2023 Top 5: # 4 How to Safely Return to Running After Childbirth: Research-Backed Guidance — with MEGAN JAMES

Coming in at #4 of our top episodes of 2023 is my conversation with Megan James. 

She is a  PhD Student at Cardiff Metropolitan University. In her studies, she is exploring returning to running after childbirth. Her goal is to help bridge the gap between clinicians and research, and has collaborated with other researchers and clinicians on recent publications. We look at all of the different factors that can play into a mom’s experience in returning to run after having a baby. 

Megan shares insight from her research and how it can help clinicians better serve their patients. This interview is full of great takeaways! 

Her e-survey is currently open and she would appreciate responses to help us in this under-researched area! Criteria is over 18, have given birth in the last 2 years and ran for at least 30 minutes per week prior to most recent pregnancy: https://cardiffmet.eu.qualtrics.com/jfe/form/SV_cHC95M4ejaiVlki

We talk about:

-choosing PhD area of study

-uplifting others in pelvic health

-rehabing after childbirth

-fear of injury

-personalized care within the guidelines

-educating sooner

Time Stamps

1:00 choosing postpartum women & running for PhD studies

6:44 biggest impacts on moms returning to run

12:20 the role running plays in a mom’s life 

18:10 biggest gaps between research and patient care

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CONNECT WITH MEGAN

IG: https://twitter.com/meganljames16

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Transcript

SPEAKER_00 0:00

You're tuning in to the Active Moment to Physical Therapist with Dr. Gary Peglian, a real mom's guide to all things postpartum return to workout after baby. If you're a postpartum mom, coach, trainer, or physical therapist looking for answers on how to get back to running, CrossFit, yoga, Pilates, you name it without the fear of public core issues or doing something wrong, this is the podcast for you. Let's start the show. All right, so I admit today's podcast guest, I was drawn to her because she has the coolest last name ever. And then I needed to know more. So we have on our podcast today, we have Megan James, who is a PhD student, and she is studying postpartum return to run. And um again, like beyond having an awesome last name, the fact that you're diving into this research, I bow down to you. So welcome to the podcast, Megan James.

SPEAKER_01 0:52

Thank you very much for having me on. It's nice to come and talk about what I'm doing, really. Um, yeah, so I'm a PhD student at Cardiff Met Uni in Wales. Um and yeah, just going into my kind of second year of my PhD now. So we've kind of started getting a few things up and running, but it's still kind of early stages at the moment.

SPEAKER_00 1:13

Awesome. So let's let's dive right in. Like as a PhD student, like what made you decide to look into this? Because it's not the sexiest, it's not the most popular thing. Like, what made you decide to look at postpartum women in running?

