You’ve finally got the go ahead to start running after having a baby. Maybe your biggest worry before was leaking or pelvic pain? But after a few runs, you start having knee pain! This wasn’t in the handout.
No one mentioned this as another one of the post-partum things to happen to us women. But believe it or not, knee pain in women runners post-partum is a fairly common complaint. Contrary to belief, it’s not just due to us having some pregnancy weight to shed or hormonal changes.
Jo Perkins, Sports Medicine and Women’s Health Physiotherapist and founder of Mumma Physio and The Glow Method At Home, has put together possible causes for knee pain post-partum and top treatment tips to minimise your risk.
Possible causes for knee pain after having a baby
Muscle weakness and tightness
During pregnancy and delivery, the body goes through many changes. This can result in certain muscles getting weaker and others getting tighter. These include the muscles around our pelvis, like our gluteals, hip flexors, hamstrings, pelvic floor and deep abdominals. These changes can affect the position of your pelvis and potentially the mechanics of the joints in your knee, putting stress on structures that aren’t usually exposed to them when returning to running or more strenuous exercise.
Your running technique can influence the loads that go through your bones, joints and muscles, including the knee and pelvic floor. Evidence has shown that braking with the heel down in front of you, upright postures, long strides and pulling back with the leg, can increase the forces going through your knee by 6-8 times, potentially causing pain. This is often related to a backward tilt of your pelvis, weaker glute muscles and a stiff running posture which is often seen in women post-partum.
Ramping up the distance too quickly
After any time away from running, the body needs time to adjust to increasing volumes, particularly with the hormonal changes that accompany us post birth. Increasing the distance too quickly can put too much load on the bones resulting in stress reactions. Paula Radcliffe talks openly about sustaining a sacral stress fracture post baby as she built up her running volume too quickly, meaning she then had to stop completely for a long period.
Top tips for minimising knee pain
The body needs time to recover from the demands of pregnancy and delivery. This of course doesn’t mean you have to sit and do nothing. Start with pelvic floor work and progressive strength work as your symptoms allow. You can start your aerobic work with walking, then introduce the bike, cross trainer and swimming, for example, before returning to running.
Get your body run ready with strengthening and mobility exercises to target those muscles that have got weaker and tighter. Getting the glutes strong with exercises like bridging, squats, lunges and deadlifts, for example, as well as single-leg stability work will help optimise your lowerlimb mechanics to minimise knee pain. Long stretches (1 minute) of tight hip flexors and hamstrings alongside this can be really helpful.
To help manage the amount of load through your knee (and pelvic floor) try and think about leaning forward and rotating through your trunk (not just your arms) so your body isn’t held stiff or gripping with your abdominals. Try and think about the weight going through your mid foot (opposed to toes or heel) and push through the foot propelling you forwards with a lean rather than pulling back with larger strides. This can be really helpful for those of you who leak while running too.
Build the distance slowly
Progressively returning to running and plyometric work is important in minimising knee pain by managing the amount of pressure put on the pelvic floor, muscles and joints. A graded programme progressing from squats to jumping to hopping makes for a sweaty aerobic workout and safe reintroduction to the ground reaction forces of running (which can be up to two times a runner’s bodyweight). Start with power walking, then a jog/walk progression, then gradually increase the time spent jogging. Even if you continued running through pregnancy, initial rest days between runs allow the body to adapt to the load.
Mixing up training with non-impact exercise minimises the load going through your knees. Think about the bike, cross trainer or swimming or low impact workouts at home. Also consider different terrains to help manage the stress on your knees, such as grass running.
Making sure you have the correct supportive footwear can also assist in managing the loads though your limbs. It can be worth investing in an assessment to look at your foot type and the right trainer for you.
The good news is that following these tips also helps manage the load going through your recovering abdominals and pelvic floor, so you get more bang for your buck!