Physical Therapy News

Marathon Training & Quick Tips

Marathon Training & Quick Tips

Is running a marathon on your bucket list? Right up there with writing a book, climbing a mountain, and jumping out of an airplane – it takes a lot to get there. If you’re one of the lucky ones to accomplish this incredible feat, you’ll join the mere 0.5 percent of the US population that actually completes a full marathon.

Northern’s co-owner and physical therapist, Gina Otterbein, recently completed the Boston Marathon for the second time! While running is now a core part of her lifestyle, it wasn’t always that way. Gina didn’t start running until she was in her 30’s, and even then, it was just a quick jog with the dog. Over time she came to really appreciate the sport and began training for her first marathon four years ago.

Marathon Training & Quick TipsThe journey to Gina’s first 26.2 miles was never easy, but always worth it. Here is Gina’s list of everything you need to know to complete your first marathon.

Marathon Quick Tips

  • Many marathons have a cut-off time. Runners in the Boston Marathon have six hours to complete the course, after the last starter begins.
  • Get to the starting line early. If you need to take a quick pit stop get in line at least a half hour before the official start time because lines may be very long.
  • If you like  to run with music, find out in advance whether headphones are allowed on the course because not all marathons allow them.
  • Start out slowly and pace yourself. It’s easy to let adrenaline get the best of you, but starting out too fast is a rookie mistake.
  • If you have a friend or family member there to cheer you on, find out in advance where they’ll be. Spotting that support system along the way can be a huge boost when you really need it.

Marathon Training

Training for a marathon typically takes anywhere from 12-20 weeks, depending how experienced you are with running. The four primary elements of marathon training are:

  1. Base Mileage – Running 3-5 times per week to build your weekly mileage
  2. Long Run – Every 7-10 days get your body used to going longer distances, eventually working your way up to 20 miles
  3. Speed / Cross Training – Practice intervals, speed, and hills to increase your cardio capacity. Gina likes to include biking and swimming to enhance her cross training.
  4. Rest and Recovery – You have to let your body recover to prevent burnout and reduce your chances for injury

Runners who are just starting out will need more time to recover from intense marathon training so it’s going to take longer to build up to the longer runs. Starting from the couch? No worries, you’ll get there, but you can’t rush things. Here are a few tips for starting a simple walking or running routine. It’s not unheard of to train for almost a year before taking the marathon leap. The key is to build up to it so you don’t get hurt – an injury will keep you out of the race far longer, and may sideline you for good if you lose all momentum. In an effort to avoid injury, Gina saw a physical therapist for an entire year before the Boston Marathon.  She also had a gait analysis conducted to review her form, strength, motion, and stride. Maintaining proper form can increase your speed, make running more comfortable, and reduce your chances for injury.

Another thing that Gina loved having done before and after the marathon was dry needling. Because of its ability to loosen stiff muscles, ease joint pain, and improve blood flow and oxygen circulation, dry needling provided positive results when Gina was feeling tight muscles, aches, and pains. She felt immediate relief after a treatment, making it one of her favorite techniques.

Marathon Training & Quick TipsChoosing a marathon
Keep in mind that you have to pre-qualify for some of the bigger races, Boston included. Choosing a marathon that’s close to home will give you an advantage because you can train on the actual course and get comfortable with it. If you qualify for a “bucket-list” course like Boston or New York City, you may find yourself motivated by the excitement of the situation. Also keep the course terrain in mind. A new course may be hilly, busy, or just different than anything you’ve run before.

Pace yourself
While marathon training, estimate how long it will take you to finish so you know how to properly pace yourself. This is also helpful when you have friends and family members waiting at the finish line to cheer you on – this way they’ll have an idea as to when you may be approaching. A handy formula to give you a general idea is to double your recent half marathon time,  then add 10 to 20 minutes, depending on the difficulty of the course. You can also use a pace calculator like this one.

What to wear
Possibly the most important item for race day is a comfortable long distance running shoe. Find one that provides the right amount of cushion and stability for longer distances, and then train in it to make sure it feels good when you go long distances.

Wear clothing that’s appropriate for temps that are 15 to 20 degrees warmer than it actually is, no matter how chilly it might seem. Once you start running your body will heat up pretty quickly.

Finally, never wear anything new on race day. You don’t need an obnoxious sock rubbing on your toe for four hours. Wear clothing and shoes that you know you’ll be comfortable in for a few hours. Consider training in fabrics that wick to help keep you cool and dry as you run.

What to eat & drink
Before your run: To sustain energy levels, eat a high-carb, low-fiber meal three to four hours before your run begins. That way your body a chance to digest the food and it reduces the risk of having stomach issues during your run. When you run long distances your body relies on glycogen for fuel, which is why people often eat carb-heavy meals the night before a big race. Pasta, bread or potatoes can help fill your glycogen stores so you can start the race feeling good.

