Runners are notorious for having weak hips and glutes, or in some cases, weak hips and “sleeping” glutes—yes, a lazy butt. Because everything in the body connects, having hips and glutes that aren’t doing their jobs properly means your pelvic floor may be at risk for overuse and injury. So what does all of this mean and why should you care?
We spoke with pelvic floor physical therapists, Madeline Urban, D.P.T., and Kaylee Simmerman, P.T., D.P.T., to help us better understand the connection between your glutes and your pelvic floor, so you can get the most out of both muscle groups.
First, an Overview on the Pelvic Floor
The pelvic floor is a group of muscles that sits at the base of the pelvic girdle, explains Urban, a board-certified women’s clinical specialist and adjunct professor for the Johns Hopkins Women’s Health Physical Therapy Residency. “It’s really the floor of your core, but also [plays a role] in the whole breath system,” she says.
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Not only does the pelvic floor constitute important muscles that play a role in pressure regulation—think lower back pain, hernias, urinary incontinence—it actually holds our pelvic floor organs, including the uterus (for women), bladder, and rectum, Urban says.
“These muscles also play a huge role in regulation and control [of the urinary tract/bowels], sexual function, and stability,” she says.
Running, of course, is a one-legged activity, which means your pelvic floor muscles and those connected to them—glutes and hips—need to be strong and activated to offset the pressure from the downward motion of running, Urban explains. “If they’re not, there will be a break in pressure regulation, and that’s when you’ll see issues,” she says. “The global term being pelvic floor dysfunction.”
Why Glute Strength Is Important for Pelvic Floor Health
There are three glute muscles: maximus, medius, and minimus. Urban explains that although the minimus is important, runners rely largely on the maximus and medius for power and stability for their sport.
“Our glutes play a huge role in power for running, as well as hip and pelvic girdle stability,” she says. “It’s a unique group of muscles; the muscles are large and produce power and speed, but they’re small enough to cross over just one joint [the SI joint which links the pelvis and lower spine].”
Not only does the glute maximus share attachment points with the pelvic floor—the sacrum and tailbone—both sets of muscles work together and there must be a balance between the two, Urban says. “The glute works to extend the tailbone, whereas the pelvic floor flexes the tailbone,” she adds. “They have to pull their own weight. One cannot be underworked because then the other is overworked.”
The glute medius sits near a deep hip muscle called the obturator internus, which attaches directly to the pelvic floor and serves as the hip’s external rotator. If the obturator internus muscle is not turning on correctly (more on that in a minute) or is overstretched, it causes the pelvic floor to overstretch. When this happens, your knees might come together when you’re running, colloquially called, “knock-kneed.”
“There is also research relating to glute medius strength and stress incontinence,” Urban says. “It’s correlation not causation, but the more strength you have, the less stress incontinence there is.”
For example, a 2020 study published in the Journal of Manipulative and Physiological Therapeutics found that people who practiced pelvic-floor strengthening exercises, plus exercises for the glute maximus, medius, and hip adductor (inner thigh) muscles, experienced less daily stress urinary incontinence.
The most simple explanation, Urban says, is if the glutes are weak then the pelvic floor is overworked. “And it will overwork,” she says. “But it doesn’t mean it will do the work well.”
Urban points out that postpartum runners already have a stretched pelvic floor from nine months of pregnancy, followed by labor and delivery. “The muscles have a hard time reacting to the impact [from running] to offset the pressure and maintain bowel and bladder control, and support the organs that sit in the pelvic floor,” she says.
For postpartum runners, weak or inactive glutes can be more pronounced, explains Simmerman, the founder and owner of Tampa Bay-based, The Hope Doctors. For nine months, a baby is growing and taking all the space in a woman’s abdomen. “That stretches the abdominal muscles and increases the curve in the lower back, which stretches out the glutes,” she explains. “That makes it harder to feel glute activation, to make those glutes fire [during exercise].”
After labor and delivery, the glutes can stay in that lengthened, weakened state. “When you have weakness somewhere, you’re going to have to compensate somewhere else,” Simmerman says.
The bottom line: Runners, particularly those who have had babies, often experience weak or inactive glutes, which cause the already stressed pelvic floor to overwork, which can then lead to pelvic floor dysfunction and other running-related injuries.
The Difference Between Weak Glutes and Sleeping Glutes
Before you jump into a routine of 1,000 one-legged squats to beef up your glute strength, it’s possible sleeping, or inactive, glutes are the culprit and require some simple activation exercises.
