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How to improve your running technique to protect your pelvic floor

How to improve your running technique to protect your pelvic floor

If you notice any leakage of urine, pain in the hip, knee or abdomen, heaviness or a bulge in the vagina during or following a run then these are some of the signs that the body is not tolerating the activity well.

How running impacts your pelvic floor

Impact is the biggest trigger for urinary incontinence in female athletes. Thyssen (2002) found that 43% of young female athletes leaked during sport - this is higher than the national average. The most likely sports to promote urinary incontinence were jumping, running, gymnastics and trampolining (Nygaard, 1994).

Here are some helpful tips to protect your long term pelvic health, reduce impact on the pelvic floor and improve your performance when running:

Run in a neutral position

Good alignment can reduce impact when running. A lot of women run with a bouncy posture (Heiderscheit, 2013) - high chested, bottom tucked under, looking up to the sky. In this posture it is difficult to extend at your hip, so you overuse your hamstrings, and your heel strikes  further out in front of you. This leads to a ground reaction force of four to six times your bodyweight - a huge pressure on the pelvic floor!

If you run in a neutral position, leaning over so that your rib cage sits on top of your pelvis and look ahead (not up to the sky), you will be able to extend your hips fully, assisting in performance by helping you propel from the glutes and drive forward. You will also get more of your body over your heel as you land so your heel will strike the ground closer to your body. This will reduce the ground reaction force to just one to two times your bodyweight - much kinder on the pelvic floor.

Increase your cadence

Another way to reduce the impact when running is to increase your cadence - the number of steps you take in a minute. Increasing your cadence by a small amount can decrease forces through the body, leading to less impact through the pelvic floor.

A well-coordinated, strong pelvic floor will contract and relax up to 3,000 times during a 30 minute run. This will happen automatically - do not hold your pelvic floor whilst running! We need these muscles to bounce - to move through range for propulsion and to absorb impact. Holding can lead to an over-recruited pelvic floor and can contribute to bladder urgency, frequency, urinary incontinence, painful sex and constipation. Yikes!

Connect your core

To manage pressure when running you need to learn how to connect your core muscles - the transverse abdominis, pelvic floor, multifidus and diaphragm need to work together in balance. Being in good neutral alignment, as discussed above, will help optimise the ability of the diaphragm and pelvic floor to connect.

Relax your abs and breathe!

One strategy I see a lot of women use is to hold their abdominals. People hold their abdominals for a number of reasons - as they believe it will make them more stable at the centre, to make their tummy look flatter, to improve posture, because they have been told to, or because their abdominals are overactive due to over training.

This prevents you from rotating through the whole torso, restricting  your ability to propel forwards when running. This negatively affects your performance and also causes downward pressure onto the pelvic organs and pelvic floor. You must let go of your abdominals and ensure that you breathe to allow the core system to work as a team.

Seek help from a health professional

There is no one-size-fits-all program. The demands of running are large, high intensity and repetitive so we need to specifically train the pelvic floor to meet this demand. If you are experiencing symptoms and these tips do not help then it is always best to visit a women’s or pelvic health physiotherapist. They will be able to assess you individually and make tailored recommendations, modifications and give you new strategies to keep you doing the sport you love.


This blog post was written by Clare Pacey. Clare is a Specialist Physiotherapist in Pelvic and Women’s Health at King’s College Healthcare Trust. You can book to see Clare at

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