Coaching the Pregnant Runner

If you start training more women during pregnancy, odds are you will work with clients who enjoy running. Whether you work with a marathoner, or someone who simply enjoys the occasional 3 mile jog around her neighborhood, the type of coaching you provide can make a big difference in helping your clients continue doing the activity they love.  Yes, while pregnancy is the not the time to start running, many of your clients should be able to continue running through a good portion of their pregnancy — especially with the right coaching. So, let’s discuss that.

The Key to a Runner’s Training Program

Pain-free running requires good strength, especially to absorb forces generated during impact (which are about 4-6x your body weight). The bigger a woman gets during pregnancy, the more force she must absorb with each step.  Therefore, you want to focus on a strength-centered program so that running will cause less disruption to your clients’ joints (ankles, knees, hips, lumbar spine) and pelvic floor.

Broadly speaking, your program for a prenatal runner should emphasize lower-body strength building moves such as squats, deadlifts, step-ups, and lunge patterns. Single-leg work is highly-advised because running is essentially a single-leg activity and you want to prepare her as closely to the demands of the activity as possible.

In addition to employing a strength-centered approach throughout her training, below are a few additional trimester-specific considerations to help you modify her program as she progresses through her pregnancy.

First Trimester Guidance

How Her Body Changes

Aside from any fatigue or nausea they may experience, running won’t feel markedly different for your clients because the weight gain and alignment shifts have not become a factor yet.  There are two key things to be aware of in the first trimester:

  1. Potential effects of relaxin: Relaxin is a hormone that increases throughout pregnancy — softening the joints, ligaments, and connective tissues to enable a woman’s body to adapt to her growing baby and provide added mobility for childbirth. It has the side effect of increasing a woman’s mobility and decreasing her stability. However, the effects vary widely from one woman to another.  Some are greatly affected by it, whereas others do not notice any difference at all. Relaxin starts to increase immediately in pregnancy, but some women feel its effects later once the alignment shifts are more pronounced.
  2. Risk of getting overheated: During the first trimester (especially the first month), a woman must avoid getting overheated (body temp above 102° F), as this could interfere with the critical process of brain and organ development.  The mother’s body does adapt to dissipate heat more, but it does mean she needs to avoid exercise in high-heat and humidity and increase her water in-take in order to keep sweating (one of the key ways she cools herself).

Programming Implications 

The recommendations below consider the factors above, but also begin to prepare her to better manage the changes in the later trimesters. 

  1. Use the Hurdle Step assessment to see if a client is being affected by relaxin and to find her baseline degree of stability so that you can compare changes later in pregnancy.  If you find she needs to focus more on single-leg stability, try these beneficial exercises.
  2. Avoid running in high heat and humidity and encourage her to drink more water — before, during, and after her workouts.
  3. Start now to ingrain proper breathing mechanics by teaching her 360° Breathing. This is the most important and fundamental technique to teach any client due to the substantial impact proper breathing has on mother and baby, but it’s also important to help prevent the constricted breathing that can occur during the third trimester that could impact running.
  4. Start now to train her pelvic floor muscles. as this will be important in helping her avoid issues from the impact of running as her body gets bigger.

Second Trimester Guidance

How Her Body Changes

  1. Nausea and Fatigue (typically) subside: Second trimester is often called the “honeymoon of pregnancy” because women are often over the first trimester nausea and fatigue, and not yet experiencing the common discomforts of third trimester.
  2. Increased Cardiac Output: This change is pretty cool! A pregnant woman’s heart pumps more blood with each beat AND beats more times per minute. This confers a cardiac advantage similar to the “blood doping” techniques some athletes attempt to use. Of course, this advantage will gradually be quelled a bit by the factors below, especially as pregnancy progresses.
  3. Weight Gain: Up until now, most women only gain a modest amount of weight (about 5lbs or so) and some may even lose a little bit if contending with extreme nausea and vomiting. However, the second trimester is when the weight gain starts to increase. This will likely cause more noticeable changes in your client’s running.
  4. Alignment Shifts: Compounding the changes caused by weight gain, the growing belly tends to pull her pelvis forward into an anterior pelvic tilt, which compresses the tissues in the lower back and increases pressure on the pelvic floor muscles. When we combine this with the added impact of running, it could result in the common pregnancy complaints of lower back pain and incontinence (accidental urine leakage).

Programming Implications

  1. Take advantage of the “honeymoon”: If your client is feeling well (and not experiencing discomforts or symptoms of PFD described below), second trimester is a great time to take advantage of her increased cardiac output and push her a bit more.
  2. Use RPE: Remember that heart rate is not an accurate gauge of exertion during pregnancy.  Instead use RPE (Rate of Perceived Exertion).  Using a 1-10 scale (where 1 is very little effort and 10 is max), she can work up to about an 8 (perhaps 8.5 for your athletic clients).
  3. Coach her into neutral alignment: The more her alignment is off, the greater the strain will be on her lower back and pelvic floor muscles when running.  Follow these tips to help your clients stay in neutral alignment.
  4. Watch for signs of PFD: A little urine leakage during running (or coughing, laughing, or sneezing) may not seem like a big deal, but it signals an imbalance in the core. If your client experiences leakage during her runs, or feels a sudden urge to go before she starts running, this could be a sign of pelvic floor dysfunction. Try reducing her speed or distance, or switch to a lower-impact activity, such as walking on an incline. If she is still symptomatic, then it would be prudent of her to avoid running altogether.

Third Trimester Guidance

How Her Body Changes

  1. Increased Weight Gain and Alignment Shifts: These changes that began in the second trimester will be most pronounced now.  For many women, their bodies will tell them they need to lower the intensity and reduce (or eliminate) the impact.
  2. Altered Gait: As relaxin levels peak, the pelvis (and, as a result, the feet) get wider, which can lead to a change in gait pattern, including her running gait. Expect a shorter stride with the potential for more side-to-side shifting. This places a high demand for strength on the legs, especially on the hip abductors.
  3. Constricted Breathing: As the belly gets larger, it may push into the thoracic cavity, thereby limiting the lungs and diaphragm from descending with the same ease that they used to. Therefore, your clients might find it harder to take a deep breath, which may cause them to alter their breathing patterns and familiar rhythm — increasing the difficulty of running.

Programming Implications

As mentioned, many women will innately feel that it is time to lower their intensity or stop running altogether.  If your client does continue to run, be sure to focus on the following:

  1. Reinforce 360° Breathing: This is important at all stages, but especially now to maximize air intake as the uterus restricts it more.
  2. Focus on lower body strengthening: Especially in single-leg stance (to help increase hip abductor activity) as long as she is not experiencing pelvic pain.
  3. Constantly check in with how she feels: Above all else, running in the third trimester really comes down to this question: Does it feel good? If there is any hesitation when your client answers, then it is probably time to focus on more comfortable movements.

Want to learn more about coaching women during pregnancy?  Consider becoming a Pre/Postnatal Performance Training Specialist.