Postpartum back and groin pain when returning to running

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. But if you do like running for the sake of running, by all means, let's get you back to running. So the first thing that we can probably tackle to make sure that we're not losing some easy wins is making sure that you're building up your mileage appropriately. Meaning if you haven't run in a long time, but you decided to go for 10 miles today, maybe that's not the best bet. I know a lot of people's brains can fathom the idea of going 10 miles again because you've been a runner in the past, but the rest of your body has changed its composure.

So things tend to deload. Tendons and muscles have different abilities over that period of time, not so you can't get them back, but it's not really fair for those tissues to be subjected to that amount of volume and load if they're not prepared for them either. So first and foremost, just make sure that you're building things up appropriately. I am not a running coach, so a running coach would maybe have a better suggestion of that. But I think using some basic logic with it would make pretty good sense. If you haven't run in about a year or so, maybe consider going back and just doing a mile or two here and there, and then eventually build up your daily volume as well as your weekly volume without having any major spikes.

I think that if I recall, the general rule is 10% or so. So if you're going to do 30 miles a week, maybe don't jump past 33 on next week for total volume. So just make sure you're still obeying some of those basic principles. The other thing in this email is about back pain and groin pain. That's something that's really common with some of our postpartum population. And it's not to say, again, that can't get better. It certainly can. But at least from even some of our non-pregnant populations or people who have been dealing with problems over the years with your lower back or pelvis, and now we are kind of in the scenario where we almost can say that our postpartum parents or our postpartum mothers kind of have an anterior tilt, but also people with past lower back injuries do as well.

So that's something that they do have in common. The reason why, obviously, mothers will have an anterior tilt is because they have a weight distribution that's forward now. And then later on, after you give birth, there may not be the need for the anterior tilt. Like the anterior tilt can help in the scenario of having weight on the front side of your body more so, but later it can reverse engineer itself back. And so the anterior tilt scenario is very common with people with lower back and groin pain, which tend to sometimes create groin and hip flexor and hamstring issues. Even things like hip impingement can come from that.

If you guys are interested in how that works, we do have a lot of YouTube videos on this topic, which covers how an anterior tilt, which is also the same thing as lumbar overextension, tend to rob the hip of some of its function and range of motion. And that can account for some of the groin pain as well. So I don't know exactly what this person's condition is. It could be something like hip impingement. It could be something like a hip flexor strain. It could be even something like a sports hernia. I think the interesting part is that there's a lower back component. Hip impingement does not tend to have a lower back component.

Now, you, especially in the beginning, now later on, we can say that the hip is not really functioning super well, and you may end up having a little bit of the workload go to your lower back. But a lot of times if the low back precedes the groin condition, a lot of times I think the low back is a big part of it. And if we're talking about the pattern that I can see, at least in this email, which developing patterns can be helpful because it helps us understand how to reverse engineer this in a rehab scenario and also pick which exercises to do. And so it seems like it's aggravated mainly with extension patterns.

So it's going to be running, right? But also heel work, especially downhill running, can be an issue which exacerbates people with extension-based problems. Normally, a lot of anterior core work can help out. Some glute work can help out. But also rebuilding the hip hinge can help as well. Now, the other questions about potential pelvic floor dysfunction. Yeah, I would say that people who have a C-section have probably a higher probability of having some pelvic floor dysfunction, but that's not always the case. Pregnancy is a bigger deal. I don't know if everybody realizes how much of an ordeal it can be.

I mean, your body has changed over the course of almost a year. And even after giving birth, it's still not exactly the same. If you've had a C-section, that is the surgery, you know? And so there's a lot of things that can be compensations surrounding that. Obviously, pregnancy is a condition that doesn't last more than a year. But the longer the compensation, the harder it is to break out of that. Old habits die hard, we say. And pelvic floor dysfunction, having urinary issues after the fact and having some lower back pain and even some hip and pelvis issues like is very common. And even people after they've had abdominal surgeries without being pregnant, they sometimes have this as well.

I would default back into the work of a lot of myrianda, which is about tonic and phasic group muscles. Tonic muscles, the ones that become overworked and have a tendency to becoming over tight and also spasmatic. And so usually the pelvic floor, the levator anise and so on that you've probably heard about can usually become a little bit more tonic. And the way to solve this is first, making sure that your intra-abdominal pressure is working well. If you have not been coached on that, it's important to have a realization of that. Because I think a lot of people that I've met who first have this problem, it's their first rodeo through it, they tend to suck their belly button to their spine, which isn't really the same thing.

I know the transverse abdominus is important. That was a target for that particular tissue, but we need everything to work as well. Which also brings us to the question about diastasis recti. Dawne Costantino has put a few videos out about diastasis recti on YouTube. So if you search performance place and diastasis recti, I think you'll come up with some of her videos. There's even a self-assessment for pelvic floor in there as well. And she shows a bunch of exercises, which we can start people with for diastasis recti. But first off, having diastasis is common, super common. But also having to persist later can be a reflection of poor intra-abdominal pressure distribution, which goes long hand-in-hand with pelvic floor.

