The Pregnant and Middle-Aged Female Runner
Bruce Buley, PT, MA, OCS, CSCS
June 2, 2005
Running During Pregnancy
1. Changes in the body during pregnancy:
- Circulatory changes
- Hormonal changes
- Body temperature increases
- Metabolism increases
- Ligaments relax
- Weakness of the pelvic floor
2. Benefits of running during pregnancy:
- feel better
- fitter for labor
- quicker recovery after labor
- gain less excess weight(less to lose after pregnancy!)
- feel more positive about your body during the pregnancy
3. ACOG recommendations:
- perform regularly and with moderate intensity
- no back-lying exercise after the 4th month
- avoid environments with excessive heat
- increase caloric intake(300 calorie increase)
- stay hydrated
4. Additional considerations:
-Never exercise to breathlessness: this could compromise you and your baby’s oxygen supply
-If you ran before your pregnancy, you should be able to keep it up (although the intensity and duration may be decreased during the second and third trimester)
-If you were not a runner before being pregnant, proceed slowly and heed the above advice
-In general, there is no evidence that running is correlated with miscarriage. However, each individual is different and if there is any question, consult with your OB/GYN professional
5. Special orthopedic concerns for runners during pregnancy:
-low back and SI strain
-swelling of the legs
-increases in foot size and flattening out of arches
Solution: abdominal and core strengthening, foot elevation, compression garments, arch supports and/or breathable and supportive shoes.
6. Alternatives to running during pregnancy:
-swimming
-stationary biking
-elliptical
7. Avoid activities that decrease oxygen availability during pregnancy:
-SCUBA diving
-mountain climbing
The Middle-Aged Female Runner
1. The body has changes during middle-age:
-after age 30, we lose 1.0-1.5%/year of weight lifting ability until age 70,
the drop-off then becomes more precipitous (because of sarcopenia and physical inactivity. Sarcopenia is denervation of type II muscle fibers)
-the bones become softer because of decreased mineral content which increases bone porosity(osteopenia is defined as 1.0-2.5 SD below the young adult mean and osteoporosis is defined as greater than 2.5 SD below the young adult mean)
-lung capacity is diminished
-there is more of a tendency toward dehydration and consider glucosamine for joint health
HAPPILY, MEDICAL SCIENCE HAS BEGUN TO SHOW THAT THIS PROCESS CAN AT LEAST BE RETARDED WITH A STRENGTH TRAINING AND WEIGHT-BEARING EXERCISE PROGRAM!
2. Priscilla Welch won the 1987 NYC Marathon at age 42!
-what is lost physiologically in the middle-aged runner may be at least somewhat made up for through improved neuromuscular training.
3. Orthopedic areas of concern in the middle-aged female athlete and how to recognize and manage them.
***It is a good idea to recognize problems early for best outcomes, decrease time away from running and to healthily extend your running career.***
The low back
Impact forces can begin to contribute to strain to the low back and/or SI joint.
Solution: correct training errors, strengthen core, reduce impact forces through reevaluation of shoes, and improve form and muscle imbalances
and inflexibilities. Correction of leg length discrepancies and orthotics sometimes helpful. Reviews of body mechanics to decrease strain from everyday lifting. Any scoliosis assessed and managed. Look at issues lower in the “kinematic” (movement linkage) chain that could be impacting the back. Fractures (“spondylolisthesis”) can occur in the back as well as herniated discs---pain going down the leg (radiation) is usually a sign of a worsened condition.
The hips
Impact forces can contribute to strain in the hip causing tightening and strain to joint surface.
Solution: Assess SI joint to check contribution from this area. Improve muscular strength and flexibility to the hips. Assess leg length discrepancy as contributor. Assess joint flexibility to determine if weight-bearing is even and well distributed (certain “capsular” patterns are harbingers of osteoarthritis of the hip and ideally picked up early to be reversed.)
Look at issues higher and lower in the kinematic chain that could contribute to hip problem. Are the running shoes worn or not correct for the runner’s needs? Questions about stress fractures need further evaluation.
The knees
It is said the knees are, “10,000 years evolutionarily behind the rest of the body” and the knees can begin to show signs of wear in the female middle-aged runner.
Solution: Look at influences from above and below the knee to understand the knee problem better. Problem in anterior versus posterior? Muscle strength and flexibility imbalances can alter knee function. Early osteoarthritis can be identified through motion deficits and tenderness---shoe wedging/orthotics and bracing often helpful to manage. Tendonitis at the knee needs appropriate time and athlete should be adequately hydrated to insure best outcome. “Internal derangements” need further evaluation.
Assess shoe wear patterns.
The ankles
The ankle is subject to a lot of pounding over the years and the middle-aged athlete should assess her balance (repeated ankle sprains worsen proprioception).
Solution: Look at joint proprioception, strength and biomechanics from the foot. Strengthening, flexibility, orthotics and bracing helpful. Reevaluate the
age and correctness of running shoe. Stability of the ankle should be addressed.
The feet
The final stop in the kinematic chain, the feet can alter weight-bearing all the way up the chain. The following are some of the more common middle-aged runner conditions:
-stiff first toe (hallux rigiditus)
-bunion (hallux valgus)
-lesser toe deformities (claw, hammer and mallet toe)
-corns
-Morton’s Neuroma: seen especially in middle-aged females and 15% of the time, it occurs on both sides
-stress fractures of the metatarsals
-metatarsalgia
-plantar fasciitis
-posterior tibialis tendonitis and rupture: most frequent reason for adult acquired flat foot.
-tarsal tunnel syndrome (inside foot and ankle pain)
Solution: appropriate muscle group stretching, corn padding, metatarsal cushioning, toe crest splints, shoe with large toe box, orthotics, socks, shoes appropriate?
“Keep your feet on the ground and reach for the stars”—Casey Casem.
Bruce Buley, P.T., M.A., O.C.S., C.S.C.S PO Box 16234
Chris Kosobucki, D.P.T. 115 TimberHill Place
Jeanne Gresko, M.S., L.P.C., C.R.C. Chapel Hill, NC 27516
Sally Sargent, P.T. Phone (919) 967-5959
Fax (919-968-1478
