Recently, I was happy to read an article in Runner's World that addresses pelvic floor dysfunction as I find this to be a common problem for a surprising number of runners who can experience some pretty unpleasant symptoms such as pain and incontinence.

Sadly most just accept this as normal, thinking it's either "just part of aging" or, in the case of women who've given birth, that it comes with the territory. The point I'd like to make today is that if this sounds like you, there are absolutely solutions to this problem and there's no reason to continue suffering.

A quick anatomy lesson can help us understand what's going on and why just “doing kegels” is unlikely to resolve these issues.

There are four muscles that make up what many call the “inner core” and they are the diaphragm (on top), the pelvic floor (on bottom), the multifidus (the back), and the transverse abdominus (wraps around you like a weight belt). The role these four muscles play is to activate first when any movement is initiated and create some intra-abdominal pressure to stabilize your spine.

Problems arise when one or more of these muscles does not activate reflexively. Your body creates a compensation pattern to deal with this (over-recruiting one of the other inner core muscles is common), but unfortunately while the compensation pattern solves one problem, it is not an effective long term solution.

And when you want to increase physical activity like raising mileage or intensity, that dysfunctional inner core won't be up to the challenge which often leads to more compensation like tight hips or calves and injury as those tissues become overloaded.

Look at the following list and you can see that it is extremely likely that your inner core is functioning less than optimally.

Most of us have had some sort of injury (surgery is an injury, btw).
We're all stressed and breathing up into our chest, shoulders, and neck.
Having a baby is definitely a trauma (!)
Our culture moves less than ever.

Now, before you start thinking you need to strengthen your core – or throw your hands up in protest because you've invested a lot of time in developing a super strong core – be advised:

Strength is NOT the same as function. One can be very strong yet also very dysfunctional! In fact, it's been said that the best athletes are the best compensators.

If one's pelvic floor is not functioning correctly, it can be overworking (this is sometimes painful) or underworking. Let's look at an 'underworking' situation.

Quite often a runner will say something like "after 6 miles I start to leak" which indicates inhibition of the pelvic floor, meaning it's not contracting reflexively / fast enough. These folks frequently also have chronically tight muscles elsewhere, to make up for the fact that they can't generate proper intra-abdominal pressure to stabilize the spine.

So, should they do kegels to strengthen the pelvic floor? Yes, that would be a part of the solution, but not ALL of the solution. If you just start strengthening, you're likely strengthening the compensation.

I would assess the motor control of the inner core by using Neurokinetic Therapy® to determine which muscle(s) may be compensating for the pelvic floor. For example, it is common in women who've had children to find that their diaphragm is compensating for their pelvic floor. Imagine you have to get this baby out – you might hold your breath to push hard while relaxing pelvic floor to allow the baby to come out.

This person's daily motor control homework until reassessment would be to first release the overworking diaphragm by massaging it, and then activate the pelvic floor by doing kegels (“use the muscles that stop you from going to the bathroom”).

Next, one would integrate those two areas by breathing properly so that you create proper intra-abdominal pressure while moving your body. You'd be surprised how many folks struggle with this and usually I start with some very basic floor-based moves like the dead bug and quadruped rocking so that compensation is less likely.

While I can't be sure of your unique situation and compensation patterns, I do know with certainty that solutions are out there. If you'd like to discuss this further with me please contact me here and I'd be happy to direct you to a qualified practitioner even if you're not in the Philadelphia area.