Runners, Shock & SUI: Episode 116 with Natalia Cardoso Campos

Hello & Welcome to today's episode where we are focusing on new research that really helps us change the conversation about bladder leakage in runners, and why we need to move beyond isolated pelvic floor muscle exercises...

I'm in conversation with Natalia Cardoso Campos, who published a really interesting paper in 2025 'Inefficient impact absorption and reduced shock attenuation in female runners with stress urinary incontinence'

Natália is a physical therapist from Brazil, and in our chat we presented findings from her master's thesis showing that female runners with urinary incontinence have poor shock absorption capacity at the ankle and significantly reduced shock attenuation compared to continent runners.

Her research revealed that while continent runners had shock attenuation values of around -29, incontinent runners had values of only -6, indicating much more energy reaching the pelvic region.

We discussed how this biomechanical imbalance could explain why some runners experience urinary leakage despite having normal pelvic floor strength, suggesting that the problem originates in the lower kinetic chain rather than the pelvic floor itself. We explored:

urinary incontinence research in runners

shock absorption & shock attenuation in runners

foot strike patterns, ankle injuries and asymmetry & how conditions like REDS (Relative Energy Deficiency in Sport) and bone stress injuries can exacerbate these issues

Some key takeaways for me were the importance of looking beyond the pelvic floor muscles when we are working with women, especially athletes, with pelvic health issues - considering the ankle, knee and hip as well as systemic issues like hypermobility and REDs.

I can't wait to see what Natalia's PhD research on this topic reveals!

We also talked about a new paper she was a co-author on, 'Sexual Trauma and Pain: A Study of Women’s Experiences With Vaginal Dilators and Perineal Massage in Trauma-Informed Pelvic Floor Physical Therapy' (Modesto et al 2026)Natália shared insights from this qualitative study on women's experiences with vaginal dilators and perineal massage in trauma-informed pelvic floor physical therapy, underscoring the significance of patient rapport and validation in treatment.

Want to learn more? My online course, The Menstrual Detective, comes with FREE access to the course 'Pelvic Health for the Young Female Athlete, which covers many of the topics discovered in today's conversation. If Female Pelvic Pain Rehab is more your zone of interest, then make sure you're staying up to date by joining us on my online course, Female Pelvic Pain Rehab is undergoing an update - I've just renovated the vulvar pain modules (lots of great new research and how to apply it clinically. I really wanted to structure these updates in a logical way - understanding the condition, assessment & treatment pathways so clinical reasoning is central. New updates coming on endometriosis and blaffer pain syndrome and neuropathic pain (the enigmatic pudendal nerve in particular!) All of the course info is at CelebrateMuliebrity.com

Until next time, Onwards & Upwards, Mx! #celebratemuliebrity