Happy Monday cheeky pals!
Today we explore the nuances of running during pregnancy with the help of Women's Pelvic Floor Physio (and founder of Physio for Women) Rachel Fitt. We break down what happens to your body in each trimester and then understand how that impacts our ability to run.
We wrap up with some all-time running recs.
If you want to support the show, please follow us wherever you listen to your podcasts or on social media: Instagram, Tiktok, Cheeky Run Club Strava community, plus Phoebe's Strava and Anna's Strava.
Music produced by Hugh Raper
Logo design by Michael Cotellessa
Thank you for listening!
Happy Monday cheeky pals!
Today we explore the nuances of running during pregnancy with the help of Women's Pelvic Floor Physio (and founder of Physio for Women) Rachel Fitt. We break down what happens to your body in each trimester and then understand how that impacts our ability to run.
We wrap up with some all-time running recs.
If you want to support the show, please follow us wherever you listen to your podcasts or on social media: Instagram, Tiktok, Cheeky Run Club Strava community, plus Phoebe's Strava and Anna's Strava.
Music produced by Hugh Raper
Logo design by Michael Cotellessa
Thank you for listening!
Cheeky Run Club recognizes that every day we live, work and run on Aboriginal land. Welcome to episode eight. Thirteen, of Cheeky Run Club, the social running podcast and community for your everyday amateur runner. Hello, Phoebe.
Phoebe1 fixed:Hello, Anna.
Anna 1:And hello, listeners.
Phoebe1 fixed:we are, we have a huge topic ahead. We're chatting about running during pregnancy. We're going to break down, each trimester and understand what are the changes that happen to your body in that trimester and how does that impact your ability to run? We have a very
Anna 1:you'll quickly
Phoebe1 fixed:I are not experts. We're not? Yeah.
Anna 1:I'm not
Phoebe1 fixed:Something else that I wanted to say, last time we did an episode that was very woman specific. Had a few comments from like male listeners, being like, Oh yeah, you know, obviously it wasn't really for us, but
Anna 1:didn't.
Phoebe1 fixed:So this is basically what I wanted to address is I think men should be interested in women's experiences and they often are, even if they haven't thought about it in those terms. And so I think. Men, if you're listening or women sending it to men in your life, like men broadcasting a message to men. Um, yeah, it is really important to be interested in women's experiences and make an effort to understand them and the things that they're going through. So don't switch off. it's on you to try and understand these things as well.
Anna 1:It,
Phoebe1 fixed:everything about that.
Anna 1:be support them better. And, um,
Phoebe1 fixed:If you went to switch off, you are now being guilted into listening.
Anna 1:an expert.
Phoebe1 fixed:Okay,
Anna 1:no.
Phoebe1 fixed:heard my worst run. My worst run was last Sunday. I, actually I was meant to run with you and a few other girlfriends in the morning. Decided to sleep in, take it easy
Anna 1:Calmer.
Phoebe1 fixed:I know,
Anna 1:No, sorry. That's so aggressive.
Phoebe1 fixed:I took myself for a cold shower. Gorgeous little trail run. The sun came out. It was a beautiful day. I was honestly having, I was honestly thinking this is going to be my
Anna 1:my best day ever.
Phoebe1 fixed:so beautiful. The trails around, there's a place called Yarra Bend Park in Melbourne, which is quite close to where I live. And I am just constantly blown away by the trails around there. It is so beautiful. So quiet. And then, duh, duh, duh. I got distracted because I was in like quite a remote part of the trails and I came across this older couple doing remote control four wheel driving. And they were clearly together but they were maybe a hundred metres apart. Just both in their own worlds, and I was watching, the woman as I was running, like so interested in like, what are they doing out here? And yeah,
Anna 1:here. Short. Um, and then I
Phoebe1 fixed:Um, and then I stacked it I was running uphill and I just like caught my foot on the rock. I'm like propelled myself forward into this other rock. And I just like, I banged both my knees and my knees were already quite bruised from Listen to my worst ride the previous week where I stacked and I hurt my knees then and now my knees got so Bruised and banged up and I landed on my hand. Oh, yeah, you can still see the
Anna 1:head. Oh yeah,
Phoebe1 fixed:It's just not been a good, um, week or so for me and
Anna 1:just not been a good, um, week or so. Yeah, last night, I was
Phoebe1 fixed:bagel. Shocker. Yeah, last night. I was in a rush, actually, because I was meeting up with you, and I
Anna 1:And,
Phoebe1 fixed:I, yeah,
Anna 1:I was,
Phoebe1 fixed:um, and I was, You know when you're chopping something and you're like, I shouldn't be chopping something like this. I'm like, holding the bagel in my hand, chopping down towards my hand. And of course it like, falls through and I was just like, Oh no. Uh, but yeah, I think I'm now done with
Anna 1:Yeah, you're done.
Phoebe1 fixed:I'm feeling done.
Anna 1:Yeah, that's good.
Phoebe1 fixed:Um, what was your worst run of the week?
Anna 1:worst run? My worst run is Merging with my best run. On Saturday night, my partner, the husband, Dave, and I went round to, a friend's place, and it was such a nice night. We like had a little dinner party, ordered pizzas, Anyway, I was so tired on the Sunday morning when we went for a run and like I had driven, so I think I'd had like one drink, but I felt like I was hungover. Like I was just so tired and like sick. Um, and it just felt like a battle the whole run. I like felt like I hadn't run for months, even though I've been
Phoebe1 fixed:running for
Anna 1:like just felt super unfit. So that was the worst run, but it was also the best run because I got to run with a couple of friends. One of which Millie, she had a baby in December, so I feel like I haven't really been able to run with her as much recently. So it was just so nice seeing her and she's just the most smiley person.
