To be run ready, your body needs time to heal and regain its strength after having a baby. Here’s your step-by-step guide to start running postpartum.
Step 1: Assess your core & pelvic floor health
Running is a high impact sport placing a lot of demand on the body. First thing’s first, you need to figure out if your body is ready to start running postpartum.
Return to running postnatally is NOT recommended before 3 months postnatal (or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running). Low impact exercise is recommended instead up to this time eg walking briskly, cycling, swimming, Pilates or yoga.
Some warning signs that you may have pelvic floor dysfunction include if you:
- leak urine when running, sneezing, coughing, or jumping (between 15-30% of first time mums will experience bladder leaks)
- can`t control bowel (1 in 5 first time mums complain of faecal incontinence at 1 year postnatal, especially if they demonstrated symptoms during pregnancy)
- have pressure in the pelvic area -heaviness, dragging sensation can be associated with prolapse (at 3-6 months postnatal up to 56% of new mothers demonstrate grade 2 or more pelvic organ prolapse)
- have pendular abdomen or noticeable gap along the midline of your tummy (this may indicate Diastasis Rectus Abdominis (DRA)
- have pelvic or lower back pain
- have ongoing or increased blood loss beyond 8 weeks postnatal that is not linked to your monthly cycle
It is important that every women, regardless of the delivery mode, receives pelvic health assessment (from 6-weeks postnatal) with a specialist physiotherapist to comprehensively assess the abdominal wall and pelvic floor including vaginal +/- anorectal examination.
Step 2: Strengthen your pelvic floor
After having a baby, the pelvic floor is weak and injured in most new Mums. Women often need support and guidance to be able to perform a correct pelvic floor muscle squeeze, especially those women who did not train these muscles before birth.
You need to be able to do the following in standing before returning to running postpartum:
✓ 10x fast pelvic floor squeezes
✓ 8-12 reps of 6-8 second maximum voluntary pelvic floor squeezes
✓ 60 seconds submaximal 30-50% pelvic floor squeeze
Majority of women do know know how to do their pelvic floor exercises correctly. Therefore, seeing women`s health physiotherapist is highly recommended.
What are the risk factors for potential issues returning to running postpartum?
- Less than 3 months post-partum
- Pre-existing hypermobility conditions (for example, Ehlers-Danlos)
- Breastfeeding
- Pre-existing pelvic floor dysfunction or lumbopelvic dysfunction
- Psychological issues
- Obesity
- Caesarean section or perineal scarring (you need to allow enough time for the scars to heal)
Step 3: Regain your strength
High-impact exercise, such as running, is associated with a sudden rise in intra-abdominal pressure (pressure in the tummy).
Studies show that ground reaction forces of between 1.6- and 2.5-times bodyweight can occur when running at a moderate speed of 11km and it is assumed that some, if not all, of those forces are also transmitted to the pelvic floor.
This is why it is very important that postnatal women regain strength, particularly in the abdominal and pelvic floor muscles after pregnancy and delivery to prevent issues during high impact activities. As women`s health physios we recommend individualised pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse and urinary incontinence.
Before your physio gives you a green light for return to running, you need to achieve the following without pain, heaviness, dragging or incontinence:
- 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’: opposite arm and hip flexion/extension (bent knee) 10 repetitions each side
Strength testing
In order to ensure key muscle groups are prepared for running, you need to be able to achieve 20 repetitions of each test:
- Single leg calf raise
- Single leg bridge
- Single leg sit to stand
- Side lying abduction
Step 4: Walk before you run
If you are at your 3 months mark, you don`t have any pelvic floor issues and you passed all the tests, it is time to start graded return to running program.
Before you go out and hit the pavements for that blessed headspace and bit of ‘me time’ consider a few things:
It is sensible to start small, often with around 1 to 2 minutes of running at an easy pace. Setting short-term goals, such as reaching a target distance, can be helpful alongside long term goals such as competing in a race. These goals will influence training progression. For more challenging performance goals, for example completing a key race in a certain time, it can be helpful to work with a local running coach.
Including walk breaks can be helpful to reduce fatigue initially and can be gradually reduced and removed. A ‘couch to 5km’ programme can be helpful as this usually includes walk breaks and builds gradually towards 5km of running within around 9 weeks. Programmes vary but the NHS ‘couch to 5km’ starts with 3 runs in week 1 beginning with a brisk 5 minute walk then alternating 1 minute of running with 90 seconds of walking for a total of 20 minutes.
Step 3: Reduce impact forces in running
A simple cue to lean into the wind while your are running will bring your body closer to your foot strike. This slight forward lean will significantly reduce the impact forces. It is also a great tool for managing issues such as low back pain and pelvic floor weakness. Practicing this by running up hills or on a treadmill incline to naturally encourage the trunk to come forward are other great tools. Getting forward over the lead leg also helps you rotate and speeds you up!
Enjoy the process!
Healing after childbirth takes time. Take care of yourself and appreciate your body. The goal is to get you back doing what you love in a safe, injury free way!
References:
Goom, T., Donnelly, G. and Brockwell, E. (2019) Returning to running postnatal – guideline for medical, health and fitness professionals managing this population. [https://mailchi.mp/38feb9423b2d/returning-to-running-postnatal-guideline]