Lack of science hindering mums
With pregnancy taking a heavy toll on the body, elite athletes face many challenges to make a full comeback. Fiona Tomas speaks to the experts on the missing post-natal research
When Saracens rugby player Jade Knight ran her first 5km after the birth of her son, she was plagued by urinary incontinence. Pregnancy and birth had caused a weak pelvic floor – the group of muscles that span the bottom of the pelvis – leading to stress incontinence, a condition affecting around a third of mothers.
Embarrassed, Knight religiously wore black leggings when she returned to training out of fear she would leak in front of her team-mates. “Unless I speak about it I don’t think anyone else is going to,” she says. Even as a qualified midwife, she was astounded at the toll pregnancy had taken on her body.
With a severe lack of evidence and information on how exercise impacts post-partum sportswomen, Knight was determined to start a conversation around pelvic-floor health. In 2016, an International Olympic Committee expert group flagged the “urgent need” for more research in the area in its only consensus statement to date on the subject, citing women in India and Nepal lifting heavy loads as the only example of how an early return to physical activity after childbirth can increase the risk of urinary incontinence. Although its Smarther programme aims to connect more experiences of post-natal athletes, the English Institute of Sport has yet to conduct any research that might benefit them.
Dr Amal Hassan, a specialist in pre- and post-natal exercise, believes the subject to be tragically neglected. “People are talking about pelvic health more, but not as much as they’re talking about menstrual health, which is definitely the No1 health topic in women’s sport at the moment,” she says.
Hassan finds herself marvelling at women who make a hasty return to sport after childbirth, such as US World Cup winner Sydney Leroux, who played for Orlando Pride last month just 93 days after giving birth to her second child.
“Leroux astounds me from a core and pelvic point of view. At 12 weeks, you’re still arguably healing. How her pelvic floor coped with the change of direction and sudden movements on a pitch is fascinating. Are we putting out this message that it’s absolutely possible to go back and play contact sport three months after giving birth?”
It is one of the many questions that looms large over how – and when – elite female athletes should return. For Alison Rose, the physiotherapist who helped to mastermind Jessica Ennis-hill’s comeback to win World Championship heptathlon gold in 2015, it meant counterbalancing the effect of relaxin – a hormone released during pregnancy which loosens joints and ligaments. “Jess’s hip range increased by about 15 degrees,” says Rose, a director at Leeds-based CSPC Physiotherapy. “Pregnancy gave Jess extra mobility, which was good – you need a really good hip range for going over a hurdle – but you need to control that range as you land and take your next step. If you are not able to control a joint through its full range, you risk injury.”
By closely monitoring her abs through gradual introduction of increased weight training, Rose ensured that Ennis-hill avoided diastasis recti abdominis – when the abdominal muscles that run down the middle of the stomach separate during or near the end of pregnancy. It is present in between 30-68 per cent of women, but the prevalence rate is not known among elite sportswomen. “With events that Jess did, you need to do the sharp twisting that goes with shot and javelin,” adds Rose. “It’s demanding on the abdominals and central core. Toni [Minichiello, Ennis-hill’s coach] was fantastic in making sure we didn’t mess her abs up by getting her to do too much, too soon.”
Endurance runners are not faced with the same problems. Olympian Kara Goucher started running again just 10 days after giving birth, before recording a new personal best in the 2011 Boston Marathon seven months later. In June, Lizzie Deignan won the Women’s Tour after nine months of competitive racing following the birth of her daughter. “Returning to sport is quite individual. Someone like Lizzie Deignan on a bike is different to someone trying to do seven events, like Jess,” says Rose, who is involved with the Jennis fitness app launched by Ennis-hill in a bid to keep women active during pregnancy. “With endurance, you’re running in a straight line, not using your abdominals the same way.”
The achievements of endurance mothers have given rise to the misconception that pregnancy allows women to return faster, and to be stronger and fitter, because of an increased red blood cell count amassed during the first trimester of pregnancy. Greg Whyte, a professor in sports and exercise science at Liverpool John Moores University, believes this is untrue.
“There are unconfirmed reports from East German athletes who were doped by making them pregnant and aborting the foetus at the end of the first trimester to gain the physiological benefit,” says Whyte. “There’s very little evidence to show that actually happened. It’s created a myth around this idea that somehow being pregnant is advantageous. It may be that a pregnant woman has an increased red blood cell mass for the first 60 days, but given that the recovery post-partum period is circa six weeks, you can see the recovery from a major physiological assault actually counterbalances those changes anyway.”
Serena Williams’s iconic cat-suit – designed to protect against blood clots following the complicated birth of her daughter Olympia – is the most high-profile example of an athlete adapting after pregnancy. But what about female athletes who are not surrounded by a team of specialists? Knight (left), knows the battle all too well. Her five-year-old son watches her on a rugby pitch armed with her now strengthened pelvic floor. She says motherhood has given her a mental edge. “At strength-and-conditioning sessions, I have such a strong mentality from childbirth and raising my son that I find them much easier than before,” she says. “My pain threshold has increased massively. Overall, I feel much more resilient now.”