A Runner’s Pregnancy Blog

Hi All!

I’m a Physical Therapist and personal trainer who specializes in treating and training runners and active individuals. I also have a certification in pre and postnatal exercise and work with many pregnant and postpartum women with staying healthy through pregnancy and returning to running and training postpartum.

I believe sharing of one’s own experiences is a great way to help set general expectations of what an active woman may encounter throughout their pregnancy. In particular, when it comes from someone who has an in depth background on how to exercise, move and modify. It can be helpful to see the approach to various things that come up or preventative measures being taken by someone who works commonly with this population.

So with this blog I will go through a brief timeline of how I’ve trained and cared for myself through pregnancy (my first!) including workouts, modifications and preventative steps I have taken along the way.

PRE-PREGNANCY

Running: ~20 miles/wk (4-5 days) with occasional long run of 7-8 miles

Strength Training: ~2 days/wk and the occasional HIIT class.

- Always a heavier compound lift: Deadlifts - 4x8 @ ~ 155lbs; Squats - 4x8 ~ 115lbs

- Single leg strength exercise: weighted reverse & lateral lunges, loaded step ups with 16-20” surface, etc.

- Lots of lateral hip and core strength: Knowing we were thinking of getting pregnant I began to add more TA focused core strength exercises with breathing in addition to a lot of the planks and leg lowers I was doing. But otherwise my goal was to continue to load heavy hip strength to make sure I was strong going into pregnancy.

WEEKS 6-18

Nausea and fatigue ebbed and flowed and when it did I listened to my body and let it rest. It’s so important in this stage not to try and push yourself through it (not that I would have had the energy at times to do so). On weeks when it was more present I was able to tolerate lighter strength days more than the impact of running (especially in the hot summer heat).

Running

Running dropped to 3-4 days/wk and with none longer than 45 minutes, all steady mileage without speed or intensity. This was mostly due to a hot summer and not wanting to push into dehydration or overheated state. Pre-pregnancy I wasn’t training for anything specific so 60+ minute weekend long runs were occasional but not a regular occurrence. If this was more regular it would be fine with proper hydration, but body temp will start to rise on endurance efforts of 60+ min so it’s always something to be cautious with especially in heat.

My OB had given me a basic handout with very dated exercise guidance that included not letting your heart rate go over 140 bpm. Luckily, I knew this was far too conservative and not specific to every woman. Here is your PSA to not be scared off by dated and fear inducing exercise guidance!

Instead, with a max HR of ~ 200, I made a point to never let my HR go above 165bpm (~83%) and let my perceived exertion and breathing guide me. If I went over that or couldn’t make small talk, I walked until I could. You can use the RPE guide pictured to help guide this for you.

Strength

With running being more of a challenge due to heat and nausea, strength became more frequent and fairly tolerable compared to endurance efforts. Strength day frequency increased and were largely unchanged. I stripped back ~20 lbs on compound lifts but, since I wasn’t having much belly growth yet, I was able to continue safely with extra awareness on breathing through movement, alignment and always feeling like I could do a couple more reps if I wanted

Prevention Steps - Movement Assessment with The Pilates Rx

Findings:

- Difficulty maintaining TA engagement in loading especially up high by ribs without compensation by crunching ribs down

- Thoracic rotation restriction and HS/hip flexor tissue length restriction

- Tendency for flattened lumbar spine and difficulty finding anterior pelvic tilt (the opposite of many pregnant women!)

Exercise Prescription:

Lots of TA work combined with focused and synergistically timed breathing. Focusing on the ability to, on exhale, get good and complete engagement of those corset muscles from pubic bone to ribs. Then, equally as important, get full relaxation of muscles on inhale. Despite it being early in pregnancy, we kept exercises fairly basic to encourage proper muscle engagement without over-recruitment elsewhere. More of a motor control focus than brute strength. We did exercises in seated and quadruped and made use of the pilates magic circle.

WEEKS 18-28

Running

I always imagined I’d be the pregnant person who ran right up until delivery so when it got less comfortable for me it was a real bummer. Around week 19-20 the odd and very noticeable feeling that I was running with a small watermelon in my stomach just made running less enjoyable. Some days felt totally fine (especially in the morning when I had less in my belly for the day) but running dwindled down to 2-3 days/wk and I stopped completely by week 25. SI belts and belly support belts helped slightly here but ultimately it just wasn’t as fun.

Nothing about the running I was doing was unsafe for me - I was not feeling any increased pressure on my abdomen or pelvic floor or any other pain or issues. I just simply didn’t enjoy the feeling. Weighing into the decision to call it on trying to run was also my pelvic floor assessment (details below) and the knowledge that extra strength focus now was going to benefit my ultimate postpartum return to run more than cardiovascular fitness. So here is your PSA that it’s OK if you’re not enjoying running while pregnant. Extra focus on strength and core will payoff as you will need that strength for your big return!

