Running Preggers: Pelvic floor

There are three muscles that take the brunt of the stress from pregnancy: the uterus (which is a group of muscles), the rectus abdominis (six pack), and the pelvic floor. It takes the uterus approximately 6-8 weeks to return to it’s normal pre-pregnancy size after the baby is born. We addressed the rectus abdominis in my last post regarding Diastasis Recti.

The pelvic floor muscles are like a sling or hammock that attaches to your pelvic bone and your tail bone. Having a week pelvic floor is not an uncommon thing even in those who have never been pregnant. In fact, men can have problems with their pelvic floor.

Your pelvic floor holds in your uterus, bladder and bowl. Only bladder and bowl in men obviously. Having a strong pelvic floor is important for both pregnant and non-pregnant people. The main symptom of a weak pelvic floor is incontinence or urine leaking, especially, when you cough, sneeze, laugh or during running. You can also have feces leak, but that’s less common. Because this is so common among women, many think it’s normal, but it’s not.

An even more serious issue than leakage is prolapse, which is when one of your organs falls down into your vagina. prolapse has to be corrected with surgery.

Having a strong pelvic floor during pregnancy is obviously important because it holds your uterus inside your pelvis. You should begin doing pelvic floor exercises as soon as you know you are pregnant. In fact, everyone should do them, especially, runners because we can stress our pelvic floor every time we run.

So what are some pelvic floor exercises? First you have to be able to isolate those muscles. The best way to figure out if you are flexing the pelvic floor is to stop the flow of urine. Kegel exercises are the most recommended pelvic floor exercise. A kegel is done by flexing the pelvic floor. Men identify the pelvic floor and do kegels in the same way as women. If you can’t feel your pelvic floor (not unusual after childbirth), use visualization.

You should be doing kegels three times a day, at least. You want to do ten repetitions of two types. First, pull your pelvic floor up and hold for ten seconds, then release for ten seconds. You can shorten the time between each as you get stronger. The second is to flex and release 2 seconds up and 2 seconds relaxed.

Other exercises that work your pelvic floor are:

  1. bridge
  2. clams
  3. hover: sit on your heels with your knees apart rise up and pull your pelvic floor up.
  4. split squats
  5. wall sits
  6. squats.
  7. elevator: pull your pelvic floor up halfway and hold it for 3-5 seconds and then pull it in as much as you can. Release in the same way.

Begin with ten repetitions and two sets. Do these three to four times a week.

When doing pelvic floor exercises it’s important to coordinate with your diaphragm and your rectus abdominus. You should be using your diaphragm to breathe. To make sure you are, lay on your back and place one hand right at the bottom of your ribs and the other hand on your chest. As you inhale it should begin in the bottom of your ribs not in your chest.

You should be relaxing your pelvic floor with each inhalation and contracting your pelvic floor with each exhalation.

You can begin doing kegels a few days after your child being born. If you have stitches you may have to wait a little longer if they cause any pain.

Pelvic floor exercises should be done in a variety of positions including laying down, sitting and standing.

Running Preggers: Diastasis Recti

This is something I had never heard of before this pregnancy (my third). Diastasis Recti is a condition when the muscles of the abdomen separate, the rectus abdominis (six pack), separate. This usually occurs during pregnancy, however, it can occur because of other conditions. It’s what causes the classic “mamma pouch.” approximately 44% of women have it even at 6 months post partum and 33% at 12 months post partum.

This separation occurs to make more room for your growing uterus, which is exerting pressure on your abdominal wall causing the muscles to bulge forward. It’s not a tear, but a stretching of the linea alba, aka the connective tissue that runs vertically along the midline of your abdominal wall.

Diastasis Recti can cause serious health problems if the separation is large. Most women do not suffer from a large separation. It can cause back pain, pelvic pain, and basically you don’t have anything protecting your organs. It’s fairly easy to check yourself for a larger than normal separation between the abdominal muscles. Here is a video .

How to check for it: lay on your back with your knees bent like your going to do a bridge. Then pull your pelvic floor up and lift your head and shoulders like your doing a crunch. In this position place your fingers on your belly button and move straight up in a line feeling for the separation go three inches above and three inches below the belly button. If the separation is more than one finger widths you have Diastasis Recti. If it’s three fingers you should see a physical therapist.

