Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women

Abstract

ObjectivesTo examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI).Methods881 postpartum women completed an online questionnaire. Clinically and empirically derived questions were created relating to running experiences and multidisciplinary, biopsychosocial contributory factors. Logistic regression was used to determine predictors for return-to-running, returning to pre-pregnancy level of running and running-related SUI.ResultsMedian time to first postpartum run was 12 weeks. Running during pregnancy (OR: 2.81 (1.90 to 4.15)), a high weekly running volume (OR: 1.79 (1.22 to 2.63)), lower fear of movement (OR: 0.53 (0.43 to 0.64)) and not suffering vaginal heaviness (OR: 0.52 (0.35–0.76)) increased the odds of return-to-running. Factors that increased the odds of returning to pre-pregnancy running level were a low weekly running volume (OR: 0.38 (0.26 to 0.56)), having more than one child (OR: 2.09 (1.43 to 3.05)), lower fear of movement (OR: 0.78 (0.65 to 0.94)), being younger (OR: 0.79 (0.65 to 0.96)) and shorter time to running after childbirth (OR: 0.74 (0.60 to 0.90)). Risk factors for running-related SUI were having returned to running (OR: 2.70 (1.51 to 4.76)) and suffering running-related SUI pre-pregnancy (OR: 4.01 (2.05 to 7.82)) and during pregnancy (OR: 4.49 (2.86 to 7.06)); having a caesarean delivery decreased the odds (OR: 0.39 (0.23 to 0.65)).ConclusionRunning during pregnancy may assist women safely return-to-running postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.

Beyond the Musculoskeletal System: Considering Whole-Systems Readiness for Running Postpartum

“…If postpartum women are struggling to return-torunning, a potential concern may be fear associated with the movement itself, termed fear of movement (FOM). 4 Derived from the fear-avoidance model, FOM is a psychosocial construct that focuses on pain-related fear associated with physical activities. 74 Evidence shows a high FOM is negatively associated with return-to-sport following musculoskeletal injury.…”

“…2,11,12 Educating women about these physical changes and the influence of lifestyle factors throughout the perinatal period is likely to be the first step to engage them with postpartum rehabilitation. 4 Other factors that influence their physical condition after childbirth include baseline physical conditioning, biomechanical changes, and birth experience. 8,13,14 Like any period of relative deconditioning, a period of reconditioning should follow as is recommended within physical activity guidance 15 and return-tosport injury models.…”

“…75 In the postpartum population FOM during the healing time may actually be a protective action to avoid behavior, such as running, which could be detrimental to recovery. 76 However, if this fear persists beyond the healing time, it could be maladaptive and lead to women not returning-torunning 4 or altering movement patterns to protect the body. 77 For example, postpartum women appear to prioritize gait stability by restricting trunk and pelvis motion, while increasing ground contact time and step width during running.…”

“…3 Postpartum women likely engage in running due to its convenience of access, cost-effectiveness, and flexibility during a transitional period in their life. 4 In recent years, the need to consider compromised abdominopelvic health in postpartum women who return to exercise too soon has been highlighted. 2,[5][6][7] This is a positive step toward stimulating female-focused research and enabling the formulation of clinical practice guidelines.…”

Rehabilitation of the Postpartum Runner: A 4-Phase Approach

“…After childbirth, runners commonly resume running between 2 weeks and 2 months postpartum 1,2. Runners who are postpartum have reported pelvic floor dysfunction and musculoskeletal pain2–5; however, running also produces psychological and physiological health benefits, including reduced risk of premature mortality and cardiovascular disease, improved endurance, and weight management 6,7. Because of these benefits, and the ease of access to running, it is important to facilitate return to running after childbirth.…”