Mend Physical Therapy Blog and Injury Information

What Factors Predict Pain in Postpartum Runners?

November 16, 2021

Postpartum runners potentially make up a large portion of community runners as most women participating in running events are of childbearing age. 35% of women returning to running after childbirth report running-related pain. In 2019, a group of international running experts developed guidelines for postpartum runners to safely and effectively return to running. This criteria were established to assist healthcare providers working with postpartum women to determine readiness for running after birth. In our physical therapy practice in Boulder and Lafayette, we routinely use these criteria as a starting point to help women make a successful return to running postnatally.

More recently, a 2021 study analyzed the biopsychosocial factors associated with postpartum runners and investigated the risk factors for experiencing pain in this population (runners with children 36 months of age or younger).

The study concluded when at least 4 of the following 6 factors are present, the risk of experiencing postpartum pain with running increases from 32.7% to 61%:

  • Novice runner

  • Postpartum accumulated fatigue score > 19 (see below)

  • History of prior running related injury

  • Vaginal delivery

  • Incontinence of any kind (bladder or bowel)

  • Average sleep < 6.8 hours per night


As in other studies identifying risk factors for running related injury in non-postpartum populations, two of the strongest predictors for postpartum running pain include novice runner type and previous running related injury. This current study gives us new insight into the biopsychosocial factors that may contribute to injury in postpartum runners, however, as with any clinical prediction rule there is need for further validation with larger study samples.

Given this new data, we strongly recommend that postpartum women see a pelvic health physical therapist for assessment and care, especially if you had a running related injury or running related pain before pregnancy and childbirth. Further, returning to run too early may negatively impact the normal healing and recovery process following childbirth, thus a holistic assessment prior to running can help individualize a program to limit injury and optimize success. 

At Mend, we feel strongly that the blend of orthopedic and pelvic health knowledge are key to helping women return to healthy, pain-free running postpartum. Schedule an appointment with one of our pelvic health experts here.

Postnatal Accumulated Fatigue Scale:

  1. Feel tired in the morning

  2. Feel exhausted (excluding after exercise)

  3. Feel more tired than before

  4. A strong urge to sleep in daytime

  5. Feel unwell

  6. Feel unrested

  7. Feel depressed

  8. Feel anxious

  9. Feel restless

  10. Feel irritable

  11. Feel apt to make many errors

  12. Feel unfocused

  13. Feel unmotivated

Scoring: 0=rare, 1= sometimes, 3=often

Tsuchiya M, et al. Cross section and longitudinal validation of a 13-item fatigue scale among Japanese postpartum mothers. Journal of Nursing and Human Sciences. 2016; Vol 22.