Running Gait Retraining in the Management of a Multiparous Runner With Chronic Stress Urinary Incontinence: A Case Study

Abstract

Background: Stress urinary incontinence (SUI) is highly prevalent in the postpartum population and can result from injury or capacity deficits of the pelvic floor musculature. Impact forces seen during running increase demand on the pelvic floor musculature, resulting in a higher incidence of SUI. Running gait retraining, with emphasis on reducing impact, may reduce symptoms of SUI. Case Description: A 43-year-old woman was evaluated for chronic SUI when coughing, sneezing, and running since the birth of her second child 8 years ago. Initial interventions focused on pelvic floor, hip, and abdominal muscle training, and after 3 visits over 4 weeks, her SUI symptoms with coughing and sneezing resolved. She continued to complain of SUI during running. After a 2-dimensional video running gait assessment, running gait retraining was initiated in the form of verbal feedback to reduce the sound intensity of the foot striking the ground. Outcomes: After 2 visits of gait retraining over 2 weeks, the patient's SUI symptoms with running resolved. Gait reassessment revealed decreased sound intensity with foot strike. Eight weeks post-treatment, the patient remained symptom-free, and their Pelvic Floor Distress Inventory-20 (PFDI-20) total score decreased from 51.04/300 to 4.16/300. Discussion: This patient experienced meaningful improvements in symptoms of SUI following standard pelvic physical therapy treatment of pelvic floor, abdominal, and hip muscle training but only achieved resolution of symptoms with running after individualized running gait modification. Running gait retraining to reduce sound intensity during foot strike may have resulted in a decrease in impact and improvements in SUI symptoms while running.