Ready To Run?
Considerations for the Postpartum Runner
Running is not only a great way to exercise, it is a popular method of fitness for new moms. It is easily accessible, low-cost and with the appropriate stroller you can even take your little one with you (because let’s face it, they are with us all the time).
Although running has many benefits, it is also important to remember that it is a high-impact activity and even if you ran before you were pregnant or even during pregnancy, your return back to running should be strategic and progressive to prevent injury.
6 Weeks All Clear? Not Exactly.
Your six week postpartum check-in is typically when your healthcare provider will give you the green light to start exercising again. The problem however, is that the recommendations are often vague and unclear. What exactly does “listen to your body” mean? How do you get started?
In fact, the traditional 6-week “All Clear” has been criticized repeatedly in the research for setting unrealistic recovery timelines, especially when it comes to running and high-impact exercise and may be setting new moms up for injury and disappointment.
The most recent evidence- based return to running recommendations (2019) emphasize that women should wait until at least 12 weeks (3 months postpartum) before returning to running and only after they have received a comprehensive pelvic health evaluation from a specially trained physiotherapist.
Why Wait?
It’s important to allow for adequate tissue recovery before increasing load on the abdomen and pelvic floor. Research has shown that recovery of the pelvic floor muscles and the associated connective tissues and nerves take 4-6 MONTHS after vaginal delivery to heal!
This means that returning to high-impact exercise before your pelvic floor support system has fully recovered can set you up for injury and pelvic floor dysfunction (leakage, pain, pelvic organ prolapse).
What about C-sections?
The same recommendations apply to moms who have given birth via c-section. In fact, special considerations should be made for uterine scar recovery. Ultrasound investigations have shown that scar tissue remodeling is still occuring at 6 weeks postpartum and that abdominal fascia (connective tissue) has only regained 51-59% of its original tensile strength!
Thus, proving that postpartum recovery extends way past the traditional “6- week” timeline.
Low Impact Exercise For the First 3 Months Postpartum.
Although it is recommended you wait until 12 weeks postpartum before returning to running, that doesn’t mean you can’t exercise. In fact, gradual and progressive strength training, walking and lower impact endurance training (swimming and biking) are great alternatives and can set you up for success when you start running again.
Focusing on functional activities like squats, lunges and bridges are a great place to start. Working with your physiotherapist on an individualized and progressive strength program is recommended.
Not sure where to start? Please reach out, book an appointment or give us a call to set up a time to connect.
3-6 Months Postpartum
If you’re past the 12 week mark and wanting to get back into running, it is still highly recommended that you see a pelvic floor physiotherapist for an evaluation to check your abdominal wall and pelvic floor strength and coordination, your lower limb strength and tolerance for impact. If that’s not an option for you, below are some guidelines to self-assess your readiness to run.
Ideally you can accomplish the following without pain, heaviness/pressure, bulging or leakage. (Adapted from Goom et al, Return to Running Postnatal Guidelines 2019).
Walk 30 minutes
Stand on one leg for 10 sec or more each side
10 single leg squats per side (not letting knee cave inwards)
Jog on the spot for 1 minute
10 single leg hops per side
It is recommended that you stop running and contact a pelvic floor physiotherapist or healthcare provider if you experience any of the following:
Urine Leakage or inability to control bowels
Heaviness, pressure or bulging sensations in the vagina (May indicate pelvic organ prolapse)
Tenting or Coning Along the abdominal wall (may indicate Diastasis Recti)
Pelvic or Lower Back Pain.
Vaginal Bleeding not associated with your menstrual cycle during or after an attempt of high impact exercise (contact your healthcare provider).
Tips Running Form and Progressions
Start Slow:
When returning to run, it is recommended that you start slow with 1-2 minutes at a time with walking in between and slowly increase the volume of running (time/distance) before you increase the intensity (speed work). A couch to 5k program can be a great starting point but if you’re a regular runner or have a specific race and timeline you’re aiming for, finding a local running coach or physiotherapist would be beneficial.
Running Form:
It is very common for moms who start running after pregnancy and birth to have altered running mechanics. Our bodies go through significant changes very quickly throughout pregnancy and again postpartum. Changes in our center of gravity, balance, core and pelvic floor strength can impact how our body moves.
Common Mistakes:
Over-striding: Landing with your foot too far in front of your body. This position often causes a hard heel strike pattern and backward shift of the trunk. This position creates more ground-reaction forces and can increase your risk of incontinence, prolapse symptoms and other lower limb strain injuries like shin splints or knee pain.
The fix: Shorten your stride and land with your trunk over your foot. This creates a stronger landing position and allows your glutes to propel you forward, decreasing pressure on the pelvic floor and improving your performance.
High Chest / Rib Flare : This is the “boobs up” running form. This can be especially common in women who are breast-feeding or larger chested as they try to control “the bounce”. This posture tends to also be associated with over-striding.
The fix: Lean forward (from the ankle). You want your chest over your pelvis. This allows for better trunk rotation and core activation.
Abdominal Gripping or “Kegeling” as you run : Gripping your abdominal or pelvic floor muscles during running actually increases intra-abdominal pressure and restricts natural trunk rotation. You need your pelvic floor and abdominal muscles to contract/relax throughout your run and over-gripping can actually create leakage and vaginal pressure.
The fix: Relax your belly and your pelvic floor. Think about allowing your breath to expand in the bottom of your ribcage and belly as you’re running and do not kegel during your run.
The tips above are general recommendations for returning to running after baby and factors such as prior running experience, birth experience, prior injuries, and more can all have an impact on how and when you return to running.
Have questions about running after birth? Are you experiencing pain, leakage or pressure with your running or do you simply want help getting started? Please reach out.
Both in-person and virtual assessments can be booked online HERE.
Not sure if pelvic floor physiotherapy is for you? Give us a call at 705-994-5744
References:
Returning to Running Postnatal- Guidelines for medical health and fitness professionals by Tom Goom, Grainne Donnely and Emma Brockwell (2019)
Returning-to-running-postnatal-guidelines.pdf
Physical Activity and Exercise in Pregnancy and the Postpartum Period: Guidelines by the American College of Obstetricians and Gynecologists (2020).