If it’s two or less, there are some exercises you can do to heal at home. The central component of all of these exercises is the core compression. To do a core compression squeeze your core to draw your belly button in and up toward your spine while doing a forceful exhalation at the same time. Perform your core compression while doing these six exercises:

  1. Cat-cow without the cow
  2. wall sit
  3. single leg lift while lying on your back
  4. Standing inner thigh lift: lift one leg with a slight 45 degree bend in your leg and then move your foot in and up.
  5. side plank
  6. Tricep kickbacks: bend over at the waist and move your arms from 90 degrees to straight. You can use light weights if you have them.

Perform 2-3 sets with 10-12 reps 3-4 times a week. You should see improvement in 8-12 weeks. If you don’t, consider seeing a physical therapist. As always check with your doctor before beginning this program.

Exercises you should avoid are the ones which cause your abdominal muscles to push out (a sure sign that you’re increasing the abdominal pressure). Also any exercises which you cannot perform without arching your lower back off the floor.  These include push-ups, front planks, sit-ups, crunches (anything that has you raise your shoulders and head off the floor), and leg lowers (either seated or laying on your back).

As you recover from pregnancy and child birth, keep in mind that it took nine months to get your body into the shape it’s in and it’s going to take some time to get back to your pre-pregnancy shape. Be patient and be kind.

 

 

Running Preggers: The Weight of It.

Pregnancy and weight gain go hand and hand obviously. The recommendation for women who are of average weight, BMI of about 18-24%, is to gain between 25-35 lbs during their pregnancy. There are few women, or men, who want to gain an extra 25 lbs. During pregnancy gaining too much or too little has health consequences for both mother and baby.

There’s a certain level of anxiety about gaining weight during pregnancy and the ability to loose it afterward. We all have friends or relatives who never lost the “baby weight” and if they get pregnant again, they put on more weight.

You’re not going to loose all that weight the moment baby is born. Some of it is fat that you’ll slowly work off over the months that follow the birth of your little one. How much fat?

For the average baby and mother the weight distribution is something close to this:

Baby: 8 lbs

Placenta: 2-3 lbs

Amniotic fluid: 2-3 lbs

Breast Tissue: 2-3 lbs

Blood supply: 4 lbs

Larger uterus: 2-5 lbs

Stored fat for delivery and breastfeeding: 5-9 lbs.

So you’re looking at losing somewhere between 12-14 lbs right at birth. Your blood volume will return to normal over the six weeks following birth and your uterus will shrink down over the same period of time. That’s another 6-9 lbs. That leaves you with breast tissue and your store of fat.

If you are planning to breastfeed your baby, you’ll add some weight when your milk comes in (2-3 days after birth of baby), which shouldn’t surprise anyone who has picked up a quart of milk. The average milk capacity of a human female is between 25-35 oz a day. Breastfeeding burns an extra 600-800 calories a day (you should be eating 500 extra calories to maintain your milk supply), which means merely feeding your baby will help you burn of some of that fat store.

You’ll still be wearing your maternity clothes for a while after baby is born, so don’t pack your skinny jeans in your hospital bag as you prepare for the birth of your baby. The important thing is to know this is normal and not to be concerned about it. Your body just created a whole other person inside of it which took nine months. You should give it the same amount of time to lose the weight.

Lugging around an extra 25 lbs is hard work and since it’s not all fat stores, I like to think we’re getting stronger in the process.

Losing weight can be a slow process after baby is born because it’s harder to get to the gym or hit the trails for a run, not only because you have a little one to care for, but because you’re tired. But it’s doable. Give your body time to recover from the most important endurance event in your life.

Nature vs. Nurture

We’ve all heard that the Kenyans are built for running-it’s in their genes. Statements like that raise more questions for me, such as: do genes(nature) limit my ability to improve my running? do my genes determine what type of training(nurture) or races I should do? How much of my improvement is from my pure stubbornness to succeed (is that genetic too?)?

I think it’s obvious that both genes and training play a role in our progress and ability in our sports. And I’m not sure if knowing which one is dominant is helpful because if it’s genes, the brain of many runners could get in the way of them making improvements through training hard due to a belief that they are limited.

There are more than 100 genes that have an impact on physical capacity. The belief that our genes determine our running performance seems reasonable, after all, our genes determine our body size and shape. Both of these influence our running performance. Those with smaller bone structures are going to be lighter on their feet. They are less likely to have non-propulsive muscle mass weighing them down.

