You’re a runner…and postpartum. These last few perfect, crisp fall mornings gave you some serious longing to run.
Maybe you had your baby a year ago? Maybe 2 months ago? Maybe you had a C-section?
The big question: When should you start running again?
Back in 2019, three physiotherapists (aka physical therapists anywhere else in the world) created free postpartum return to running guidelines.
They can be found at the link here:https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population
Birthing a baby via vaginal delivery or cesarean birth is no joke. Both take their toll on the pelvic floor.
When it comes to exercise, “pounding the pavement”(running) challenges your body to absorb high forces. Researchers found that running at a moderate speed generated forces 1.6-2.5 times greater than your body weight (Gottschall and Kram 2005).
Your pelvic floor has some pretty important quality of life functions including sphincteric function, support function, and stability function.
Running before your body has had the time to heal and recover can compromise those functions. You risk pain, leakage, or feelings of pressure in your lower abdomen (prolapse) as a result.
Is there a right time to start running again?
Well, yes…and no.
Your body is simply amazing during pregnancy. During a vaginal delivery, your muscles “down there”, nerves and connective tissues accommodate and stretch quite a bit. Baby needs more space during delivery. It takes approximately 4-6 months post vaginal delivery for the body to naturally recover in this area (Shek et al. 2010, Stær-Jensen et al. 2015). Sometimes, of course, you may need the help of a professional.
When delivering via cesarean birth, your body has a lot of work to do healing. Cesarean section is a major surgery. At 6 weeks postpartum, your scar continues to heal and remodel (Hamer et al. 2007).
Cesarean birth= major surgery. Your abdominal muscles change in strength and function as a result. The tissue in your abdominal muscles are only about half as strong as they were before your delivery by 6 weeks postpartum. By month 6-7, your connective tissue has 73-93% of its original strength (Ceydeli et al. 2005).
Though you may be given the “all clear” and good to go at your 6 week check up, your body has some healing left to do. Don’t underestimate the amazing thing you just did and respect the time needed for recovery.
The experts who composed the guidelines recommend waiting at least 3 months before starting to run.
Three months….at least. Perhaps, more important than time are the signs your body sends you.
Your body may not be ready to run if:
- You leak urine or feces
- You run to the bathroom with very strong urges to pee or have a bowel movement
- You feel heaviness or pressure in your pelvic area. This may feel like a tampon is falling out
- You have pain with sex
- You feel a block when you try to have a bowel movement
- You have low back, hip, or SI joint pain
- You have significant core weakness
Diastasis recti or DRA can compromise your core strength. Permission to use copyright image from Pelvic Guru LLC
These signs of pelvic floor dysfunction should be addressed by a trained professional. The authors of the guidelines reinforce several times that all new moms should have access to comprehensive assessment of their pelvic floor and core.
How are you sleeping?
Any new moms out there probably laugh at this one. Sleep belonged to your pre-baby life. Even if your baby is a good sleeper, you likely don’t get your eight hours interrupted. If your baby seems to be “allergic to sleep”, forget it.
That being said, if you want to run, try to get more sleep.
Sleep-deprived athletes put themselves at greater risk for injury (Milewski et al. 2014). Researchers have found links between decreased muscle repair and weakness with lack of sleep (Knowles et al. 2018). Your body and mind heal when you sleep.
Still skeptical about just how much sleep impacts your readiness to run? Check out the Joe Rogan experience podcast #1109 with Matthew Walker, the author of Why We Sleep. (On a personal note, I can’t recommend this episode enough…life changing.)
Ready for a self-test?
You delivered your baby four months ago, your baby is a sleep rockstar, and you can get through the day without any of the signs of pelvic floor problems listed above….now how can you make sure that you’re run-ready?
The guidelines have a self test to determine your body’s readiness to run. If you leak, feel pressure/heaviness, or feel pain during the test, seek out the help of a professional to get your pelvic floor and core run-ready.
Complete the following movements
-Walking 30 minutes
⁃ Single leg balance 10 seconds
⁃ Single leg squat 10 repetitions each side
⁃ Jog on the spot 1 minute
– Forward bounds 10 repetitions
⁃ Hop in place 10 repetitions each leg
⁃ Single leg ‘running man’ 10 repetitions each side
-20 single leg calf raises
-20 single leg bridges
-20 single leg sit to stands
-20 side leg raises on your side
The running man “woman” exercise shown
So let’s say you’ve passed the test. Congratulations… time to get back into running. But where to start?…. Stay tuned for part 2 of this blog post with recommendations from the guidelines on how to start running again.
Maybe, you didn’t pass the test….that’s okay too. You’re a mom. You do incredible things every day, and you will get back to running, but you may just need a bit of help along the way. Be patient, listen to your body, respect what your body has done and continues to do each day, and seek out the help you deserve.
References
Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, 220–5.
Gottschall, J.S. and Kram, R. (2005) Ground reaction forces during downhill and uphill running. Journal of Biomechanics 38, 445-452.
Hamar, B.D., Saber, S.B., Cackovic, M., Magloire, L.K., Pettker, C.M., Abdel-Razeq, S.S., Rosenberg, V.A., Buhimschi, I.A. and Buhimschi, C.S. (2007) Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two layer closure. Obstet Gynecol 110, 808–13.
Knowles, O., Drinkwater, E., Urwin, C., Lamon, S. and Aisbett, B. (2018). Inadequate sleep and muscle strength: Implications for resistance training. Journal of Science and Medicine in Sport 21(9), 959-968
Milewski, M., Skaggs, D., Bishop, G., Pace, J., Ibrahim, D., Wren, T. and Barzdukas, A. (2014). Chronic Lack of Sleep is Associated With Increased Sports Injuries in Adolescent Athletes. Journal of Pediatric Orthopaedics 34(2), 129-133.
Stær-Jensen, J., Siafarikas, F., Hilde, G., Benth, J.Š., Bø, K. and Engh, M.E. (2015) Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol 125, 531–539