Making a return to running or high intensity exercise after giving birth can be both a frustrating and confusing journey, particularly with all the conflicting information out there. The female body undergoes so many changes, meaning often it’s hard to know what exactly our body is ready for, and what it should or shouldn’t be doing in the early stages after giving birth. This blog serves to provide some guidance and bridge the knowledge gap to help you safely return to running after giving birth. We see lots of women who report feeling pressured to ‘return to normal’ and regain their pre-pregnancy physiques because of what they see on social media. This can often lead to women jumping straight back into running before they are ready. It’s important to note no journey is the same. Take your time, listen to your body and seek the guidance of an expert if you’re unsure.
What changes happen to our body?
After having a baby, the pelvic floor is weakened and often injured, particularly with vaginal delivery. High impact exercise such as running causes an increase in intra-abdominal pressure, meaning there’s more force being placed through the already weakened pelvic floor than lower impact activities.
The research investigating urinary incontinence in female athletes shows that high impact exercise (including running) was found to result in an increased risk of pelvic floor dysfunction compared to low impact exercise. This means those who run regularly are more likely to experience symptoms such as urinary incontinence and prolapse compared to those who don’t. As such, you need to be careful you’re ready to return to running at the right time!
Regaining the strength of contraction in the pelvic floor muscles to allow them to carry out their role in pelvic organ support and continence during high impact activities is vital and often overlooked.
What factors influence when I’ll be able to return to running after giving birth?
It is important to remember everyone’s journey and time frame in returning to usual activity will be a little different depending on a number of factors. These include:
- Pre-existing hypermobility conditions (e.g. Ehlers-Danlos)
- Whether or not you’re breastfeeding
- Pre-existing pelvic floor dysfunction or lumbopelvic dysfunction
- Previous births and level of trauma as a result
- Psychological issues which may predispose a postnatal mother to inappropriate
intensity and/or duration of running as a coping strategy
- Caesarian Section or perineal scarring
What stages should be considered in my return to running?
Firstly, it is important to remember postnatal women need adequate time to heal and regain strength, particularly in the abdominal and pelvic floor muscles after pregnancy and delivery. It is recommended that you don’t return to running prior to the 12 week stage at a minimum. This doesn’t mean you can’t exercise! In the 0-12 week time period, low intensity exercise is recommended, as well as strength work. These time frames will change from person to person, particularly if you have had a C -section (as you have just had abdominal surgery!). We know only 50% of the abdomen is healed at the 6 week mark post C section.
At the 6 week postnatal stage (around the same time that you will have a check up with your GP), it is recommended that every postnatal mother, regardless of the delivery mode, should be offered the opportunity for a pelvic health assessment with a specialist women’s health physio. This assessment will include:
- A screen for signs and symptoms of pelvic floor dysfunction
- Test for abdominal strength and separation.
- Internal pelvic floor assessment to assess whether you can get a pelvic floor contraction (quite commonly new mum’s can’t), the coordination of the pelvic floor and endurance of the pelvic floor. In this assessment you will also be screened for pelvic organ prolapse.
This information from the assessment will help guide and formulate a plan for returning to exercise.
Here’s a typical example of an exercise program in the 0-12 week stage utilised by our women’s health physiotherapists to kickstart your recovery, and build to a return to running.
|Week 0-2||gentle pelvic floor exercises, gentle walking|
|Week 2-6||begin more functional movements such as body weighted squats, lunges and bridges. Continue with some core and pelvic floor rehab. Continue walking potentially increasing load.|
|Week 6-12||stationary bike, continue walking moving into more of a power walk, add in weights to squat, weighted deadlift and increasing lower limb strength work to ensure muscles are strong enough to return to running without an injury.|
3-6 months: Making sure you’re REALLY ready to return to running
After 12 weeks, providing you don’t have any symptoms of pelvic floor dysfunction, we like to undertake a series of tests to ensure your body can cope with the demands of running. Just because you’ve waited 12 weeks post birth, doesn’t mean you’re necessarily ready to start running again. As such, we like to leave nothing to chance.
How we ensure you’re REALLY ready to start running again?
PELVIC FLOOR STRESS TEST
The first test is a series of exercises to stress the pelvic floor. These exercises include hopping, bounding, running on the spot and more. Rather than looking at the technique of the exercise, we are more so looking at whether you are experiencing any pelvic floor symptoms. This includes
- Feeling like you will leak urine
- Leaking urine.
- Heaviness or dragging in that area.
Generally if anyone returns to running or high intensity and hasn’t done any strength training then other injuries are more likely to come about. Next test is a series of strength tests that we use for anyone returning to running post injury. This includes
- 10 x single leg rises
- 20 x single leg calf raises
- 20 x single leg bridges
- Side plank endurance test for time.
PELVIC FLOOR ASSESSMENT:
Lastly we will then look at your pelvic floor strength and endurance. This includes:
- Reaching appropriate strength on a pelvic floor assessment by a women’s health qualified physio
- Completing 10 x fast pelvic floor contraction repetitions
- Holding for 10 sec for 10 reps to ensure you have the pelvic floor endurance necessary
In summary, the return to running post natal depends on:
- Ensuring you are between 3-6 months post natal
- Being able to activate pelvic floor muscles with the strength and endurance needed for running
- Passing pelvic floor stress test with urinary no symptoms.
- Meeting the necessary muscle strength testing.
What happens next?
If you have met the criteria does not mean you can pass a test and automatically run 10km even if you did so before! Load management is very important here and it is important to plan a program that will allow a graded return to running. 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 also be motivating.
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.
What should I look out for in my return to running?
If you’re experiencing feelings of heaviness, dragging, incontinence or moderate to severe pain, consult an expert women’s health physiotherapist. Outside of these symptoms, mild musculoskeletal pain (0-3/10 on a pain scale) which settles quickly after a run with no pain lasting into the next day is often acceptable.
If you’d like a tailored approach in your return to running post birth, or would like to know how our expert women’s health physio can help you, book a time here, or call the clinic on 8490 0777.