If you want to listen to my episode with Kaitlin, I recommend subscribing to the RunBuzz podcast on Apple podcasts or other popular podcasting apps, and downloading episode 127. Or, you can also listen directly here:
One of the most common questions that is asked of expectant mothers, is how long can I run while pregnant and is running while pregnant safe? How far up to my due date can I run?
Answer: Running is a very individualized sport. It often comes down to what you were doing prior to getting pregnant. If you are an avid runner prior to getting pregnant, then most likely you will be OK running during your first trimester of pregnancy as long as there are no complications or medical condition that would prohibit running. This is something you would discuss with your doctor and in most cases, running while pregnant during your first trimester is fine.
Once you get past the first trimester, Kaitlin recommends looking at risk vs. reward. What is your goal? Running is a high impact activity, and as a result can increase pressure to your pelvic floor muscles, your bladder and your abdominal area. Knowing your goals and intended outcome is important. Often, you can still run but with modified goals. For example, do you need to race for performance or would you be happy modifying your running to be less intense and more focused on fitness? Kaitlin recommends that once you start to feel pressure in the belly and your stomach starts to show, consider modifying your exercise to more walking, biking, and swimming for the duration of your pregnancy and by doing so you will be better off during your postpartum period.
Answer: After delivering a baby many women are often told to not do anything for six weeks other than normal day to day activities or some walking as they feel up to it. If everything has healed properly, and there are no medical issues like elevated blood pressure that may pop up, they are usually cleared for exercise by their doctor at, or around their 6 week checkup.
Since running is a major physical activity Kaitlin recommends seeing a physical therapist to have your core and pelvic floor strength evaluated around the six week postpartum period. This will help make sure you are ready to return to running. While it is not always cut and dry, the research shows that following a low-impact exercise program for the first 3 months postpartum and then following a graded, return to running program from that three to six month postpartum period is best for returning to running after giving birth. Waiting at least 3 months will give you the time to heal and strengthen your body to handle the rigor of running.
Answer: The pelvic floor muscles are a group of muscles that sit at the base of your pelvis. They are responsible for a lot of things from proper continence to supporting your internal organs. The pelvic floor muscles help hold urine in when it needs to and they relax to let urine out when it is time to. They also provide a base for your core muscles and core muscle function. The reason your pelvic floor muscles are so important, especially postpartum is due to the fact that these muscles take a big hit during childbirth and often need to be properly healed and strengthened before you return to running.
Returning to running too soon after pregnancy can lead to complications. So much so, that Kaitlin recommends working with a PT who is properly trained to help guide you through your return to running program. A good PT will help you prevent or address some of the following complications such as:
During pregnancy and childbirth, your pelvic muscles can get torn and stretched. Returning to running too soon before they are properly healed can lead to issues like urinary or fecal incontinence, or leakage while running. This is common but should not be considered normal.
Because pelvic floor exercises often take a backseat to more popular core strength exercises, the pelvic floor muscles are often missed or overlooked in many core strength exercise programs. Since the pelvic floor muscles sit so close to your hip and lower back muscles, poor pelvic floor function is often mistaken for lower back or hip pain.
Another issue that can come up after childbirth is pelvic organ prolapse. With a weak pelvic floor, sometimes women will mention that they are experiencing a feeling of heaviness or pressure in the area. This could be a sign of pelvic floor prolapse meaning that your uterus, or organs in the area have descended because the pelvic floor is unable to keep everything in it's place.
Another issue that can come up after childbirth is diastasis recti. Diastasis recti is an abdominal separation that is often caused due to weak abdominal and pelvic floor muscles. As your baby grows and you stomach grows, it is normal for the abdominal muscles to start to separate. Postpartum, the abdominal muscles may not immediately return to normal and often require specialized core muscle strength exercises to help facilitate returning to normal.
One of the biggest mistakes Kaitlin sees with runners, not just pregnant runners is improper breathing technique. Most of us are shallow breathers. If we could learn better diaphramatic breathing technique it would go a long way towards preventing leaking, as well as hip and back pain while running. Not to mention be more effective at getting oxygen into our lungs and blood stream.
Working with a PT can help get you on a program that focuses on strengthening your pelvic floor muscles, overall core and any other areas of weakness. A PT can help set you at ease that what you are experiencing postpartum is common and what you are experiencing is not the result of anything you did or did not do. By leading you through a guided strength program as well as specific core exercises that focus on increasing strength, you can rest assured you are ready to return to running. In Kaitlin's case, she has a checklist she uses to make sure you are ready to return based on criteria she uses to evaluate your progress. For example, she would want to see that you can walk for 30 minutes first, do single leg balance exercises, squats and hops as running essentially is a series of single leg hops in sequence. She also evaluates stability in your knees, hips and ankles, etc.
One last thing to be aware of before we wrap up is this idea of Female Athlete Triad Syndrome. This is a condition sometimes found in athletes, not just women and it occurs when you body functions are impaired as a result of doing too much exercise or energy expenditure without adequately replacing the energy whether that is through proper recovery or from under-eating.
This can sometimes occur in postpartum women as there is often that strong societal pressure to lose the post-pregnancy baby weight as soon as possible. For many women there is a strong urge to return to their pre-baby weight, figure or activity level, but poor sleep due to a new baby combined with nutrition demands from breastfeeding or under-eating can all add up and wreak havoc on their body that is already trying to heal from childbirth.
These demands on our bodies can greatly increase the chance of stress fracture as well as some of the complications we mentioned above. Even fertility issues for those thinking about having another baby in the future is something that should be considered.
The best way to combat Female Athlete Triad Syndrome, especially for runners, is to return to running slowly and make sure that you are nourishing your body with healthy foods. If you are breastfeeding, realize that hormones are impacting your healing process as well and lack of sleep, stress and other factors. All these things add up to make you more likely to go into an energy deficient state. So being educated about the cause and effect and using this information as a guide to take your time with your return to running will go a long way in avoiding Female Athlete Triad Syndrome.
Kaitlin Hartley PT, DPT
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