Phoebe1 fixed:So nice. Yeah, I feel like, um, you've done a good job this week at trying to like, catch up on your sleep and
Anna 1:Yeah. Yeah. I've been, I've been sleeping
Phoebe1 fixed:well it's taper week. Taper week?
Anna 1:for me. Yes. I'm racing the time of the podcast comes out, I will have completed hopefully a Ballarat half
Phoebe1 fixed:What are your, what are you, what are you thinking for the race? Got any goals?
Anna 1:hopefully get a PB. I haven't actually, I haven't looked at the weather or the course, or spoken to my coach. It is Thursday, so I've got a couple of days.
Phoebe1 fixed:I'm gonna check the weather for you
Anna 1:Yeah, we'll do some live checking. Um, but yes, hopefully run a PB. I'm excited.
Phoebe1 fixed:Going to say Christmas. Let's Oh, and it doesn't look like there's
Anna 1:like there's wind. Yeah. And it'll be
Phoebe1 fixed:Might be on here.
Anna 1:might be on here, we'll see how these little legs go. But yes, excited for the race. Yeah. And what was your best run? I think I also know what this is.
Phoebe1 fixed:think you know, I, it was this morning, we went for a run while I ran an Anna Road with, Grace Tame. Friend
Anna 1:Friend of the
Phoebe1 fixed:the Pod, officially can now say Friend of the Pod. some of you will remember back in season one we read out a number of quotes from an article that, Grace had written about running and yeah. Since then we kind of have been bugging her to hang out with
Anna 1:out
Phoebe1 fixed:and be our friend. And she finally caved She
Anna 1:her girlfriend, and she finally gave. But
Phoebe1 fixed:But yeah, we, honestly, it was such a nice run. Anna and I are both massive fans of Grace Tame, if that wasn't already clear, and so, meeting her was, like, quite surreal, but she's so lovely, so clever, so funny, loves running so much, but yeah, we just had a great run.
Anna 1:Yeah, I don't know, people say don't meet your heroes, but, If you're here, it's Tame. I reckon me, though.
Phoebe1 fixed:her Yeah.
Anna 1:Oh, she's such a
Phoebe1 fixed:Yeah.
Anna 1:All righty. Our main topic of this week is running during pregnancy to help us explore this space. We're joined by Melbourne's own Rachel Fitz. She is a pelvic floor and continence physiotherapist who has her own practice called Fit Physiotherapy. Rachel studied exercise and sports science before completing her Doctor of Physiotherapy. She then went on to complete her graduate certificate in pelvic floor physiotherapy. She is also a mother to a newly born baby. one year old.
Phoebe1 fixed:old.
Anna 1:crowned one year old and a keen runner herself.
Anna:Welcome Rachel.
Rachel:Thank you for having me.
Phoebe1 fixed:Before we get started, thank you so much to everyone who submitted questions. We had, a huge amount of super interesting, specific, detailed questions, pertaining to running during pregnancy. So what we thought we'd do is sort of step back and talk holistically about the experience of running during pregnancy. And as I said in the intro, kind of break it down through each topic. Trimester. And we're going to start by, just giving
Phoebe:a bit of a 0 1 on some of the terms that are thrown about a lot in regards to running during pregnancy. Um, so we might start off with. what is a pelvic floor and why is it important?
Rachel:what maybe we'll just like explain like the bony anatomy and the muscles and everything so everyone can get a bit of an idea. So you imagine the pelvis is just like a bowl and you have no floor to it. So you have your pubic bone at the front, kind of your hip bones around the back, and then your lower back attaching to the pelvis, your sit bones underneath. It's like a hollow bowl in the middle and your pelvic floor ends up making up the floor of the pelvis, really. So it runs between your pubic bone, your coccyx and your sit bones.
Phoebe:The
Rachel:floor is made up of muscle, connective tissue, nerves, blood vessels and ligaments. Often, I guess when people are talking about the pelvic floor, most people are probably referring to the muscles because that is the one thing that we can change and improve its function. But we can't forget about the other structures, particularly the connective tissue, which is supporting your organs, your bladder, uterus and rectum. Um, from a pelvic floor perspective, it does have a lot of roles. So it does help with bladder and bowel continence. It helps you hold on to go to the toilet, but it also must relax to allow you to empty appropriately. It has a role in sexual function and orgasm, and then it also has a functional role in supporting bladder, uterus and rectum and working with your deep core to just control and maintain your intra abdominal pressure. Interesting.
Anna:And, why, why is it so important in regards to running, and pregnancy?
Rachel:so I guess from a running perspective, running being a form of high impact exercise, there's a lot of pressure that hits your pelvic floor every time your foot lands on the ground. And so when we're doing activities that increase intra abdominal pressure and therefore pressure on your bladder and your pelvic incontinence. Um, And then I guess from a pregnancy aspect, the weight of the baby does end up putting a lot of pressure on your pelvic floor. So you can have a lot of weakness start to occur, and you can be more prone to pelvic floor dysfunction, like stress incontinence as well.
