I am often asked, can I run while pregnant? For a pelvic floor physiotherapist that can be a very loaded question. Firstly, the health of the growing baby and mother are of utmost importance and approval must be granted from the primary physician, usually a family doctor or an obstetrician. That being said, most Canadian guidelines encourage physical activity and exercise in an uncomplicated pregnancy. (Curious about what factors are considered for a complicated pregnancy? See SOGC/CSEP clinical practise guidelines here.) The benefits of exercise during pregnancy include lower risk of gestational diabetes, high blood pressure, varicose veins, excessive weight gain, deep vein thrombosis, loss of strength, low back pain, fewer complaints of shortness of breath as well as improved cardiovascular fitness and mental well-being. Women are also encouraged to choose activities that are least likely to lead to falls or abdominal injury.
So what about running? At the beginning of my career I would have just given the blanket statement of “NO”. Running can put quite a force on the pelvic floor. Add the weight of a growing baby, and hormones that make connective tissues very flexible and some of my colleagues would argue that there is too much repeated stress on the pelvic floor. However, we are starting to make decisions based more on the individual in front of us and to consider each case carefully.
If someone has been running consistently prior to becoming pregnant, they are a better candidate to continue running during pregnancy. The Society of Obstetricians and Gynaecologists of Canada (SOGC) does not promote starting a new type of exercise during the first trimester. The SOGC also cautions women about exercising in heat or if there is a risk of fall – so running at noon on a summer day, or on icy sidewalks in January are probably bad ideas.
However, the SOGC guidelines currently make no comment on the health of the pelvic floor in their exercise recommendations. As a pelvic floor physiotherapist I look at the pelvic floor muscles much like other muscles in the body. Some women maintain very strong pelvic floor muscles throughout their pregnancy. The shape of their pelvis, the size of the growing baby, the health of their pelvic floor prior to becoming pregnant all create a pelvis that can withstand the force of running without any issues. Other women might have a less than ideal pelvis for running while pregnant. Some women have weaker muscles, previous low back/ sacro-iliac joint/sciatica issues, larger babies, etc., that lead to problems with high impact exercise like running.
If I was working with a runner, and her knee gave out after 1 km of running, I would advise her to walk, or maybe stop running while we rehabilitate the knee. Similarly, if a pregnant woman starts leaking urine, or experiences pain in her pelvis or genitals during a run, I often advise her to adapt her running technique or choose a different form of exercise. Possible signs that a pelvis or pelvic floor is struggling to cope with high impact exercise includes urinary or fecal incontinence, low back or pelvic pain, vaginal heaviness, hemorrhoids, or vaginal varicosities. If these symptoms occur, it is time to re-evaluate the current exercise program.
Now, there are the occasional patients who experience symptoms like urinary incontinence while running and who get my recommendation to choose a low-impact activity, but decide to continue running. Urinary incontinence isn’t a painful symptom, and incontinence pads can be worn during exercise. In this situation, there is very little research investigating if continuing to run will cause any risk to the pelvic floor in the long term. Also, pregnancy can be stressful enough. If a pregnant woman uses running as a stress reliever, and the woman’s general health is fine and the developing baby is safe, the advantages of continuing to run might outweigh the stress placed on the pelvic floor. The decision is up to the individual at this point.
For now, I will continue to monitor the muscular and pelvic health of my patients and give advice based on the information that I have, for the individual in front of me. I will always try to keep a woman as active as her pregnancy allows. All pre-natal exercise plans should be discussed with a patient’s obstetric practitioner. A practical tool to prepare for this discussion is the PARmed-X for Pregnancy, available from the Canadian Society for Exercise Physiology. We should all strive to help create more healthy, happy and active pregnancies.
BSc, MSc. PT