During your run: If you don’t fuel up during your run, your glycogen will typically run out within a couple hours so you’ll have to consider a mid-run snack to replenish your energy stores, keep fatigue at bay, and help activate your fat burning for fuel. A high carb snack like sports drinks, energy gels, nuts, raisins or two tablespoons of honey will help.

After your run: Eating a combination of carbohydrates and protein 30 to 60 minutes after your run is essential in helping speed up your body’s recovery time. The carbs help to restore the energy that was burnt and the protein helps heal and repair your muscle tissue. Even a 200-300 calorie snack will help, then a few hours later you can have a larger meal that’s filled with carbs and proteins.

While training, and on race day, it’s essential to get enough to drink. Even the slightest amount of dehydration can slow you down. Before you run we recommend eight ounces of water or sports drink. During your run try to drink three to six ounces of a sports drink that contains carbohydrates and electrolytes to replenish sodium.

Marathon recovery
Drink several cups of water or a sports drink to feed your tired muscles right after the race. Take a little time to walk and stretch so you can let your muscles cool down. In the days after the race you should hold off on running for at least a week, then take your time easing back into it. Take good care of your body post-race because your immune system may be more vulnerable right after a marathon.

What if you get injured while marathon training?
Injuries can affect beginner and seasoned runners. If you’re feeling a slight ache or pain every time you run, don’t ignore it – it will only get worse. The sooner you get these pains taken care of, the less chance you have of experiencing a more serious injury. If you’re currently training for a race of any kind it’s a good idea to have your form and body mechanics checked out. A functional movement screen will find potential weaknesses and reduce your chances for injury. We also offer free consultations so if you’ve got a 5k or marathon training question, or issues when you run, schedule an appointment with a specialist before it gets worse.


If you have any questions on running, training, dry needling, or a Gait Analysis, contact one of our sports rehab specialists – Gina Otterbein, Terri Jeurink, or Diana Painter.

Pelvic Floor Pain Shouldn’t Be Ignored

Pelvic Floor Pain Shouldn’t Be Ignored

Do you feel like you’re always running to the bathroom, leak a little when you laugh, cough or sneeze, or avoid intercourse because it hurts?

These are embarrassing problems that most people don’t talk about – bladder problems, frequent urination, and pelvic floor pain. If you’re feeling this way, you’re not alone. Approximately one in four women experience some form of pelvic floor dysfunction, ranging from chronic pain to constipation to stress and urge incontinence. Men can also experience urinary incontinence, especially after prostate cancer.

Oftentimes, people suffer in silence due to embarrassment and shame, or they think what they’re experiencing is normal, and there’s no help available. While certain illnesses and lifestyle factors can contribute to incontinence, the truth is, loss of bladder control is not a natural part of aging. And the good news is many pelvic floor disorders can be treated through physical therapy and lifestyle changes. Luckily, you’re not destined to a life of pads or pills. Working with a specially trained physical therapist can alleviate pain, restore normal bladder control, and help improve your quality of life.Pelvic Floor Pain Shouldn’t Be IgnoredWhat is the pelvic floor?
The pelvic floor acts like a hammock and supports the pelvic organs, primarily the bladder, uterus/prostate, and rectum. These muscles also help to control functions of the bowel and bladder. The female pelvic floor includes the openings of the urethra, for urination; the vagina, for intercourse and childbirth; and the anus, for fecal elimination.

The pelvic floor consists of pliable muscles that wrap around these openings in a figure-eight shape. There are a lot of organs in a tiny space and they can drop or shift due to childbirth, obesity, a hysterectomy, and age. Pelvic floor muscles also can become weak, tight or spastic as a result of disuse, surgery or trauma.

Pelvic Floor Pain Shouldn’t Be Ignored

Men have pelvic floors too
Men experience incontinence as well and can usually be treated in a similar manner. For more complex male pelvic pain and dysfunction, there are therapists who specialize in the treatment of male pelvic floor dysfunction.

Signs of pelvic floor dysfunction
There are a variety of symptoms associated with pelvic floor dysfunction, including urinary or fecal incontinence, a frequent or urgent need to urinate, or pain in the pelvic region.

