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Are You Ready to Return to Running Postnatal?!

Did you just have a baby and are itching to get back into your fitness routine?

Or it's been years since you've worked out since you had kids? 

If your fitness routine included running pre-baby and you want to get back to it, take a second and determine if your body is ready or not to run!

If your post baby experience was like most, then you went to your 6 weeks postnatal doctor's appointment, got the "all clear" signal, and were sent on your merry way. Only to find out, one back problem after another, that maybe there is something more you needed to deal with before lacing up the running shoes!

The good news is that recently guidelines were published on returning to running postnatal by three physical therapists: Tom Goom, Emma Brockwell, and Grainne Donnelly. What makes this so significant is that there is not a lot of research out there on returning to running for postnatal women!

Running is a High Impact Sport that puts a lot of strain on the core muscles

First of all, high impact activity like running has been shown to create a sudden rise in intra-abdominal pressure, as well as, is associated with large ground reaction forces. In layman's terms - running is high impact and hard on your body!

We can thus assume that some of this force is translated up to the pelvic floor muscles (the muscles under your uterus, bladder and bowel, acting like a trampoline to hold everything in).

The pelvic floor then has to be able to contract with enough strength, and at the right speed, in order to support the pelvic organs and prevent incontinence during running. (If you are interested in learning more about incontinence during exercise, check out our blog here: Athletic Incontinence: A Common Problem for Female Athletes)

Note: You don’t have to have recently had a baby to experience incontinence during running.  It is very common in female athletes, and seeing a physical therapist can help you determine WHY the leaking is occurring. This can happen in women at ANY age and ANY activity level!

Before getting back into running postnatal, you need to make sure your core is strong and stable

Since running puts such a high demand on the body, it is crucial in the postpartum period that you take all precautions to ensure you are ready to return to running.

You need to allow adequate time in the fourth trimester (the healing trimester) to heal, reconnect/retrain, and regain strength of the inner core system (diaphragm, deep abdominals, and pelvic floor).

Check out this video on diaphragmatic (360) breathing for a good place to start learning how to reconnect to all the players of your core canister:

https://www.youtube.com/watch?v=SyEViLElmcc&t=8s

The new postnatal return to running guidelines call for a phased in approach

The recommendation consensus of the postnatal return to running guidelines recommend a low impact exercise progression during the first 3 months postpartum, followed by a gradual return to running program between 3-6 months postpartum at the earliest.

However, this may look different for EVERY woman!

Your ability to handle the high demands of running may be different than someone else’s and thus, we cannot fall into the trap of thinking “I’m now 3 months postpartum, I can start running.” Maybe you can! Maybe you have great ability to connect with your inner core and have regained significant strength, have no pain, and have no symptoms of urinary leakage.

However, just because you are now 3 months, 4 months, etc. postpartum does not tell you that you are ready to return to running/high impact activity. You have to look at your entire system to assess readiness to return to running because running stresses your entire body!

Not sure if you are ready to return to running? Then turn to the professionals

It is so important to have a team of health professionals with specific training in postpartum care to help guide you in your return to exercise.

These health professionals may include:
  • a pelvic floor physical therapist
  • a postpartum or orthopedic physical therapist
  • a trainer with certifications in postnatal fitness

Taking the time and money now to make sure your body is working properly can decrease your risk of injury in the future, saving time and money in the long run (pun intended).

Symptoms & Conditions To Look Out For Before Returning to Running

The following is a list of situations where you may have some difficulty returning to running.  

Risk factors stated in Table 2 of the recent guidelines for potential issues with return to running:

  • < 3 months postnatal
  • Pre-existing hypermobility conditions
  • Breastfeeding (due to the hormone changes)
  • Pre-existing pelvic floor or lumbopelvic dysfunction
  • Psychological issues
  • Obesity
  • C-section or perineal scarring

In addition to knowing these risk factors for potential issues when returning to running, it is also very important to know reasons in which it is recommended to hold off on running temporarily until you are seen by a physical therapist:

  • Heaviness in the pelvic region
  • Leaking urine or inability to control bowels
  • Pendular abdomen or noticeable gap along midline of abdominal wall (diastasis recti if not functional, meaning you are not able to manage intra-abdominal pressure and transfer load through the abdomen -- may see bulging/doming along the midline of the abdomen)
  • Pelvic or lower back pain
  • Ongoing or increased blood loss beyond 8 weeks postpartum (not associated with menstrual cycle)
NOTE: If you have any of the above listed symptoms prior to or after attempting running, it is very important that you see a pelvic floor or postpartum physical therapist!

Functional Fitness Tests the Help Determine your Readiness to Return to Running

In addition to assessing for pelvic floor dysfunction and other aches/pains, there are also numerous strength and plyometric tests to ensure an individual is ready to return to running. Your physical therapist will look at things like your single leg balance, single leg squat, hopping tests, single leg calf raises, hip strength and stability, etc.

Running is essentially a series of single leg hops and thus, it is important to ensure adequate strength and stability prior to being cleared to return to running in order to prevent injuries.

What about if you are breastfeeding?

If you are still breastfeeding and returning to running, it’s important to recognize that breastfeeding prolongs the altered hormones in a woman’s body. It is suggested that estrogen levels are decreased and the levels of the hormone relaxin remain increased. Although it hasn’t been proven in research, relaxin increases joint laxity in women and thus, may put you at potential increased risk of injury.

If you are experiencing any of these issues and feel like you may not be able to run again, don't give up!

There are exercises you can do to get you ready and back on track. If you are wishing to return to high impact exercise such as running in the postnatal period, I would love to help you with this process!

Email me directly at khartley@grandviewprimarycare.com!

This will help save you from developing injuries or other issues down the road. It’s so important to have a solid foundation prior to returning to high impact exercise.

 

Happy Running!

 

About the Author:

Kaitlin Hartley, PT, DPT, PPCES
Doctor of Physical Therapy
Prenatal & Postpartum Corrective Exercise Specialist
Physical Therapist at Grandview Primary Care
Instagram: @movewell.pt
Facebook: Dr. Kaitlin Hartley, PT, DPT

 

 

References

  1. Leitner, M., Moser, H., Eichelberger, P., Kuhn, A. and Radlinger, L. (2016) Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study. Neurol Urodynam. 9999, 1-7.
  2. Goom, T., Donnelly G., Brockwell E. Returning to running postnatal-guidelines for medical, health and fitness professionals managing this population. 2019. 1-40.
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