I am fresh off debuting my new Treating and Training the Female Runner course in the UK. I was grateful and honored to be hosted by Emma Brockwell** (aka @physiomumuk, co-founder of @pelvicroar and co-author of the recently published Return to Running Postnatal Guidelines). Folks came from all over the World-Ireland, Scotland, Bulgaria, Iceland, Finland, Israel, and England – I was floored. The collaboration, conversation, and questions were a blast. We worked together to assess, care for and clinically reason through the pelvic, musculoskeletal and performance needs of women who want to return to running. Secretly, the ideas can apply to all female athletes, but our focus was on runners and impact athletes (think double-unders, plyometrics, volleyball, basketball, tennis, gymnastics….).
What is their stage of recovery?
One of the big messages I had hoped to convey for a return to run, post-injury or post-pregnancy, is not timeline related. Instead, it is recovery and running preparedness related. Whether it has been 6-weeks, 6-months, or 6 years, where you are in the recovery process and your level of preparation for a return to running determines your readiness.
We have two small studies, Thein-Nissenbaum et al. (2012) and Provenzano et al. (2019), that observed pregnant runners through pregnancy and followed up at 6-7-weeks postpartum. Both studies noted changes in trunk and pelvic motion during pregnancy running that were not back to baseline at 6-7-weeks after delivery. This is often when women are released to return to activity by their doctors after giving birth. In addition, co-author of the 2012 study, Bryan Heiderscheit, presented additional information at a conference indicating that at 6-months postpartum the woman in their case study had resolved most of her pelvic motion changes, but still retained excessive frontal plane tilt of the pelvis during running. That means the pelvis tilted from side to side in running more than it had before. If you have ever watched a postpartum mama run, this fits. Postpartum runners tend to demonstrate a lot of side to side movement, and not enough propulsion forward.
The running form changes that occur during pregnancy are a necessary and appropriate compensation for the way the mama’s center is changing over 9-months. You simply cannot grow a baby and its companion belly without impacting the way the trunk and pelvis are moving in a reciprocal activity like running. Once the baby is out, these compensations are no longer necessary. However, as our limited research above shows and clinical experience supports, these changes at the center linger and we can see it manifest in the running form of postpartum moms (i.e. side to side, not forward). In addition, this is compounded by the impact of pregnancy and delivery on the interaction and teamwork of the deep and superficial postural muscles and the pressure systems (more about that here, here, here, here). Simply put, these changes and compensations mean mamas need some guidance reconnecting, reorganizing, rebalancing and for lack of a better word, re-teamworking their resilient centers for running.
Have you prepped them?
To accomplish this, the question isn’t has enough time passed, or has basic tissue healing occurred? It is – have we helped our female runner change these lingering issues and return to more appropriate movement patterns? Have we helped them find, recover and use their centers (trunk and pelvis) again in meaningful ways that prepare them for and look like running? Have we helped prepare them for impact, speed, or endurance? I understand and acknowledge the need for loose parameters to help guide choices and progressions, such as the Return to Running Postnatal Guidelines. However, we must be sure that even at suggested time points, we have adequately prepared the patient/client for that next step in the process. For example, we cannot have a female runner do non or low-impact activities for 6 weeks or 6 months and expect that to prepare them for the impact forces of running. We must provide a gradual re-introduction to impact, monitor their symptom response and modify as we go (#monitorandmodify).
See video for an example of a graded exposure progression for impact and speed for a woman with a pelvic health consideration. (Thanks to @maria_ramsdell for the demo help!)
Ahead of schedule?
If we have provided a path to preparedness, gradually progressing women with activities that make sense for a return to impact and look like running, they may even be ahead of a prescribed timeline. How do you know? #monitorandmodify applies here, too. Monitor your female runner for improvements in those lingering pregnancy and running compensations, look for improved pelvic health and pain symptoms and restored confidence as you put them through gradual progressions. Modify as you go. When appropriate, allow them a short run-walk trial. Progress or regress from there.
Let’s start using the time we ask folks to recover, heal and rest after delivery or injury wisely. Create gradually progressed readiness opportunities to prepare a female runner for their goal activity, the passage of time alone is not enough.
Want to learn more?
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**Emma gave a thumbs up for this blog!
Byl N, Davis I, Heiderscheit B, Powers C. Research Symposium- The Science of Running.(2013) California Physical Therapy Association Conference. Los Angeles, California.
Provenzano, S. G., Hafer, J. F., Peacock, J., Kempner, S., Zendler, J. D., & Agresta, C. E. (2019). Restriction in Pelvis and Trunk Motion in Postpartum Runners Compared With Prepregnancy. Journal of Womenʼs Health Physical Therapy, 1. doi:10.1097/jwh.0000000000000129
Thein-Nissenbaum, J. M., Thompson, E. F., Chumanov, E. S., & Heiderscheit, B. (2012). Low Back and Hip Pain in a Postpartum Runner: Applying Ultrasound Imaging and Running Analysis. Journal of Orthopaedic & Sports Physical Therapy, 42(7), 615-624. doi:10.2519/jospt.2012.3941