  • Pain in the abdominals, buttocks, pelvic floor, tailbone, vagina, rectum, penis or testicles
  • Urinary urgency or painful urination
  • Constipation or strained bowel movements
  • Lower back pain
  • Painful sex or inability to have penetrative sex for women
  • Pressure in the pelvic region or rectum
  • Pelvic prolapse
  • Muscle spasm in the pelvis or pelvic floor
  • Vaginismus or endometriosis
  • Vulvodynia (pain of vulva) and genital skin conditions
  • Pregnancy and postpartum recovery
  • Painful or premature ejaculation for men

Two most common symptoms
Most patients complain of pain or issues with bladder or bowel controlUrinary incontinence can present itself in many different ways, including frequent urination and a strong urge to urinate. Leakage is often, but not always, associated with incontinence. Other symptoms include painful urination and stop and go urination.

Stress incontinence occurs with activities such as coughing, laughing, sneezing, jumping, lifting and running. If the pelvic floor muscles are weak, they have trouble holding back urine during times of increased pressure on the bladder.

Urge incontinence is related to an overwhelming urge to urinate, sometimes so strong that you can’t hold back the flow of urine. You can have urinary urgency without leaking. Certain things can “trigger” an urge sensation like getting close to a bathroom, being near water or the cold. Urge incontinence can develop from an overactive bladder muscle, due to neurologic damage or from irritation to the bladder itself – like drinking tons of coffee.

Mixed incontinence is a combination of the two and most common in older women.

Pelvic pain can be experienced in the pelvic floor, abdomen, or low back. The pain is often chronic and severe. Some may experience discomfort in the way of heaviness or bulging in the pelvic floor. This pain and/or discomfort can interfere with daily activities and impede sexual function.

Pelvic Floor Pain Shouldn’t Be Ignored

Why see a pelvic floor therapist?
Before costly and invasive surgery, it’s worth a visit to a urogynecologist, urologist, specialty bladder clinic or pelvic floor therapist. Many pelvic floor conditions can be treated and managed through a combination of therapies, including pelvic floor rehab.

Pelvic floor therapists specialize in rehabilitation of the pelvic floor and resolving dysfunctions in the pelvis that contribute to bowel, bladder, sexual health, and pain complaints. They can help you understand your symptoms and lifestyle factors that may aggravate them. They will work with you to create a personalized program to minimize or manage pelvic discomfort or pain, along with retraining and strengthening your muscles, and maintaining lifelong pelvic health.

Your physical therapist may recommend:

  • Education: Nutrition and behavioral strategies including reducing bladder irritants and retraining your bladder to go less often
  • Pelvic floor exercises: Working with a therapist to learn to do Kegel exercises correctly at home with or without a biofeedback tool (egg or wand)
  • Manual therapy: Hands-on trigger point massage to release muscle tension, improve posture, blood circulation, and mobility
  • Therapeutic exercise: Stretching, yoga, and core stabilization exercises
  • Self-care: Mindfulness, breathing techniques, and other pain management methods
  • Pelvic floor biofeedback: This technique helps patients “see” how the pelvic floor muscles are working by doing Kegels and watching the results on a computer screen.
  • Electrical stimulation: Using a probe inserted into the vagina or anus, a low-voltage electrical current helps exercise muscles, reduce spasms, and teach patients how to coordinate muscle contractions.

Tips for a healthy bladder

  • Aim to go every 3-4 hours
  • Avoid “just in case” (JIC) urination
  • Take time to relax and sit on the toilet. Don’t hover or rush through urination
  • No straining or “bearing down” on your pelvic floor
  • No nighttime just in case peeing; avoid fluids a few hours before bed
  • Avoid constipation with plenty of water and high-fiber foods
  • Drink enough water (at least half your body weight in ounces, or try our 100 ounce challenge)
  • Limit bladder irritants including coffee, soda, and sugary drinks
  • Do regular Kegels and pelvic floor exercises

Don’t ignore your pelvic floor

When your pelvic floor is not functioning correctly, it can impact your life on many levels. Don’t be embarrassed to discuss these issues and find treatment – it’s more common than you might think. Frequent urination, pelvic pain, and urinary leakage can be very personal and difficult to address. Treatment through physical therapy is very private and each patient is treated with respect and understanding.

Contact a Northern Physical Therapy clinic today and free yourself from pelvic pain, pads and revolving your life around bathrooms. We offer free consultations so you can meet with a pelvic floor expert and find out the treatment method that’s best for you.


Pelvic floor therapy is now being offered in our Caledonia clinic! Set up a free consultation to get your questions answered and see if pelvic floor therapy is right for you.

Treatment for Pediatric Constipation, Bed Wetting, & Leakage

Treatment for Pediatric Constipation, Bed Wetting, & Leakage

I never imagined that bowel movements and urination would become a daily topic of conversation. Then I had kids. It instantly became the norm to pay attention to whether the baby went poop each day, what it looked like, how many times, etc. As my child got a few years older the questions changed, but the topic stayed the same – do you have to go potty, does your stomach hurt, when was the last time you went, etc…

When your child is having issues with constipation or bed wetting, it can be difficult to properly diagnose. As a parent, you can’t help but wonder if this is just a normal part of growing up, or if you should be concerned.

