Whether you’re an aspiring runner or a seasoned runner, having a baby shakes things up a bit. You’ve probably been ‘cleared for activity’ and you may have already started light exercise or even started care with a pelvic health PT (all of which deserve a huge pat on the back!). However, many questions still remain. The most pressing: Can I start running again even if my pelvis and low back ache a little?!?! But also: Is running bad for my pelvic floor? And: Am I causing harm to my body if I run with pelvic, hip, or low back pain? These are questions that researchers and clinicians are increasingly trying to answer. While researchers and clinicians have a way to go before truly understanding the dynamics within the pelvic floor muscles (PFM) during running, the take home message = don’t stop running altogether! Simply train differently.
Resistance and cardiovascular exercises are supposed to be good for us, and clinicians are increasingly encouraged to not create fear avoidance in these activities. With that said, there might be a better way to train in order to run/jog so as not to overload the pelvis or the PFM. While running and resistance training may not be bad for the PFM, it’s important to note that there may be certain levels of weakness (or tightness) within the PFM that make the PFM unable to resist intraabdominal pressure or even gravity. If you experience leakage or pelvic/low back pain while running, then consider several things: What can be done to decrease the leakage or pain? How can the activity be modified? More personally, how much is one willing to tolerate in order to continue running?
One key principle that helps inform the decision to run or not to run, is the overload principle. When we work out in our postpartum months, we want to work our muscles to their point of fatigue. The PFM, especially when in a weakened or tightened state, will reach their overload point more quickly and urinary leakage and/or pain occurs. In order to nudge the threshold of this early overload point, we can use a specific graded exercise approach in order to withstand various intraabdominal pressures as well as gravity. In other words, we start with small/simple exercises and progress into more complex/dynamic as the muscles restore in their function (this was discussed in an earlier blog). We eventually use impact exercises as a stimulus for muscles to adapt, which includes jumping, squatting, lunging, hopping, use of varied surfaces, etc. After all, even for non-runners, the PFM have to learn how to adapt to impact on a daily basis (examples: sneezing/coughing, moving boxes, doing heavy loads of laundry, housework, chasing/lifting children, etc). When we know our body’s thresholds, we can encourage muscle work up until we are hovering just below the point of fatigue, and then we slowly nudge that threshold by gently challenging the muscles so the tissue can adapt over time. The good news: it works! The bad news: it takes time and patience (sometimes it takes up to 3 months after starting a program…or even longer depending on your personal health history). Be patient with yourself!
Because impact affects us daily whether we are runners or not, it’s important to train our muscles to act and react as well as work voluntarily and involuntarily. This is why going beyond the traditional kegel is important. Kegels are often static and performed only on voluntary basis. However, recent research as shown that the pelvic floor muscles have a reflexive component when we run. In other words, for a very brief moment in time (we’re talking milliseconds) prior to one of our heels even hitting the ground, the PFM experience a downward movement (researchers are still trying to figure this out – it’s still a mystery!). While the details are still TBD, the take home message is that only teaching the pelvic floor muscles to “kegel” (ie, squeeze/lift up and in) on command is selling the muscle group short on its overall function. Once you know your baseline PFM functioning and can more easily touch base with the muscle group while in different positions during the day, then it’s time to move you along into more dynamic PFM training as noted above. This involves training the PFM along with other muscle groups in order to get your body connected and behaving as a coordinated unit. It takes a village….!
The process involved with pelvic floor muscle (or really any muscle) adaptation varies for everyone. And in the postpartum months, our muscle physiology certainly depends on other factors (sleep, nutrition, hormones, etc). Nonetheless, pelvic floor muscle re-training is most often guided by a pelvic health physical therapist. But consider your full tribe of people to help you along if you need it! Your dream team of providers and you will then decide as a team what dosage and intensity is right for you to train at. After all, your journey and goals are unique to YOU. Whether you’re training for your first marathon or simply hoping to chase your children around with more ease, the benefits of learning to specifically train your body and pelvic floor muscles are far-reaching!