Return to Running
Return to running is a goal that many postpartum women have. There is nothing wrong with running, it’s just a difficulty activity.
Here are the return to running guidelines that were put out in 2019 by Tom Goom, Grainne Donnelly and Emma Brockwell:
Return to running guidelines - full version
Here is a podcast episode where I discuss these return to run suggestions with Grainne Donnelly:
Here is a summary of the most important key points:
Things to keep in mind about your body after baby
1
After having a baby, the pelvic floor is weak and injured in most women and may need instruction and supervision to be able to perform a correct pelvic floor muscle contraction, especially in those women who did not train these muscles before birth (Bø et al. 2017).
This is why you started with gentle activation of the pelvic floor and core and have been progressing through the program.
If you are unsure of whether you are doing this correctly, I highly suggest you seek out individualized assessment and guidance.
2
High-impact activity, such as running, is associated with a sudden rise in intra-abdominal pressure (Leitner et al. 2016). It has also been reported that ground reaction forces of between 1.6 and 2.5 times bodyweight can occur when running at a moderate speed of 11 Kilometers/hour (Gottschall and Kram 2005). Presently, it is unknown if or how much of this is absorbed through the lower limb on impact and therefore it is assumed that some, if not all, of those forces are also transmitted to the pelvic floor. This highlights the importance of strength and speed of contraction in the pelvic floor muscles in order to carry out their role in pelvic organ support and continence during high impact activities (Leitner et al. 2016). It also helps reason why weak, less co-ordinated muscles in postnatal women may not achieve the level of function needed to maintain these roles and highlights the importance and indication for adequate rehabilitation. This is why we progressed the core activation in 3 ways:
moving through all the motion with breath
holds with breath
pulses
3
Running is a high impact sport placing a lot of demand on the body. In a recent systematic review investigating urinary incontinence in female athletes (De Mattos Lorenco et al. 2018), high impact exercise was found to have a 4.59 fold increased risk of pelvic floor dysfunction compared to low impact exercise.
This is why we have focused on low impact exercise thus far and why I suggest gradually adding high impact
4
The opening at the bottom of your pelvis widens during pregnancy and increases significantly after vaginal birth. It is thought to return to similar area by 12 months postpartum (never quite to prenatal size) and much quicker post c-section. This area is significant as it supports the organs to protect against prolapse and incontinence. Recovery of the muscles, tissues and nerves in the area is maximized by 4-6 months postpartum.
This is an example of why time is important for recovery
5
Bladder neck mobility increases after vaginal delivery and, while the support to the bladder neck can improve postnatal, mobility remains higher than when measured at 37 weeks gestation (Toozs-Hobson et al. 2008, Stær-Jensen et al. 2015).
This is another example why time is important for recovery
This also explains why bladder symptoms are common postpartum.
Having good pelvic floor strength and coordination will help this.
Some women will benefit from using vaginal inserts like a pessary or Poise Impressa to support the bladder neck
6
Following cesarean section delivery, consideration should also be given to the healing and remodelling of the uterine scar. It has been shown by ultrasound investigations that the uterine scar thickness is still increased at 6-weeks postnatal suggesting that the process of scar remodelling after caesarean delivery extends beyond the traditionally accepted period (Hamer et al. 2007). This is further supported by the understanding that abdominal fascia has only regained 51%-59% of its original tensile strength by 6-weeks post cesarean section and 73%-93% of its original tensile strength at 6-7 months postnatal. (Ceydeli et al. 2005).
This is an example of why scar mobility is important
Also an example of why time is important for tissue healing
Symptoms that would suggest that you should hold off on running:
leaking pee or poop
Urinary and/or faecal urgency that is difficult to put off
Heaviness/pressure/bulge/dragging in the pelvic area
Pain with intercourse
Difficulty passing bowel movements
Diastasis that has not been addressed
Low back or pelvic pain
Risk factors for returning to running:
(these do not suggest you cannot run, but do factor into your return)
Less than 3 months postpartum
Pre-existing hypermobility conditions (e.g. Ehlers-Danlos)
Breastfeeding
Pre-existing pelvic floor, low back or pelvic issues
Psychological issues which may predispose a postpartum mother to inappropriate intensity and/or duration of running as a coping strategy
Obesity
Cesarian Section or perineal scarring
Relative Energy Deficiency in Sport (Red-S)
Here is a visual of the recommendations for building up to running postpartum:
To start running, the guidelines suggest that you are able to complete the following (summarized below the video).
1
Adequate pelvic floor strength, endurance and quick reaction time in standing
10 quick contractions
8-12 reps of 6-8 second holds (maximum contraction)
60 second hold (30-50% contraction)
2
Tolerate load and impact 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
3
Have adequate strength in key muscle groups for 20 repetitions.
Single leg calf raise
Single leg bridge
Single leg sit to stand
Side lying abduction
4
Once you start running (suggested after 12 weeks +):
Suggest starting with very gradual progression (ex “couch to 5km”) where intervals are heavily focused on high walking: running ratio initially.
running with a stroller is a progression as it involves pushing a weight and changes movement required in the spine and rib cage.
Alright… that was a lot to take in wasn’t it?
I trust this leaves you feeling informed about your body to help you progress your exercise intensity with awareness. I can’t stress enough that each of you is an individual and best case scenario is that you take this information and combine it with seeing a physical therapist in your area that can provide you with 1:1 assessment and guidance to take everything you have learned and put it into practice.