By six years old, most children should have full control of their bowel and bladder function. Yet, it is estimated that up to 20% of pediatric healthcare visits revolve around bladder and bowel problems. And, up to 25% of children visiting a pediatric gastroenterologist experience bouts of constipation or encopresis (bowel leakage or soiled undies).

These issues can be frustrating for both parents and children. But, help is available through pediatric pelvic floor physical therapy – a safe and effective treatment options for infants, toddlers, and children.

Common pediatric pelvic floor issues include:

Pediatric bed wetting & daytime incontinence – Most children begin to stay dry the entire night between the ages 3 and 5. The primary reason for nighttime leakage is constipation, followed by not fully emptying during the day. Our bodies are designed to hold urine and children should not have to get up to urinate at night.

Pediatric Constipation – Constipation is one of the most common gastrointestinal complaints among children, but can also be a contributor to urinary leakage or the urgency to go. Pediatric bladder and bowel dysfunction can continue well into adulthood so it’s important to get this taken care of early on. Contributing factors to constipation can include diet, emotional issues, and sometimes busy children simply ignoring the signs that they have to go.

Diastasis Recti – A common issue in infants, especially those born prematurely, diastasis recti is a separation between the left and right side of the rectus abdominis muscle, which is the muscle that covers the front surface of the belly. This can also lead to poor trunk control, which can affect the bowels as well.

Other diagnosis that affect the pelvic floor in children – voiding dysfunction (when your child’s bladder is not emptying, or they are not urinating normally or fully), urinary urgency and frequency, vesicoureteral reflux (backflow of urine into the kidney), and pelvic pain.

Treatment for pediatric pelvic floor issues

Physical therapy can be a safe and effective way to help a child gain control of his or her bladder. By focusing on a group of muscles and soft tissue, called the pelvic floor, which support the pelvic organs and help control bladder function. When these muscles are too tight, too weak, or in spasm it can cause problems in children because the pelvic floor muscles aren’t working well with the bladder.

Children who are experiencing issues with bladder and bowel control may be more prone to bladder infections, constipation, difficulty sensing when the bladder is full, or other problems resulting from not completely emptying the bladder. This can also lead to urinary or bowel leakage and wetting during the day or night.

Pediatric pelvic floor treatment techniques may include:

  • Biofeedback – Helping children learn to strengthen or relax their pelvic floor muscles in order to improve bowel or bladder function and decrease pelvic floor pain
  • Behavorial and diet modification
  • Soft tissue mobilization – Using hands-on techniques on muscles, ligaments and fascia with the goal of  optimizing muscle function
  • Stretching and strengthening of pelvic floor and surrounding muscles
  • Relaxation techniques

Treatment for Pediatric Constipation, Bed Wetting, & Leakage


As a mother of two children, I’m passionate about pediatric pelvic floor issues and eliminating the stigma surrounding them. There’s a level of stress and embarrassment associated with these conditions, for both parents and children. It’s important to understand that pediatric pelvic floor issues aren’t normal, but they are treatable with the right help. If a child had ankle problems, you would address those problems with a specialist. The same should go for bowel and bladder issues – these are real problems that should be talked about openly so children can get the help they need.

Melissa VanKampen
Pelvic Floor Expert & Physical Therapist Assistant

Physical therapy may help if:

  • Child is 5 years or older and still wears pull-ups
  • Medication is needed for bladder or bowel control
  • Urinary incontinence or leakage
  • Bed wetting (nocturnal enuresis)
  • Laughing causes urine leakage
  • Frequent urination or overactive bladder
  • Infrequent urination or underactive bladder
  • Constipation/diarrhea, painful bowel movements, over/underactive bowels

With a parent present, a physical therapist with specific training in pediatric pelvic floor therapy will examine the muscles of the abdomen, pelvis, and pelvic floor area. Consultation and treatment often consists of muscle retraining, biofeedback, patient and family education, behavior and diet modification, soft tissue massage, stretching and strengthening of the pelvic floor and surrounding muscles, and a home exercise program. We have expert physical therapists on site who are specifically trained to work with this population.

If you feel your child may be suffering from any form of pelvic floor dysfunction, call our Coopersville office at 616.997.6172 or schedule a free consultation with Melissa VanKampen, physical therapist assistant and our lead expert in pediatric pelvic floor treatment. Melissa has taken numerous continued education courses in pediatric pelvic floor issues related to constipation and bed wetting.


Get more information about pediatric incontinence and pelvic floor dysfunction from Herman & Wallace, the pelvic rehabilitation institute.