Return to Running Postpartum
One of the biggest problems in answering this question is that every woman is different and their birthing experience and healing post-partum is going to be very individual. I would therefore highly recommend that women start their journey of recovery by having a postpartum check by a specialist pelvic floor and women’s health physiotherapist between 6-12 weeks following delivery. This will help identify any weakness or deficits in the strength and control of the pelvic floor and abdominal wall that could be a barrier to returning to running or sports symptom free. This assessment is especially important if your delivery included any of the following:
- A pushing stage longer than 2 hours,
- Use of forceps or vacuum,
- If you had an episiotomy or tearing,
- If you had a C-section delivery.
It is also highly recommended to see a pelvic floor physiotherapist if you are experiencing any of the following symptoms:
- Urinary or fecal incontinence,
- Heaviness/pressure/bulging in the vagina,
- Pelvic girdle or low back pain,
- Pain with intercourse,
- Bulging or doming along the central abdominals commonly known as Diastasis or DRA (see my previous blog on DRA for more information on this),
- Difficulty feeling or activating your core,
- A feeling of weakness or poor control with movement or physical activity,
- Needing to or being aware of holding your breath or bracing with movement, lifting or exercise.
These symptoms are not uncommon to experience after delivery, however women should start to see these resolve with the natural healing of the body within the first 8 weeks postpartum. If they do not, an assessment by a pelvic floor physiotherapist will help to identify where your dysfunction lies and will help guide a specific rehabilitation program for you to help you return to running or any other sport or activity you love.
So what are the recommendations if I don’t have any of the above signs or symptoms and want to return to running post-partum?
Unfortunately there is not a lot of good research evidence out there to answer this question. However, in March 2019, the first expert consensus guidelines for “Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population” (Goom, Donnelly & Brockwell 2019) was published. (Check out the full guidelines for free here). So what did it say? Here is an outline of some of its main points and recommendations:
- In their guidelines, the authors recommend getting an assessment from a pelvic floor physiotherapist prior to starting a return to running program to ensure adequate pelvic floor and core strength and co-ordination together with adequate hip and leg strength, balance and control.
- Return to running should not be started prior to 3 months post-partum. This is to allow for adequate healing and recovery of the tissues that have been stretched, torn or surgically cut during your delivery that are essential in supporting you while running.
- Pelvic floor and gentle core activation exercises can and should be started as early as 1-2 days post-partum or after any catheterization is removed.
- Gentle and functional pelvic floor and core exercises can be started within the first 2-6 weeks post partum, as can low impact cardiovascular exercise such as walking, elliptical or cycling.
- If cleared for return to running at or after 3 months post-partum the authors recommend a gentle program such as a ‘couch to 5km’ program with a slow and gradual progression of training volume (distance and time) prior to any increase in training intensity
- A return to running program should also include a complementary strength training program to ensure adequate strength to control the demands of running on the body
- Signs and symptoms of pelvic floor and/or core stability dysfunction (see symptom list above) should be monitored throughout the return to running program and if any of these signs or symptoms return/start, appropriate modifications should be made and any deficits should be identified and specifically addressed with your physiotherapist.
To assess readiness for return to running, the guidelines recommend that you are able to demonstrate the following load impact management tests without any of the symptoms listed above:
- Walking for 30 minutes
- Single leg squats 10 repetitions each side
- Jog on the spot for 1 minute
- Forward bounds 10 repetitions
- Hop on the spot 10 repetitions each leg
- Single leg ‘running man’ – opposite arm and hip flexion/extension 10 repetitions each side.
They also suggest that 20 reps of the following movements should be able to be performed to ensure key muscle groups are prepared for running:
- Single leg calf raises
- Single leg bridges
- Single leg sit to stand
- Side lying hip abduction
The British Journal of Sports Medicine also recently published these handy infographics featuring the key points from these guidelines when returning to running postnatally.
If you are recently postpartum or are experiencing pelvic floor or core dysfunction and are wanting help returning to running or other impact sports, you can make an appointment for a pelvic floor assessment with one of our specialist pelvic floor & women’s health physiotherapists through our online booking or by calling Trillium Integrative Health Centre at 778-640-1119.