WASHINGTON, DC – Nov. 5, 2015 – Leaking urine during exercise — called stress urinary incontinence, or SUI — is common, but not “normal.” In the U.S., the national average of women who experience incontinence is 1 in 3. A 2002 study done by Thyssen et al. surveyed 291 elite female athletes competing in a variety of sports from basketball to ballet regarding their history of urine loss during participation in their sport or day-to-day activities.

A full 151 reported leakage of some kind. Of the 151, five discussed it with a medical provider, and only six got pelvic floor training. Incontinence is very prevalent in the athletic community, yet most women do not seek treatment because they are either embarrassed or they assume it’s normal because everyone else they know has the same issue.

As physical therapists, we treat women every day who say that they leak urine when coughing, sneezing and exercising. The most common activities that lead to SUI are box jumps and double-unders (some women also experience SUI with deadlifts). In a physical therapy evaluation, women nearly always follow up admitting to SUI with a statement like, “Of course I leak, I’ve had two kids!”

While it is true that childbirth can be one of the factors that contribute to pelvic floor dysfunction, not all women experience incontinence after childbirth; and, it can be treated if it occurs.

Any women’s health physical therapist will tell you that it is not okay to leak urine when working out (or coughing or sneezing). It is a sign that the whole system is breaking down, and the pelvic floor is just the place it shows the most at the time.

Incontinence is just one way of identifying a pelvic floor insufficiency. It is a signal that an imbalance in the deep core exists. The deep core is a closed-pressure system, and insufficiency in any component will impact the capacity of the whole. A female athlete may not be incontinent, but may come to physical therapy with complaints of low back, hip or knee pain. As part of our initial evaluation, we ask every woman if they ever experience any incontinence. Over half of the women will say no, until we press, and then they admit that they do.

What they don’t understand is that pain in the knee may be related to weak and/or uncoordinated pelvic floor, diaphragm and hip muscles. Chronic groin strains, IT band syndrome, trochanteric bursitis, low-back pain and patellofemoral syndrome are a few of the common diagnoses that female patients seek treatment for — and an integrated approach is necessary to identify the root cause of the issue and to successfully treat the problem.

There are many factors that can lead to SUI and/or pelvic pain. The muscles of the pelvic floor may be weak from being stretched during vaginal delivery. The muscles may be hypertonic (overactive) and unable to relax, which decreases the strength of the contraction when they do fire. So they are overactive, but weak. The pelvic floor muscles may be overactive but strong; yet, the client has stronger abdominal, back, diaphragm and glottis (voice box) muscles.

Women who leak while lifting a heavy load may be in this category — holding their breath leads to a rigid thorax, yet they can’t contain about all of the pressure, so they either grunt/yell, leak urine, or sustain an abdominal hernia or herniated spinal disc. The pressure escapes the system through the weakest link. The pelvic floor may have been damaged (think episiotomy, forceps, vacuum extraction of baby, cancer/radiation) and the scar tissue affects the ability for the muscles to contract properly.

It is important to work with a therapist who can evaluate your specific condition and treat you with appropriate exercises and manual techniques. 

Sources used in this release include:

Written by Ann Wendel


About MedStar National Rehabilitation Network

The MedStar National Rehabilitation Network (MedStar NRH) is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia.

The Network’s interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury.  Rehabilitation medicine specialists, psychologists, physical and occupational therapists, and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient’s unique needs.  Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research.  

The Network provides comprehensive programs specifically designed to aid in the rehabilitation of adults and children recovering from neurologic and orthopedic conditions such as amputation, arthritis, back and neck pain, brain injury, cancer, cardiac conditions, concussion, fibromyalgia, foot and ankle disorders, hand and upper extremity problems, post-polio syndrome, stroke, spinal cord injury and disease, and sports and work-related injuries.

Inpatient and day treatment programs are provided at MedStar National Rehabilitation Hospital located in Northwest Washington, DC and at more than 40 outpatient sites conveniently located throughout the region.  MedStar NRH is consistently ranked by physicians in U.S. News & World Report as one of America’s “Best Hospitals” for Rehabilitation, and is fully accredited by The Joint Commission,  the Commission on Accreditation of Rehabilitation Facilities (CARF), with CARF accredited specialty programs for Amputations, Brain Injury, Spinal Cord Injury and Stroke.

For more on MedStar NRH and to find a location near you, log on to




Contact: Derek T. Berry
Director of Communications
Ph: 202-877-1773
[email protected]

Study: Women who wear heels more prone to Arthritis

MedStar National Rehabilitation Network physician Bryan Murtaugh, MD, recently talked with WTOP-FM 103.5 in D.C., about a new British journal study showing that women who wear high heels for long periods of time through their lives are at greater risk of developing arthritis, in addition to many known problems from wearing heels such as knee and back issues.

Dr. Murtaugh explains that while more research is needed on this subject, there is plenty of evidence to support the fact that wearing high heels can put more stress and strain on women’s knees and set them up for trouble down the road.

He says one of the big factors is that heels can pitch the body forward, causing the joints to have to make adjustments.

“When you look at force going through the knees when walking, you see as the heel height goes up or increases, there is more force that is put through the knees,” says Dr. Murtaugh. “The damage is most evident in women who have been wearing high heels for years on a regular basis. This can cause joint problems to creep up, usually from wear and tear and stress on the joints over time.”

One significant medical fact in all of this: Women are more prone to osteoarthritis in the knees than men and have knee replacement surgery in far greater numbers than men.

-courtesy of WTOP-FM/Paula Wolfson

For Immediate Release

Contact: Derek Berry
Director of Communications
Ph: 202-877-1773
M: 571-218-7594
[email protected]

New Book Helps Breast Cancer Survivors Live Well After Treatment, Manage Disease

Breast cancer. Scary words that have become commonplace in our language with more and more cases appearing every year. In fact, last year, according to the American Cancer Society, an estimated 232,340 new cases of invasive breast cancer were expected to be diagnosed among U.S. women, with nearly 40,000 women expected to die of breast cancer. Only lung cancer accounts for more deaths in women. And yet with those frightening, sobering words comes a very manageable disease after surgery, chemotherapy and radiation. The key question that many don’t think about is – what next?

That’s what a new book from MedStar NRH Press explores. Managing Breast Cancer – A Guide to Living Well Through Physical Medicine and Rehabilitation is a guide for women to cope with the physical and psychological aspects of the disease.

The book serves as a tool to help with everything from fighting post-operative pain to sexuality after breast cancer, and addresses topics that patients may often feel uncomfortable discussing.

“The book can give you the tools you need to recover fully – and move forward with your life after treatment,” says Eric Wisotzky, MD, FAAPMR, associate director, Cancer Rehabilitation Program, MedStar National Rehabilitation Network.

Managing Breast Cancer goes inside various topics including:

  • Types of breast cancer treatment and surgery
  • Managing the post-operative period
  • Dealing with various types of pain – muscle, joint and nerve
  • Managing lymphedema
  • Understanding exercise
  • Proper nutrition
  • Appearance and psychological issues
  • Sexuality and relationships after treatment

Contributors to the book include an array of clinicians – physicians, nurses, social workers, psychotherapists, physical therapists and more.

For further information on this book or to order a copy, click here or call 202-877-1776.



Derek T. Berry
Director of Communications
202-877-1773 PHONE
202-829-5161 FAX
[email protected]