By the Axis Sports Medicine Team | September 2026
Key Takeaways
- More than half of elite female track and field athletes (51.7%) report leaking during training, most often during high-impact movements such as jumping and sprinting.
- High-impact movement carries nearly 4.6 times the risk of pelvic floor dysfunction compared to low-impact activity – which is why symptoms appear more on the way down than on the way up.
- Running and similar high-impact movement can send 1.6 to 2.5 times your body weight through your legs and pelvic floor with every stride.
- Most pelvic floor specialists recommend waiting at least 3 months after having a baby before returning to running or comparably high-impact sport.
- Colorado’s cold, dry, high-altitude air can independently increase urinary urgency, on top of anything happening with your pelvic floor.
Do you find that you leak a little when you land a jump or push hard through the last mile of a trail run?
You’re not the only one. And it’s not something you have to just live with.
Research has found that pelvic floor dysfunction shows up consistently in active women. That includes skiers, runners, riders, and hikers – a big part of our mountain lifestyle.
It’s also one of the most under-treated, over-normalized issues we see at Axis. Most assume it’s either a postpartum-only problem or something a few Kegels here and there should fix.
The truth is, neither of those is a hard fact. It’s more about how your body handles impact and how altitude and hormones change the picture at elevation.
Let’s look at what the research says, and what you can do to get help if you’re one of the many individuals in our area who struggle with pelvic floor dysfunction interrupting your active lifestyle.
With Pelvic Floors, Common Doesn’t Always Mean Normal
You might feel as if you’re the only one dealing with pelvic floor dysfunction, but the research shows you aren’t alone.
A 2022 study of 211 elite female track-and-field athletes found that over half (51.7%) reported urinary incontinence. Interestingly, it occurred during the highest-impact events — horizontal jumps, sprints and hurdles, and middle-distance running.
Nearly a quarter said the leakage happened specifically during training, mostly around jumping.
This means that dysfunction isn’t only more common than you may think, but it’s also not limited to women who’ve had children. It’s a mechanical response to load on a muscle group.
And that means, just like any other muscle group, it can be undertrained, overloaded, or simply not yet rehabbed for the sport you’re asking it to do.
Why Pelvic Floor Dysfunction Happens on the Way Down
High-impact activity carries roughly 4.6 times the risk of pelvic floor dysfunction compared with low-impact exercise.
Running-style movement sends 1.6 to 2.5 times your body weight through your legs and pelvic floor with every stride.
That may help explain a pattern a lot of our patients describe: leakage that shows up on the descent instead of the climb — the last mile of a trail run or a rough section of singletrack — where the loading is sharpest and least controlled.
We see the downstream version in other ways too. The knee pain that shows up on the way down a 14er and the joint strain we talk about in our mountain biking injuries guide come from the same kind of repeated, high-force loading — it just shows up in your pelvic floor instead of your knees.
Not sure which of these applies to you? Here’s a quick way to sort it out:
| When It Shows Up | Possible Cause | What Can Help |
|---|---|---|
| Right after having a baby, especially on high-impact days | Postpartum pelvic floor changes | A graded return-to-sport plan and a pelvic floor PT evaluation |
| New in your 40s or 50s, with no pregnancy involved | Perimenopause or menopause-related hormonal shift | Pelvic floor PT, regardless of age or childbirth history |
| Mostly during descents, jumps, or hard efforts | High-impact loading on a pelvic floor that isn’t ready for it yet | Strength and load-tolerance training with a pelvic floor PT |
| Worse on cold days or at higher elevation | Altitude and cold-related urinary urgency (a second, compounding factor) | A hydration strategy, plus a PT evaluation to rule pelvic floor involvement in or out |
| Pain or numbness after long days on the mountain bike | Saddle pressure or pudendal nerve irritation | A bike fit review and a pelvic floor PT evaluation |
New Moms: What “Cleared to Ski” Should Mean
Many new moms look for guidance from their doctors at their 6-week postpartum checkup. But this visit is usually focused on healing, not whether your body can handle high-intensity workouts.
