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  • Writer's pictureZion Physical Therapy

Running Strong through the Trimesters: A Therapist’s Perspective

I run to feel good, both physically and mentally; therefore, I needed running even more during pregnancy. But running while my body was (and still is) constantly changing presents some new challenges. Here’s a guide of some helpful tips to avoid running into any problems.

pregant woman and man taking a rezist class


Take it Slow

Let’s start with the usual disclaimer: make sure you are cleared by your doctor (obstetrician/midwife/gynecologist) before beginning an exercise program. There are a number of medical and obstetric conditions that may make exercise unsafe during pregnancy.

With that out of the way, the current guideline for exercise during pregnancy calls for about 30 minutes of moderate intensity exercise, most days of the week (as per the American College of Obstetricians and Gynecologists). Fortunately, running is an activity that allows you to moderate the effort you put forth. You may be a seasoned runner, aware of how hard you feel you’re working and able to regulate on your own. Or, your doctor might want you to wear a heart rate monitor and stay within a certain range. As for me and my slightly competitive nature, I needed additional external factors to slow me down. I ran with my dog so that his incessant need to stop and smell the roses would force me to take rest breaks, or I chose a running partner who was slower than my current pace (shown below at 34 weeks gestation, with my 60 year old dad).

Staying out of the red zone is important because your blood volume is increasing tremendously (from 30-50% as early as 16 weeks gestation), causing your heart rate to be higher than normal even at rest. And if you’re like me, your iron stores haven’t necessarily caught up with the increased red blood cells, so your risk of anemia is increased. Add to that your difficulty breathing now that your rib cage has expanded and your diaphragm is less efficient (it’s stretched out and contracting against more resistance), and you’re likely to find yourself short of breath way earlier than usual. So, go for your run, but be prepared to slow down and incorporate intervals of walking.

Don’t Overheat

If you’re in warmer climates or it’s summertime in the city, be especially cautious to not overheat, which could be harmful for your developing baby. I usually like to get a tan while I run, but soon I found more comfort in taking routes that were shady instead of sunny. The thought of carrying a water bottle with the weight I had already gained seemed preposterous, so I memorized all the water fountains along the route as well. If you have retained fluid during your pregnancy, and have found that your hands or feet are swollen on the regular, keep this in mind. Dehydration will come on sooner (especially if you skipped your normal glass of water pre-run so that you could last a little longer without a bathroom break.) By my third trimester, during the heat of the summer, I kept all my runs close to home, sometimes just circling the park next to my apartment, just in case.

Pregnant physical therapist exercising with two men pointing at her belly


Do Your Kegels

It was early on in the second trimester that pressure built on the pelvic floor and the pelvis started to stretch and change, which meant leakage, first with sneezing and then with running. I had to up my kegel game immediately. I ran with a liner at first, but I caution you that you must change out of your running clothes pretty immediately after your workout, as UTI risk is higher during pregnancy. I recommend a pretty solid kegel routine as soon as you become pregnant (some apps even let you track your sets and reps), but make sure that you’re holding the kegel for 5-10 seconds at a time for improved endurance. I would try to focus on my pelvic floor contraction during the first half mile for good strengthening practice under running conditions and was able to get rid of my leakage in about one month. If you need more help on this front or aren’t sure you’re doing them correctly, check in with us.

Strengthening Rules Still Apply

Logically, it’s fair to say that your joints now think that you’re going out for your usual jog while wearing a weighted vest. This is not something most people do voluntarily to enhance their training, and for good reason. An increase in one pound of body weight multiples by 3-4 times that amount when you are running, and it will take its toll on your joints. So strengthening is even more important now than it was even before. Keep up your squats and lunges throughout the pregnancy to ensure support for the knees and hips as you gain weight. I chose to stick with my usual HIIT classes (high intensity interval training) with the support of some solid teachers (check out the great team below) and a number of modifications to make it a MIIT class (moderate intensity interval training).

Recover Well, Stretch With Caution

Recovery is more important for the same reason, mostly by means of rest and refueling. If you were an avid stretcher or just love to feel flexible, this is where you might need to hold back. With your ligaments being looser than ever, stretch with caution as it’s easier now to “over-stretch.” Keep it gentle with a minimal intensity stretch instead of moderate. I had to change my usual runner’s lunge stretch for my hip flexors to more conservative quad stretches, since it started to make me feel a little unstable (more on that later).


Invest in a New Sports Bra

First trimester feels a bit like all the other runs you’ve done while at peak-PMS. Mostly your boobs hurt and you feel bloated. Over the course of the pregnancy, you may need to invest in a new sports bra, the same as you will with your other bras to accommodate the change in size. Mostly, my bras made it feel hard to breathe because they were too tight against my expanding rib cage (which can widen up to 3-4 inches over the pregnancy). I ended up doubling up on some older, looser sports bras to stay supported and comfortable at the same time.

Consider an SI Belt

If you have a history of sacroiliac (SI) joint pain or low back pain, are feeling excessive movement in your pelvis while running, or are dealing with some SI joint, or sciatica symptoms now that you’re pregnant, consider wearing an SI belt (with extender strap) while running to decrease shear forces on your pelvis. I love the Serola belt and keep one in my office in case you want to do a trial run before you purchase. Just make sure to read the instructions to make sure you’re wearing it at just the right level.

Check Your Shoes

My old posterior tibialis tendonitis (an inflammation of the tendon that runs along the inside of the ankle) said hello during second trimester. Since the ligaments of your feet are also stretching, your lower leg muscles will be working overtime to stabilize your ankle as your foot hits the ground. If you notice your feet are expanding or you start to feel pain in the arches of your feet, considering switching out your neutral or minimal shoe to a stability shoe for some more extrinsic support. I threw my old orthotics into my running sneakers and it remedied the situation immediately. Couple that with a shortened stride to reduce joint loading and you should be on your way to safely running in trimester three.

Suffice it to say that being a good body-listener becomes more important than ever, especially since you’re listening for two. If you’ve been cleared to exercise but just want a little more guidance, if you are struggling with feelings of heaviness or incontinence, or if you are having any pain, don’t hesitate to reach out. Zion’s physical therapists specialize in treating both prenatal clients AND orthopedic cases, so rest assured that we can put the pieces together in a way that works for you and helps you keep exercising safely throughout your pregnancy.

pregnant woman from Zion physical therapy running a 5 k with her dad
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