What are the biopsychosocial risk factors associated with pain in postpartum runners? Development of a clinical decision tool

The takeaway

What biopsychosocial factors are associated with running-related pain in women who run after childbirth?

Six factors are independently associated with running pain in postpartum women: being a novice runner, high accumulated fatigue, a previous running injury, vaginal delivery, incontinence, and sleeping less than 6.8 hours per night. Having 4 or more of these factors raises the probability of pain from 33% to 61%, though the cross-sectional design means causation cannot be established.

DescriptiveRead paper

Primary study538 ParticipantsLimited evidence

Key points

32.7% of 538 postpartum runners surveyed reported current running-related pain
Novice runner status carried the highest odds of pain (OR 3.51; 95% CI 1.65, 7.48)
High postpartum fatigue score (>19 on PAFS) doubled the odds of pain (OR 2.48; 95% CI 1.44, 4.28)
Having 4 or more of the 6 risk factors increased post-test pain probability to 61.2%
There are currently no peer-reviewed return-to-sport protocols guiding postpartum women

How it was conducted

Design: International cross-sectional survey (December 2019 to January 2021)
Participants: 538 postpartum runners (child 36 months or younger) who ran at least once per week or were unable to run due to pain
Outcome: Self-reported current pain with running (yes/no)
Analysis: Bivariate logistic regression followed by backward stepwise multivariate logistic regression; clinical decision tool built from retained variables
Tools: Postpartum Accumulated Fatigue Scale (PAFS), Edinburgh Postpartum Depression Scale (EPDS), ROC-derived thresholds for continuous variables

What they found

176 of 538 participants (32.7%) reported current running-related pain
Novice runner type: OR 3.51 (95% CI 1.65, 7.48), p = 0.001
PAFS score >19: OR 2.48 (95% CI 1.44, 4.28), p = 0.001
Previous running injury: OR 1.95 (95% CI 1.31, 2.91), p = 0.001
Incontinence: OR 1.93 (95% CI 1.31, 2.84), p = 0.001
Sleep <6.84 hours per night: OR 1.89 (95% CI 1.28, 2.78), p = 0.001
Vaginal delivery: OR 1.63 (95% CI 1.06, 2.50), p = 0.027
4 or more risk factors: positive likelihood ratio 3.24 (95% CI 2.01, 5.29), post-test probability 61.2%
5 or more risk factors: positive likelihood ratio 18.51 (95% CI 2.46, 390.14), post-test probability 90.0%
Multivariate model R2 = 0.161

Limitations

Cross-sectional design allows only non-causal associations; longitudinal validation is needed before using as a predictive tool
Sample was predominantly white (93.5%) and highly educated (93.5% at least high school), limiting generalisability
Survey methodology could not capture biomechanical, musculoskeletal, or physiologic impairments measurable in a clinical or lab setting
Pain intensity was not measured, only its presence or absence

Why it matters

For patients: Postpartum women who run should know that being new to running, having poor sleep, experiencing incontinence, or having a history of running injury all independently raise their risk of pain, and combining several of these factors substantially increases that risk.
For clinicians: A simple 6-factor screening tool can stratify postpartum runners by pain risk and inform education on fatigue management, sleep, pelvic floor referral, and structured training programmes, though the tool requires prospective validation before formal clinical use.
For readers: This is the first large survey to quantify biopsychosocial risk factors for running pain after childbirth, producing a preliminary clinical decision tool; findings are hypothesis-generating and should be interpreted cautiously given the cross-sectional, self-report design.

Source

doi:10.1371/journal.pone.0255383

Read the original paper