“A weak muscle is one that you’re truly not using and you have difficulty activating it under any circumstance,” Urban says. “A sleeping muscle might be strong and when you’re doing a glute-specific exercise it’s functioning, but it might not be turning on when you’re running.”
In that case, your body is going to rely on other muscles, ahem, the pelvic floor, to provide power and stability because your butt is basically sleeping.
Simmerman says there’s an easy way to differentiate between sleeping or weak glutes. “Sleeping implies that [the muscle] can come back,” Simmerman tells Runner’s World, which means you really just have to get these muscles to move more often rather than get them stronger. “If your glute is sleeping it will come on during an exercise. But if it’s weak, you’ll feel the glute muscle on that first repetition and start noticing that it will only be five or six reps before you feel fatigued.”
She also points out that if you cannot feel a muscle during an exercise, you might need to change position or assess other areas like ankle or feet placement. For example, placing a mini band around the thighs during a squat may help you better feel the glutes working.
“Every muscle in the body should fully lengthen and shorten with every contraction,” she says. “If we don’t train for all ranges of motion, we’re missing a big part [of training] and that’s when injuries will begin.”
For example, if you are doing a glute squeeze exercise—tightening your muscles and then relaxing—you’re training in just one range. Cut to running: Your front leg swings forward (fully lengthening the glutes), strikes the ground, and then pushes down and back (contracting the glutes). So you want to practice the full range of motion in your strength workouts—which you’ll do with the exercises below.
4 Exercises to Activate and Strengthen Your Glutes for a Healthier Pelvic Floor
We know runners groan at strength training and stretching and foam rolling, and basically anything that’s not running, but committing to these four exercises will activate and strengthen your glutes, helping to protect your pelvic floor.
Why it works: “I hate and love a clamshell,” Urban says. “It’s not so functional for running [because you’re laying down], but it’s such a good way to build awareness of the glute medius. And subsequently, you’ll get at the obturator internus [hip] muscle.”
How to do it: Lie on left side with head resting on left arm, knees and hips bent about 45 degrees, hips, knees, and feet stacked. Slowly externally rotate right hip, engaging glute and drawing right knee up toward ceiling to open legs like a clamshell. Slowly lower back down. Repeat for 10 reps. Then switch sides. Do 3 sets. On the last rep for each leg and set, hold for 1 minute, Urban says, to promote endurance for running.
2. Standing Clamshell
Why it works: “For runners, I like to get them into a standing position quickly because that’s most functional for them,” Urban says. A standing clamshell will work your stationary leg (specifically, the glute maximus) more than your active leg.
How to do it: Stand against a wall and step about 12 inches away with left foot in front and the back right foot’s heel resting on the wall. Hinge at hips by sending butt straight back, torso coming parallel to the floor with a flat back, shoulders packed down and back. Let glutes tap the wall behind you. Squeeze right glute, rotating knee to the side, opening leg like a clamshell. Repeat for 10 reps. Then switch sides. Do 3 sets. For the last rep of each leg and set, hold for 1 minute.
Why it works: A lunge is a good way to get at the entire lower extremity, especially the glute muscles, Urban says. If you have trouble feeling the lunge working your glute, start with a reverse lunge, which will activate the glute muscle, and then switch to a forward lunge to mimic running, she adds.
How to do it: Stand with feet hip-width apart. Step forward with right foot while keeping left foot in place. Bend both knees 90-degrees, right knee tracking over toes, and back left knee hovering just off the floor. From the side, the angle of shin and back should form parallel lines. Push off through right heel and stand back up, stepping backward. Repeat on left leg. Continue alternating for 3 sets of 10 reps per side, resting as needed between sets.
4. Single-Leg Rotation With Ball
Why it works: In order to strengthen your glutes through their full range of motion, Simmerman recommends this exercise.
How to do it: Stand on left leg, making sure entire foot drives into floor, including big toe, little toe, and heel. Extend back right leg and lift it off of the ground behind you. Hold a small ball or yoga block between hands with arms extended in front of you. Rotate down and toward standing leg to outside of ankle. Allow pelvis to drop down toward standing leg and inhale. Exhale and bring the ball and pelvis to rotate open and up toward lifted leg. If this is too challenging, place the right toes on the ground. Repeat for 10 reps. Then switch sides.
Heather is the former food and nutrition editor for Runner’s World, the author of The Runner’s World Vegetarian Cookbook, and a seven-time marathoner with a best of 3:31—but she is most proud of her 1:32 half, 19:44 5K, and 5:33 mile. Her work has been published in The Boston Globe, Popular Mechanics, The Wall Street Journal Buy Side, Cooking Light, CNN, Glamour, The Associated Press, and Livestrong.com.
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