Broken Runner: Dealing with a Pelvic Floor Injury

I’m in the best running shape of my life.  My body looks like this. But more importantly, it performs.  I just ran a 50 second PB in the half marathon with a 1:26:12 in my goal spring race.  

But my body is broken on the inside and is limiting my training.  I have a pelvic floor injury which is an injury that no one ever talks about.  While I continue to work on sorting this out and I’m going to take this chance to talk about it because this happens to women, especially mother runners. Because knowledge is power and in running, that power = longevity.

The name of my pelvic floor injury is a rectocele and I sustained it 3 years ago during the birth of my second child.  The injury is to smooth muscle which is muscle that isn’t under voluntary control and does not heal on it’s own. Aside from the injury, I’m also dealing with general pelvic floor dysfunction: a fancy way of saying that the musculature is all eff-ed up.

When I started on this journey of figuring out what was so wrong up with my body, I was diagnosed with a grade 2 rectocele.  There are 4 grades with 4 being the worst and like “oh Lord, go to the ER now.”  Grade 3 is usually the threshold for surgical repair because smooth muscle will not repair on it’s own. It’s basically an internal hernia. The most common cause of this injury is childbirth, especially with babies born over 9 pounds or rapid births.  In my case, it was a rapid birth (my second rapid birth). For me, this pelvic floor injury causes pain.  Running didn’t cause this.  Childbirth did.  Because I run and train the way that I do, the symptoms and pain are probably more pronounced.

So maybe you don’t even know what a pelvic floor is. Everyone has a pelvic floor.  My running guys, y’all mostly don’t have to worry about yours because it’s enclosed inside and nothing interrupts it’s function the way pregnancy and childbirth does for women.

Pelvic floor injuries are thankfully getting more attention.   Women’s Running Magazine has several features on pelvic floor dysfunction for women after childbirth. Articles have even been popping up in mainstream media.  I’ve noted that most of them make sweeping statements about the experience and focus mostly on incontinence or urine leaking.  But the pelvic floor makes up many muscles so it’s easy to understand that the injury experience is diverse depending on what muscle(s) are damaged.  I don’t have any leaking problems. Just pain.  

Time for an anatomy and physiology lesson:

Your pelvic floor is the hammock of muscles at the base of the pelvis that run from the back of your pelvis bones to your pubic bones at the front.  Your pelvic floor muscles’ job are to stabilize the organs in your pelvis.

Tied to your pelvic floor is your core. And your hips. And your glutes. All of these need to be strong to stabilize you and support you while running.  The pelvis is not supposed to move/rock while running.  We runners are all familiar with our core muscles.  Our core muscles have to respond fluidly and efficiently to meet the complex, high-impact demands of running. If another part of the core is weak or not working properly, another muscle group has to work harder to compensate and support your pelvis. Likewise, if a part of the pelvic floor muscles are weak or injured or damaged, another part of the pelvic floor, core, hips or glutes are going to have to work harder to compensate and support the pelvis.

Pain coming from the pelvic floor can be felt around the sacroiliac joints, the pubic symphysis (that’s the joint, you have a right and a left pubic bone), groin, hamstrings, butt, iliotibial band or the abdominal and lower back muscles. A person in my boat might even have tried some kind of treatment for pain in one of these areas that wasn’t effective and that would be because the pain is actually coming from the pelvic floor.  

My experience:

I have been to every health care provider possible. Family doctor, many times. Specialist/surgeon. Pelvic floor physiotherapist. Chiropractor. Massage therapist. Osteopath. That’s a long list.

When I first saw the surgeon/specialist in the IWK Women’s Pelvic Floor Clinic in October of 2016, it was looking like surgical repair would be required and the expected trajectory was that the injury would either stay steady or deteriorate.  Scary news for a girl who loves to run and race.  

There are a few treatment options aside from surgery and I’m using all of them.  I got right to work with a pelvic floor physiotherapist. Physiotherapists specializing in women’s health can offer effective, non-surgical treatments to help with pelvic floor dysfunction and injuries.  They can prescribe a program of exercises tailored to your individual needs.  My pelvic floor physiotherapist at Synergy Physio, Francesca Ambrocichuk, has been amazing at trying to keep my running body on the road.  She has helped me with both building strength and down-training or relaxing some of the musculature. Her physio treatment has helped manage the symptoms and undo some of the very angry overworked musculature surrounding the site of my injury. Though she can’t fix or heal the actual rectocele.