Strength

Increased to 3-5 days/wk. 1-2 days were a faster-paced HIIT style to get the cardio and HR benefits I lost with running and 2-3 days continued focus on getting and staying STRONG.

- Heavier compound lifts reduced further: Deadlifts - 4x8 @ ~105-125lbs (from 155 pre-pregnancy; Squats - 4x8 ~75-85lbs (from 115 pre-pregnancy)

- Single leg strength and core/hip focus continued mostly unchanged

Prevention Steps - Internal Pelvic Floor Exam

Around week 21-22 I made a point to have a preventative pelvic floor assessment. I was feeling pretty good overall but knowing the effects of a growing pregnancy I wanted to have the knowledge of how my body was handling the strain so I could adjust my focus and routine accordingly if needed.

Findings:

- Mild pelvic floor tightness (L side > R )

Now here is your PSA not to just do Kegels blindly like many internet sources will tell you. Very often there is a tightness issue at the pelvic floor (often combined with weakness) that is at the root of pelvic floor related issues (ie. leaking or prolapse). If this is the case - Kegel’s may only worsen the problem if tightness isn’t addressed first.

- Some poor motor control/firing pattern of pelvic floor (pelvic floor dropped slightly instead of contracted on cough or exertion)

I was able to self-correct this with the proper cuing and awareness meaning it was likely more of a motor control issue than a pure pelvic floor strength issue. BUT this is exactly the dynamic that can lead to leaking with running or any impact activity if not corrected.

Exercise Prescription:

- Active and passive breathing exercises for pelvic floor muscle release

- Gentle and infrequent Kegel exercises times with breathing

- Constant vigilance on all coughing, sneezing, lifting or other exertion to feel pelvic floor lift vs drop and time with breathing

This preventative check is well worth it. I was able to learn what my body needed most and get good biofeedback on it which I wouldn’t have been able to identify myself. This information helped my decision to call it quits on running as I knew impact may further promote pelvic floor tightness and/or continue to perpetuate poor activation dynamics of the pelvic floor with each foot strike.

WEEKS 28-35

Running Cardio

Long walks with my dog and some hikes in the Fells gave me my cardio fix when I pulled the plug on running. Overall I felt great, even partaking in a couple games of pickle ball around the 32 week mark because I was still feeling pretty spry. This, however, was the likely catalyst for onset of some pelvic girdle pain at the pubic symphysis and SI joint. At this stage of pregnancy the pelvic girdle is becoming super lax in prep for delivery. Asymmetrical and high impact loading (as with cutting and pushing off one leg in pickle ball) can create irritation of these joints.

After weeks without running or cutting and an exponentially growing belly I knew what caused it and took my lesson to cool it on the competitive fun and games (for now). So here is your PSA to always be aware of your stage of pregnancy and use caution with certain activities that may feel sneaky good before they don’t.

Strength

Weeks 28-35 saw a much steadier decline in load and adjustments to exercise selection as belly growth felt much faster at 30+ weeks. Because of the aforementioned pelvic girdle pain that was occurring, I cut back on asymmetrical single leg exercises and dropped lateral band walks which were making it worse. When this type of discomfort becomes frequent late in pregnancy you want to be aware of this and any wide stance loading or waddle walking which can irritate these joints.

Around 34 weeks I was starting to notice pressure out on my abdomen with barbell deadlifts and squats despite bringing the weight way down to 45-75 lbs. This was my cue to shift to goblet squats and dumbbell deadlifts and my body telling me it’s about time to start letting the muscles relax and prep for delivery!

Here is your PSA to listen to your body late in pregnancy and know when the hay is in the barn!

Prevention

TA and Core Stab Work with The Pilates Rx

In weeks 18-28 we increased the challenge of my initial set of exercises including some reformer work you can check out below. There was no need to add much challenge to the initial set of exercises in weeks 28+ as stretching abdominals and the weight of a growing baby were making them more challenging on their own. It’s a tough pill to swallow but there’s not a lot of room to make these harder because they are simply going to get harder as pregnancy progresses! I will continue to do these though right up to delivery and they are perfect for early postpartum as well.

Pelvic Floor Work

There was a noticeable reduction in pelvic floor tightness with the active breathing release strategies. Shortly before my assessment I had been having some mild SI joint pain only with sleeping. The asymmetrical tightness I had can create a shearing force on this joint even with sleeping and this went away shortly after incorporating these exercises. These exercises also helped give great feedback for breathing with exertion to best serve smooth pushing in labor and delivery!

I look forward to sharing part 2 in a few months: Weeks 36 on + returning to run and exercise postpartum!

Somerville, MA