Phoebe:Yeah. Um, and
Anna:and so when should someone come and see you or another pelvic
Rachel:floor physio? I guess if we're talking about like a running population, Probably like when you're thinking about trying to conceive is a good idea to see a pelvic floor physio because runners or people that do a lot of high impact exercise generally are prone to pelvic floor dysfunction because they are stressing their pelvic floor more than the average person and so it's good to have a checkup before you have Hormonal changes and more weight on your pelvic floor from a growing baby to just see if you have any pelvic floor dysfunction. And so if you were to present before falling pregnant, your pelvic floor physio would kind of assess your general bladder, bowel, sexual health, kind of have a look at the type of exercise you're doing and what stresses your pelvic floor is facing daily. And then just look at your muscular function to work out, is there any muscle dysfunction already there that. should be optimized prior to falling pregnant to minimize the risk of you having any dysfunctional complications occur from like a stress incontinence point of view. Um, some people don't get the time to do that before falling pregnant. And so I guess if you found out you're pregnant and running is something you want to keep doing. Seeing a pelvic floor physio to have these discussions as early as possible is great. Um, usually the best way for us to assess the pelvic floor is to do a vaginal examination so that we can actually feel what you're doing when you use your muscles and have a look at your anatomy to see what your baseline is before having your baby. Um, in a first trimester, unless it was really clinically indicated to do an internal examination, We would usually hold off until the second trimester, just to minimize any kind of infection risks that could contribute to pregnancy complications, but there's still a lot of information we can gather without doing an internal exam in the first trimester.
Anna:anything. Yeah. Okay. So ideally you'd come sort of before. like when you were about to start trying, um,
Rachel:pregnant, so
Anna:So you could have that examination,
Rachel:Yeah, you can have that examination. Yeah. And we can also kind of get some baselines with your anatomy before any hormonal changes would start to impact that, I guess, because like the luxury of having baseline measurements about certain things with your anatomy and a baseline for your pelvic floor muscles is that if there is any dysfunction that occurs in pregnancy or post natally, you're really struggling with certain symptoms. We know what your normal was before there were any changes.
Phoebe:Yeah, to compare that
Rachel:compare.
Phoebe:Um, what's involved in the, in an internal exam?
Rachel:Yeah, so generally like I suppose everything from the waist down off, um, you'd be laying on the bed, um, usually with your legs separated, very similar to like if you're having a pap smear or any other kind of like internal exam with your GP. Um, from a physio perspective, externally. We look at the The tissue and the skin quality. We would have a look like where your sit bones are in relation to your perineal body and your perineal body is in between the vaginal entry and the anus. And if the perineal body is sitting really high, it can indicate that you are holding a lot of tension through your pelvic floor, which is kind of just like having a tight muscle, I guess, that's not relaxing properly. And we generally look at your ability to contract and relax externally with your pelvic floor, we can take some measurements just to see, um, from a prolapse perspective, do you have any risk factors and then from an internal perspective, we're literally like when you assess other muscles in the body, we're touching the muscles. Is there tenderness? How tight do they feel? When you contract, are we feeling like a good quality contraction where the muscles do squeeze Equally, like, are you relaxing the pelvic floor correctly? What's your endurance like and then we have a look at what your general coordination is like with the muscles and if you you have a reflex. Um, which would kind of give us a general idea of what's happening with the mechanisms around like, say, for a runner, every time your foot hits the ground, is your pelvic floor responding appropriately to that kind of pressure? And if your coordination is not good, it might impact its ability to respond to that. Yeah, so it's pretty detailed. Yeah. So it's,
Anna:I mean, really what you're saying with like testing the sort of like strength, um, and like tightness, it's very similar to any other like parts of your body that
Rachel:be like this? It is definitely. And the way that we like grade the pelvic floor strength and endurance is exactly the same as any other muscle in the body. I suppose just because it's internal, the assessment to be able to do it is just a little bit more invasive. Yeah.
Phoebe:bit more well, let's dive into it then. So the way that we're going to structure this is we're going to talk about each trimester. we'll talk about high level kind of changes to your body at that time and how those changes impact your ability to run and, risks involved And then we might touch on some examples of how you can keep active in each trimester as well.
Rachel:Great, sounds good.
Anna:So, trimester one. Um, what what happens, what, what happens?
Rachel:Yeah. So trimester one, I suppose from like a body perspective, like the baby is like super tiny, uterus is going to start getting bigger than what it was pre pregnancy. So there is a little bit more kind of pressure from a intra abdominal perspective onto the pelvic floor, but it's not significant enough to, to cause any problems or to consider changing your running at this point. there are a lot of hormonal changes. that start to go on in your body none that would particularly impact someone's ability to exercise, other than the ones that make you feel really crap and maybe potentially feel really sick. I suppose, from a sickness perspective, that's going to be the thing. That maybe changes people's exercise the most. And from a pregnancy perspective, we do want people to be doing consistent exercise to be able to maintain whatever they're doing. So they're not starting new things in the second trimester or when they feel better. So it is like a consideration if someone is doing a lot of running pre pregnancy. If they do feel really unwell in the first trimester and they're not able to do that level of exercise or any exercise, it is something we have to consider quite heavily depending on how long they've had a break for. Is that an appropriate form of exercise for them to return to? Because I suppose like going on a holiday or having an injury, when you have a period of time off doing a certain type of exercise, you are just prone to injury and dysfunction when you return. Um, from a sickness perspective, I guess, though, it's about survival. And I guess you just do whatever you feel like you can manage. It's really up to an individual what they feel like they can do. And so I think it's like, you just have to listen to your body and do what you can, stay as active as you can, but you just have to eliminate the pressure and just do what you can do really at that point. And that's just like completely unique to everyone's different situation. Probably the only thing that is really important to consider and the only recommendation that we have that exercise in the first trimester is thinking about heated environments though. And so from a running perspective, if you increase your core body temperature too much, it can impact your, ability to, have embryogenesis occur, which is like if your core body temperature exceeds 39 degrees, which can happen if you're exercising in a heated environment. So say you were to go for a run in the middle of Um, um, there is um, there is a chance that you could have a, um, high core body temperature above 39 or a 1. 5 degree increase. If that affects your ability to have embryogenesis occur, there can be congenital defects that occur to the fetus, which may result in a miscarriage, which is why like people that are doing hot yoga, hot pilates all have to
Anna:Pilates, you
Rachel:their exercise because of that. Yeah.