Two measures scientists use for unraveling the nature vs. nurture questions are VO2 max and Lactate threshold. What they’ve discovered is that the degree to which VO2 max increases in response to exercise has a 47% genetic component. That leaves 53% friends-more than half. The degree to which Lactate threshold increases in response to exercise is a 55-80% genetic component. That’s a pretty big spread if you ask me.

How important is VO2 Max for ultrarunning? VO2 max is the highest rate at which your body can transport oxygen to your muscles, through blood, to provide your muscles with the energy they need. Most people can only sustain this level of effort for 8 minutes. Not helpful in an ultra that lasts up to 36 hours. Your VO2 max becomes less important as the distance of your run increases. This is not to say doing VO2 max training isn’t worth while. See my post on that here.

What about Lactate Threshold (LT)? LT is the point at which the level of lactate accumulating in your blood is higher than what your body can get rid of. During lower intensity exercise (ultrarunning by nature), lactate levels remain at or near resting levels- a steady state. Training your LT is still important. See my post referenced at the end of the last paragraph.

Other factors that determine running performance are diet, attitude toward running, daily activity pattern, amount of sleep, injuries, running efficiency, determination, and much more. What the science has concluded so far is there are just too many genes that impact sport performance to be able to predict who will be a good athlete and who will not.

So what can our genes tell us? no more than our personal experience which is the better route to go. Yes, there are companies out there who will test your DNA and tell you if you have a low, medium, or high aerobic potential, but I ask again does that really help you to know? I think this is a situation where ignorance is bliss. If we believe we have an insurmountable genetic limit, it will become a self-fulfilling prophecy.

I look out there at my fellow ultrarunners and I see the “impossible” accomplished at every race. Grit is a better predictor of our ability to succeed than any genetic test.

 

 

Running Preggers: To Breathe or not to Breathe

Remember how great it feels to pull in the fresh air of the mountains until your ribs are at their limit and then to let it out slow just because you can and your lung capacity is impressive as a runner. Well, if you’re in your third trimester of pregnancy (28-40 weeks), you’re missing that ability and those impressive lungs.

Having reached the third trimester, you can see the finish line (even if you’re not ready for it) and you’ll be able to realize those breathing dreams once again and even baby will be expanding their lungs as yours reclaim their glory.

As your uterus grows to it’s max, it pushes on your diaphragm which shifts upwards about 4 centimeters. This also compresses your lungs a bit. This combination means you are not taking in as much air with each breath. To compensate you breathe more slowly. Wait that doesn’t make sense…

The hormone progesterone stimulates your respiratory center in your brain so the air your breath in stays in your lungs longer allowing you to get as much oxygen out of it as you can. There are a few things you can do to help with this feeling of being out of breath all the time.

First, good posture. Make sure your sitting and standing straight. If your hunched over when sitting it’s going to compress your diaphragm and lungs more (and it may keep baby turned sunny side up which is not the optimal position for birth).

Second, keep running and/or exercising. You may have to slow down to compensate for your cramped internal organs. Pregnancy isn’t the time to hit a new personal record anyway. Mostly you want to maintain your fitness level or lose as little as possible. Yoga also helps with it’s use of the breath during poses and it’s breathing exercises.

Third, relax and don’t over do it. Being hyper-vigilant about your breathing is only going to make things worse. Take time to relax each day even if it’s only for ten minutes.

Fourth, if your having trouble with breathing because of congestion try using a humidifier at night. Exercise will also help break up the mucus.

Take heart, your baby is almost ready to be held in your arms rather than in your belly. As baby gets into position to be born, she will drop into your pelvis and you may find it’s easier to breath. This is also called lightening. It usually happens two to four weeks before delivery. If this is not your first child, baby may not drop until right before delivery. As nice as this lightening is on your lungs and diaphragm, it’s not so great for your bladder.

Weekly Miles: My running is very inconsistent at this point. I run on days I feel good and it’s comfortable to run. Other days, baby’s position makes it very uncomfortable. I don’t really track miles. I’m just happy when I’m able to do a little run. Thirty-eight weeks and counting.

Hydrating, It’s Complicated.

Staying hydrated is essential to being able to sustain a good pace on race day. Too much or too little water can cause serious problems for runners. Maintaining optimal hydration is more complicated than we’d all like.

There are many factors that play a role in your hydration during training and races. We all hear the pervasive message of 8 glasses of 8 oz of water a day, but is that right for everyone? It’s not even close. It’s difficult to calculate exactly how much fluid a person needs each day. Some factors that impact your recommended fluid intake are: the type of food you eat, your activity level, your body fat percentage, and your acclimatization to the heat.

