Why Runners Need Pelvic Floor Therapy

I had never heard of pelvic floor physical therapy until I had my daughter in the summer of 2019, and I didn’t utilize the treatment until I had my second baby this past year. Having two babies in two years, it seemed, did a number on the hammock of muscles that support my pelvic organs: the pelvic floor.

To many, pelvic floor therapy is considered a niche area of physical therapy; it’s used by moms who want to rehab the muscles involved in birthing babies (and that includes the core!). And I can attest: It’s tremendously effective at doing just that.

But experts are quick to point out that pelvic floor PT has benefits that go far beyond training and retraining muscles that endured the trauma of birth. In fact, about 13 percent of women who have never given birth have pelvic floor dysfunction. And pelvic floor therapy can provide unique benefits to runners.

The pelvic floor is a site of untapped potential for general core strength, says Sara Tanza, a pelvic floor physical therapist and founder of Pelvic Potential in Aptos, California. And when it comes to minimizing injury risk and maximizing athletic performance, “the pelvic floor is a big piece of the puzzle.” Have a history of chronic hip or high hamstring issues? “Pelvic floor PT can be a big secret weapon,” Tanza says.

A lifelong runner, I, perhaps, could have benefited from pelvic floor PT years before I became a mother. After reading this, maybe you’ll realize you could benefit, too.

What is Pelvic Floor Therapy?

“I describe pelvic floor physical therapy as no different than any other orthopedic physical therapy,” explains Jessica Dorrington, director of Therapeutic Associates Bethany Physical Therapy in Portland, Oregon. “Just as you go to physical therapy for your hip or back, you can go to physical therapy for your pelvis.”

Pelvic floor PTs “look at the pelvis as the keystone part of the whole system,” says Dorrington. They study how joints move, how muscles function, and—largely—how the pelvis moves with the rest of the body.

Through manual treatment, exercise plans, muscle training (and retraining), and tools such as biofeedback, PTs work to treat all kinds of dysfunction in the pelvic area.

They see patients whose symptoms run the gamut from urinary or bowel leakage (leaking urine or feces, often with movement) and urgency (you have to go to the bathroom a lot) to pelvic pain (around your pelvic symphysis bone at the front of your pelvis, for example), pain with sex or sitting, tailbone pain, feelings of “heaviness” in the pelvic region, constipation, and more.

More broadly? “I always say if you can’t get things in or out—you can’t have penetrative intercourse, you can’t insert a tampon without pain, you’re having problems with constipation—your pelvic floor could be involved,” says Dorrington.

In fact, any time you’re struggling with hip or low back pain that hasn’t gotten better with time or other forms of treatment, your pelvis could be the culprit.

How Pelvic Floor Physical Therapy Can Help Runners

If you’ve ever had hip, high groin, or high hamstring pain, you might be surprised to know that your pelvic floor could be involved. “There are some muscles from the hip joint that actually connect to the pelvic floor and have really strong connections with it,” says Tanza. Picture tugging the end of a shirt. Just because you tug the bottom doesn’t mean the neckline doesn’t move; it’s all connected.

Low back pain or sciatic-type pain can also point to the pelvic floor. “The pelvic floor muscles attach into the tailbone, and we know that that the tailbone has connections to the entire nervous system,” Tanza says. “A lot of times, treating the tailbone can help with people who are having issues with nerve-type pain down their legs.”

Core strength and stability (or a lack thereof) is another big reason to consider pelvic floor PT. That’s because while you run, your core is tasked with not only producing power but also stabilizing your pelvis and spine and transferring the ground reaction forces of your foot hitting the ground.

“When your foot strikes the ground, ground reaction forces come up through the leg and hit the pelvis,” Dorrington says. “The pelvic floor is part of the stability component of that. If you have good stability, those ground reaction forces continue to travel up your spine and then back down and you become an efficient runner and have less variance for running injury.”

If you’re not transferring load forces as well? Little nuances pop up and down the chain that can increase your risk for injury.

And while you can do all the abdominal exercises you want, if you’re not working with the entire core (pelvic floor included), you’re missing a huge piece of the puzzle when it comes to power, strength, and control, says Tanza.

“The transverse abdominis and the pelvic floor work in co-contraction with each other; they work together to stabilize,” adds Dorrington.

But it’s important to remember that the pelvic floor doesn’t always need strengthening. Specifically in an athletic population, these muscles can actually become overtrained. Specific exercises (the Child’s Pose in yoga, for example) can help you relax your pelvic floor.

A pelvic floor PT can help ID your individual challenges and work with you to create a plan that works for you.

How to Try to Get Pelvic Floor Physical Therapy Covered By Insurance

If your pelvic floor physical therapist is “in-network” for your insurance, you should have coverage for pelvic floor therapy. (Pelvic floor PTs use the same “billing codes” for insurance purposes that other PTs use.)

But you may find that many pelvic floor PTs are not in-network providers. The reason, Tanza explains, is because a lot of the worked pelvic floor PTs do can’t be covered under a traditional insurance model of a 20- to 30-minute session. “Having something like an hour long visit every single time with patients is super beneficial when it comes to appropriately addressing all of the issues someone might have,” says Tanza, who notes that with some patients she even takes time to watch them run.

And while in-network PT may seem more affordable (a $50 copay and, say, 20 percent of a full session’s bill), it could wind up being more expensive if you consider the time spent with a provider over time.

Tanza says that if you can’t find anyone near you who is in-network, even one session with an out-of-network provider—for an evaluation and some take-home strategies—can be beneficial. If your provider is out of network? If your insurance plan has out of network coverage, ask your PT for “super bills” that could can submit to your insurance company for potential reimbursement, suggests Tanza.

In terms of finding a pelvic floor PT, The American Physical Therapy Association’s website or site like pelvicrehab.com are good places to start. You can also visit your insurance company’s website or give them a call for a list of in-network providers near you.