Anna:because of that. Yeah, so. Sorry to interrupt. What
Rachel:it's literally just like, so when the, when there's the, when the embryo is like formed, I guess, and like the formation of it all needs to be out of like attached to the uterine wall for it to continue to. develop and grow, I guess, and like miscarriages occur when something is not quite right with that. So, um, it's really like, I guess, like from a bottles, uh, like your body's kind of like all the chemical reactions and things that are occurring to allow that to occur. It's a failure of that really. So we know like it's definitely safe to like exercise in 25 degree weather. I think it's about 43 percent humidity for that temperature for 35 minutes at an 80 to 90 percent max heart rate, which would be like anaerobic exercise. So we
Anna:that's still,
Rachel:definitely safe, but it's not that hot. Right. So like, you know, in like summer, like if you were like. You know, there's some warnings where I guess it can be like, you know, high
Phoebe:Or I don't think it ever gets to like 40 percent humidity in Queensland. I think it's just permanently,
Rachel:unplayable. Yeah. Yeah. So, so it's just like something to consider. Most people though are probably not going to feel great to be exercising and pushing themselves that much. Yeah. In high temperatures though when they're pregnant. So that's the only consideration though with the first trimester. Otherwise it really is just, Doing what feels right for you. Yeah. And
Phoebe:so, in your first trimester, what are you considering with your pelvic floor?
Rachel:There's not a lot going on that would significantly impact pelvic floor at that point, unless you're already prone to a pelvic floor dysfunction and there's been something going on before pregnancy. Yeah. And so quite common for people to have stress incontinence with high impact exercise like running. So if you are one of those people that does suffer from it. from urinary incontinence with your exercise, it does indicate that you've got a pelvic floor dysfunction already going on. You probably should be seeking help for that because it's something that might worsen throughout pregnancy. Yeah.
Anna:So like, for instance, I
Rachel:struggle sometimes
Anna:with urinary incontinence and with running. Does that mean, like, even if it's sort of not to the, it's not really, really bad, should I probably be seeing someone about my pelvic floor, now? To ensure that in, if I was to get pregnant in years to come, that I, like, won't have further complications.
Rachel:Yeah, it would be a good idea because I suppose, even though it can be common to have those symptoms, they're definitely not normal and they can worsen, one, as you get older, but yeah, two, throughout the childbearing years. And so in pregnancy, if someone develops stress incontinence, once they develop it, it's actually quite hard to treat it properly. when they're pregnant, where physio and pelvic floor works really well as a preventative for incontinence in pregnancy. So the best time to see someone in pregnancy is before you actually have any symptoms of dysfunction.
Anna:so examples for keeping active in this trimester, as you said, it's just. Do whatever you feel.
Rachel:I feel like super unique to the individual I generally like tell my patients the best rule of thumb in pregnancy is that if you're questioning whether you should be doing something, it probably means there's something about the form of exercise that you're doing that's not maybe making you feel a hundred percent means you probably shouldn't be doing it. Um, because of the lack of research about exercise in pregnancy, and you know, we don't know a hundred percent what is unsafe from a high impact exercise perspective. Um, If you doubt it, it probably should be modified. But otherwise, if you're feeling really good, you don't feel different doing it, then keep going, um, but work with a public health physio to ensure that you don't have any risks of developing new public floor dysfunction.
Anna:Yep.
Phoebe:Well, let's jump into Trimester 2 then. Uh, so, talk us through what, what are the changes, what happens to your body?
Rachel:Yeah, so I guess trimester two, so it's from 13 to 27 weeks, um, your baby is definitely going to grow a lot in this trimester. And so often people will start to show at some point. Um, for a first pregnancy, people tend to show a little bit later than subsequent pregnancies. but because baby is getting bigger and bigger, there is kind of more pressure on the pelvic floor. from a hormonal perspective, your estrogen levels just keep rising as your pregnancy goes on. estrogen is the hormone softens your connective tissue and your ligaments. So it does mean that your joints become a little bit more flexible than what they are outside of pregnancy. So in particular from a running perspective, ankle sprains might be a little bit more common. You might be at a high risk of falling. so thinking about like trail running and the snow. That's a really good question. surface that you're running on probably be a consideration for what you're doing. You would need to work on a lot of balance to try and make sure you've got good proprioception so that when you are doing single leg exercises, your foot is good at balancing and landing in space without you having to think a lot about it.
Phoebe:Um,
Rachel:with the changes in hormones, with the high oestrogen levels and that. extra movement through the joints, you are prone to pelvic girdle pain. Pelvic girdle pain is very common. We think like anywhere between 50 to 90 percent of women in pregnancy will experience pelvic girdle pain. And it's just an umbrella term that really describes like pain around your pelvis. So it can present in different people in different ways. Some people it's like a pubic bone or like a groin pain. It can be like a hip bone pain or, um, like a lower back SIJ coccyx type pain. So it kind of encompasses.
Phoebe:encompasses any kind of pain. Yeah. And what's it caused by
Rachel:It's a change in your increased estrogen levels with the ligaments and the connective tissue softening, but also because your baby is growing, your posture changes, which changes your biomechanics. And so your center of gravity changes as well. So it's probably a combination of all of those things. All of those things that does contribute to someone experiencing that. single leg activities are generally the things that aggravate it the most if someone is going to experience it. And I guess from a running perspective, it's a single
Phoebe:leg. Yeah.