Pelvic floor specialists generally recommend waiting at least 3 months postpartum, ideally 3 to 6 months, before returning to running or comparably high-impact sport — and passing a few specific tests first, not just going by how you feel:
- 30 minutes of brisk walking with no pain, heaviness, or leaking
- Single-leg balance and single-leg squats, held steady
- Hopping and bounding in place, on both legs, without leaking
That’s the running standard, but it applies consistently to activities like skiing, mountain biking, and trail running, which load the pelvic floor in the same way or even more so.
If you’re planning a return to the slopes this season after having a baby, a pelvic health evaluation before opening day is a far better gauge than “I feel ready.”
What About Perimenopause and Pelvic Floor Dysfunction?
You don’t need a pregnancy history for this to apply to you. Declining estrogen during perimenopause and menopause changes the strength and support of pelvic floor tissue. That’s part of why many women in their 40s and 50s notice new leakage or urgency on the same runs and ski days that never bothered them before.
Rather than aging “catching up with you”, you may be experiencing a hormonal shift that has its own treatment path, and pelvic floor PT works for this population just as well as it does postpartum.
Mountain Biking Has Its Own Version of This
We see a lot of bikers, so we always try to apply the same guidance here as we would any other sport.
When biking, pressure from the saddle on the perineum can irritate the pudendal nerve. On long rides, this can lead to numbness, pain, or tingling, which can cause leaking.
Research on female cyclists backs up what many of our mountain biking patients already suspect — saddle and handlebar position matter.
If that sounds familiar from your own rides (on top of what we already covered in our mountain biking injuries guide), a bike fit review alongside pelvic floor PT is usually the fix.
What Does Pelvic Floor PT at Axis Look Like?
We tailor each treatment to each patient we see. For those who may feel that they are struggling with pelvic floor dysfunction, a typical plan includes:
- A prescribed home exercise program
- Manual therapy
- Trigger point dry needling
- Targeted strengthening
- Load-tolerance training built around your sport — skiing, running, riding, or hiking.
Internal assessment is available and sometimes useful, but it’s never the only tool, and it’s always optional.
Our pelvic health program is led by Christine Rost, PT, DPT, OCS, based at our Frisco clinic — orthopedic board-certified, Herman & Wallace pelvic floor trained, and a certified prenatal and postpartum specialist.
You can read more about our pelvic health program or, if a joint issue is what’s limiting you right now, aquatic therapy can be a gentler place to start.
Get Started with Axis Sports Medicine
You shouldn’t have to choose between staying active and dealing with physical limitations. And you aren’t alone in this journey.
From the elite athlete to the weekend warrior, our team helps active Colorado women stop hurting and get back in the game of life. Contact us today to get started.
Frisco · Breckenridge · Avon · Silverthorne
FAQ
Is it normal to leak urine when I run, ski, or mountain bike?
It’s common — more than half of elite female track and field athletes report it — but common isn’t the same as normal. It’s a treatable dysfunction, not something you have to accept.
How soon after having a baby can I get back to skiing or running?
Most pelvic floor specialists recommend waiting at least 3 months and passing specific load and strength tests first — not just going by how you feel, but please consult your doctor for specifics.
Does high altitude make bladder issues worse?
It can. Cold, dry mountain air can independently increase urinary frequency and urgency, which can add to — but isn’t the same thing as — pelvic floor dysfunction.
Can mountain biking cause pelvic floor problems?
Yes. Saddle pressure and nerve irritation from cycling is a distinct issue from childbirth-related pelvic floor dysfunction, and it’s treatable too.
Is pelvic floor therapy only for women who’ve had children?
No. Perimenopausal and postmenopausal hormonal changes, and high-impact sport on their own, can also cause new symptoms — at any age.
Do I need a doctor’s referral to see a pelvic floor PT in Colorado?
Not always. Many insurance plans allow direct access to a physical therapist without a referral first.