The Montreal half marathon training cycle that I just completed was a particularly hard road at times.  I had lots of time to dissect my Montreal race with Coach Lee because we hung around Montreal until the following evening.  The demise of my last 2km (I was on pace to run  sub-1:25) certainly had something to do with the pelvic-floor injury related difficulties of this training cycle.  Lee figures I have been training at about 75%.

In the last full training weeks of the Montreal build, I saw Francesca.  Things weren’t going well. I was having pain with at least four out of five runs per week.  I had been collected a growing number of running log entries featuring workout drop-outs. I had my first ever DNF.  I showed up to a Saturday workout and said that I didn’t like running anymore, I was ready for Montreal to be over. It was because I knew the post-workout pain would be big. David said he wanted a new running partner. We laughed, I got on with business and we did the workout because that’s what training partners do for each other.  I showed up for him and he helped me.  But back to the physio appt:  I asked Francesca the same question that I’ve been asking repeatedly: “Is this a strength problem?  Is it that the musculature just isn’t strong enough.” 

She patiently explains that she doesn’t believe this to be a strength problem.  My core and my pelvic floor are plenty strong.  I am like a core and pelvic floor soldier. The problem is that the supporting structure of the pelvic floor is structurally damaged and it can’t easily (read painlessly) handle the stress of training 70-85km/week.  And 70km of weekly mileage is only about 75% of the training that I would like to/am capable of doing.  I am sailing a broken ship.  All of the surrounding pelvic floor and skeletal muscles are working hard to try to stabilize the broken ship = Overuse. Pain.  

I haven’t hidden any details of this injury from anyone who has asked. Because this is just an injury body part.  It may be an injury classified as women’s or reproductive health and it’s about as personal as possible.  But it’s just a body part and if it was an injured achilles tendon, there would be no hesitancy to talk about it.  I haven’t really perceived any real discomfort on the receiving end because the wonderful people who I surround myself with are athletes who understand injured body parts.

I’ve made many training modifications since October, 2016.  That’s when this started to really cause problems, when I got into the meat and potatoes of the California International Marathon build.  I wrote before about being upset over the training modifications because I didn’t want to be limited. I wanted to be doing the same thing that everyone else headed to CIM with the Halifax Road Hammers was doing.  But the reality was: I was limited. The training modifications have let me survive until this point.  

There are no more 6 running days per week unless day #6 is an easy run commute home of 6-8km.  I can’t do a Saturday workout followed by a Sunday long run: the stress on my body and resultant pain is too big.  All of my long runs are combined with Saturday workout.  I don’t do hill workouts or hill sprints.  I can’t do the full range of dynamic warm up drills because even butt kicks are too much stress on landing. I can’t run hilly courses.  I DNF’ed the Moose Run because the hills were destroying me, even at an easy long run pace of 5:00/km.  

Coach Lee said to me at one point this winter, while the training changes kept piling up: “Jesus, I could write a book about all the different ways to massage you to the start line.”  Thankfully, I made it to the start line in Montreal with his help.

I saw the surgeon for a 6-month follow up in early May to evaluate where I am at and what the trajectory/need for surgical repair looked like.  Praise the running Gods, that appointment revealed that the rectocele can be downgraded from a grade 2 to a grade 1 on account of all of the pelvic floor strength and core work that I’ve been diligently doing.  The injury (the rectocele) is still there and always will be but the skeletal muscles that I have worked hard to strengthen have picked up some slack and lessened the prolapse at the site of the injury. Things have improved despite putting my body through the second half of my California Marathon build and the Montreal training cycle I just completed. So there’s no surgical repair needed at present and in fact, the surgeon says that she’s not convinced that she could even surgically make it look or function better than it is right now.  

So that seems like great news.  I’ve run the last 6 months with this racing-death-sentence over my head, wondering with each race if this was the last one as it looked like I was facing surgery. I am hopeful that my body is giving me a chance to continue on.

I’m still left with a significant pain problem coming from my pelvic floor.  That’s for me to carry on with sorting out and working on.  The treatment for this has been hugely complicated because it just is complicated and there’s no simple universal solution.   There’s no “do x and y and then z happens.”  This has been like managing a sinking ship. As soon as you fix one hole, another one sprouts up.  Few healthcare providers (physicians) have known what to do with a competitive athlete nor do they understand what the training load is like.  “Runner” is often interpreted as 5 km a few days/week.  At present, there’s no surgery in the future but I’m still broken. I’m still running fast.  That’s the kicker: I’m still in the best running shape of my life.  But I’m still broken.