Rachel:exercise, so, you can be prone. So I suppose like it's just something not everyone gets it. Yeah. but it's something to consider because if you do start pulling up, so from a run, it means that the exercise is probably not actually. very good for you at this stage of pregnancy, or you need to do a lot more strengthening work to kind of like treat your muscles around the pelvis to stop them from getting really tight and weak. because everything tightens to help you stabilize. So when you're doing single leg exercises, your muscles are just working so hard to help you stabilize on one leg. But writing can be something that a lot of people do need to cut out if they start experiencing this because it just keeps aggravating
Anna:need to cut out if they start experiencing this because it just keeps aggravating them. run through and it will be okay. Like you have to stop.
Rachel:most of the time, like with the pelvic girdle pain for most people, it might start off as like, or I'm sore after a run, or it might be like, I'm sore laying down at night in bed, my hips feel achy. And then the pelvic girdle pain prognosis is because your estrogen levels just keep increasing as the pregnancy progresses. The pelvic girdle pain prognosis is that it does worsen. And so depending on where you are in pregnancy.
Phoebe:if you are
Rachel:to experience this type of pain, then the more you push through it, the worse it's probably going to get. Treatment can help stop it worsening. Um, sometimes it can resolve it, but often you have to make a lot of lifestyle modifications to treat it. And one of those sometimes can be like quite heavy exercise modification because at the end of the day, exercise should be making you feel good in pregnancy and kind of keeping you healthy. Aches and pains at bay. If exercise starts to flare things up, it's often not a good form of exercise for you, but everyone's bodies are very different. Not everyone gets the same symptoms. So it's really again, just like a case by case kind of unique situation.
Anna:Yeah. And this is probably a silly question, but if you were to. like run through it. Could that cause long term effects like post pregnancy or like with stress fractures and that kind of thing? Or is it once the baby's out, if the pelvic, no matter how bad the pelvic girdle pain is, it'll decrease?
Phoebe:I
Rachel:decrease? any stage of life, if you have any soreness in your body and you keep pushing through it, your brain knows the movement and it will do whatever it needs to do to allow you to keep doing that movement. And so just kind of imagine that you've got a bit of a sore hamstring and you keep pushing through with your running, like you just end up compensating. And like with the compensation, you might develop this like change of like gait with your running and you're like loading your other side way more which might make you prone to like a stress fracture or other things and I guess once you develop those compensations they're pretty hard to undo all of that so if you keep pushing through that in pregnancy the compensation that you've then kind of created for yourself, that's not just going to go away postpartum because your brain and your body are now used to working in that way. Yeah. And so like, I suppose if I talk about me, I was quite unwell in my first trimester and I've been a runner my whole life and I probably didn't exercise a lot for about six months. weeks. I went for a run at 11 weeks in my pregnancy. And I felt okay running. And as soon as I stopped, I like kind of developed this really severe pubic bone pain. I couldn't run the rest of pregnancy. I even struggled to do walking and other forms of exercise because it just flared up so acutely. And so I guess like, You know, when I experienced that myself, it made me realize how acute these things can be. and that if I had kept pushing, I would have, one, made it worse, but I just would have developed the worst compensation pattern and really impacted my ability to do it in the future, I guess. And so I feel like my role as a pelvic floor physio is to help guide patients to, at the end of the day, ensure that if running is really important to them, that we get them back to it, to be able to do it lifelong. And pregnancy is a temporary stage of life. We do really want people to be able to return symptom free postpartum. And that's the ultimate goal, really. Yeah.
Phoebe:was like the sorry, a slightly personal question, but like psychological
Phoebe1 fixed:impact
Phoebe:of that for you, like, running your whole life and then not being able to exercise to a large extent. Like,
Rachel:Yeah, it was hard because I think you kind of go into pregnancy and you like, think that you're like going to be really healthy and eat all these like really good foods. And then when you feel sick, you're like, okay, just survival. You just eat the plainest stuff. Like one night for dinner, I had like rice with cheese on it, which is like probably what I ate as a kid, like it being really fussy. But then like, from an exercise perspective, to have something that really impacts. your ability to exercise in all forms, like the groin pain and pubic bone pain that I developed. Like I couldn't swim with it. I couldn't like do a lot of my Pilates exercises with it. So there was a lot of stuff that I like just all of a sudden couldn't do. and then postnatally, like I've only done a handful of runs because it actually persisted to be an issue with me for running and it's only recently resolved with running and I'm One year postpartum now. So it was something that a pelvic girdle pain for a lot of people resolves as soon as baby is out. And I didn't have any issues with my day to day stuff. But as soon as I would load myself with a run, it's like my pelvis couldn't cope with it and it was still there. Um, and I'm still breastfeeding and the hormones are probably contributing to that as well. But. I guess it's been a really long journey. So it's been almost two years since I've been able to put together, you know, consistent runs. Yeah.
Anna:together. Yeah. Wow. what are some examples of how to keep active in
Rachel:Mm. I think from like a strengthening perspective, definitely making sure you're maintaining some form of strength. And runners are like notorious for not doing a lot of strength work ensure your muscles are working well, to keep you running for as long as possible. Um, so if you're not used to doing a lot of strengthening, Pilates is probably, the safest way to start, you know, whether you do like a pregnancy reformer, Pilates class, or you sign up to some kind of like pregnancy safe, um, exercise through an app where you do it at home. Definitely at this kind of time in pregnancy when we're considering like exercise on your back, maybe something you might want to do. It's not like there's a full course on pregnancy that
Phoebe:So running throughout your second trimester, in terms of the impact on your pelvic floor, other risks associated with it by then?
