Integrating pelvic health and orthopedic programs to treat pelvic floor dysfunction in female runners


Todd Davenport: 0000-0001-5772-7727


Physical Therapy


Purpose/Hypothesis: The female athlete population has a high prevalence of pelvic floor dysfunction (PFD), putting them at increased risk for urinary incontinence.1, 2 Very few studies have investigated the use of a home exercise program (HEP) to prevent PFD in sports, particularly running.3 While PFD prevalence is high, the advocacy for preventative recommendations is low; most incontinent women irrespective of age report never speaking about their condition to anyone and having no knowledge of preventative measures.1, 4 This study investigated whether a 1-time educational workshop on pelvic and core health and a generalizable HEP had positive changes in reported PFD at 2-week and 6-month follow-ups for female runners.

Number of Subjects: 22 (age: 44±11 years; BMI: 22±2 kg/m2)

Materials and Methods: A pilot study was conducted where participants attended a workshop comprised of education about the pelvic floor and core muscles and about the pelvic health and orthopedic-based HEP of breathwork, posture, strengthening, and stretching of the hips, back, trunk and pelvic floor muscles. A blinded assessor evaluated overall core strength (CoreFirstR Strategy, using 0-5 scale) pre- and post-workshop. Questionnaires evaluated the frequency of leakage during jumping, landing from jumping, running, during competition, approaching the finish line, during other sports, coughing, sneezing, heavy lifting, walking to the bathroom, sleeping, and hearing running water. Time points were baseline (i.e., pre-workshop) and 2-week and 6-month follow-up. Paired samples t-tests and McNemar’s tests were used for comparisons.

Results: Overall core strength improved after the workshop (Right foot forward: +1.4 (1.3), Left foot forward: +1.3 (1.4); both p<.001). HEP adherence was 86% and 55% through 2 weeks and 6 months, respectively. Results are presented as the percent reporting any instance of leakage baseline to follow-up (i.e., a decrease in percent is symptom improvement). Improvements occurred after 2 weeks for jumping (41 to 5%, p=.021), landing from jumping (46 to 9%, p=.008), coughing (64 to 14%, p=.003), sneezing (59 to 14%, p=.002), and walking to bathroom (59 to 32%, p=.031). Improvements occurred after 6 months for jumping (41 to 14%, p=.031), coughing (64 to 14%, p=.001), and sneezing (59 to 23%, p=.008).

Conclusions: Educating competitive female runners and providing a generalized HEP focused on pelvic health had immediate positive changes in overall core strength and PFD at 2 weeks, which were maintained through 6 months. Future studies are needed with larger cohorts and randomized controlled study designs.

Clinical Relevance: PFD is reported as a barrier to women's participation in sport and fitness activities and may be a threat to women's health, self-esteem, and well-being.3,4 Currently, there are no standard recommendations or training programs for the prevention of PFD in female athletes.5 Providing a 1-time in-person workshop focused on pelvic health education and pelvic health and /orthopedic exercises can have immediate, and long-lasting improvements, in competitive female runners' core strength and PFD.

Document Type

Conference Presentation

Publication Date


Publication Title

American Physical Therapy Association, Combined Sections Meeting

Conference Dates

February 2-5, 2022

Conference Location

San Antonio, TX

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