Francesca and my chiropractor Richard Thompson at Active Approach understand the training load and the performance that I’m after.  Right now, they are my best shot at getting out from under this.  I’m grateful that they talking to each other and have sort of teamed up.  I don’t know for certain what the future will hold for running fast. I need to be able to train to continue running fast. The training modifications will remain in place.  The pain sucks some of the joy out of the process.  I am running into problems convincing myself to grind it out in workouts on Saturdays when I know the pain later is going to be bad. The workout drop-outs continue.  I just ran the Osprey 5km, the 5km opener to the RNS Performance Series.  I had been to 3 providers for this injury in the week leading into this race.  I used up all of my mental fierceness coping with this. There was no mental fierceness left for the race and I all the way blew the race. But I’m all the way ok with that.

I’ve tried to be as peaceful about this whole injury process as possible. A few people have been tremendously helpful.  From the beginning, my coach Lee has said that he understands that this is personal but he has insisted that he needs to know all the details because it’s just an injured body part and needs to be managed from a training perspective.  He has said that he’s not going to shut me down, that will remain my call, but he has been clear that his opinion is that no PB is worth pain everyday.

My sister Kristen and Nick McBride, Damian and Jamie, my guys, have listened and supported and encouraged me to work on the things that I can control and the race that’s coming up next, not the whole future all at once.  They’ve never once insisted that things will be ok and that I’ll carry on to train and race like normal.  Linda has allowed me lots of 5am airing time while running for all the nitty-gritty details along with care and understanding.  My best girls: same thing.

So what:

I’m sharing this for education and awareness and because I have the ability to hold this up and say “this happens to women, to mothers.”   Our running community knows a lot about the run of the mill injuries: achilles tendonitis, ITB syndrome, runner’s knee, plantar fasciitis etc.  I went 15+ running years without ever hearing the words “pelvic floor”.  We should talk about it and we women should seek out the proper care quickly, just like we would with an achilles injury.  If anything related to the pelvic floor hurts when you’re getting back to running after having a baby, you should seek care. Scroll back up and look at that diagram: know what the pelvic floor is.  We should know that proper care exists and where to go.  In my opinion, the best care comes from Pelvic Floor Physiotherapists.  There are probably a handful of them in your local city.

I am now encouraging all the pregnant runner friends that I have to see a pelvic floor physiotherapist before their bundle of joy is born so that they can get a head start on strengthening what needs to be strengthened.  This specialized physio will teach how to do that properly and with a routine that’s individual and specific.  I also encourage my new mama runner friends to see a pelvic floor physiotherapist to “get cleared” before they return to running postpartum.  Don’t just rely on your 6 week postpartum check up with your family doctor.  For the athletes that we coach at Love Training More, I will pretty much require that check in with a pelvic floor physio before we take them on.  

I wish I had known about pelvic floor physiotherapy when my body was messed up when I returned to running when my son was 5 months old. The rectocele injury had already been sustained but I now know that there is work that I could have done with building pelvic floor strength; with learning to down-train or relax some of the muscles; and with building specific areas of core strength that might have enabled more longevity to training fully and running competitively with this injury.  In addition to suffering the rectocele, the surgeon believes that some damage was done to the pelvic floor by resuming running at 5 months postpartum. I’m still trying to get out from under this. The hope is that it’s not permanent.  I was “cleared” medically to resume physical activity at 6 weeks postpartum by my family physician and I thought that I did well waiting to run until my baby was 5 months old.  I am a nurse.  I just simply didn’t know this could be a thing.

When I was first diagnosed with this, I tried to read up online.  There’s almost nothing to read.   A search for “Competitive runner and pelvic floor injury” yields nothing. Nor does elite athlete and pelvic floor injury.   Most of what I could find was not at all relevant to me and most of what’s available is just chatter on message boards by women who exercise in a very recreational way and struggle with weight.   Francesca, my pelvic floor physio, has noted that the lack of evidence and research regarding treatment of women with pelvic floor injury is limiting and frustrating.  What’s there definitely doesn’t apply to a competitive athlete.

There are a huge number of women and mother runners out there including a huge population of fast mother runners. It’s just not possible that this hasn’t happened to others. I would have loved to read about or have been aware of another mother-runner’s experience.  I think women remain quiet.   

So I am adding this to the very small dialogue that is out there.  If you have questions, please reach out to me.

As far as my running goes, I’m going to remain hopeful because being hopeful is the best option.