PREGNANCY AND CHILDBIRTH produce dramatic changes in women’s bodies that can complicate their ability to return to high-impact exercises such as running without risking injury. Among the potential changes are weakening of the pelvic floor muscles leading to problems such as stress urinary incontinence, bowel issues, or pelvic pain; postural shifts that alter gait mechanics and musculoskeletal loading; and hormonal changes that can adversely affect bone health and joint integrity. To put these issues in perspective, consider the following data:
According to the Journal of Orthopaedic & Sports Physical Therapy, “For 1 in 2 women, urinary incontinence (UI) symptoms negatively affect exercise participation. Half of women with urinary incontinence (UI) will either stop or modify exercise due to their symptoms.”
The British Journal of Sports Medicine reports that 29% of postpartum women experience running-related urinary stress incontinence, and 84% of postpartum women experience some form of musculoskeletal pain that affects running.
Unfortunately, many women runners who develop these problems believe they are normal, unavoidable byproducts of childbirth that they simply must learn to accept, or they may be too embarrassed by symptoms such as incontinence to seek medical help. However, therapies are available to get them back to full and safe participation in the activity they enjoy most.
The good news for women in our community is that Mercy Health has two teams of physical therapists that specialize in pelvic health and running. Kelsey Dyer, PT, DPT, pelvic health specialist, and Dayna Pirrwitz, PT, running specialist, are two members of these teams collaborating to provide expert care that addresses the various issues that can limit women’s ability to run after childbirth or discourage them from returning to exercise altogether.
Dyer elaborates on the postural changes that occur during pregnancy and childbirth and how they can affect runners: “A person’s posture changes gradually throughout pregnancy, and the muscles, ligaments, and joints adapt to working in this new position. Then, once baby is born, there is an abrupt change when the woman loses a significant amount of weight quickly that can lead to issues during postpartum. Examples of issues that you can see in postpartum are separation of abdominal muscles, stress urinary incontinence, urinary urgency, bowel issues, low back pain, pelvic pain, hip pain, and prolapse.”
Pirrwitz adds that if a runner can’t maintain a neutral spine due to these postural changes, it will affect where the foot lands in relation to their center of mass as well as cause an inhibition of gluteal muscles, thus increasing the rate at which the leg is loaded and the risk of stress fractures. “You’re already at 2½ times your body weight, and if you can’t hold your posture and you’re running at a lower cadence, that loading rate continues to climb higher,” she states.
Furthermore, women who breastfeed their babies also have to consider caloric intake. If they do not take in enough calories to meet the demands of breastfeeding and running, they are putting themselves at risk for hormonal changes that can lead to loss of bone mass. This alone can put them at risk for a bone stress injury. Certain hormones involved in milk production can remain elevated for several months after breastfeeding is stopped, temporarily putting them at an increased risk of osteopenia, osteoporosis, and joint pain.
The ideal approach to preparing postpartum women to return to running involves first seeing a member of the pelvic health team to be assessed from the standpoint of pelvic health. “We can look at their posture and core stability, examine the abdominal muscles to rule out separation, and check their pelvic floor function. The gold standard is an internal/external muscle assessment to evaluate their strength and endurance and determine whether the muscles turn on when they should,” Dyer says. Once cleared by the pelvic health team, the women can move on to the running specialist for more intensive running training that addresses factors such as hip and core strength, posture, and running mechanics.
One challenge that Dyer and Pirrwitz often face is persuading postpartum clients that they shouldn’t return to running too soon after childbirth. “A lot of moms enjoy running because it gives them the ‘me time’ and a sense of self they need, so some of them try to get back to it too quickly or too aggressively. But pushing too hard or too fast postpartum is courting injury, so having advice on appropriate exercises as well as a return-to-running program to assist new moms in resuming such a high-impact activity can make for a more successful return,” Pirrwitz explains.
According to the British Journal of Sports Medicine, the average time that elapses before women can safely return to running postpartum is about 12 weeks. “However,” says Dyer, “the actual time necessary varies from individual to individual depending on a host of factors such as the type of delivery (vaginal or cesarean), complications during pregnancy or delivery, the number of prior births, and other health concerns. Our two teams working in collaboration take all these and other factors into account to ensure each individual patient returns to running at the time that’s best and safest for her.”
When it comes to resuming a strenuous, high-impact activity such as running after childbirth, working with expert physical therapists who specialize in pelvic health and running mechanics will help moms stay healthy and injury-free while they enjoy that essential “me time.” ✲
