Returning to running postpartum can be incredibly scary. At most individual’s 6 week postpartum check up they are told that they can return to all activities they were doing prior to pregnancy/childbirth, including running, but no one tells you how. Additionally, just because you are cleared to return to all activities, it doesn’t necessarily mean that you should. When it comes to running the research shows that most people can return to running at 2-3 months postpartum if they have been medically cleared and screened for running readiness.
Why wait until 2-3 months postpartum?
First, you need to think about what has happened to the body during pregnancy. The diaphragm gets pushed up not allowing it work properly. The organs are moved around to accommodate the mother’s growing uterus. The pelvic floor has to handle significant amounts of pressure from the growing fetus. The abdominals stretch substantially and the back extensors tend to overcompensate for the abdominals inability to handle to increased growth in the front of the body. All of this does not go back to normal overnight, or in 6 weeks.
During childbirth (whether vaginal or C-section,) the body goes through a lot as well. The pelvic floor is weak and often times injured. Most individual’s need guidance and supervision to properly contract the pelvic floor. Additionally, the pelvic floor muscles are less coordinated. As a result individuals cannot achieve the level of function needed to maintain speed, timing and coordination of running. It is important to take caution and get the pelvic floor ready first. Running forces can be up to 5x your body weight. After pregnancy the body is recovering from increased laxity of ligaments and potential lengthening/shortening of various muscle groups.
What are the risk factors for potential issues with return to running?
- preexisting hypermobility
- preexisting pelvic floor or lumbar spine injuries
- breastfeeding
- psychological issues resulting in a predisposition to exercise at an inappropriate intensity/duration too early
- obesity
- C-section or perineal scarring
- RED-S
- Diastasis Recti Abdominus
When is return to running not advisable?
If you are experiencing any of the following symptoms you should discontinue running and follow up with your OB-GYN and/or pelvic floor physical therapist
- urinary or fecal incontinence
- pressure or bulging in the vagina
- vaginal bleeding
- musculoskeletal pain
I have no risk factors and can return to running, now what?
- Start slowly – it is advised that postpartum individuals start with run/walk intervals. As you get stronger you can increase the run interval and decrease the walk interval. As previously stated, running forces can be up to 5x your weight so you want to ease back into putting that sort of stress on your body and pelvic floor. A running coach can help you come up with a gradual program to return to running. Generally speaking weekly mileage should never increase more than 10% at a time. You should also never increase duration of runs and intensity of runs at the same time in order to avoid any potential injury.
- Work on breathing – during pregnancy the diaphragm is pushed up and the ribs flare out to make room for baby. As a result the diaphragm has difficulty functioning properly. Breathing properly helps the abdominals and pelvic floor to fire to stabilize the pelvis when running.
- Schedule an appointment with a pelvic floor PT – 12-80% of all female runners experience stress urinary incontinence (whether they have been pregnant or not.) During pregnancy pelvic floor muscles can be lengthened increasing the risk for stress urinary incontinence. Pelvic floor PTs can help assess the strength of the pelvic floor muscles to decrease the risk of incontinence as well as injury.
Be Aware – Often Running Mechanics Change Postpartum
With increased relaxin, comes decreased stability. As a result when returning to running postpartum, mechanics tend to change to help you improve stability throughout the body. Some changes that can be seen are decreased pelvic and trunk excursion, decreased sagittal hip range of motion and decreased cadence. Additionally, there tends to be an increase in stance time, step width and sagittal knee range of motion.
For all these reasons it is highly recommended that you seek out guidance from a pelvic floor physical therapist, not only when returning to exercise but specifically to running. Here at Hudson Valley Physical Therapy we have Pelvic Floor Physical Therapists and a certified running coach who can help get you back to running safely postpartum.
References
Branco M, Santos-Rocha R, Viera F. (2014). Biomechanics of gait during pregnancy. Sci World J.
Christopher SM, Gallagher S, Olson A, Cichowski S, Deering R. Rehabilitation of the Postpartum Runner: A 4-Phase Approach. Journal of Women’s Health Physical Therapy. 2022 (46)2:73-86.
Goom T, Donnelly G, Blackwell E. Return to Running Postnatal: Guidelines for medical, health, and fitness professionals managing this population. Published March 2019.
Provenzanl S, Hafer J, Peacock J, Kempner S, Zendler JD, Agresta C. Restriction in Pelvis and Trunk Motion in Postpartum Runners Compared with Pre-Pregnancy. Journal of Women’s Health Physical Therapy. 2019 (43)3:119-126.