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Baby, I’m Coming Back: Postpartum Fitness, Weeks 6-10

Baby, I'm Coming Back is a series during which we follow Train Like a Mother Coach MK Fleming as she returns to running shape from having her fourth kid in six years.

Weeks 6-10 focus on Pelvic Floor health (see below), as well as two exercises: TA March + Heel Slide, demonstrated in this video and explained in this PDF you can reference anytime.

Find Weeks 0-6 here, and look for weeks 10-14 in about four weeks! 

"Women tend to think of the pelvic floor with regard to sex and continence, but you may not realize pelvic-floor muscles play a major role in core stabilization and injury prevention. These muscles, along with the rest of your core, are responsible for stabilizing your pelvis and thorax through movement. If any component of your core breaks down, you risk injury when you move." - Kara Vormittag, M.D., a sports medicine physician in Park Ridge, Illinois, quoted in Runner's World

As the elevator descends from the heights of pregnancy, I think of the first stop as home with the new baby, as you adjust to your new—and possibly sore—vagina.

The next stop, usually 6 weeks after birth, is the OBGYN visit where you are examined and hopefully released to resume regular activity, specifically intercourse and exercise.

What the doctor says: "Medically speaking, exercise isn't dangerous right now."

What we hear: "OMG I RUN NOW YAY! I am never thinking about my vagina EVER AGAIN!"

It's easy to think we are home free at this point. I mean, who WANTS to keep thinking about their vagina?

What's important for runners to remember is that your doctor probably isn't evaluating the integrity of the muscles or tendons in the area. She isn’t saying that your pelvic floor is A-OK and won't be a problem when you start running again. She’s definitely not saying that you won’t leak in your capris, because you probably will.

That's not her job; her job is to say, more or less, your body is healthy enough to run.

I hate to say it because none of us really want to hear it, but this is MY job: The very next stop on your recovery elevator should be a Pelvic Floor Physical Therapist (PFPT). It is a super helpful, necessary stop (IMHO), especially for runners.

In fact, now that I've been to a PFPT (the first one in four births!), I can say with assurance you shouldn't resume running until you've been released by your OBGYN AND a PFPT.

Even if your birth memories are as hazy as the memory of your first finish line, know that it's never too late to address your pelvic floor. Even if your youngest is 18 years old. Especially if you are a runner.

Running (and jumping and other high-impact activities) put a lot of pressure on your pelvic floor, the sling of muscles at the base of the pelvis which support the bladder, bowel, vagina and uterus.

A weak pelvic floor can cause urine leaks, which is super-common in women who've had a baby, whether they run or not. Hormone changes around menopause can make this worse.

There can be signs, other than leaking urine, that your pelvic floor needs to be stronger to cope with the sustained impact of running. These include:
· You have seen or felt any bulge at the entrance to, or inside of, your vagina (this can indicate prolapse of bladder, uterus or bowel);
· You feel a sense of heaviness in the vaginal area or that something may literally fall out
· You feel an urgent need to urinate after you have been running;

Leaky bladders are a sure sign that the pelvic floor isn't doing its job. If this is the case and you continue to run without addressing it, you are headed for injury. This is entirely preventable.

A lot of the time, the signs aren't as obvious. If you aren't leaky, if your kegels are strong, if sex or bowel movements aren't painful, you may still need to work on your pelvic floor, especially if you’re battling injuries as a runner.

As a running coach, I’d say your pelvic floor may need some attention if:

· You complain about tight hips. More often than not, this isn't about hips being tight or overworked as it's about something pulling the muscle abnormally. It's entirely likely this source is internal.

· Near chronic piriformis issues: Same situation as above; the pulling could absolutely be coming from the posterior pelvic floor.

· If you have tight hips AND near-constant piriformis tightness that regular PT hasn't been able to solve, this is a sure sign you need to see a pelvic floor PT.

· Inexplicable recurrent lower back pain, especially if chiropractor hasn't helped.

· Continual SI joint pain (especially if previous therapy hasn't helped)

"So, ok, I think you're talking to me. I'll check with my insurance to get a referral. In the meantime, WADOIDOO, COACH?"

· Find a pelvic floor PT in your area. Pelvic Guru and Pelvic Rehab both have helpful directories. If you can, find one with the OCS certification who is also certified to do dry needling and manual therapy.

· Cease and desist all speedwork or pacework IMMEDIATELY. Odds are you're doing more harm than good.

· Avoid downhill running for the same reason: this involves greater forces on your pelvis.

· Consider doing workouts on the elliptical to reduce impact to your pelvis.

· DO WHATEVER THE PT TELLS YOU TO DO, NO MATTER HOW HUMBLING OR SILLY IT MAY SEEM. Little movements add up really quickly and lead to lasting change.

If you plan to run for the rest of your life, taking 16 weeks off to repair a really big problem right now is a small tradeoff compared to all the running ahead of you. Let's make sure that running is injury-free.

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Violet is now 3 months old (OMG HOW?) and my PVPT visits have dropped from 2 per week to 1 per week, but I still have daily exercises to perform.

This video and this handout give you ideas of some of the moves I've been doing from weeks 6-10; give them a go!

p.s. I'm really excited to report that my pelvic floor PT and regular physical therapist both cleared me to start (GENTLE, EASY) running last week! I can't wait to tell you all about it! Stay tuned!

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