Rachel:it by that? Generally around 20 ish weeks we start having conversations with people about baby's weight on pelvic floor and the lack of research we have about how it does impact your pelvic floor. I suppose to get good quality research, you need to be able to end up having a control group, which is like, keep doing your low impact exercise. Let's not stress your pelvic floor with running. And so there are people that are in a safe group, I guess. And then you have your experimental group, which are the people that you'd be pushing to do high impact exercise and monitor how that impacts your pelvic floor. In pregnancy, we can't really do that. Like it's not it's not ethical. Yeah,
Anna:I was going to
Rachel:not, it's not ethical. Yeah. And so we're probably never going to get good research that compares that for us. Um, So we can't be certain that running is safe for your pelvic floor, but we also can't be certain that it's unsafe. So I think when you're working with a pelvic floor physio, you know, we're looking at your pelvic floor muscle strength, your endurance, your coordination. We're looking at your anatomy, seeing what your connective tissue is doing in terms of how I suppose lacks or how much movement is it allowing your organs to move. And then what's your technique with running? How strong are you? Is it something you should continue to do because we can't find any other risks other than you being pregnant. Um, and if that's the case and running is really important to you and we can't find a substitute exercise to replace it, we will keep people running and keep monitoring their pelvic floor function and their strength. To ensure that they're doing it in a safe way. Um, so that's about 20 weeks onwards. We have those conversations, but other people running might not be as important. They're already feeling like, Oh, I've got these niggles, or I feel like it's probably not the best thing for me to be doing. And they start to modify their exercise anyway. Um, The weight of baby at this point isn't enough to be causing weakness, but the load of running on top of the weight of baby, we're just not sure. I guess our biggest concern is the connective tissue, if you imagine that as like a femur, Fishing around your organs. Once that stretches, we can't just fix that for you. We can't train that. It is something that hopefully will spontaneously stiffen and improve postpartum, but we can't fix that by doing exercise. That's our biggest concern with high impact exercise in pregnancy, because we know with the hormonal changes, it's already going to be more laxal more stretched than it is outside of pregnancy. A weight of baby is going to stretch it as well. Bye. is running something that may stretch it or overload it too much that's irreversible, we don't know. Yeah,
Phoebe:What are the risks of the connective tissue getting expanded,
Rachel:Yeah, like stretched. Yeah, so the biggest risk is prolapse. So the word prolapse means like a slipping or a falling. So the vagina in our female anatomy is space for the organs to be able to slip or fall down into. So the bladder can kind of fall backwards into the front vaginal wall. The uterus could sit low or the rectum can fall forwards into the back vagina wall. And if they're resting low near the vaginal area, entry. It can cause symptoms of vaginal heaviness or a lump or bulge or a dragging sensation. Um, prolapse, we don't have great treatment options to fix it. So postnatally, because you have like a big kind of drop in estrogen levels that helps stiffen everything up and you have like a big recoiling effect in the postnatal period, which can resolve these things. But not for everyone. There are, um, certain risks associated with postnatal. birth that can make you more prone to not having spontaneous recovery occur or to having further injury of the connective tissue. Um, But I guess like pregnancy is already a risk factor for that to occur because you've got baby stretching everything plus the hormonal changes. A vaginal delivery is going to be a risk factor of prolapse as well. But things from a lifestyle perspective that are risks of that is high impact exercise, exercise. really heavy repetitive lifting, um, constipation and straining on the toilet and then sickness like vomiting, coughing, sneezing, um, repetitively for prolonged periods of time. So lifestyle wise in pregnancy, because pregnancy and vaginal births are already big risk factors for prolapse, We try and manage everything else as best as we can from a lifestyle perspective to decrease Yeah. So baby is much, much bigger. Yes. Um, so weight of baby in trimester three from For most people, it's between 31 and 33 weeks. You've got a constant strain on your pelvic floor. Weakness does start to occur to the pelvic floor from this point onwards. So, um, most people in this point, a lot of the focus does turn to birth prep And like for vaginal deliveries, we have more and more races. study research coming out that pelvic floor muscle relaxation is really important to decrease the length of the second stage of labor. So with the pushing phase of labor that's your second stage of labor the longer you push for the high the risk of complications and intervention and then for pelvic floor trauma but also poor outcomes with your recovery postpartum. So the role for us in the third trimester is to prepare your pelvic floor to decrease, the risk of you having a long pushing phase. So a lot of our focus moves away from strengthening in it. I guess it sounds silly because you know, your pelvic floor is already getting weaker, I guess, because of baby's weight, but we do work a lot on relaxation. And for most people that starts at 34 weeks onwards for their birth prep
Anna:what does that look like?
Rachel:So I guess kind of like if you're doing relaxation exercises for other parts of your body, you might be doing a bit of body scanning where you're just aware of the area regularly throughout the day, checking in, are you tensing it? And if you are like relaxing it, you might be practicing what we call a down training program, which is a relaxation program where we do a small contraction to elicit a good relaxation. And the idea is to just be practicing those things as often as possible. So you know exactly what your relaxed pelvic floor should feel like. Um, and then you're looking at your perineal massage and, you know, other things to work with pelvic floor relaxation and to stretch the perineal
Anna:was, I actually was talking, I know, as you can tell, I don't know anything really about
Rachel:pregnancy
Anna:and running or just pregnancy in general, but I was telling Phoebe yesterday that I'd heard of PMS. The perineal
Rachel:But that was
Anna:but that was the extent of my knowledge. I don't know why he did it, but I've heard of
Phoebe:A massage happens,
Rachel:A massage happens, yeah.
