Postpartum Injury Prevention Starts with Your Core & Pelvic Floor

Sure babies are cute, but they do some ugly things to our runner bodies. As I explained in my intro post, I didn’t train for a marathon until after I had my second child. Like many eager new running moms, I fell victim to “too much, too fast, too soon” after giving birth. I thought at seven months postpartum I was well past any potential injury related to labor and delivery, but I was wrong.

The bright side? I gained an increased awareness and understanding about what my body needed to stay strong and support a heavy training load. I especially learned a lot about my core and pelvic floor, which were perhaps the parts of my body most impacted by pregnancy and childbirth and, perhaps worse, the parts I most neglected.

The End of the World Injury

When my doctor gave me the green light at my four week postpartum check-up, I felt confident returning to running. After all, I ran through 90% of my pregnancy, had a 45 minute labour, and had already successfully returned to running after my son was born in 2012. Days, weeks, and months went by and I felt stronger all the time. By the time my daughter was five months old, I felt good enough to start training for that first marathon!

In March 2016, I was only seven weeks into an 18 week marathon training plan, seven months postpartum and still breastfeeding. Part way through my 21 mile long run, I hopped off an unusually high curb and felt my left side drop. I kept running, but something didn’t feel right. Then my left hip and lower back completely seized up. I went home, stretched, soaked in the tub and then went back outside to finish my run — NOT a smart move.

The next morning I woke up and I couldn’t walk. The panic started setting in. My chiropractor was on vacation so I booked an appointment with a different one and went in for an adjustment that morning. She discovered my pelvis was locked in a forward tilt and there was a lot of swelling. That week I alternated between massage and chiropractic care each day.

I noticed small improvements in my mobility, but still didn’t know exactly what was wrong with me. Another week of chiropractic care and massage, and I decided to look for a physiotherapist. That first physiotherapy appointment opened my eyes to what I was going through, and thankfully she didn’t think I was crazy for still thinking I could run a marathon in two months.

The diagnosis? I had sprained my sacroiliac (SI) joint. The impact of the curb jolted my pelvis and locked it forward as my ligaments were still very loose from giving birth and breastfeeding. My pelvic floor was incredibly weak, and my core wasn’t much better.

If I could go back in time, what nuggets of wisdom would I impart to myself to have a healthier postpartum return to training?

Rebuild Your Pelvic Floor and Core

Do not ignore your core or pelvic floor! Your pelvic floor muscles do a lot of heavy lifting during pregnancy, and especially during a vaginal delivery. It is not uncommon for there to be dysfunction with these muscles after giving birth. But the pelvic floor does so much more than keep us from peeing in our tights; these muscles are essential to maintaining hip stability. Likewise, pregnancy often does a number on our abdominal muscles too.

Postpartum pelvic floor and core strengthening are essential, and the two of them go hand in hand. The strengthening routine my physiotherapist gave me focused heavily on engaging my transversus abdominis (TVA). It’s the least sexy ab muscle in the human body, but probably the most important one. It’s key to maintaining spine and hip stability. By actively engaging this area, especially when running, I noticed a decrease in lower back pain and a more stable pelvis. I am now much more aware of this area and the role it plays in injury-free running.

If your OB or midwife checks you out and thinks you’re not suffering from a severe dysfunction of either your pelvic floor or your core, ease into a restrengthening routine. For the pelvic floor, consistent Kegels are the most recommended exercise for restrengthening the pelvic floor, although core exercises like bridge and plank also engage the pelvic floor. You can begin Kegels as soon as you can do them pain-free.

As for core, wait until you get the go-ahead from your doctor because you can make an ab separation, a common post-birth condition called diastasis recti, worse by doing conventional ab workouts like crunches and planks. Once you get the go-ahead ease back into core work slowly, consistently, and gently.

Get Help

I assumed I didn’t have pelvic floor issues, as I wasn’t peeing my pants, but you know what they say about assuming, right? When returning to running after childbirth, I wish I had consulted with a physiotherapist or pelvic floor specialist sooner. If you can afford to see a postpartum specialist to assess your weaknesses and make a plan to regain strength and re-balance your body, it’s worth it.

But if you’re experiencing signs of pelvic floor or core dysfunction, like incontinence while running, pain in the pubic area, back pain, etc., seek help of a medical professional to get yourself back on track and ready to run like a boss again.

***

Until I got injured, I didn’t realize anything was wrong. Had the injury not happened when it did, I could have been sidelined with something even worse, further into my training, which could have resulted in missing the marathon. In my situation, I found that a combination of PT, chiropractic and massage helped me bring balance back to my muscles. Almost a year after this injury, I keep up this routine in order to remain strong and help to prevent injuries.

Did you have pelvic floor issues after returning to running after having a baby? How did you overcome them?

*The information above is based on my experience with an SI Joint sprain after giving birth. This is not medical advice and I am not a medical practitioner. Always consult a professional before returning to running after having a baby or experiencing an injury.

A mother runner chasing big dreams.

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16 comments

  1. Thank you for sharing this. It concerns me seeing all these posts about women running so soon after giving birth without consulting with a physical therapist first that other women think it’s ok for them to do, too. Your doctor does not give you advice on recovery. It took me a full year for my pubic bones to get back into alignment. I also had pelvic floor issues and worked on strengthening my core. I had a c-section, so that was even more important.

