“When can I start to run?” One of the most frequently asked questions after a woman has a baby. The ability to run satisfies many things for us as women. Being able to run allows us to sweat, to let off steam, to be alone. Running is accessible, it is free and can be done with baby in a stroller as well!
There is no straight forward answer to this question. Most moms don’t really know to ask and try to figure it out themselves but left feeling weak, unstable and painful. If we do ask, it is normally lumped into the standard, “you’re clear to start at 6 weeks but listen to your body” or some variation of that nonsense. Running is a high-impact exercise. To be able to run safely, our bodies need to be able to withstand high ground reaction forces, to be able to transfer load and to be able to do these things for long periods of time.
There are currently no guidelines or standardized practice patterns for us as clinicians to help women return to run after baby. Bridging the gap between pelvic health and high-level activity is also a realm rarely treated and studied very little. Many women suffer from injuries with running after baby so we know there is a methodical return to ensure safety, but what is it? Is there a magic timeframe? What is needed to ensure a woman is safe to return?
Thankfully, a group of very smart clinicians, Tom Goom, Gráinne Donnelly and Emma Brockwell have put together the “Returning to Run Postnatal – guidelines for medical, health and fitness professionals managing this population.” These guidelines are written specifically for health professionals but free and available for any and all to read. Today, my goal is to share with you my top take-a-ways from the document to help you better understand what all goes into deciding when it is okay for you to run.
This document is a compilation of all the research we have up to date as well as the professional opinion and experience. These individuals took the time to gather, sort through and establish some guidelines for us as we navigate return to fitness, specifically running after babies. This is a game changer for health care professionals as we now have organized research to back up our treatment and greater confidence in the advice we give to our patients.
So let’s dive into the top 5 takeaways!
Postnatal women can benefit from individualized assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse, the management of urinary incontinence and to improve sexual function.
After having a baby, a woman’s pelvic floor is left weakened and injured. These muscles and tissue require rehab just like any other muscle does after a traumatic injury or tearing. Correct pelvic floor training and contraction often require supervision and education, especially if a woman has not to be trained before pregnancy.
When we run, ground reaction forces can be up to 2.5 times our body weight which is transferred up into our legs and to our pelvic floors. Having adequate speed and strength of contraction is required to absorb these forces and to protect us from pelvic floor injury including prolapse, incontinence, and pain.
Undergoing a full assessment and then rehab for your pelvic floor is recommended to ensure it is ready to absorb these forces prior to returning to run. It is suggested that all women see a pelvic floor specialist after pregnancy, but especially those returning to fitness.
Return to running is not advised prior to 3 months postnatal or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running.
We know that after a vaginal delivery, tissues including the neck of the bladder and vaginal hiatus are injured and require time to heal. Studies have looked at tissue laxity and status with 12 weeks post delivery being the earliest tissues are reported to be back to baseline.
This same timeline is true after c-section as well. Newer studies show that uterine scar is not fully mature at the 6-week post op appointment which means we are still healing past the traditional 6-week release point. Other studies show that our abdominal fascia has only regained a little over 50% of its tensile strength at 6 weeks and only between 70-90% at 7 months post-op.
3 months is the absolute earliest point mothers are advised to begin running with closer to 6 months being more realistic for optimal healing.
Return to run is not advisable if any of the following is reported:
- Urinary and/or fecal incontinence prior to or during the commencement of running
- Pressure/bulge/dragging in the vagina prior to or during the commencement of running
- Ongoing or onset of vaginal bleeding, not related to the menstrual cycle, during or after attempted low impact or high impact exercise (refer back to care provider).
- Musculoskeletal (MSK) pain e.g. pelvic pain prior to or during the commencement of running.
We know that a preemptive return to run or fitness can be detrimental to women. Starting too early, without proper strength and coordination can cause damage to our abdominal wall and to our pelvic floors. Understanding the signs and symptoms that accompany these things is key to help moms decipher their return to fitness timeline.
Here we have a list of symptoms that are suggestive of pelvic floor dysfunction. If a momma experiences any of these at rest or once running has commenced, it is highly advised more rehab is required and before running is allowed.
Load management and strength need to be assessed prior to return to run.
A clinician can help assess not only the pelvic floor but ability for your bones and muscles to withstand the forces brought on by running. Things that will be evaluated could include the following:
- Ability to walk 30 minutes without symptoms
- Single leg balance
- Single leg squatting
- bounding/hopping
- Strength of glutes and hips
All of the above are precursors to running and not only can they be evaluated but also issued in a low impact exercise routine for a woman to perform in the weeks and month leading up to her return to run.
Obesity, sleep, breastfeeding, clothing/shoe wear, breathing mechanics, scar mobility, presence of DRA and psychological status all play a huge part in if a woman is appropriate to return to run.
Having a strong, healed pelvic floor is the most important factor in our decision making, but looking at these other variables is crucial as well. Mother’s who weigh more (BMI>30) are at a higher risk for pelvic floor injury. Mothers who are still breastfeeding are going to hormonally be in a different place than those that are not, which has an impact on our tissues. Dealing with DRA affects our ability to transfer load which can impact our ability to run safely and the amount of sleep a mother gets can negatively affect recovery and tissue tolerance to load.
Being able to know how these things can affect you and your pelvic floor will allow you to make more educated decisions on when return to run is appropriate and how your running schedule will look initially. Being able to weigh out risk versus reward in a certain exercise is one of the greatest battles a mother has but in the end, can save her from years of pain and dysfunction!
Returning to high impact sports such as running is not guaranteed and it is not just a matter of waiting a specific amount of time. Pregnancy and delivery cause tissue damage that requires methodical healing and attention. We do not ask athletes to just wait it out after a quad tear or ACL surgery – so why wouldn’t we do the same after pelvic floor injury?
In my opinion, the price a woman pays for returning to run too early is too high and yet, talked about and discussed very little. I am thankful for these guidelines and the information it provides healthcare professionals to better serve this population.
As a new mom looking to return to run, you are not alone and you are not meant to go at this by yourself. Seek out help to help you navigate this time to make sure your body is ready to get back!
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