Patient Highlight: Returning To Running after Prolapse And Becoming A Postpartum Running Coach
My name is Jen Craver and I’ve loved running for a long time. I started running in middle school, when my friends joined our school’s track team and I tagged along. I ran with school teams during high school and very casually during college and in my early 20’s. When my husband and I moved to Austin in 2015, I joined a running group as a way to meet people in the city. I found some of the best friends in that group, and a large part of my social life has revolved around running ever since.
Checking out the bump post run, December 2018
I found out I was pregnant in August 2018. At that time, I had a strong base of fitness and was able to run easily for most of my first two trimesters. Near the end of my second trimester, a long car ride to visit family proved problematic, and I ended up going to see Rebecca Maidansky for some pain in my pelvis. While getting help managing that, we also talked about preparing the pelvic floor for birth and what a return to running could look like. She mentioned a recent (at the time) study that suggested waiting three months to begin running again. Three. Months. I could not wrap my head around that time frame. Wasn’t your follow up doctor appointment at six weeks post delivery? Even that seemed like an eternity.
I stopped running around the beginning of my third trimester because my body was clearly saying Nope!, so I ended up on the stationary bike at the YMCA until I had my beautiful kiddo in April. Like my pregnancy, I mostly found labor and delivery to be a manageable experience. I had an epidural and delivered an 8lb baby vaginally with minimal tearing, and I expected recovery to come as naturally as the rest of the experience. I was a fit, healthy person and, aside from one wicked bout of food poisoning, I hadn’t spent a night in a hospital since my own birth. How could recovery be that hard? My first clue as to the extent of my fatigue came when I hobbled over for my first shower in the hospital. The nurse walked me there and put a towel on the seat in the shower so I could sit if I needed to. Why on Earth would I need to sit down during a shower? I thought as she left. It felt pretty silly until about two minutes later, when I sat.
I spent the following days surrounded by loved ones, but feeling very far from my normal physical and emotional state. Once the first round of family had left and my husband went back to work, I took a solo outing with my daughter to a local botanical garden. When I got home, I felt tired and heavy in my pelvic floor. I took the next day really easy and felt a bit better. The following day I tried the garden again. Heaviness again. The day after that I went to the grocery store and when I came home, I knew with certainty that the outing had not been a good choice. I took a peek at how things were healing…and let’s just say that where things were once concave, they were now convex. Not. Good.
I got an appointment with my ob/gyn for a day or two later, where she told me I probably had stage 1 or 2 pelvic organ prolapse (my googling had already pointed me in that direction). As I cried, she made it seem like not that big of a deal (in direct opposition to what my huge emotions and the internet were telling me). I started to feel angry - at the lack of clear, preventative instructions from my doctor; at other moms for not telling me how hard recovery was; at my husband because it was me, the one who loved running, dealing with this instead of him (logic and reason were not huge parts of the thought process at this point). My doctor said, truthfully, that three weeks postpartum is very early in recovery and that physical therapy could do a lot to ameliorate prolapse. All I could feel was my future as an active and happy person being ripped away from me.
Running the soft trail at Little Zilker Park, Sept 2019
I messaged Becky and she got me in for an appointment right away. Because it was so early in my recovery, she focused on getting my core re-engaged and, honestly, providing me with some much needed pep talks. I have never cried so much or felt so seen and heard by a medical professional as I did during those visits.
Once we hit the six week mark, near the end of May, we moved on to addressing my pelvic floor more directly. Strengthening is what it needed and I followed my exercises to a T. No one has ever completed their PT exercises as thoroughly as I did during those weeks! Throughout June and July, we continued to work on strengthening my pelvic floor and other supporting muscles. It was emotionally draining, but as I slowly had less and less heaviness in my pelvic floor, I could tell we were making progress. In July, we added something that scared me a lot - jumping. I was so hesitant and scared to undo our work or feel additional symptoms, but I continued to feel better.
Throughout the summer, I was able to get back to no-impact exercise. I rode my bike on a trainer and did a lot of aqua jogging with an injured running buddy (bless her heart). While it wasn’t running, these baby steps of activity helped me so much mentally. At one of our last sessions together, near the end of August, Becky came with me on my very first run postpartum. We went to the Town Lake Trail and did three by five minutes running, five minutes walking. The running sections were a good three-four minutes slower than my easy pace from the Before, but it was RUNNING.