SPEAKER_01 1:27

Yeah, um, it was yeah, like as you say, I think if you if I'd have gone back a few years ago, I don't think I'd ever thought I'd have ended up doing this kind of area of study because it's not the kind of thing you think that you're gonna do when you're like starting your undergrad, or just it doesn't appear as something that's really obvious that you should get into. Um, so I did my undergrad degree at Swansea University in sport and excise science. Um, and when I did that, I kind of got more interested into the injury side of things rather than um kind of sporting performance. Because I know when you're when you kind of start doing your undergrad in sports science, everyone's thinking, oh, I want to go and work at the elite rugby football, whatever teams. Right. Um, which you know, I thought maybe beforehand, I thought maybe I would, but um yeah, I kind of got more interested into the injury side of things, um, did a dissertation looking at kind of uh asymmetries between limbs in field hockey, and doing my dissertation, I really enjoyed the research aspect. So I thought, okay, I'm gonna go on and do a master's. Um, did a master's in sports science at Cardiff Met, um, kind of got interested in uh running and running injuries. Um, so my current supervisor, Dr. Izzy Moore, um met from my masters. Um, and she's obviously like, you know, super big name in running and running injuries, and I got interested in that uh working with her. Um, and my kind of dissertation for my master's uh focused on running, it got a little bit um kind of interrupted by COVID. Um we we did have to change the focus a little bit and things like that, but um kind of running injuries and then started focusing on the pelvis in that uh particular dissertation project. Um, and then kind of because everything was interrupted with COVID, um, there were certain studies going on that you maybe wouldn't have necessarily normally done. So um Izzy got involved with a kind of survey study um that we've now released papers from um looking at kind of postpartum return to running and experiences of postpartum women returning to running. So she said to me, Oh, do you want to jump onto this? You know, come help out with this while you're doing your masters. And I thought, yeah, like it sounds something different that I haven't uh done before. It's like a different kind of analysis, it's a different population. It's still running, but it's kind of uh a different population then. Yeah. Um and I got involved with that, and it just like you know, like really enjoyed it. Obviously, spoke to some friends and family who were experiencing the same things that I was researching, you know, if they just had kids. Um, and yeah, like I just had kind of started getting quite interested in it and then spoke to Izzy after we kind of finished the kind of analysis for those, and and she was like, Yeah, so do you fancy maybe carrying on and let's let's look at kind of applying for some grants for a PhD? So I thought, yeah, yeah, it sounds great. And to be honest, like since then it's been like working in that field. The um the kind of people you speak to, either if it's engagement on social media, like where they see your research, um, kind of, you know, when we're looking for volunteers or um even through like survey responses, the reaction you get from people who are just so glad that you're doing research into that area, um, it just feels quite fulfilling. Um, so it's definitely kind of it's been nice to be involved in an area where you're thinking, oh, I'm actually having potentially, if I do a good job, a nice impact on these people's lives, potentially. Um, so yeah, it's just kind of grown from there, just applying what I know in sports science kind of traditional um disciplines and concepts in that under-researched population.

SPEAKER_00 5:17

So that's fantastic. I mean, like clinically, that's kind of what we've had to do too. And I much like you, I went into um caught into this field not having any kids, and in, you know, thinking, oh, well, you know, it's an area where I can make change. And then for me, it just was a game changer when I had my own kids being a runner myself. And I think you just appreciate it in an entirely different way. And again, there's so little, it's been great the last couple of years. So you're right on the way up here. It's it's such a fun time to also see some of these elite moms turning out some serious, serious results. Um, and I think that's just spotlighting it more. But for for me, again, like there just was so long that we didn't have research. So now that I think with social media and everything, it's so much easier to be. And I think I just DM'd you, I was like, hey, you wanted like you don't know me, but I I like I want to elevate as much as we possibly can because for for somebody to have the background that you have in sports, um, that's where it's gonna come from. Like, I think when you just come from pelvic and you don't understand, you know, running or injury or those sorts of things, it it's a very different kind of question. You get kind of stuck in the the pelvis, so to speak. So for me, like I love the fact you're like, I'm coming at it from here. I love that.

SPEAKER_01 6:39

Yeah. No, I also feel like, as you say, the kind like with just DMing me and stuff, the community, like either by social media or whatever, is very together on this kind of topic. Like anyone you speak to about it, like researchers or practitioners or just actual volunteers and participants and people in that population are just really like keen to chat to you and see what you're doing. And they're just yeah, yeah, they're just glad that you're doing something. So um, yeah, it's a really nice area to be involved in.

SPEAKER_00 7:08

We're nice people. Yes.

SPEAKER_01 7:10

We're nice people.

SPEAKER_00 7:12

All right. So pulling from one of um the studies, I think uh this one that we're talking about, you know, all the possibilities that could impact moms when getting back to babies. I had to laugh because for me, like again, having done this for 20 some odd years, my kids are now nine and eleven. Like, I'm like, yep, yep, absolutely, 100%. Like fear, age, did you run during pregnancy, weekly running volume, number of kids that you have, kind of unpack high high level sort of what you found in some of these studies that you've done the last couple of years.

