Running during pregnancy - Practical advice from the CSPC Physiotherapists.

Comprehensive research has been done on the effects of exercise in pregnant women and has shown that in most cases for normal, healthy women, regular exercise during pregnancy is beneficial and safe for both the mother and the baby. Exercise during pregnancy should be done with medical guidance, but is safe assuming there are no medical risks, that mother and baby are both healthy, and that there is no sudden increase in exercise levels. Running during pregnancy is a great way to maintain aerobic fitness levels, but not for aiming to dramatically increase fitness, and obviously in the latter stages, the ability to train will reduce.

If you have not run before, you might be better to choose other forms of exercise while pregnant, for example walking, swimming, stationary bike or circuit/strength training using exercises that are safe for pregnant women.

Pregnancy is a time of great change in a woman's body, and it is recommended that pregnant women start or continue exercising to gain the health benefits associated with exercise. There are some small things that you can do to help to look after yourself and prevent injury, if you choose to continue to run during pregnancy. This advice is also good for those who don’t want to run, but who want to reduce the risks of aches and pains in pregnancy.

What are the benefits of exercising during pregnancy?

For normal pregnancies, regular weight bearing exercise has been shown to improve the fitness of both the mother and the baby; reduce excessive weight without affecting the growth of the baby; protect against coronary heart disease, osteoporosis, high blood pressure and reduce the risk of gestational diabetes mellitus.

It can also help to improve bone density of the mother.

Other common issues during pregnancy are fatigue, constipation, varicose veins, and swollen feet and ankles and these are all reduced in women who exercise.

Hormonal effects of pregnancy on our bodies

Pregnancy has a massive effect on our bodies - the size of the growing bump changes our body alignment enormously, which puts huge stress on our muscles and joints. In addition to this, the hormone relaxin is released from the beginning of the pregnancy.

The effects of the hormone relaxin, which increases the laxity (looseness) in the ligaments around the pelvis to prepare the body for the birth of the baby, starts to show at 6 weeks, and peaks at 12 weeks. Relaxin also increases mobility in joints such as the hips, shoulders, feet and ankles.

The resultant ligament laxity and hypermobility can be long lasting and can cause pain and altered biomechanics throughout the lower limb and altered spinal alignment. Exercising and including strengthening, stabilising and balance work during pregnancy can help to reduce pain and dysfunction by supporting the ligaments and joints, and are even more important if one is trying to continue to run when pregnant.

Stay cool, eat well

It is important to keep body temperature from rising excessively (hyperthermia)- both exercise and pregnancy raise the metabolic rate, and it is important to stay cool, for example by exercising with few enough clothes and to use fans etc. Pregnant women do perspire more readily, which helps with temperature control. Drink plenty of water to remain hydrated. Pregnant women are more likely to become hypoglycaemic, so adequate calories should be eaten before and after exercise. Keep pace of running steady, rather than doing hard reps, which will also help to control body temperature.

Joint care

Excessive weight gain, in addition to normal “baby weight gain” during pregnancy can be a big problem for many women, and exercise, along with a healthy diet can help to minimise this. Muscle strength is important to protect joints whether pregnant or not, and this is doubly important in pregnant women where joints will have increased laxity, and there is an altered centre of gravity and posture. One study has shown that weight gain in pregnancy may increase hip and knee joint forces by up to 100% in weight bearing exercise, so it is important to stay strong to help protect your musculoskeletal system.

To help protect all of the joints in your body, it is important to include some exercises to combat the effects of increasing laxity, changes in alignment, and alterations in the mother’s centre of gravity as the bump gets bigger. Balance work is important as it helps with all of these issues, and helps to strengthen the feet. Stand on one leg, pelvis level, and keep the arch of the foot lifted, and ensure that you are keeping your toes relaxed, and do this on a daily basis.

