When my sister asked “How do I go about returning to running after pregnancy”, I have to admit I didn’t know much. It is a topic that is not discussed often in the world of sports medicine and this needs to change. So I searched the internet for basic advice and found many conflicting statements, few of which were backed by evidence. After searching academic journals, I found comprehensive, evidence based guidelines created by some of the top running, postnatal rehabilitation and pelvic health physiotherapists. This information is essential for anyone returning to higher impact sport after pregnancy and should be shared widely.
The aim of this article is assist my sister and any other new mums to return to running in the right way at the right time. This article and the evidence based guidelines it is based on do not substitute an essential consultation with your GP or a womens health physiotherapist about returning to running.
Pelvic Floor Assessment
Any high-impact activity such as running is associated with a high forces being transmitted through the pelvic floor (the pelvic floor is a group of muscles at the bottom of the pelvis). The pelvic floor provides support for the pelvic organs and has an important role in continence when running. In the postnatal period, most women will have weakness and reduced coordination in the pelvic floor muscles. This normal change in function of the pelvic floor post pregnancy can increase the risk of urinary incontinence and pelvic organ prolapse (POP) when completing high impact activities such as running.
Recommendation: The majority of postnatal women can benefit from an individual assessment and pelvic floor rehabilitation program for prevention of POP and urinary incontinence. Speak to your GP or womens health physiotherapist about getting an assessment (from 6 weeks postnatally).
Identifying Pelvic Floor Dysfunction
It is essential that health professionals and postpartum women know the key signs and symptoms of pelvic floor dysfunction. The list below outlines the most common but is not comprehensive:
- Urinary and/or faecal incontinence
- Urinary and/or faecal urgency that is difficult to defer
- Heaviness/pressure/bulge/dragging in the pelvic area
- Pain with intercourse
- Obstructive defecation
- Separated abdominal muscles (noticeable gap along the midline of your abdominal wall)
- Ongoing or increased blood loss beyond 8 weeks postnatal that is not linked to your monthly cycle
- Pelvic or lower back pain
When To Return To Running
To be ready to return to run, your body needs time to heal and regain its strength. Thus based on expert opinion, running is not advisable for women within the first 3 month postnatal period, given the high risk of pelvic floor dysfunction. A gradual return to running from 3-6 months postnatally can be undertaken. More time and further guided pelvic floor rehabilitation is likely required if any signs of pelvic floor dysfunction are present (see above) before, or after attempting to return to running. Some women are able to return to running safely earlier than 3 months post pregnancy. If you are planning to do this, guidance from a health professional is essential.
Before returning to running, postnatal women should undertake load and strength assessments with their womens health physiotherapist. These assessments will look at the strength of the pelvic floor, as well as your ability to handle loads (e.g walking, hoping, running on the spot) without signs and symptoms of pelvic floor dysfunction. If pelvic floor dysfunction is present, external supports such as EVB sportswear can be helpful in reducing these signs and symptoms.
Low Impact Exercise Within 3 Months Postnatally
Low impact exercises have significantly less risk of pelvic floor dysfunction. These types of exercises are a great way to regain strength and function, preparing yourself for returning to running. It is best to discuss returning to these exercises with your GP or physiotherapist, as delivery method, scar healing etc. will impact when these activities will be appropriate.
- Strength exercises such as squats, lunges and bridges.
- Static exercise bike or cross-trainer. Must take into consideration individual postnatal recovery, delivery method and perineal scar healing.
- Dead-lift techniques no more than the weight of the baby.
- Swimming (discuss with GP). May be appropriate about 8-12 weeks postnatally
Returning To Running Safely
A graded return to running is important. The steps below are a starting guide to return to running. Every one will differ in how quickly they can return depending on individual circumstance.
- Begin small, achievable goals e.g Run/walk 2-3km without signs of pelvic floor dysfunction
- Begin with shorts bursts of slow running mixed with short walking period e.g 30s easy run/ 30s walk repeat x 10.
- Consider working with a run coach if you are aiming for challenging goals such as a certain race distance or race time.
- Build running distance before increasing intensity.
- Build your running distance slowly and always monitor for signs or pelvic floor dysfunction.
- Weight: Being overweight significantly increases load on the pelvic floor. Women are considered to have increased risk of pelvic floor dysfunction if they have a BMI of >30. Low impact exercises are advisable until a BMI of less than 30 is achieved.
- Breastfeeding: Working with a health professional to understand timing of feeds around running and the effect of hydration status on milk supply is an important consideration when returning to running.
The information above is summarised from the guidelines here. These guidelines contain more in-depth information for women and health professionals. They include more information on perineal/c-section scar mobilisation, sleep, RED-S, postnatal depression and more.