SPEAKER_01 7:49

Yeah. Um, so the first study we did, um, we kind of looked at all of these factors um kind of and looked at like in terms of what kind of odds they gave in whether you'd return to running, whether you'd return to like the same level as running as before, because that's equally as important for some people. It's like, okay, well, I've returned to running, but I haven't returned to what I want to return to. So uh we thought it was important to look at that as well. And we found that kind of running during pregnancy um was like the high gave the highest odds of you then returning uh to running afterwards, which is quite interesting because obviously we found that a lot of people stop before or because of like this kind of stigma around, oh, I should just stop, you know, as soon as I know I'm pregnant. Um, and then following that was having a high weekly running volume. And I guess that's to do with kind of people who are like ultra keen, um, then think I really want to get back to it. I suppose if you didn't run as much beforehand, it's not as big a part of your life. So maybe then that doesn't, you know, I don't know, but it could be that. Yeah. Um, and then the third, the next one, Dan, was kind of a lower fear of movement. So we found this in our paper, um, and it's it's been mentioned a little bit in other uh kind of literature that it's evident that there is this kind of fear of movement in the postpartum population, but it hadn't really been looked at too much with uh returning to running yet. Um, well, like there's not a lot on returning to running anyway, but you know what I mean? It hadn't been looked at in that specific context. So it's quite interesting that we found that. Um, and I guess it's just is to do with like similarly to treating kind of childbirth as a kind of musculoskeletal injury, that it doesn't often get looked at. You know, if if if if you said to somebody who got injured, like, oh, we just want not going to rehabilitate you and you've just got to start running again, they would be like, What? Is that not you know, I'm supposed to go through some kind of rehab program. Um, so I guess the fear of movement is like that injury site, um, I guess is kind of depends on your delivery mode, but like could you know, pelvic floor, potentially like abdomen if you've had a cesarean, um, kind of that fear that you're gonna kind of re-injure something or like you know, get some pain and that kind of thing. Yeah. Um, you know, some of the quotes from people in the survey that we did were things like, you know, I'm worried about my scar tearing, I'm worried about, you know, my my kind of perennial tears haven't healed. Um, and it's all that kind of thing where, you know, it's like that psychological component to then returning to running. So that was really interesting, and I think we'll probably uh focus on that a little bit as we go through the PhD as well. Um, because we're kind of at the moment looking into kind of what's stopping you and you know, helping you return to running a little bit more. So hopefully we can find something useful to try and help with that. Yeah. Um, and then yeah, um, age, we found so younger people were more likely to return to their kind of pre-pregnancy level of running. So um, not running altogether, but just the the level that they were hitting before. So whether that's related to kind of as you get older your priorities might change, or if it's a physical thing, we don't know. Um, but you know, I think I'm not sure if I'm correct in saying this, but I think the age of having children is increasing. Um, like the age of where you have your first child is kind of increasing uh on average. So that's obviously something that means then it's more difficult for people to get uh get back into their like pre-pregnancy level. Um but also I think I've seen somewhere that potentially like that fear of movement can be higher in older people as well. So it could be that that's interacting or something. Uh but again, these things are just they haven't been explored in enough detail to make really solid claims. Um, but yeah, and then number of children. I think so. We found that having more than one child actually increased your odds of returning to your pre-pregnancy level.

SPEAKER_00 12:02

But that was really interesting. I was like, there's a sanity issue there, like we we need to get out of the house.

SPEAKER_01 12:07

Yeah, so I so either, so either, because like you would, I don't know, like before I might have thought, oh, having more than one child, you have less time, you can't run as much. Doesn't make sense. Um, but potentially that previous experience of doing it before as well. So they've gone, oh well, I've done it before, this worked, this didn't work, so I know what to do now, and I feel confident that I can do it again, potentially. Um, but it's just very interesting because I just immediately thought, more kids, less time, more childcare to have to do.

