Episode 1582 - Four weeks to return to running?

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic lead faculty Alexis Morgan discusses the research & practical approach to helping runners return to running beginning at 4 weeks postpartum. She references research that about 50% of postpartum patients begin reintroducing running at approximately 4 weeks postpartum, with varying degrees of symptoms. Alexis emphasizes utilizing the symptom behavior model to monitor symptoms, educating & encouraging patients that about 85% of all individuals have some sort of symptom(s) with running, and that volume is an important variable to have a successful return to running.

Take a listen to learn how to better serve this population of patients & athletes.

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EPISODE TRANSCRIPTION

00:00 - ALEXIS MORGAN Good morning, Instagram. Good morning, fellow ice people. Welcome to the PT on Ice Daily Show. Welcome to Monday. It is the start of another week. And we are so excited to be here. Really as we're wrapping up the end of this year, we still have a lot going on at the end of the year that I want to tell you all about this morning. And then we are really getting already very excited about 2024. And just want to talk to you all about some of the things that are going on. If you are in the ICE Students Facebook group, you've been to an ICE course or you were just recently added in because you just finished a course this weekend, welcome. You've seen some announcements in there as well a while back. And I just want to highlight a couple of things. So let's get started on that before we discuss four weeks returning to running, four weeks postpartum. So number one, we've still got three more chances for a live course, or you've got three more chances to hit us in the pelvic division at a live course. So this, not this weekend, but next weekend, if you're listening live, November 4th and 5th, we will be in Bozeman, Montana, and then a few weeks after that in Bexar, Delaware. And a few weeks after that in Halifax, Nova Scotia, Canada. That is the first weekend in December, December 2nd and 3rd. So those are your three chances to get into seeing this Pelvic Live course, experiencing it, having fun with us, learning so much about pelvic floor health. not just for pregnancy and postpartum, but in general, across the lifespan, men and women, pregnancy, yes, but also all things pelvic health. So those are your three chances, Bozeman, Bexar, Delaware, and Halifax, Nova Scotia, Canada. So if you're on the fence, go ahead and pop onto those. Second, thing that we i want to share with you all is about the pelvic level one course so our name is changing as you all have heard us talking about and we're actually going to be taking a little break through the next few months and our new level one cohort is going to start in january so Be sure, we've already got people signed up for that, gearing up, ready to experience the new content. Very regularly, we are always reading the research on a weekly basis. And once enough of it stacks up, we've got to reframe the way that we're teaching, particularly in the space, because it changes so incredibly rapidly. And so with that, we are updating that material. So that is coming up on, that will be on the website soon. Actually, that is actually already on the website. So that is on there. So a lot of things coming up at the end of this year, the beginning of next year. We've got even more announcements, so stay tuned. And we're gonna be announcing a couple more exciting things in our ice pelvic newsletter. So if you're not already signed up for the pelvic newsletter, go ahead and sign up for that because we've got even more things to discuss and share with you all. 04:31 - RETURNING TO RUNNING 4 WEEKS POSTPARTUM So all of that aside, let's go ahead and discuss this four week return to running. This is a topic that a handful of years ago really was not discussed. No way are we going to be facilitating someone running one month after giving birth. That's what we thought a handful of years ago. But fast forward, we've got several examples of elite level athletes which then trickles down to our recreational level athletes, we've got several examples of people returning to running. And it's actually even showing up in our literature. And when we are starting to see this, it's kind of interesting in the pelvic world, like we have all of these thoughts and beliefs and oftentimes you're you're gonna run into some strong opinions surrounding those, and a deep connection here. We've gotta have that connection with our beliefs, but also be willing to let that go once the evidence and once the, even the anecdotal evidence that your clients show up to you with, once that narrative begins, and it's maybe opposite of yours, we need to be able to let that go and to explore and ask questions and be curious about, well, what are some other possibilities? And that's exactly what we're seeing in this four-week return to running. So what we've seen is people aren't running. Runners will run, as we always say, in pregnancy and then early postpartum. And what we know is that the longer someone runs in their pregnancy, the sooner they're going to run in that postpartum phase. And in Shefali Christopher's study looking at returning to running and risk factors associated with musculoskeletal pain, she actually saw that it was close to half of those individuals, 46%, reported returning to running at four weeks. And so we've got some information to kind of digest, right, as therapists. And what we know, and again, in her research, what we know is that when runners return to running, we're seeing that musculoskeletal injuries or musculoskeletal pain does occur. And so that's the number one thing that we want to be educating our runners on and we want to be looking out for. But rather than waiting until they've hit certain guidelines, what we are proposing and what we are doing, what I am doing clinically, what a lot of our faculty is doing clinically is we're educating our patients. And we urge you to educate your patients as well. Based on this evidence, this is what we're seeing. We're seeing that when we're returning to running, we're actually, many people are experiencing musculoskeletal pain, about 85% of people. Not just those that are returning at four weeks. The median time returning at 12 weeks. So that's significantly before and significantly afterwards. We educate them. So we can, Educate them. They know that okay. There's a risk of injury. There's a risk of musculoskeletal pain Of course, just like with everything and what we tell them is when you feel something You need to let me know That visit is so much easier to discuss that if it's already been planned. So you schedule your person a couple weeks out. Go ahead and return to running and see how that feels. We're gonna control for the volume. We're not gonna go out and run five miles for the first time in eight weeks. We're gonna control that volume. Build up slowly and see how they feel. If you're experiencing some mild knee pain or some hip pain, we are gonna address that. All the while, absolutely, we're doing our basic hip strengthening, right? I say basic, not just talking about a basic squat, but also your accessory movements like clamshells to work on that rotation. Or better yet, some single leg standing you know, the standing variation of the clamshell or the hip abduction with your foot on the wall. That way you're working both sides. We love that accessory work to decrease the risk of pain. But even while they're working on that strength, they're still, everyone is still at a risk. And so the best thing they can do is talk to you about it as soon as they experience that. And tell them, okay, let's back down on that volume right when they're when they experience that let's say they bumped it up to a two mile total volume of running maybe they were doing one minute of running 30 seconds of walking and they had just bumped all of that volume and those intervals up experience that bit of lateral knee pain let's bump that back down. What were they doing last week? Let's repeat last week's volume. Let's repeat last week's running workouts and let's calm that system down. That's how we'll address it from that pain aspect. And then of course, we're going to be continuing to build that accessory strength training and coaching their running, looking at their running form. We're not afraid of them experiencing that pain. In fact, we know more than likely they're going to experience that. Again, 85% of runners are experiencing some level of pain, typically in the lower extremities, not necessarily their pelvis or pelvic floor. So we know we're gonna bump into that. So we educate them on the factors, and then we schedule a