Unfortunately there are not set guidelines here in NZ on the return to running post baby. Mums are often unsure on when to start running and health professionals are also unsure on the right advice to give and often no advice is given. However in March this year, a group of specialist physios in the UK published a document collating the current research on running postnatally along with expert opinions of specialists around the world giving us some better guidelines. This is a really exciting document and will hopefully clarify when is safe to return to running postnatally. I have tried to summarise the document for all my fellow new mum runners.
Running and the pelvic floor
Running is a high impact activity which places a large amount of stress on the body (up to 9 x body weight going through the leg as it contacts the ground). The role of the pelvic floor is to support the pelvic organs (bladder, bowel, uterus) during high impact activities, such as running. During pregnancy the pelvic floor is weakened and then injured through vaginal delivery. A cesarean section also creates significant weakness in the abdominal muscles that are cut during the procedure. We need time for the body to recover and mothers need to perform exercises to strengthen these areas before the stresses of running. If you return to running too quickly you are at risk of pelvic floor and/or abdominal dysfunction.
What are the signs and symptoms of pelvic floor and abdominal dysfunction?
- A heavy feeling or a dragging feeling in the pelvic area
- Leaking urine or inability to control bowel function
- A noticeable gap/separation along the abdominal midline (diastasis rectus abdominis)
- Lower back or pelvis pain
- Ongoing blood loss after 8 weeks that is not related to your period
Do not panic if you do have any of these symptoms. They will improve as your body heals and as you do the correct exercises. If you need assistance or further information, then get in touch with a pelvic health physiotherapist.
When is it safe to return to running?
Running is NOT recommended in the first three months post birth. This is a set recommendation and does not change depending on how long you continued running in pregnancy, type of birth etc. It is recommended that EVERY MUM wait a minimum of three months before they run. Gradual return to running can commence between 3-6 months if none of the symptoms listed above are present at rest. Running should be built up gradually and should be reduced or stopped if any of the symptoms above come on. The rate at which you can start or increase running will vary dramatically from mum to mum, but using the above symptoms will guide your own personal progress. No symptoms means you are progressing safely but any of the above symptoms means you have done too much too soon. Exercise is recommended in the first three months post birth, but it should be low impact for example cycling, gentle Pilates, walking, swimming (once bleeding stopped).
If from a pelvic health perspective a mum is doing well, it is also important to check the rest of the body is strong enough to cope with the demands of running.
A mum should also be able to perform the following with good control and no symptoms as per the list above before starting to run.
- Walk 30mins
- Single leg balance for 10s
- Single leg squat x 10
- Jog on the spot for 1min
- Forward bound x 10
How to return to running
The return to running should always be gradual to reduce the of risk pelvic dysfunction occurring down the track. A 10% increase in speed or duration is a good rule of thumb. Walk/running programs are often a good place to start, for example 1min run, 4min walk and then repeating. Slowly you would build up the run portion and reduce down the walk.
Other Important Factors
There are many other things that will affect the speed at which you can return to running including breastfeeding, pre-pregnancy and during pregnancy activity level/fitness, abdominal separation, mental well-being and all important sleep (or lack of!!).
The most important thing to remember is that every pregnancy, birth, postpartum and baby are DIFFERENT and it is impossible to compare yourself to anyone else. Listen to your body and let it tell you when running feels right!
- Running is high impact and puts large stress on a healing body post birth
- Running should not commence before three months post birth
- Running should be gradually built up and the mum should not have any pelvic/abdominal dysfunction symptoms during or after running
- Everyone is different and mums should not become disheartened if it takes longer than expected.
Return to Running postnatal – guidelines for medical, health and fitness professionals managing this population. T Goom, G Donnelley & E Brockwell. March 2019. Full document link.