SPEAKER_00 12:41

Um but yeah, and I found all of this incredibly interesting again through my lens, you know, having two kids. And I was an older mom, I was 34 with my first and 36 with my second. Where we live here, we tend to be an older mom, kind of very driven population here. And I some of the stuff I was just like, yep. If you are running high volume and you're that intense person and you're gonna run all the way through, you're going. I I'm interested to see later on some of the questions that get asked because I think some of that plays into kind of advice we give on return to run. And I I've spoken about when I have clients that go back to run earlier than they probably should, but there's a question of are they using that to manage postpartum depression or things like that? You have to be aware of what role does running play in their life. Um, and so it it just I feel like this just opened up this whole can of worms of like, what about this and what about this? And I think, you know, I'm an older mom, but what about younger moms? Like I loved it in that it put it out there for us to start to now kind of play with and snack on and and ask more questions. So that was super cool.

SPEAKER_01 13:53

Yeah, and the thing is, I think um, like we always talk about like we want more information so that we can come up with some more guidance and advice and things, but ultimately the things that we give need to be kind of flexible enough to be individualized to different people, because not everyone's gonna be the same. It's like it's if you go back to looking at like muscular skeletal injury, not everyone takes the same amount of time to heal, you know, it all of those kind of things, like psychological factors, it's different for everyone. So, although we might have guidelines, advice that we do desperately need because there is not a lot out there, um, I guess it needs to be usable in a way that people can say, Oh, I'm in this kind of rough bracket, not that we want to kind of bracket people, but just you know, so that they can kind of think, oh, or or monitor it themselves with like their own kind of checks and things, because otherwise, if you just give like a blanket of um advice, they might be like, Well, well, that that's not working for me. Um, so it's just so difficult because there are so many factors, you know.

SPEAKER_00 14:59

That's that's gonna be hard for, but that's why I'm the clinician and you're the researcher because that's my sweet spot. The the gray, like I love that all day long, which is why I could never be a researcher. Like that's that's my I love that. But then the questions that come up for me too are like what uh you know, where can we start to educate sooner? Um, I have a daughter, she's nine, you know. At what point? I mean, you know, obviously we're talking about anatomy and this is what your body does and things like that. But like when I look back on the assumptions that I had going into pregnancy, even having, you know, a professional background of this is what I did, like I have to go back and be like, where did some of those biases, where do some of those um thoughts and fears, where did that start? And how can we take a step back and start to educate and get people to understand that it isn't black and white, it's great, and that's the beautiful part, and that's where there's so much so much hope and options and and you know it depends. We can we can make things work because if you don't fit into this one pathway, that's okay.

SPEAKER_01 16:07

Yeah, exactly. Exactly, yeah. Yeah, and I think it is just you know, like like you say, like just getting that education out earlier, because I think if people know about it before, like some people were like replying to the survey saying things like, you know, I didn't understand what impact this was gonna have on me, like what child birth was gonna mean, like because people just go on, you've just you know when you talk when you're younger and you you know have family or older siblings or whatever and they have children, they just have children, unless there's any like major complications, you're just like, Cool, you've had your baby, right? It's a go less normal life, do you know? Um yeah, but things like the difficult things that happen as a result of it probably aren't discussed because it's embarrassing or you know, so I think just talking about those, it's like anything, really, I suppose, isn't it? Like talking about it more makes it more normalized, which is it's fine to normalize it, but you still need to understand that some of the things are a problem and need to be addressed. So they could be common things, but they're still not kind of they shouldn't be happening, like you know, he renewed incontinence is very common, but it shouldn't happen, it shouldn't be accepted.

SPEAKER_00 17:16

Um those stories where, and and I think this is where you kind of get mixed messaging, where you're like, Well, you know, back in the day they gave birth in the fields and went on working, and so then you're left thinking, okay, I don't work in a field, I should be fine. But again, like I I I I'm in a generation, I I think you're you're a little bit younger, but um, where my mom's generation exercised for weight loss. Um, and our generation and the generations going forward, that's not the sole reason. They're doing it for health reasons and for you know social reasons, and we're far more active than our previous generations. And so, yes, we were in the fields doing things, but you know, were we out doing marathons? Were we, you know, deadlifting 300 pounds? I don't know. Like there's a lot of this stuff. So I think how we are using our bodies and how that's become part of our social fabric, um, I think that's changed too. And so, you know, we're we're asking these different questions because we have different expectations for what we want to be able to do and and our life expectancy. I I was talking to a urogynecologist. I was like, well, we're older. And she's like, actually, no, with COVID, our life expectancy's gone down. I'm like, oh sorry. Yeah, sorry for the reminder. Yeah, exactly. Yeah, exactly. All right. So you've been in postpartum research now for a little bit. Um, it's gotta feel like a little bit of the desert from an information perspective coming from you know, sports and and you know, uh injury management and those sorts of things. Um, what are the biggest gaps? Like what's got you chomping at the bit to I want to know more about this, or where do you see the biggest holes that potentially might impact us um as clinicians and how we can help um our moms at home?

