Returning to Running (Part 5)

Part 5-

Pelvic Floor assessment for running. 

Due to the amount of impact and load on the pelvic floor - running is less advisable when:

1. The pelvic floor strength is graded below a 3/5. This is graded with manual muscle tests by a provider. The provider (Physical Therapist, in my case) will assess all 4 quadrants of the pelvic floor through all three layers using a finger and having the client perform a pelvic floor contraction at the most force she is able to generate AND with good form without substitutions. Ideally this testing is done in standing where you are fighting gravity and on your back where you are not having to work so hard. Your muscle performance is graded based on muscle force and lift felt by the provider.

   • Here’s the breakdown:

     • Grade 0 (zero): No palpable contraction

     • Grade 1 (Trace): Flicker or pulsation

     • Grade 2 (Poor): Contraction but no lift

     • Grade 3 (Fair): Moderate contraction with more posterior lift than anterior

     • Grade 4 (Good): Contraction and lift with compression from anterior, posterior and side walls

     • Grade 5 (Strong): Stronger lift and compression with cephalic lift of the finger with resistance against posterior vaginal wall (in other words - everything’s up and in!!)

2. Standing pelvic floor endurance is reduced with:

   • 10x fast reps

   • 8-12 reps of 6-8 second maximum voluntary contraction

   • 60 seconds sub maximal 30-50% contraction

3. Prolapse score of GH and PB less than or equal to 7 (see self assessment button above and picture below to understand better) with valsalva or bearing down. A pessary may be beneficial to help fascial support and facilitate return to running. A pessary is considered a little orthotic that stays in the vaginal canal and can help hold tissues up and in where they belong. Sometimes the prolapse can reverse if we strengthen but sometimes the prolapse is not because of weak muscles but because of lax or loose tissue. The best analogy i’ve heard is to think of it like boobs. The muscles behind the breasts are still strong and you can do lifting, pushing and all sorts of movements but the tissue on top is still softer or looser than it should be and can sag. This can happen with the fascia or connective tissue in the pelvic floor. It can get stretched and because it is not elastic nor has recoil abilities like muscles, it stays slightly stretched. Most of the time we can prevent this from worsening by recognizing symptoms, recognizing when symptoms worsen and avoiding those actives or modifying the activity to reduce pressure through the system. 

4. Incontinence during exam - If someone has leaking with the physical assessment or any of the activities, it is advisable to avoid running and determine the cause or refer appropriately.

The best way to test this is with a therapist who can palpate. You can also purchase biofeedback tools that will tell you when you contract and relax. They often sync with your phone. 

I hope this helps you to understand the importance of proper pelvic floor strength and the importance of understanding how your system can work together. I have a little more to share…keep tuned!!