🦀 PT Crab Issue 101 - Running after Pregnancy

This week, we’re talking postpartum running. The Journal of Women’s Health Physical Therapy just did an awesome series on this and we’re going to give one of their pieces a look. Why does this matter? 50 million Americans (about 15% of the population) identify as runners and almost half of them are women. And by the time they’re 44, 85% of women have given birth at least once (an average of 1.2 times, actually). Technically, there doesn’t have to be crossover between these populations (cuz math). But there definitely is. And postpartum women should be able to return to any activity they want. That’s what we’re here for. As activity promoters and enablers, that’s our job. So how do we do it effectively? We understand the barriers to running.

For King Crab supporters this week, we also consider how to fix them those barriers, and we learn a little about postpartum women’s biomechanics along the way. If you’re interested in all of that, become a PT Crab supporter by upgrading your membership to King Crab. It’s a teeny bit over $1 per issue. Like $1.15. C’mon, you know you want to.

Also, I want to tell you that next week’s issue will be about integrating pilates principles into PT care for multiple conditions and Issue 103 will be about interventions for total joint arthroplasty in both outpatient and acute settings.

Now, let’s dive in!

Why pregnant women stop running. And don’t restart.

The Gist - As part of their series on running during pregnancy and postpartum, the Journal of Women’s Health PT opened with a survey to see why mothers stopped running and didn’t get back to it. They got 883 responses from mothers who reported running at least once per week prior to their pregnancies and the results are unsurprising but important. 46% reported they didn’t run during pregnancy and 25% hadn’t returned to any running postpartum (the average mother was 321 days postpartum, jsyk). There were many reasons why the mothers stopped running, though the most frequent citations were morning sickness (19%), general discomfort (9%), pelvic pain (13%), fear of or previous miscarriage (9%), and fatigue (19%).

The reasons why these 25% of respondents didn’t return to running were elucidated as well. 27% reported a lack of time, 23% reported not knowing how to do it safely, 38% reported they had experience scar pain, incontinence symptoms, breast pain, or other concerns when they tried, and 11% reported other MSK pain.

For those 75% who had retuned to running, many had ongoing concerns. 34% reported urine leakage, 21% were concerned about safety, 20% were experiencing diastases, and 14% didn’t have direct symptoms but were being cautious so they don’t develop them.

Tell Me More - Okay, that was a lot, I know. But here’s what more we have. Of those surveyed, it’s important to note that time-based barriers weren’t what stopped them from running either during pregnancy or postpartum, most of the time. More people reported stopping running due to pregnancy-related factors than time-based ones. And many of these barriers were fear or anxiety-based, not actual symptom based. There are some very positive takeaways here too, like the fact that 54% of these people continued to run during pregnancy and 75% returned to running after. That’s great! Still, there are a lot of people to reach to improve with both pelvic PT and general advice. Guidelines for return to run do exist even though they’re pretty fresh and not heavily reviewed. In general, a gradual return to running “is recommended from approximately 12 weeks postpartum.”

The fact that women are concerned about pelvic floor dysfunction is, in the authors’ minds, both good and bad. Bad because it’s usually due to them lacking advice, but good because: “Awareness of these concerns may be seen as positive, whereby women are beginning to identify the importance of pelvic health and understand when these issues may contraindicate a safe return to running.” In other words, we’re getting there but we’re not there. You don’t have to be a pelvic health provider to help either. More on that in our next paper.

But where’s this paper? It’s right here y’all.

Now that you know why women don’t run during pregnancy and postpartum and what some of the common problems are, consider following up for even more information on the topic.

If you’re interested in learning more about this topic and the future ones (as well as accessing the entire archive), become a King Crab supporter. You get more and you help support the Crab. It’s a win-win. Just mash this link. Or head to PTCrab.org/subscribe

Also, because I’m really passionate about this topic, I plopped a couple more articles here that I’m not going to summarize for space concerns (and cuz it takes a while to do) but if you treat this population, definitely give it a look. And get to know who the pelvic floor providers are in your area, your postpartum patients will thank you for that referral.

Here are those articles:

And now, ta-ta!

Here’s this week’s bibliography:

James, M. L., Moore, I. S., Donnelly, G. M., Brockwell, E., Perkins, J., & Coltman, C. E. (2022). Running During Pregnancy and Postpartum, Part A: Why Do Women Stop Running During Pregnancy and Not Return to Running in the Postpartum Period? Journal of Women’s Health Physical Therapy, 46(3), 111–123. https://doi.org/10.1097/JWH.0000000000000228