Anna:heard the word massage and I was like,
Phoebe:like, okay. And
Rachel:Literally. And that's exactly what it is. It's like massaging the perineal body. Cause it's like a fibrous junction where the muscles come into so it doesn't stretch or elongate as well. So that's all to kind of hopefully decrease risk of severe pelvic floor injury with vaginal birth and to decrease risk of complications. So, the shift does move a lot to that in the third trimester. And like, I guess from a running perspective, I would, I would argue a lot of people do start to feel uncomfortable running in the third trimester. but if you didn't, and it was something you were continuing to do, if you're not already seeing a pelvic floor physio at that point, it's definitely recommended that you do, because of the weight of baby already on the muscles and the connective tissue, the stress of writing is really something. There is something that should be, um, I suppose spoken about with someone that is specialized in that area just to ensure that you're not doing anything that could be harmful for your pelvic floor. Based on the individual and how important it is to them, I would, we'd definitely be having the conversation of, is there another form of exercise that is going to tick those boxes for you of whatever the reasons are that you're running, can we find something to substitute it, that's still going to have the same outcomes for you with your mental and physical health that you want, if there's
Anna:would examples of that be?
Rachel:It could be like jumping on a spin bike. It could be like, you know, getting in the pool. It could be doing a little bit of strengthening instead. It really just depends on why someone's running at that point.
Phoebe:it, it sounds like you could be feeling really good, but still be doing damage to your pelvic
Rachel:Correct, yeah, yeah. And you're
Phoebe:it's not like a sign that it's
Rachel:of that. Yeah, it's not a sign that it's okay. And I guess like, we haven't touched on it, but from an intensity perspective with um, running in pregnancy, the recommendations are that you can hold a conversation with someone while you're exercising. So the entire time, so you're You can push yourself as hard as you want, as long as you're in a non complicated pregnancy, as long as you feel like you could talk to the person next to you. And so that's the general advice for exercise in pregnancy at the moment.
Phoebe:Does the, the temperature recommendations, are they the same across pregnancy or is that just in first trimester?
Rachel:trimester is probably when it's more essential because of the risk of the congenital defects But they do recommend that for the entire duration of pregnancy And so it's the same with like your hot pilates, hot yoga It's kind of ruled out for the whole pregnancy as well as like saunas, heated environments in general
Anna:But so, um, like Pilates and yoga
Phoebe:like
Anna:unheated, like that's okay to continue to do?
Rachel:yeah, totally fine. As long as so with the whole laying on your back in pregnancy, um, as baby gets bigger, there is a compression of one of the arteries, which decreases the blood flow to the uterine cavity. Therefore your baby. And so. It's really conflicting advice out there at the moment. Some of the recommendations are that you shouldn't lay on your back from 12 weeks in pregnancy. And then there are other recommendations that are like 16 weeks, 18 weeks, 20 weeks and then 27 weeks. So I think it's like everyone makes their own decision in pregnancy based on what they feel like is right for them based on the information that they're gathering. And so for different people, some people will cut out that type of exercise at 12 weeks very early on because it has to be modified at some point anyway. for others, they'll cut it out in the third trimester. Similar how some people drink coffee in pregnancy, some don't. Like, everyone chooses, I think, to do what's best for them. but in the third trimester, it's definitely not recommended to exercise on your back. And so everyone needs to modify it by the third trimester if they can. And so, I always have the discussion with my patients needs to be modified at some point. So can we try and modify early to get you in good habits and just then keep your exercise consistent throughout.
Phoebe:And what about core
Rachel:in general? Yeah, so once you have a bump or you're showing, your six pack muscles are on a little bit of stretch. So if you do crunches, it is a risk for further abdominal separation. So I guess your six pack muscles run straight down the midline of your tummy. It's normal to have a small gap between the six pack muscles because there's connective tissue there. In pregnancy to allow space for your baby to grow, they naturally separate. So by 33 weeks in pregnancy, Everyone has abdominal separation that's more than normal. It's just unavoidable. But you are at risk of making that worse if you do inappropriate core exercises like crunches. because they need to, like, stretch and allow room, like, the tie to your core is sometimes. The more prone you are to the abdominal separation as well.
Anna:And Just say for, whatever reason, you can't get to a pelvic floor physio before you get pregnant. Is there anything, um, any advice
Rachel:Yeah, I guess like from a, I suppose the pelvic floor is a hard one because you can't see it. It's really hard to know what your pelvic floor is doing prior to, seeing a pelvic floor physio. But if you, if you can't get to one for whatever reason, I think that it's important to just know that the relaxation is just as important, if not more important than your ability to contract the pelvic floor. So the most common thing that people are presenting with. on assessment in pregnancy or even like any stage of life is like an overactive pelvic floor where they actually struggle to relax. And so if you have an overactive pelvic floor, which is a lot of people that do running or high impact exercise and you can't relax and you're like, Oh, I need to do all this strengthening because I have X, Y, or Z going on. The strengthening can actually make things worse if you're not relaxing properly. So That's probably just the biggest thing to keep in the back of your mind. And then I guess if you're someone that is doing like exercise, that's not appropriate for pregnancy, like exercising in heated spaces and things like that, it probably is a good idea to think about how can I modify those exercises before pregnancy to still be doing something that's safe for me to be doing in pregnancy in the first trimester so that you can just keep it going. I think for me that was maybe a downfall because I was doing a lot of hot pilates. And then all of a sudden when I was pregnant I couldn't do that. But I had to change my whole routine around that and maybe that didn't help. Yeah.
Anna:I guess like so many things are changing anyway. It's probably nice to have like some consistencies.
