👣 How Your Feet Influence Pelvic Floor Function While Running

Is there a solution to my leakage when I run?

Running might seem like a simple, natural form of exercise, but for many, especially postpartum women or those with pelvic floor dysfunction, it can feel anything but straightforward. If you’ve experienced symptoms like urinary leakage, heaviness, or discomfort while running, you’re not alone. And surprisingly, your feet and the shoes you wear may be playing a bigger role than you think.

🏃‍♀️ The Link Between Running and Pelvic Floor Dysfunction

Stress urinary incontinence (SUI) is one of the most common pelvic floor symptoms triggered by high-impact activities. Defined as the involuntary leakage of urine during movements that increase intra-abdominal pressure (like coughing, sneezing, or exercise), SUI affects about 20% of postpartum women, and up to 36% of postpartum athletes.

For some, running is the only activity that provokes leakage, even after pelvic floor muscle training. This suggests that other biomechanical factors, like foot strike, cadence, and shoe type may be influencing pelvic floor activation and pressure management.

👟 Footwear Matters: Minimalist vs. Traditional Running Shoes

Runners tend to fall into two camps when it comes to shoes:

• Traditional shoes offer cushioning, support, and a raised heel (known as “drop”) to absorb impact and enhance performance.

• Minimalist shoes mimic barefoot running, with less cushioning, little to no drop, and a lighter build.

Recent studies show that women running in minimalist shoes demonstrate greater pelvic floor muscle activation especially at speeds of 5.6 mph (10.7 min/mile) and 6.8 mph (8.8 min/mile). This suggests that less cushioning may increase the demand on the pelvic floor to stabilize and absorb impact.

Running Mechanics and Ground Reaction Forces

Footwear isn’t the only factor. A case study found that a runner who experienced leakage only during running (not coughing or sneezing) resolved her symptoms by softening her landing. By reducing the noise of her foot strike, she decreased ground reaction forces—and her incontinence disappeared.

Other mechanical adjustments that can reduce pelvic floor strain and affect performance include:

• Cadence: Increasing steps per minute by 5%-10%. 

• Foot strike: Landing midfoot or forefoot.

• Vertical oscillation: Minimizing bounce.

Is success achieved by generating demand to counteract these forces (as seen with minimalist footwear), or by reducing their impact on the pelvic floor through alterations in running mechanics? Both are likely true, depending on your pelvic floor strength, symptoms and level of fitness.

The Foot–Pelvic Floor Connection: More Than Just Impact

Research is exploring deeper connections between the feet and pelvic floor:

• Tibial nerve stimulation (which affects the lower leg and foot) continues to be studied as a treatment for bladder dysfunction.

• Foot posture and muscle tension influence pelvic alignment and fascial tension, impacting pelvic floor efficiency.

This suggests that the relationship between your feet and pelvic floor isn’t just mechanical—it may be neurological and fascial as well.

🩺 When to Seek Help

If you’re struggling with pelvic floor symptoms while running, or unsure how to safely return to running postpartum we are here to help. We complete a comprehensive assessment to identify the root causes of your symptoms and guide you toward personalized solutions.

Whether it’s adjusting your stride, exploring footwear options, or retraining your pelvic floor to handle impact, we’ll help you build a plan that supports your goals and gets you back to the movement you love.

REFERENCES:  

1. García-Arrabe, M., García-Fernández, P., Ruiz-Ruiz, B. et al. Effects of minimalist shoes on pelvic floor activity in nulliparous women during running at different velocities: a randomized cross-over clinical trial. Sci Rep 12, 21218 (2022). https://doi.org/10.1038/s41598-022-25344-6

2. Steimling, Michael PT, DPT1; Roberto, Michael PT, DPT2; Steimling, Melinda PT, DPT3. Running Gait Retraining in the Management of a Multiparous Runner With Chronic Stress Urinary Incontinence: A Case Study. Journal of Women's & Pelvic Health Physical Therapy 47(2):p 114-121, April/June 2023. | DOI: 10.1097/JWH.0000000000000265  

3. Lee K. Activation of Pelvic Floor Muscle During Ankle Posture Change on the Basis of a Three-Dimensional Motion Analysis System. Med Sci Monit. 2018 Oct 10;24:7223-7230. doi: 10.12659/MSM.912689. PMID: 30301876; PMCID: PMC6192454. 

4. Bhide AA, Tailor V, Fernando R, Khullar V, Digesu GA. Posterior tibial nerve stimulation for overactive bladder-techniques and efficacy. Int Urogynecol J. 2020 May;31(5):865-870. doi: 10.1007/s00192-019-04186-3. Epub 2019 Dec 18. PMID: 31853597; PMCID: PMC7210232.