    1. It’s really sad that it’s not standard to check women for such common dysfunctions after birth or to even advise women on what they can do to keep their bodies strong and recover better.

      1. Great post! I got a referral for a pelvic PT at my 6-week postpartum appointment (when I also got my IUD replaced). I saw my PT for a couple of months, and although she gave me lots of good exercises to do, the number one thing that helped my hips/pelvis? The S-I belt! It helped hold my pelvis firmly in place while my ligaments were still loose. I wore it 24/7 for 8 weeks, then only when I ran for several months after that. Before pregnancy, I’d always had hip pain of some sort but haven’t since- it’s been over 4 years!

  2. Great post and definitely going to remember this in a few months when I start to think about postpartum running and getting back to “me”. As of Friday, I was told no more running until after the baby (which, I’m oddly very at ease about) as I have some Pelvic bone pain (stupid hormone Relaxin!). if anything it’s good because it will be a good reminder after little lady is here to focus on strengthening things and not just diving back in!

    1. Smart idea to stop now – relaxin is crazy! 😉 It’s better to take the slow and steady approach. I could ramble about post-partum running all day. I took a slower approach after baby #1 and then assumed that I would be fine to resume harder training after baby #2. In hindsight, my body went through much more getting to the birth of baby #2, but I didn’t factor that in. Finding a PT that specializes in running and pelvic floor is very beneficial – mine also had kids and was a runner, so it was a really great match for me 🙂 Best of luck in the remainder of your pregnancy! So excited for you!

  3. I could have written all of this myself! After I had my twins I never really worked to strengthen my core or stabilize my hips. That’s how I landed with a pelvic fracture from overtraining on hips that were so out of whack. You would think I would learn my lesson after that debacle. After my 5th baby I came back to running a lot easier, but again, I never started up a core routine. Luckily I worked on stabilizing my hips, so I didn’t have that issue, but I had such awful lower back pain and months and months of sciatic pain. I had to go to a sports chiropractor for a while. Luckily he gave me the tools, starting with strengthening my TA muscles, and I have been fine ever since. I am religious about that now. Every other day I work on my TA muscles and core. I think so many people don’t realize the strong connection between core, pelvis, lower back, until it seriously affects them. The SI joint pain – awful, I dealt with that after a hard fall on a trail run.

    1. Same here – I can also tell if I’m slacking 😉 I feel like these imbalances are extremely common, but often not thought about right away since someone might feel fine, and then discover (after an injury) that it could have been prevented. The low back pain is also another thing that I ignored and assumed came from carrying a baby around or the way I was sitting while breastfeeding. There are so many changes your body goes through, and everyone is different, but seeing a specialist is always a good idea 🙂

  4. This is some good info! I feel like I have a lot of reading up to do before returning to running post-baby. I have a ways till that happens, but I’ve heard countless women say to take your time coming back after delivery. Thanks for the info!

  5. I’d like to add that just because you bounced back unscathed from one pregnancy, does not mean you’ll have the same easy recovery after another pregnancy. I bounced back really quick after my first, pretty darn quick after my second, but my third wrecked me. My abs and pelvic floor gave up! Haha. Fortunately, I didn’t get an injury per se, but I knew something was wrong when I was experiencing tons of back pain as I increased training after #3. I kept having knots in back muscles that started off as annoying, but got really bad to the point an orthopedist was convinced I slipped a disc. Xrays showed a severe curving of the spine, but upon MRI my spine was perfectly healthy. So it was a mystery — until I saw a post-partum physio a few months later who found the four-finger width separation in my abs. I did TVA exercises to get it back to about 1-1.5 fingers and now I’m all right. I could still stand to work on these muscle groups, but I’m back together enough to do what I want to do for now.

    1. So true. I was the same after my first two, bounced back quick and fine. After the twins and #5, nope. I have my ab separation down to the same as yours and my core is strong….the mom pooch of excess skin on the other hand:(.

  6. Great advice. I was pretty much pregnant constantly for three years. Birthed a ten pounder, then a miscarriage and delivery at 20 weeks, then another smaller baby. After that third delivery I started running after about three weeks and felt great for quite a while. But the hips don’t lie. So now I’m trying to unravel the thread of compensations and pain, years later. It is SO WORTH the slower start post partum in order to save your long term running! I think it is great there is more information out there these days, and sites like this one to point people in the right direction.

  7. I’m coming back post pregnancy and all of this resonates. I’ve been looking for more specifics, though. Any good suggestions on exercises to perform? So far, I’ve compiled kegels, pelvic tilts, bird dogs, and low boat. Any other good ideas?

  8. I think the key is that many women are at risk for, or are already, injured and may not know it. Same as your story, I know plenty of running mamas who went back to running and were fine, but months down the road developed some kind of hip/back/groin injury that could all be traced back to pelvic floor/core. While I’ve started post-baby running maybe earlier than a lot of people, I’ve always made sure to do PF exercises (kegels, planks, bridges) regularly during pregnancy and as soon after as I was able. And just recently started PT for DR finally, so keeping my fingers crossed it works and I stay post baby injury free!