SPEAKER_01 19:11

Yeah, so as you say, I think it's difficult to pinpoint one thing because it's so like it's it's so little research that like anything at the moment is great. But um I say, like, so my uh just to give you a bit of background. So my kind of uh steps of my PhD is to first kind of assess what mums think that they need, um things that are stopping them from running and things like that. Uh then looking how we can kind of gradually come up with some kind of program, monitor that uh kind of biomechanical loading and psychological kind of reaction and things like that to um to how they're getting on with loading gradually, and then hopefully doing some kind of program to see, like an intervention kind of program to see if it can help. Um, I'd say like intervention studies in this area are quite um, they kind of haven't been done an awful lot. Like physical, yeah, physical activity ones have been done a little bit, and some kind of online ones have been done a little bit as well, which is obviously great in like a post-COVID situation and things where people haven't got access to being close together or whatever. Um, but I think even like people who do interventions that are unsuccessful, it needs to be published because often if stuff that isn't successful, if you know if people do studies and they they don't show anything and they're not successful, people just don't publish them, right? Which means that then people can't see what hasn't worked. And it's like that's just as important as finding something that could work because if you know what hasn't worked, you know not to try it again, and then you can try and kind of focus in on what you could try instead. Um, so I think definitely some kind of practical application kind of studies, but then on the flip side, it would be really great to have more just descriptive data, anyway, that can inform those kind of interventions because at the moment we've got such little data on kind of how the population moves, like there's so many changes you go through physically, psychologically that could affect how you move physically, you know, through birth, morphological dis differences to like your weight, like you know what I mean? So many different things. I do like you know, it's like people um we want to try and I suppose apply some of the return to sport kind of literature concepts, but in a population that we know barely anything about, and even when you look at like uh return to sport and injury and kind of the um musculoskeletal injury literature, there's a kind of bias up until recently on publishing male data as well. So, like we haven't even got information on females before pregnancy. So, like you know what I mean? You know, it's just I feel like any at the moment it's it's a bit of a cop out answer, but anything is great. Right.

SPEAKER_00 21:57

No, I I I I love that though, because again I I think it's so important when I when I'm working with a client in clinic, I'm like, I want to know, I wanna lay everything out. And I think it's so important to know and understand why people are starting the way that they're starting. Like, you know, if if people are starting back to running, when are they starting and why? Do they start with a couch to 5k or do they start with a one-minute walk, one minute run? How often does that work? What is yeah, what are the variables that that make that work and what are the variables that don't? Like there's a million questions. Yeah, definitely. You probably are just it's like a smorgasbord of, you know, just keep it coming at this point.

SPEAKER_01 22:37

Right. Just give us information. Like I think a lot, you know, a lot could be done in terms of uh, as I say, trying to come up with some kind of advice. Um I don't know if you've seen the published guidelines from 2019 from um Tom Goom, Ryan Donnelly, and Emma Brockwell. Um so like you know, we've worked a little bit with uh a couple of those guys on some of these projects and are still working kind of with them a little bit. And I guess some of that is like you know, backing up some because, like, you know, they've said that um what they've released is very much this is what we think of clinical opinion, but we've got nothing to base it on because uh part from clinic, you know, which is obviously very valuable, but it needs some evidence to uh back it up because there's just not enough work on it yet that we can say uh kind of super super confidently, like this is with you know, there's a reason behind doing this. Um, and uh I think that those guidelines are great. Like so many people, I think 97% of people who read them in our study said they were useful um to helping them return.