Becky told me to start on slow on soft surfaces and slowly build up my run-walk endurance. I started going to a local park with a dirt walking trail twice a week and building up the number of minutes running. By the beginning of October, I could do 20 minutes continuously. By the beginning of November, I was up to five miles. I even got to go on some shorter runs with my friends again. I was making progress! It wasn’t perfectly linear - in particular, I noticed some symptoms when I ran with friends and the pace was a bit quicker than what I was doing on my own - but it felt like an upward trajectory.
Spectating the 2020 Olympic Marathon Trials with my running friends
Then, cold and flu season hit. Our daughter was now in daycare and she and I both spent most of November, December, and January sick. Disaster for the pelvic floor. Coughing and vomiting put a lot of pressure on it, and my progress seemed to go backwards. I wasn’t able to be consistent and there was so much stress on my pelvic floor. Finally, I decided that it was better to just take a break. It was too emotionally draining to try and fail, try and fail, to have a run without symptoms (for me, at that point, symptoms were heaviness in my pelvic floor and leaking urine).
For me, there were two components in turning things around and getting back to consistent, symptom-free running. First, I went to watch the 2020 Olympic Marathon Trials in Atlanta, GA at the end of February. I had been looking forward to this trip with my girlfriends for over a year. All the months when I wasn’t running, or struggling to run, I looked forward to this trip, to feeling like I was part of the running community again. Watching the unprecedented number of women competing in the race, knowing that some of them were moms, made me feel like I would get there. I could do it, but maybe I just had to be more patient, to be better at listening to my body. I really needed the inspiration and sense of community this trip provided.
Second, the world as we all knew it stopped in mid-March 2020. COVID-19 shut down my in-person work and our daycare. Suddenly, we were physically healthy (no daycare) and I didn’t have to rush out the door in the morning (no office). I took this as my silver lining and started running again. I took the pace metric off the face of my running watch and turned off the beeps it makes each time you hit a mile. I needed to be listening only to my body, without external input. I traced out a loop around my neighborhood and slowly increased how much of it I ran, then how many times I ran it. I ran two, then three times a week throughout March and April. In May, I tried incorporating baby surges, for a touch of speed, into my runs for the first time. In June, I added a fourth run each week. I was BACK
Now, it was not all rosy. I had some terrible runs during that build. On Mother’s Day, I went out for a long run, ran down a hill, and had some intense leakage. Honestly, I haven’t loved Mother’s Day since. I had to go back to PT at one point - a good reminder to keep up your strength work…for all your key muscles. But each small milestone of progress made me feel like I could get to the next one.
Running with my daughter, 2021
Dealing with postpartum prolapse and leakage put an enormous gray cloud over my experience of my daughter’s first year of life. It sucked a lot of joy and energy from my life overall, and once I had made it through the worst of the situation, I knew that I wanted to use what I learned from my experience to help others have better ones. I’m not a physical therapist, but I’m pretty vocal about sharing how amazing Becky and the Lady Bird PT crew are. Becky’s pep talks during those early weeks were an incredible lifeline and the fact that I can run as much as I do now is a testament to her excellent clinical care.
And, now that I’m a certified running coach, I can offer other types of help to postpartum walkers and runners. One of the things I missed so much during those months without running was being part of a community of runners. There really wasn’t a natural way for me to be part of Saturday morning long runs or to commiserate about a hard workout. I would have loved to be part of a group of other runners who were in the same season as me. So, I reached out to Becky and the postpartum walk/job group was born!
We envision this group as a place for all faces and all paces. This includes what I’m calling coffee pace - if you aren’t ready for movement yet, but want to spend time connecting with others who love running, come join us at the picnic tables at Garrison Park for some coffee. We’ll start with some mobility warm ups from LadyBird, then have loops mapped out for those who chose to walk, walk/jog, or run. We’ll chat about the best sports bras for breastfeeding, how to safely build mileage, and how to get in runs around the demands of being a parent to a tiny human. We can’t wait to see you there!
This guest blog post was written by running coach Jen Craver of Southwood Running.
I’m a runner who dealt with postpartum prolapse, but the amazing team at Lady Bird PT got me back out on the road. Now, as a running coach, I want to use my experience to help others have better ones. I’m very excited to be starting a postpartum walk/jog group with Lady Bird PT to do just that! Southwood Running was born out of a deep love for running and the joy it can bring to life. Whether you are training for your first 5k or looking to set ambitious new personal bests, Southwood can provide the guidance you need.