a “soda-pop can”. The front of the can is the abs, the back is the multifidi, the pop top is the glottis and the bottom of the can is the pelvic floor. The core pressure is maintained by a functioning glottis and pelvic floor, with the diaphragm acting as a pressure regulator.
When you take a breath in, the diaphragm descends. This requires the pelvic floor muscles to descend and lengthen. When you exhale the diaphragm rises and the pelvic floor rises and tightens.
In fit individuals, (notice I said individuals and not just women), a common pelvic floor problem is overactive muscles. Very strong back or abdominal muscles can cause increased inward pressure. It’s been shown that when your deep abdominals contract, so does your pelvic floor.
Imagine squeezing the can from both sides with the pressure maintained. The bottom and top will have to withstand more pressure and bulge. If your abdominals are always squeezing in then your pelvic floor is always pushing up to withstand the pressure. It’s overworked! The diaphragm is pretty darn good at its job. If it does not work, we have a bigger issue on our hands.
So often, when something’s ‘gotta give’- it’s the pelvic floor. When all of these muscles work in concert, your canister and the force it can produce is maximized. Thus, your workout improves.
A conversation about breathing techniques regarding the glottis and diaphragm is essential to training the entire core. Here I am simply touching on one contribution but remember it does not work alone.
Keep in mind, PFD can also manifest in ways such as pelvic pain, painful intercourse, low back pain, urinary frequency or even the dreaded butt wink. It is not just urinary incontinence.
“ Pelvic floor pain is only caused by pregnancy, right?”
Wrong. There has been no correlation shown between PFD and post-partum women. Sure, some moms experience issues but again, it is not normal for any population. Weakness and/or tightness of the pelvic floor can be caused by poor postural habits, extended periods of sitting, over training of the abdominals and pregnancy. Excluding pregnancy of course, men are susceptible to all of the other risk factors.
“Ok, so I pee on myself at the gym and it’s not normal. What do I do to stop it?”
Sapsford, Ruth R, Hodges, Paul W. Contraction of the Pelvic Floor Muscles during Abdominal Maneuvers. Physical Medicine and Rehabilitation, 2001, Vol.82(8), pp.1081-1088.
Presentation at CSM 2016 by Mary Massery: referencing Massery 2005 & 2006.
All too often the answer is “I just run my first half mile slower and then get into my running pace”.
Paula Radcliffe, one of the greatest female marathoners in English history, does a warm up for 45-50 minutes before a marathon race! That’s longer than most of us will run for our work out.
So why is it that elite runners and athletes put such an emphasis on warming up and we do not? There are a few factors that can lead to the lack of using a warm up.
We’re going to try and solve these issues with the warm up and put something together that you can do in a short period of time (15 minutes) before your next run.
Here’s the strategy in a nutshell: we need to get tissues opened up that can be primary limiters of running mechanics and we need to get muscles firing that need to be working for proper movement. Let’s start with opening up the tissues we need for running.
One of my favorite pre-run mobilization for runners to do is a quick pressure-based technique for the bottom of the foot. All you need is a lacrosse ball, baseball or some other type of hard ball to step on. Do not use a racquetball or a tennis ball, it’s a waste of your time because it’s not enough pressure. We want to open this area up before running because every little bit of increased ankle dorsiflexion will be a mechanical advantage for us in particular on hills.
Do this technique below for 1 minute on each foot
Next, we want to open up the hips, in particular hip extension. This allows us to get our leg behind us while we run without having to compromise our back to do so. This is also a huge area of emphasis because of the amount of time most of us spend sitting. When we sit we are in a hip-flexed position. When we run, we drive into the opposite range, hip extension. If you sit all day in hip flexion, your tissues get tight in that range and cause you to lose hip extension.
This is essentially a hand brake that you have with your forward movement. By opening up your hip extension, it allows increased ease of movement in the running gait. Here is what you’re going to do. This stretch is called the world’s greatest stretch and it really might be!
Perform this sequence twice on each side. It should take you about 1 minute to go through this sequence on each side. This gets things moving at the upper back, front of the hip and hamstring/calf. It’s really a catch all for many athletic movements but in particular running.
Alright, we should have those done in about 5 minutes. On to the priming of the movement that we want to perform.
I’m a big fan of working on the skill of running. That’s right, running is a skill and if you treat it that way your body will thank you and your finish times will be better. Practicing certain movement prior to running can help us ingrain good moving patterns while we are running.
The first drill is a pulling drill that I use all the time with my athletes. Do 1 minute of pull drill work like Nate explains in the video. After that, run for 1 minute trying to emphasize the same exact pull feeling that you got doing the drill.
The last drill will be to work on your cadence. Cadence is how many foot strikes you have in a minute. Coaches and researchers have found that having a cadence around 180 foot strikes per minute is a very efficient place to run. This allows for you to pull your foot quickly off the ground and minimize some of the elongated ground reaction force that happens with a very slow cadence.
Download a free metronome app on your phone. Put the beats per minute at 90. You’ll try and have your right foot hit the ground every time it bets. This will equal 180 foot strikes per minute since you’re only counting the one side. Run for 1 minute at this cadence but try and keep a slow to moderate pace. Don’t go bananas and try to run a 4 minute mile because you’re increasing your cadence. Stride length plus high cadence is what allows us to run really fast efficiently. Shorten your stride and keep your cadence high during this drill. You should imagine you’re running on hot coals.
In summary your warm up should look like this:
Don’t be surprise if you’re breathing a little harder after your warm up. That’s why it’s called a warm up! You’ve got to prime your body for what you’re about to do. This could be the single most important thing you can do to maintain your body as a runner and improve your skill of the movement.
If you’re a runner, triathlete or CrossFitter that wants to improve your running or are dealing with a run-related injury let us know. We’ve literally helped thousands people with knee, foot, hip and back issues related to running. Don’t wake up every morning wondering if this is the day your knee will stop hurting when you run. There are answers out there and we can help.
Contact us below if you would like to set up a free talk with one of our Doctors of Physical Therapy to see how we can help you run pain free
Thanks for reading,
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.