Feet

Laxity in the joints in the feet can cause them to flatten, so doing some strengthening exercises for the feet- for example foot tunnels (curl all toes under, so making a tunnel under the foot (i.e. the outside of the foot is lifted as well as the arch). I would also recommend that good trainers are worn for running, and that when not running, wearing supportive shoes in the house and when walking elsewhere.

Calves

Normal weight gain for a woman through a pregnancy is approximately 10-15 kg, and should largely be around the abdomen and pelvis. It is important to get the calves strong and to maintain this throughout the pregnancy, in part to protect the feet as the ligaments become more lax and also if you are running, to keep the calves strong enough to cope with the extra body weight, and prevent injury. I would suggest that calf raises are done with both a straight leg and a bent leg. If you have never done these before, start with two legged calf raises, building to 3 x 20 reps, and then progressing these to single leg calf raises, 3 x 20 reps of each. Calf raises should be done after running, not before, and can be done on other days too.

Quads stretches

Quads are the muscles down the front of the thighs and it is vital to stretch these in pregnancy - the position of the baby, and the bump can result in a forward tilt in the pelvis, and is worsened by short quad muscles. Anterior pelvic tilt puts stress on all of the joints in the pelvis and lower back and results in pain. To help to address this we recommend side lying quads stretches, which should be done daily, throughout the pregnancy, to gain length initially, and to maintain it through the pregnancy.

Core control and strength

As the abdominal muscles are stretched throughout the pregnancy, they lose tone and strength. It is possible to continue to work on the strength of the abdominal and core muscles throughout pregnancy, under the guidance of a physiotherapist or Pilates teacher, who will take into account the stages of pregnancy. There will also be a normal split in the tendon vertically in the middle of the abdominal muscles, because of which care will need to be taken in the rehabilitation of the abdominal muscles after the baby is born. Just remember that you should not lie flat on your back to do core work after 12-16 weeks, as there can be an effect on circulation, and should definitely not be done if dizziness is felt. The pressure of the baby can compress the large vein in the abdomen, the vena cava, and reduce blood flow in the mother, resulting in feeling faint, associated with lower maternal cardiac output in this position and symptomatic hypotension.

Pelvic floor

Pelvic floor exercises are useful during and after the pregnancy to reduce the risk of future urinary incontinence. Advice should be sought from a physiotherapist experienced in this and is important to do especially if running due to increased pressure on the pelvic floor from the running itself, and from the ever increasing weight of the bump

Pec stretches

As the bump increases in size, and the bust gets bigger, I would recommend stretching out the pectoral muscles which are the muscles at the front of the chest, which when tight, can cause pain in the upper back, alter breathing and cause the posture to become more rounded. This can also help to alleviate symptoms of carpal tunnel syndrome. It is also important to continue with this when the baby is born, due to the increased amount of time new mums spend in a flexed position, feeding and holding their babies.

Running bra

A good running bra should always be worn by women when running, but especially during pregnancy as the bust size increases throughout the pregnancy, and I would also recommend a supportive bra at other times too, which can help to alleviate upper back pain.

Getting back to running after the birth

Don’t rush back to running after you have had your baby! Giving birth has a huge impact on your body, and it is important to follow advice to return to running safely. Please make sure that you are given the green light by your health professional, and that if you have had issues during the pregnancy that these are checked and addressed before you start to run. It is important to follow advice to correctly improve core and abdominal muscle strength to avoid long term problems. Exercises that can and should be done to help ease your return to running are the calf strength exercises, and balance work, in addition to having a safely graded abdominal strengthening program. 

This blog was contributed by our partners Coach House Physiotherapy (CSPC). Find out more about the team and the work they do here. For the exercises advised please see here for full description. 

References:

1. RCOG (2006) Exercise in Pregnancy: Statement No 4, London Royal College of Obstetricians and Gynaecologists
2. Guidelines of the American Collegs of Obstetricians and Gyaecologists for exercise during pregnancy and the postpartum periosd. R Artal, M O’Toole; Brit J Sports Med Feb 2003