You got the 411- female athlete pelvic health is a thing. You’ve added some questions to your intake, and your athlete told you they have leaks while running-now what?  How do you interpret pelvic health symptoms as a part of the whole clinical picture? You got this! Bring your sports physical therapy (physio), strength and conditioning, and sports med lens to pelvic health!  Reason through it by looking for clues and triggers like you would an athlete that presents with a pain or performance need. Let’s look at things to consider as you build a well reasoned plan.

Age? Pregnancy history?

Is this a young athlete (<12- prepuberty? Teen-post puberty? 18+ ? Never had a baby?)

• If they are young, or never had a baby- pelvic floor ‘weakness’ or ‘damage’ doesn’t really fit as the only source of leaks, so Kegels may not either. Instead, think about it like an overuse injury— you would identify triggers, look for patterns, and symptom behavior. When do the leaks while running occur and what factors contribute to them is crucial.
• If they have a pregnancy or delivery in their history, we need to consider other variables. Vaginal or C-section? Number of pregnancies? Time between pregnancies? Were the symptoms present prior to pregnancy (see previous paragraph)? Started during pregnancy? Or new postpartum? Think about this as someone with an acute “injury or multiple injuries to the same area” who never rehabilitated and went straight back to their previous fitness or sport (over and over again). We need to promote resilience in those tissues, and positive adaptive strategies to rebuild and prepare them to take on the forces and demands of the activity. They need a graduated progressive overload plan.

Timing of Leaks While Running?

We learn a lot about running related pain symptoms based on when in the activity they occur- we need to ask that same questions about leaks while running.

• Leaks occur Immediately or early run? Poor impact absorption, pelvic floor overwhelm (may not be weakness-check out this blog for more depth on this concept) and/or trunk stiffness could be factors.
• Mid-to-late run leaks?  Think fatigue- not just pelvic floor fatigue- think whole body fatigue and fatigue related form changes (poor proximal hip control, respiratory endurance, heavier foot contact).

Leak Pattern?

Again, we can take the same clinical reasoning approach we do for pain during running or any physical activity, and look patterns. Are the leaks while running more common on…

• Certain surfaces (trail, track, or concrete)?
• With specific inclines (downhill or uphill)?
• Do speed changes make a difference-sustained speed changes or quick accelerations?

Identifying these triggers helps you plan a graded exposure program to address those specific challenges.

Comorbidities? 

Think whole person, whole presentation – what else is going on for that patient?

• Do hip or knee pain and leaks occur at the same time while running? Solve that trigger- Ex: poor proximal hip control and impact absorption may be build a plan that addresses those variables and you will have a win-win. Hint: There is a strong neuromuscular link between the glutes and pelvic floor!
• Are there sleep deficits? Do symptoms follow a hormonal pattern-worse certain times of the month? This may suggest modifications to training volume or intensity when sleep is less optimal or the part of the cycle that is more symptomatic to see if it would change symptom behavior.

There’s No Place Like Home

Click those ruby red heels together sports med pros- you’ve had the tools to understand and interpret an athlete’s leaks while running all along! Use your reasoning skills to dig deeper and address leaks as a part of the your care plan. Don’t get results? Refer, co-treat, learn more (see below)! 

Wanna learn more about integrating sports medicine and pelvic health? Check out our sports medicine online courses: Treating and Training the Female Runner (or Any Female Athlete, Sports Medicine Bundle, Persistent Pelvic Pain in Athletes: A Biopsychosocial Approach. 2024 Black Friday Sale is coming soon! 

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