SPEAKER_00 23:42

Um that to me was no, I I I was I I remember reading those results and being so excited because before that we really didn't have much to go on. And it's interesting, and I I've talked to Grenya about this, is you know, at the time, you know, those of us that were in the clinic, we were just grasping it whatever we could. So pulling from you know, Achilles tendinopathy or bone stress injury because there was impact involved or things like that. And so they did such a great job of saying, let's just take everything and put it here, and then you guys have added. And so I I'm so excited um that that's become I I think disseminated is the right word that so many people, um, not only professionals, but moms have found that via social media or Google or or whatever. Um and again, it's it gives us a place to start, it gives us a place to form a conversation that says we we should have something in place, we should have some criteria. You shouldn't necessarily just go out and see what happens. And there's so much value to just saying that. And I'm looking so forward to you know, whatever a revision looks like that you know, informed by a lot of the research that I think has been inspired by putting that out into the world. So um no, it was is such again like wonderful timing to have that pre-pandemic because again, we've all been chewing on anything that we could get off the internet for the last couple of years, yeah. Um, that's given you guys time to do those survey type studies that really did need to happen for us to understand more. So I I do think the timing has been, you know, as good at it as it could possibly be. But again, if it weren't for people like yourself that are like, hey, this is something where I feel like I can make an impact and it's interesting to me. And you have the the type of mindset and thinking that this, you know, this feeds you and serves you, and then we get to benefit from it. Like again, I my brain does not work that way. I will drink from the fire hose and read everything that you have, but I will not.

SPEAKER_01 25:58

Yeah, but no, it's just it's very exciting, I think, as well to think that we could make something that people can just use. Um, and that's why I think as well, that research into seeing how people would like to receive that, what kind of format they want it in to improve that dissemination to either mothers or people who can then pass it on to mothers' health professionals. Absolutely because then you know they can use it. Whereas if they don't hear about it or they can't understand it because we've put it out in some awful format, um it's not as worthwhile. Um just kind of seeing what people want, you know.

SPEAKER_00 26:34

Yeah, and that's where I think again, trying to figure out the the age-old relationship between clinicians and you know, researchers is like we can provide you the cases, we can inspire the questions, but if we can also be a megaphone to getting your information out into the world and making it, you know, user-friendly or facilitating that, like I think that's where um, at least in this corner of the the world from a medical perspective, you can't find a more supportive group of people because a lot of us that are in it have had our own issues. So we it's personal for us too.

SPEAKER_01 27:11

Yeah, I feel like yeah, I feel like it's a real area where clinicians and researchers are really starting to work together and it's making a big difference because you're bringing you know different perspectives and skill sets to the same area, and it's just great, yeah. Totally, totally.

SPEAKER_00 27:27

So I've got your Twitter handle here. This is where you tend to reside the most. Um so if if you are interested when you're hearing this um about what Megan's up to as far as her research, um, you can go ahead and find her over on Twitter. Um, and then again, like you're you've been kind of putting up as you have studies coming up and you're looking for you know subjects, you've been posting that stuff up there. And and the beautiful thing is now a lot of the things you don't have to live, you know, in Wales to participate. Which I love. So uh even if you're not what if you're listening to this and you're not in the UK, totally fine. Megan needs you. Megan needs you. Thank you so much, Megan, for all that you do. And um, we're excited to see um kind of where things go with your PhD and celebrate you when you're at the end of it. And um and thanks for being on the podcast. No worries, thank you very much. Did you enjoy the podcast? If so, leave us a five-star review on iTunes and tell a friend to do the same. Are you a postpartum mom or postpartum pro wanting to know more about getting back to running after baby? Check out all my free goodies on carypagviano.com. This podcast represents the opinions of Dr. Carrie Pegviano and her guests to the show. The content should not be taken as medical advice, and it's for entertainment purposes only. Always consult your healthcare professional for any medical questions.