It also goes hand-in-hand with low back pain and groin stuff and hip impingement and hip flexor strains and overtonic muscles. So all these are kind of colliding into a similar scenario. So this is a very good email to encompass that. I would start first with making sure core stability has a foundation of intra-abdominal pressure, which is well distributed. After that, you can make the exercises harder. You can make them into planks or side planks or glute bridges or banded bridges or whatever you want. We have the ones that we like that we share with our people when we do some of our telehealth sessions.

They're very easy to coach. But I think understanding that there's a foundation that needs to be laid first is important. Because if you blow right through that, I mean, you can do sit-ups to the cows come home. It's not going to change your problem, right? It's how you do it, which is important too. Now, the other questions of this email was return to safe running protocol. We discussed that a little bit before strengthening pelvic floor. I think as long as you understand there's intra-abdominal pressure first, and then you can choose whatever exercise you want. That is an important scenario.

But also if we had to choose exercises, which are the safest, they're going to be non-movement ones or isometric loading exercises. Isometric loading, you can make them very hard. And they make it so there's a lot of abdominal contraction or the obliques or the multifidus or the pelvic floor, whatever you want. But they're lower load and you hold them for a little bit longer. And they're the exercises where you're not moving. People are typically giving them post-op, so they're very safe to do. But you need to make sure you're breathing during them too. But I think when we give people the choice of exercise to pick, a lot of times they default to the ones that they've done in the past.

Rush and twist, boat pose, V-ups. And you can even see them with ones like hydrant exercise, which is supposed to be for the hip, like isolated hip movement and with core stability. People move a lot. And so just realizing that not that your core can't move or your spine, your pelvis can't move. It can. It certainly can. But if we're trying to condition it and you want to know what's safe in the beginning, isometrics are not letting it move too much, at least in your rehab scenario, is super important. But if you're bending over to pick something up or you're running, yeah, don't brace. Like you can pick up stuff or run without having so much stiffness and attentiveness to your core.

That would be ideal. Now, how to differentiate between normal post-partum discomfort and potential injuries. I tend to think that timelines are important with this. Now, if I, like, obviously I've never been, I've never been pregnant, but I have had other injuries. Like right now I have a hamstring tear that I had yesterday. I started yesterday. I've had three of them before. And so I realized day two is always better. You know, within a week I'm not as much limping around, but I still can't really run. But over the course of about probably a month, I should be able to kind of start jogging around.

Maybe not sprint, but I can push a sled. I can do squats. Like there's normal things I should be able to do. And so for you as well, like once you've been cleared by your OBG, like you're kind of, what is it, six weeks or so? It's kind of like you're able to quote unquote do anything, but we know that you may not feel comfortable doing it or not everything feels good. But I think at least for most people's pain associated to giving birth or C-section and stuff like that, most of it should be dissipated at about week six, week eight or so. And then everything else may be remnant of some older, older injury, an old knee condition, an old hip one, the old hip one that resurfaced when you got pregnant.

Or in this scenario, it's like maybe you had a hip condition back when you were in college running and now it just, it's, it's post-pregnancy stuff. It's manifested itself. And so not to say that you pregnancy did it, but the lack of stability or the change of body over the course of that year and now putting your body under some workload, such as running with good or bad buildup is now getting it to manifest itself again. And so the only thing you can really do to predict future injury is to look at the person's past medical history. Like I tore my hamstring four times now, right? Not even the same one.

I would expect for it to happen again in my lifetime, but I don't expect for it to happen again immediately. Like it should be years and years if risk factors and all the other parts are, are looked at. I would make sure that for this email listener that we need to make sure that number one, if their mileage is appropriate based upon what their buildup was again. Number two is are they choosing trails or lengths that are provoking factors of them exclusively? Like we can try other types of paces and cadences that are not provoking just to get some mileage upon your body. Also the exercises they're picking on their own.

Are they picking ones that are, are, that feel good or do they always hurt to do? Squatting may not feel good, but split stance or, or doing like, like non-moving lunges or split squats may be fine. Deadlifts should be incorporated back into the program if they're not already. So, and the last thing is going to be make sure that they didn't have a past history of this. That's all of a sudden now manifesting itself. So there's a lot of ways that we can spin this. Not to say I won't be, we don't cover it in our other videos and podcasts. We do, but I think at least an overview on this is considering the variables.

I don't want to say that giving exercise and suggestions can be helpful. They can, but everything is a guess. Literally everything is a guess until you look at the individual and ask for the questions and examine them. And I remember that I had a person recently that we were a telehealth session. And so we had like five minutes left. They said, so what do you think I should do? Because there was a consultation. We don't usually give suggestions and consultations because we're just learning. And I said, I don't think you're going to want me to suggest anything. They said, no, I suggest things. I said, would you rather me make a bad suggestion for the sake of making a suggestion that makes you feel worse?

Or you just want me to make good suggestions? They said, well, you know, I'd rather make good suggestions. Well, then let me, let me examine you. Let me talk to you a little bit more and then let me actually coach the exercises. Don't just say do V-ups because that may make you feel worse. And I'm sure that's not what you want. So if you guys are looking for help, just reach out to us. We do have telehealth. Again, we're licensed in various different states. 714-502-4243 or email us info at p2sportcare.com. Subscribe to the show. Listen to all the other old shows. And we have a ton of great information that's completely free on your podcast.

Take care.