Department of Physical Therapy Education, Elon University, Elon, NC, United States of America.
Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia.
PLoS One. 2021 Aug 12;16(8):e0255383. doi: 10.1371/journal.pone.0255383. eCollection 2021.
In 2019, a majority of runners participating in running events were female and 49% were of childbearing age. Studies have reported that women are initiating or returning to running after childbirth with up to 35% reporting pain. There are no studies exploring running-related pain or risk factors for this pain after childbirth in runners. Postpartum runners have a variety of biomechanical, musculoskeletal, and physiologic impairments from which to recover from when returning to high impact sports like running, which could influence initiating or returning to running. Therefore, the purpose of this study was to identify risk factors associated with running-related pain in postpartum runners with and without pain. This study also aimed to understand the compounding effects of multiple associative risk factors by developing a clinical decision tool to identify postpartum runners at higher risk for pain.
Postpartum runners with at least one child ≤36 months who ran once a week and postpartum runners unable to run because of pain, but identified as runners, were surveyed. Running variables (mileage, time to first postpartum run), postpartum variables (delivery type, breastfeeding, incontinence, sleep, fatigue, depression), and demographic information were collected. Risk factors for running-related pain were analyzed in bivariate regression models. Variables meeting criteria (P<0.15) were entered into a multivariate logistic regression model to create a clinical decision tool. The tool identified compounding factors that increased the probability of having running-related pain after childbirth.
Analyses included 538 postpartum runners; 176 (32.7%) reporting running-related pain. Eleven variables were included in the multivariate model with six retained in the clinical decision tool: runner type-novice (OR 3.51; 95% CI 1.65, 7.48), postpartum accumulated fatigue score of >19 (OR 2.48; 95% CI 1.44, 4.28), previous running injury (OR 1.95; 95% CI 1.31, 2.91), vaginal delivery (OR 1.63; 95% CI 1.06, 2.50), incontinence (OR 1.95; 95% CI 1.31, 2.84) and <6.8 hours of sleep on average per night (OR 1.89; 95% CI 1.28, 2.78). Having ≥ 4 risk factors increased the probability of having running-related pain to 61.2%.
The results of this study provide a deeper understanding of the risk factors for running-related pain in postpartum runners. With this information, clinicians can monitor and educate postpartum runners initiating or returning to running. Education could include details of risk factors, combinations of factors for pain and strategies to mitigate risks. Coaches can adapt running workload accounting for fatigue and sleep fluctuations to optimize recovery and performance. Future longitudinal studies that follow asymptomatic postpartum women returning to running after childbirth over time should be performed to validate these findings.
2019 年，参加跑步活动的跑者中大多数为女性，其中 49%处于生育年龄。研究报告称，女性在产后开始或恢复跑步的比例高达 35%，并报告有疼痛。目前尚无研究探讨产后跑步者的与跑步相关的疼痛或产后疼痛的风险因素。产后跑步者在恢复高冲击运动（如跑步）时，需要从各种生物力学、肌肉骨骼和生理损伤中恢复，这可能会影响她们开始或恢复跑步。因此，本研究的目的是确定与产后跑步者的与跑步相关的疼痛相关的风险因素，包括有疼痛和无症状的产后跑步者。本研究还旨在通过开发一种临床决策工具来识别有较高疼痛风险的产后跑步者，从而了解多种关联风险因素的复合效应。
对至少有一名 36 个月以下的孩子的产后跑步者进行调查，这些跑步者每周跑步一次，且因疼痛无法跑步，但被认定为跑步者。收集跑步相关变量（里程数、产后首次跑步时间）、产后相关变量（分娩类型、母乳喂养、尿失禁、睡眠、疲劳、抑郁）和人口统计学信息。采用单变量回归模型分析与跑步相关的疼痛的风险因素。符合标准（P<0.15）的变量被纳入多变量逻辑回归模型，以创建临床决策工具。该工具确定了增加产后与跑步相关的疼痛的概率的复合因素。
分析包括 538 名产后跑步者；其中 176 名（32.7%）报告有与跑步相关的疼痛。多变量模型纳入了 11 个变量，其中 6 个变量保留在临床决策工具中：跑步者类型-新手（OR 3.51；95%CI 1.65，7.48）、产后累积疲劳评分>19 分（OR 2.48；95%CI 1.44，4.28）、既往跑步损伤（OR 1.95；95%CI 1.31，2.91）、阴道分娩（OR 1.63；95%CI 1.06，2.50）、尿失禁（OR 1.95；95%CI 1.31，2.84）和平均每晚睡眠<6.8 小时（OR 1.89；95%CI 1.28，2.78）。有≥4 个风险因素会将与跑步相关的疼痛的概率增加到 61.2%。
本研究的结果提供了对产后跑步者的与跑步相关的疼痛的风险因素的更深入的了解。有了这些信息，临床医生可以监测和教育开始或恢复跑步的产后跑步者。教育内容可以包括风险因素的详细信息、疼痛的因素组合以及减轻风险的策略。教练可以根据疲劳和睡眠波动调整跑步工作量，以优化恢复和表现。未来应进行长期的纵向研究，以跟踪产后女性在分娩后恢复跑步的情况，从而验证这些发现。
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