PT on the Net Research

Incontinence and Exercising


Question

I have a client who suffers from incontinence when she skips or runs hard. Often while jogging she maintains a good pace but when we interval train her and I try to speed her up into sprints or faster jogs - she feels like (and sometimes does) leak.

Answer

Your question is a popular but quiet one. Without an assessment it is difficult to give you an exact strategy. However, a review of the literature shows mass confusion in the nomenclature of tightness, weakness,strength, etc. Try to keep in mind with all kinetic chain dysfunctions there is always a neural component and a mechanical component. Example regarding your question; the pelvic floor may neurologically be inhibited due to a tight psoas. Tightness in the psoas causes reciprocal inhibition to the glute maximus creating a mechanical deviation of the ilium, etc. This articular position alters muscle length tension relations throughout the entire lumbo-pelvic-hip complex placing abnormal stress to the lumbar spine. Mechanically speaking, the intrinsic stabilizers of the lumbo-sacral region are not in a position to produce optimal force thus stability can be altered. It is important to remember, where there is altered muscle length tension, there is altered force couple relationships which leads to altered neural control.

The question may not be a matter of strength. The question may be: Why is the pelvic floor, transversus abdominus, multifidus and diaphragm not providing the necessary control to the lumbo-pelvic-hip complex (which in turn controls your clients problem).

Recommended Reading

  1. Paul Chek's article on the Inner Unit and Outer Unit to gain an understanding of the function and relationships in the lumbo-pelvic-hip region.
  2. Rodney Corn's article on the Gluteus Maximus and Neurological Rationale for Integrated Training which will give you great ideas on how to increase your clients functionality.
  3. Lenny Parracino's article on Stretching (A Simple Guide to Stretching) which will give you an understanding of corrective strategies for commonly tight muscles.