Another recommendation we hear a lot is to drink to thirst, but once again the phrase, “it’s complicated,” rears it’s head. When you’re exercising, especially for extended periods of time, your body may not signal you to drink because of imbalances in your system. You need to be looking at other objective measures such as the amount of fluid you are taking in, the temperature, the color of your urine (we’ll talk about this more in a few paragraphs), and any GI issues you’re having.

You’re unlikely to need to hydrate during a 5k or 10k event. For a 1-2 hour run, you’ll need water, but not electrolytes. If you’re running five plus hours, you’re going to need some form of electrolyte replacement strategy. If you’re between the 2-5 hour range, water is necessary and electrolytes would be helpful but are not necessary like they are after 5-6 hours. Electrolytes are helpful in the 2-5 hour range because they help you hold onto the water you’re consuming rather than it just going straight through you.

 

Most ultrarunners use some type of electrolyte supplement during training and in races. There are lots of options as far as different sports drinks, powders, and tablets/capsules. It’s likely that you’ll want a variety of options when you’re racing because things change and some times something that has worked throughout training suddenly stops working. Sports drinks usually do double duty by providing you with both carbohydrate and electrolytes, so make sure you have options for both when the drink doesn’t work so well. Aid stations typical fare will consist of foods with both carbohydrate and with sodium, the main electrolyte you need, so keep a mental note that you’ve taken in some electrolytes there too.

After a run or a race, there’s no need to ingest a sports drink to replenish your electrolytes. Your body will be able to balance it out within the next 24-48 hours. If you have another run within that time frame, however, drinking a Gatorade is probably a good idea.

One way runners often judge their hydration is through urine color. The problem is there are a lot of things that impact your urine color, so it’s not always the most accurate. You can have clear urine because your body doesn’t have enough electrolytes to hold onto the water so it just spits it back out. The best time to judge hydration with urine color is when you first wake up in the morning because it’s had time to accumulate. The first urine in the morning tells you about your hydration the day before. So if you track your hydration and exercise, you’ll get a good idea of what your body needs for different workouts.

 

 

 

Running Preggers: Vein Popping

Popping veins may be every body builders dream, but as a pregnant runner it’s not something you show your friends with joy and enthusiasm. It’s more along the lines of shock and horror. Varicose veins are another one of those lovely pregnancy symptoms. Not all pregnant women have to deal with them.

Varicose veins appear during pregnancy because your blood volume increases and at the same time the rate at which blood flows from your legs to your pelvis decreases. This increases the pressure on the veins in your lower body and can cause them to become enlarged.

Another contributor to varicose veins is the increase in progestin levels, which dilates veins. The pressure of the uterus on the inferior vena cava, the vein that carries blood from the legs and feet to the heart also adds to the possibility of having vericose veins.

There are a few things you can do to minimize and/or prevent varicose veins during pregnancy. First don’t sit or stand too long. Changing position is your first line of attack. Next is don’t wear high heels (none of you wear them anyway because your runners, right?). Wearing high heels weakens your calf and can shorten (through tightening) your Achilles tendon.

Third, wear compression socks or sleeves on your calves or you can go full out and get maternity support hosiery. Fourth, don’t cross your legs (like you could if you wanted too) during pregnancy. Fifth, elevate your legs every so often to improve circulation. Sixth, sleep on your left side. This takes the pressure off of the inferior vena cava I mentioned earlier.

Finally, exercise. Specifically, running and/or walking. The idea is to have strong calf muscles which promotes good blood flow in the lower legs. Other than these suggestions, there isn’t much you can do about the vein popping while your pregnant.

Varicose veins that appear during pregnancy typically go away within three to twelve months after baby is born. But if they don’t, you’ll be joining the ranks of 1/4th adults in the U.S. who develop them during their life time.

When they don’t go away what’s happened is the small valves within the veins that prevent blood from getting backed up are not working like they should and the blood pools and increases the pressure in the veins. The body then tries to widen the veins to compensate and they end up bulging and thickening.

Varicose veins that don’t go away after pregnancy or that you develop outside of pregnancy should be monitored by a doctor. They can cause achiness, heaviness, throbbing, cramping and swelling in the legs. They are treatable and seeing someone about them sooner is better since they can indicate a more complicated issue.