Training Drills in Postpartum Return-to-Run Programs

Abstract-

Quantifying the External Loading of Running Drills: Ranking Drills to Design Progressive Postpartum Return-to-Run Programs

Celeste Goodson1, Aubree McLeod1, Max R. Paquette2

1ReCORE Fitness, Franklin, TN, U.S.A

2University of Memphis, Memphis, TN, U.S.A

Introduction:

During running, vGRF increases proportional to speed, with high speeds (e.g., 9-12 m/s) reaching forces over 4x bodyweight (1). During periods of decreased pelvic floor strength or altered muscle activity (such as the postpartum period), high-impact activity is considered a risk factor for pelvic floor dysfunction, prolapse symptoms and urinary incontinence (2-3). Postpartum return-to-run protocols should include a gradual increase in external loading over time to allow progressive loading and subsequent adaptation of pelvic floor musculature. Drills are valuable in this progression as they can mimic the motions and muscle activations of running with lower magnitudes of vertical force compared to running (4). The purpose of this study was to quantify and rank the vertical force magnitude of common training drills, to provide clinicians with a tool to program postpartum return-to-run protocols.

Methods:

11 experienced runners completed five trials of 46 training drills while in-shoe vertical reaction forces (vRF) were measured with wireless force insoles (100Hz, loadsol, Novel, Inc). Average peak vRF was calculated for each drill, and drills were ranked in order from least to greatest vRF.

Results:

Drills were ranked by increasing vRF (Figure 1). The drill titled “Single Leg Hop Forward” demonstrated the highest vRF at 2.8 BW, while the “Squat Mini Jump” drill demonstrated the lowest vRF at 1.0 BW.

Discussion/Conclusion:

Early postpartum runners should begin rehabilitation with low vertical force drills, and progress gradually as pelvic floor strength and coordination improves. The clinician should take care to slowly increase the total load on the pelvic floor, which is dependent on both magnitude and loading rate of vRF, as well as the number of repetitions. Though not measured in this study, drill vertical oscillation (vertical movement of center of mass) also affects the load experienced by the pelvic floor. As a result, some of the low impact drills with high vertical oscillation (such as “Large Forward Jump” or “Split Jumps”) may not be suitable early on for those with pelvic floor dysfunction. The selection of specific drills and the speed at which a runner should be moved through drills depends on the individual- additional factors such as birth injuries, other musculoskeletal issues, athlete goals and of course patient feedback should also be taken into account. Though these data only lays out a uni-dimensional aspect of the postpartum rehabilitation process, it provides a valuable tool for clinicians and practitioners to more objectively program return-to-running (and vertical force) training for postpartum runners.

Complete Data and Figures (46 Training Drills):

Training Drills and Vertical Force:

46 Training Drills ranked and categorized by Average Peak vRF (± 95% Confidence Interval). “% Fast Running” column refers to the % of the Average Peak vRF measured during “Fast Running” (performed at a 10K race pace). Categories are arranged by bodyweight (BW) and are as follows: Category 1 (<1.60 BW), Category 2 (1.60-1.90 BW), Category 3 (2.00-2.40 BW), Category 4 (>2.40 BW). Categories are provided for ease in clinical use.

Bar graph of training drills vs average vertical force

Rank	Drills	Average Peak vRF ± CI (BW)	% Fast Running	Category
1	Squat Mini Jump	1.02 ± .09	38%	1
2	Squat Small Jump	1.20 ± .14	45%	1
3	Squat Big Jump	1.32 ± .18	50%	1
4	Small Forward Jump	1.35 ± .20	51%	1
5	Split Jumps	1.36 ± .20	51%	1
6	Line Shuffle	1.46 ± .16	55%	1
7	Line Lateral Jumps	1.48 ± .44	56%	1
8	Large Forward Jump	1.50 ± .17	56%	1
9	Ladder Icky Shuffle	1.55 ± .15	58%	1
10	Stair Switch	1.57 ± .20	59%	1
11	Ladder Jumps Forward	1.60 ± .33	60%	2
12	Run Up Stairs (Double)	1.60 ± .17	60%	2
13	Line Switch	1.60 ± .13	60%	2
14	Ladder Quick Steps	1.60 ± .11	60%	2
15	Stair Jump	1.61 ± .21	60%	2
16	Ankle Jumps	1.69 ± .18	63%	2
17	Stair Shuffle	1.69 ± .21	64%	2
18	Ladder Jumps (Back and Forth)	1.74 ± .14	65%	2
19	Easy Wall Knee Drive	1.81 ± .22	68%	2
20	Run Up Stairs (Skip Stairs)	1.85 ± .61	70%	2
21	Double Jump Rope	1.97 ± .22	74%	3
22	Bulgarian Split Hop	1.98 ± .26	74%	3
23	A-Skip	2.00 ± .24	75%	3
24	Run Up Stairs (Single)	2.01 ± .17	76%	3
25	Jump Rope	2.03 ± .24	76%	3
26	B-Skip	2.11 ± .22	79%	3
27	Side Jacks	2.15 ± .17	81%	3
28	Carioca	2.16 ± .21	81%	3
29	Single Leg Squat Hop	2.24 ± .30	84%	3
30	Easy Jog in Place	2.32 ± .22	87%	3
31	Fast Wall Knee Drive	2.37 ± .34	89%	3
32	Carioca (Knee Up)	2.40 ± .23	90%	3
33	Easy Hill Run	2.46 ± .26	92%	4
34	Single Leg Hop	2.47 ± .26	93%	4
35	Easy Run	2.47 ± .22	93%	4
36	Fast Hill Run	2.54 ± .32	96%	4
37	Power Skip	2.54 ± .36	96%	4
38	Easy Butt Kicks	2.56 ± .21	96%	4
39	Soldier Easy	2.60 ± .25	98%	4
40	Easy High Knees	2.64 ± .22	99%	4
41	Fast Run	2.66 ± .33	100%	4
42	Fast Butt Kicks	2.68 ± .35	101%	4
43	Fast High Knees	2.77 ± .40	104%	4
44	Bounding	2.78 ± .38	104%	4
45	Soldier Big	2.80 ± .37	105%	4
46	Ladder Single Leg Hop Forward	2.80 ± .37	105%	4