Phoebe:Um,
Anna:thank you so much for answering all of our questions, and excited to have you on next week as well to talk about all things running postpartum.
Rachel:Perfect, thanks for having me.
Phoebe1 fixed:We're going to finish off with some running recommendations. I've gone down the route of, obviously Anna with your race this weekend, I've had a really good think about a race wreck. And I've got a cracking race wreck. And I believe you have a race wreck as well, or no?
Anna 1:a running wreck. Oh, okay. Can be race wreck, actually. Okay. Not really. Well Running race wreck. Wait, so it's not a
Phoebe1 fixed:so is it a race rec or just a
Anna 1:wreck? Uh, running wreck, but like, it can
Phoebe1 fixed:It applies. If you're running in your
Anna 1:race, I mean, cause to do a race, you gotta run,
Phoebe1 fixed:gotta run. Okay, well I'm interested. What's your, what's your rec?
Anna 1:I've got a, I've got a highbrow rec and a not so highbrow rec. Catering for all. Catering for all. So, this rec is a listener rec and it's also a host rec, um, by listener Maddie. She's run, she's run 38 minutes. I know this listener personally, long run for listener Maddie. Um, she's on 5. 5 kilometers.
Phoebe1 fixed:Turning into a weekly weapon segment,
Anna 1:Sorry. Yeah. So this morning's run, as she says, was 100 percent fueled by Wait for it. The Tortured Poets Department. Taylor Swift's newest album release. So, that's just a recommendation, um, for life in general, and to accompany you on your run. Can confirm. Great lesson. Should we swap to you
Phoebe1 fixed:I've Got, um, props.
Anna 1:this is, okay, this is
Phoebe1 fixed:big, but I'm going to say this might be the best running rec. given on the show because this running wreck changed my, it's a race wreck and it changed my life.
Anna 1:So,
Phoebe1 fixed:one of the biggest challenges people have in races is hydrating sufficiently and it is really hard. So if you're an elite runner, you get a little bottle and you get to put it on a bench and that's great because it's easy to drink from, but all us plebs need to be able to pick up a cup as so that's full of water. And as you're running somehow transfer that water into your mouth without just spilling it all over yourself. And I know a lot of people, well, me for years, I would like choke on the water. I'd really struggled to get more than just like a sip, just a sip in. So let's demonstrate.
Anna 1:So this
Phoebe1 fixed:this is a cup. As listeners can hear, I'm pouring water into the cup. Okay, this is a cup. You've picked it up. You know, it's swishing everywhere, you're losing all this water, you can't drink
Anna 1:you're losing all the space. Okay, I'm gonna
Phoebe1 fixed:There's not much left. Yeah. Place your hand as such. So I am, I'm basically holding it like this. like you'd normally hold a cup, I guess. So you have your thumb on one side and then your
Anna 1:then
Phoebe1 fixed:forefinger.
Anna 1:Index
Phoebe1 fixed:index finger, other fingers. Yeah. But yeah, that's true. Wrapping around the other side, close it up Like you want it to be like a line either side. And I, that obviously stops the water from escaping, but it actually forms a little it forms like a little mouth hole.
Anna 1:And you can
Phoebe1 fixed:really effectively.
Anna 1:for
Phoebe1 fixed:carry it with you for like a few hundred meters. Take sips, drink from it. As you go,
Anna 1:catch
Phoebe1 fixed:over at the end. Exactly. Catch your breath, have a sip, have a proper like swallow of water. I not need to try and like scull a cup, but just actually have a few sips.
Anna 1:I will test it out on Sunday and report
Phoebe1 fixed:Sunday and report
Anna 1:Um, so my second recommendation.
Phoebe1 fixed:your high brow? Yeah,
Anna 1:I guess more highbrow.
Phoebe1 fixed:high brow. Ha ha
Anna 1:Um, yeah, so this is my highbrow rec. I guess quite topical for today's episode because we're talking about pregnancy and running through pregnancy, but this is to read Jess Stenson, who is a professional Australian marathon runner. Blog post, her most recent article, is about the marathon that she completed a couple of weeks ago in Korea, um, as a mom of two and Seven months after the birth of her second child, she has gone on to actually run a PB, in Korea, but less so about the PB, but more just about her like mindset and the logistics between, behind the planning and even on race day, she goes into detail about that. And I just think it's an amazing read from an amazing
Phoebe1 fixed:Yeah, yes, her perspective and her ability to remain feeling grateful and focusing on those things is so impressive. At every stage, she's working through these massive challenges, and she is so hyper focused, on the opportunity and the gratitude and like the love of her family and that side of things. It's very inspiring.
Anna 1:so inspiring. And also quite refreshing. I think sometimes, you know, we're like, we all tend to sort of get caught up in like the running race and like how serious it is and blah, blah, blah. But it's like, she's performing at such a high level. Like she's on that elite race bus with her seven month old baby. When people are warming up 15, 20 minutes before the race, she's breastfeeding and just the like calmness, um, that she like obviously has like internally is just amazing.
Phoebe1 fixed:Go Jess.
Anna 1:Go Jess! all right. Thank you so much for listening. We hope you enjoyed the podcast today. it's a one of two part series, so we will be dropping the second episode about, how to come back from running post birth next week. As usual, please subscribe, leave a review on wherever you get your podcast, that really helps the show. Um, share this episode with a friend that you think might get something out of it. Um, and yeah, we can't wait to be in your ears next week.
Phoebe1 fixed:Nice. Bye! Bye! Like,
Anna 1:like, mouth hole. I've
Phoebe1 fixed:I
Anna 1:you find
Phoebe1 fixed:don't speak.