Getting Back to Running After Pregnancy

I was lucky to have been able to run through a big part of of my pregnancy. Sadly, pelvic pain, which is apparently more common among active moms, stopped me from continuing for as long as I hoped. In December, after feeling extremely sore for days after running the Gunner Shaw Cross-Country 5k, I decided it would be my last run. I continued to teach dance fitness for another couple months, then stayed active by walking and dancing. I even went for a 2-hour long hike that included a hundred or so stairs the day before giving birth to my sweet little girl. A few weeks after the birth, I was feeling as good as a tired new mother can and was hoping I could return to running regularly quickly. Unfortunately, my body decided otherwise. I thought I should share my experience here as there are many inspirational stories of women who had a smooth and quick return to running after their pregnancy, but few women who had challenges at the beginning seem to be sharing their story. This can lead to false expectations and even to some women trying to get back to running faster than they should. So here are some of the challenges I had to face during and after my pregnancy:

Relaxin: a running mother's kryptonite

I had to stop running when about 6 months pregnant due to hip and pelvic pain.  Wanting to remain active, I tried doing other types cardio training, but swimming, the elliptical, the stair-master, and even brisk walking was painful. The pains only started receding about five months after the birth of my child and did not completely disappear until nine months postpartum.  It was all caused by a hormone called relaxin.

Relaxin, as it name implies, is a hormone that relaxes ligaments and muscles. During pregnancy, relaxin levels are at their highest in the first trimester and then towards the end of the pregnancy. It is helpful in loosening up all that needs to be loose for the baby to come out, but when it comes to running, relaxed ligaments and muscles can mean joint pain, a higher risk of injuries, and less raw speed.  After the birth, I thought that my hip and pelvic pain would just disappear after a few weeks like it did for a few of my running mother friends, but it did not. The effects of relaxin can continue for up to 6 months after birth! Additionally, breastfeeding's effects on estrogen production also affect joint stability. A 2008 study by Walsh suggests that joint stability only improves three months after breastfeeding stops. Since breastfeeding was more important to me than running fast, I had to wait until my baby started nursing less, with the introduction of solid foods, to see my pelvic pain go away.

Diastasis Recti: it is about more than the "mom pooch" 

As soon as the pelvic pain started to recede, I got excited and quite literally "jumped" back into training. I bounced around at home to samba beats, did some plyometics, core exercises, hill repeats pushing the stroller, etc. I was just so excited to be able to move painlessly again! However, when studying for my post-natal fitness instructor certification I learned that I should have avoided these exercises as I had diastasis recti. Diastasis recti is a condition in which the connective tissue between the left and right halves of the abdominal muscles becomes overstretched.  Nearly all women have some form of it just before and after the birth. For about a third of all women, the issue does not correct itself 6 months after the birth. I was one of these women and all this intensive cross-training I did were partly to blame. When I discovered that diastasis recti can increase the risk of back pain, injuries, and even embarrassing leaks when running or jumping, I decided to stop running again until I had seen a physiotherapist and dealt with it.

If you have diastasis recti, it is recommended to avoid certain exercises that increase pressure in the abdomen (such as crunches, sit-ups, planks, push-ups, exercises on all fours, running uphill with a jogging stroller, etc.), to not hold your breath at any point when doing strength training,  and to rehabilitate the issue to reduce the abdominal separation and regain core function before returning to running. Returning to running too early could also worsen the abdominal separation or at least slow down the healing. 

So what are you supposed to do when returning to running after your pregnancy? This is what I ended up doing after 6 months (but wished I had done earlier).

1. Talk with your doctor and see a physiotherapist

Before returning to training, I would recommend getting your family doctor to do a full check up that includes checking for diastasis recti and to mention any pain you might have. I would also recommend going to a physiotherapist specialized in women's health for pelvic floor rehabilitation prior to doing any kind of training on your own. My physiotherapist was also very helpful in teaching me how to breathe deeply again (and not just through the chest and shoulder as you are often forced to do when the baby was taking up all the space below).

 

 Here is a short list of women's health physiotherapists in Vancouver, Burnaby, and North Vancouver:
Full Circle Physiotherapy: http://www.fullcirclephysiotherapy.com/
Dayan Physiotherapy and & Pelvic Floor Clinic: http://www.dayanphysio.com/
Treloar Physiotherapy Clinic: http://www.treloarphysio.com/services/pft/
Marpole Physiotherapy Clinic: http://marpolephysio.com/services-2/womens-health/
Envision Physiotherapy http://www.envisionphysio.com/integrative-post-natal-program/
Dunbar Physio http://www.dunbarphysio.com/services/pre-post-natal/
Absolute Physio Care http://www.burnabyphysiocare.com/physio-therapy/pre-and-postnatal-therapy/
BC Women's Hospital Continence Clinic: http://www.bcwomens.ca/our-services/specialized-services/continence-clinic
Physiotiques: http://physiotiques.com/

2. Train at Home

As a new mother, I did not have much time to get out without my baby and also had lost enough strength that most bodyweight exercises would already be hard enough, so all my workouts were done at home. In the first months, the focus should be on no-impact deep core and posture training exercises. Here are exercises that are safe to do even if you have diastasis recti or pelvic floor problems:

Bridges and Marching Bridges

Side Planks

 Clamshells

 These are exercises you can do with your baby lying next to you for some extra bonding time. You'll be surprised to see how much some babies enjoy watching their parent working out: my daughter was my best coach and cheerleader during the first year.

3. Walk

As soon as brisk walking was no longer painful, I took my little one out for walks that were progressively longer. I was "lucky" to live in a hilly neighbourhood, which made the walks a great workout for my glutes, quads, and core. This allowed me to start gaining back both some of my strength and cardio and my growing baby made sure that the workout would never become too easy: as I was getting stronger, she was also getting heavier.

Going out for walks was also a great way to socialize with friends and other moms: which helped with the mental health aspect of postpartum recovery. If you can, connect with other mothers in your neighbourhood to organize walks in small groups.

4. Be Patient and be Kind to Yourself.

Be patient. As hard as it is for someone who loves running, one has to focus on the long term: rushing back to running before your body is ready could have negative long-term consequences. Among others: urinary incontinence, back pain, and joint injuries. At first, I was scared of seeing a physiotherapist. I was itching to get back to running as soon as possible and I feared they would give me an answer I would not like, which they did. But I am really glad they did, as I am now able to not only run, but also sprint, pain-free and leaks-free. Take it slow. Once getting back to running, you might feel frustrated by how much fitness you have lost. I remember not being able to push my jogging stroller for more than 15 seconds at a time during my first attempt! Remember that you have been pregnant and have experienced hormonal changes for nearly a year: it might take that long for you to return to your previous levels of fitness. Some of the changes to your body might be permanent, and it is OK. Take the time to discover your new body, its new weaknesses, but also its new strengths. I was excited to discover, among other  "New Mom Super Powers" that my previously overly tight hip flexors had now regained their full range of motion ("Hello long smooth strides!") and that my pain/ discomfort threshold had gone up.

Most importantly, do not compare yourself to others, even other new mothers. I would hear of other mothers who were already running, or even racing, and, instead of feeling inspired, the competitive runner in me would feel bad: as if I were behind in a race. But then I remembered that every body is different, every person goes through the experience of pregnancy differently. Becoming a running mother is not a race: it is a very unique journey.  

Have you faced challenges when returning to running after becoming a mother? How did you deal with them? Which ones do you find the hardest to overcome? Share your own experience in the comments section and I might include you in the next post.