Training Drill Execution:

Drills labeled as “Easy” were performed at the cadence of an easy running pace. Drills labeled as “Fast” were performed at the cadence of a 10K race pace.

Drill	Explanation
A-Skip	High knee march while skipping, with a focus on landing midfoot, close to center of mass
Ankle Jumps/Hops	Quick jumps from the ankles (keep legs straight), landing midfoot, keeping toes up
B-Skip	A-Skip with knee extension before landing midfoot, close to center of mass
Bounding	Exaggerated running stride, increasing vertical and horizontal displacement.
Bulgarian Split Hop	Bulgarian split squat with front leg hop
Carioca	Moving left- step cross right leg laterally, first in front then behind left leg. Repeat with left leg while moving right
Carioca (Knee Up)	Carioca Drill with traveling leg knee drives upwards during cross
Double Jump Rope	Jump rope in place, jumping twice between swings
Easy Butt Kicks	Pull heel of foot towards butt and land on ball of foot. Alternate legs
Easy High Knees	Drive knee to hip height and land on ball of foot. Alternate legs
Easy Hill Run	Easy run up 10% grade slope
Easy Run	Run at easy pace
Fast Hill Run	Fast run up 10% grade slope at 10K race pace
Fast Run	Run at 10K race pace
Fast Butt Kicks	Pull heel of foot towards butt and land on ball of foot. Alternate legs quickly
Fast High Knees	Drive knee to hip height and land on ball of foot. Alternate legs quickly
Easy Jog in Place	Easy paced running motion in place
Jump Rope	Jump rope in place, single jump between swings
Ladder Icky Shuffle	Going forward through ladder, R-in, L-in, R-out, L-out, as quickly as possible.
Ladder Jumps (Back and Forth)	Jump off both feet forward and backward (double feet landing) over one ladder line as quickly as possible
Ladder Jumps Forward	Jump off both feet forward to each ladder square (double feet landing) as quickly as possible
Ladder Quick Steps	R then L in each ladder square going forward as quickly as possible
Ladder Single Leg Hop Forward	Single leg hops forward through each ladder square as quickly as possible
Large Forward Jump	Big jump forward off two feet, landing on two feet
Line Lateral Jumps	Feet together, jump laterally back and forth across a line
Line Shuffle	One foot at a time moving laterally back and forth across a line. R, L to side, R, L back to starting position as quickly as possible
Line Switch	One foot in front of the other, switch feet as quickly as possible
Power Skip	Lift knee and spring off opposite foot into air. Alternate legs
Run Up Stairs (Skip Stair)	Fast pace up stairs, single leg lands on every other step
Run Up Stairs (Double)	Fast pace up stairs, both feet land on each step
Run Up Stairs (Single)	Fast pace up stairs, single leg landing on each step
Side Jacks	Step laterally with R and follow with L to step together. Raise and lower both arms alternately on the R lateral step
Single Leg Hop	Hop and land on single leg
Single Leg Squat Hop	Single leg squat with hop at top of motion, land on single leg
Small Forward Jump	Small forward jump off two feet, landing on both feet
Soldier Big	Straight leg bounds, hitting ground hard with midfoot as you go forward
Soldier Easy	Straight leg bounds, hitting ground lightly with midfoot as you go forward
Split Jumps	Stand with legs staggered right in front of left. Jump and switch legs to land left in front of right. Alternate legs
Squat Big Jump	Double leg squat with large jump at top of motion
Squat Mini Jump	Double leg squat with small jump at top of motion. Toes do not leave the ground
Squat Small Jump	Double leg squat with small jump into air at top of motion
Stair Jump	Jump with both feet up (double feet landing) each stair
Stair Shuffle	One foot at a time up and down the step. R, L forward, R, L backward as quickly as possible
Stair Switch	One foot on the step, one on ground, switch feet at same time as quickly as possible
Easy Wall Knee Drive	With feet several feet away, lean into the wall, leading with hips and brace with arms. Drive knee up keeping toe up. Switch legs quickly, hitting the ground midfoot with force
Fast Wall Knee Drive	Perform knee drive at a quick pace, keeping toes up.

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