Guidelines for Returning to Running for Postnatal Mums
Running is a great form of cardio - It gets your heart rate up, gets you sweating, it’s time efficient, can be done solo for some much needed “me time”, or can be done with friends or in large groups to get that “community feel”. Not to mention the amazing endorphin kick at the end of a run! Wow - that makes it all worth it.
So, what’s the catch?
Well, running is a high impact activity and that means that after having a baby your body needs to be strong enough to return to running (RTR) safely. The risk of getting back into running too soon after having a baby may mean you do more harm than good i.e. you could negatively impact your post-partum recovery. This can include weakening your pelvic floor and abdominal muscles and may result in things like bladder and bowel leakage, back/pelvic girdle/hip pain, and/or pelvic organ prolapse.
On the flip side, if you do the ground work and prepare your body with graduated strength and conditioning, you’ll be ready to RTR with a good foundation of fitness, reducing your risk of injury.
When you RTR it is important to listen to your body and avoid the unwanted symptoms of pain, vaginal heaviness and/or leakage during or after your run. To avoid unwanted symptoms you need to take it slow, and modify your running program to suit your individual needs.
Running can be great for whole-body fitness, and do wonders for your mental state, but you need to put in the ground work to be ready to RTR after having a baby.
This blog provides you with a guide to safely RTR, including simple self-checks tests.
When to consider RTR:
Research suggests that women should not consider returning to high impact exercise for 3 months (or more) after the delivery of their child.
Unfortunately, research on return to running in the post-partum population is scarce. Most of our RTR recommendations are based on expert opinion. The biggest thing to remember is that everyone’s pregnancy and postnatal journey is so different and specific time-frames for RTR will vary greatly between individuals.
The following factors may influence your RTR time-frame:
Injury – such as low back/pelvic girdle/hip pain
Incontinence (bladder and bowel leakage, inability to control wind)
Prolapse (vaginal heaviness, dragging, feeling of a bulge at the vagina)
Bladder frequency and urgency
Obstetric history (Difficult long labour, large baby (>4kg), perineal tearing, nerve injury)
Perhaps none of the above sounds like your story and you had a great pregnancy and an even better birth or caesarean delivery - Although you may be feeling good post-partum, it’s still important to have a postnatal assessment with a pelvic floor physiotherapist at 6 weeks after the delivery of your child, and we also recommend having a follow-up assessment prior to RTR, which, as previously mentioned should be no sooner than 3 months post-delivery. These postnatal assessments are to identify risk factors and provide you with a tailored and specific pre-running exercise program, give you guidance on individualised RTR time-frames, and when appropriate provide you with a graduated RTR program.
The following assessment findings will influence your RTR time-frame:
Pelvic floor weakness/vaginal tissue laxity/prolapse
Abdominal separation/reduced abdominal wall tone/weak abdominal muscles
Weak glutes
Poor balance
Poor motor control/stability/co-ordination around the back, hips and pelvis
Research has found that at 6 weeks post-partum the abdominal wall had only regained 51-59% of its tone/strength, and by 6-7 months 73-93% of its tone/strength. Now, although running will help to improve your abdominal wall tone and strength, due to high demands of running you will need to have a good baseline of abdominal wall strength before commencing running. If you RTR when your abdominal wall is not strong enough this can put too much stress on your tummy and pelvic floor muscles and may result in these muscles weakening and the connective tissue ‘down there’ becoming stretched. This can result in things like prolapse, incontinence and reduced pelvic floor tone which can impact your sexual function. Further, if your abdominal wall is not strong, running may result in injury, such as back pain or knee pain.
Research has also shown that the pelvic floor takes an average of 4-6 months to recover well. Therefore, it’s important to commence a RTR program at the right time in your postnatal journey. This may be as early as 3-6 months post-partum or depending on your abdominal wall and pelvic floor recovery it may take more than year until you can safely RTR.
Whatever the time-frame is, it’s important not to go from 0 to 100. In other words, don’t go from not exercising in the first few months post birth, to getting straight back into running at the 3 month mark. To reduce your risk of injury you need to put in a lot of ground work: work on improving your strength, endurance and stability for at least 6-12 weeks prior to RTR. This can be done in the form of low-impact strength and conditioning exercises, such as Pilates, yoga and functional gym work that’s tailored to your unique body.
How to test if you are ready to commence a return to running program
There are three different types of RTR tests:
1) Pelvic Floor tests
2) Strength tests
3) Load and impact tests
Pelvic Floor Tests
The pelvic floor test criteria (ie. how to check if your pelvic floor is ready for return to running) are as follows:
You should be able to perform 10 quick on/off pelvic floor contractions in a row. You should be able to perform these contractions with good speed and co-ordination, feeling a definite ON and a definite OFF with every single rep!
You should be able to perform a strong (maximal effort) pelvic floor contraction and hold this strong contraction for 6 seconds and BREATHE normally AND repeat this 10 times in a row. You are allowed a 6-12 second rest in between each rep.
You should be able to gentle contraction your pelvic floor (30% effort) and hold and breathe for 60 seconds. At TPS we are a little surprised by this last pelvic floor test, it seems awfully hard (60 seconds is a long time ekkk!).
Strength Tests
Prior to returning to running you should be able to perform the following tests without pain, vaginal heaviness, or leakage:
20 side-lying leg lifts
20 single leg bridges
20 single leg sit-to-stands
20 single leg calf raises
See our Pelvic Floor Physiotherapist, Jaclyn, showing you how these are done!
Functional Tests
Prior to returning to running you should be able to perform the following tests without pain, vaginal heaviness, or leakage:
30 minutes of walking, including inclines/declines
10 seconds of single leg balance
10 reps of single leg running man
10 single leg squats
Jog on spot 1 minute
10 forward bounds
10 single leg hop on the spot
See our Pelvic Floor Physiotherapist, Emma, showing you how these are done!
Graduated Returning to Running Program
Once you have passed the return to running tests rather than run 8km on your first run after having a baby, we suggest starting slowly with a Fartlek walk/run type program. See below for a bit of guide to get you started:
a) Run 1min, walk 2 mins, repeat x 5
b) Run 2min, walk 2 mins, repeat x 5
c) Run 3min, walk 2 mins, repeat x 5
d) Add pace & inclines
e) Run 5 mins, walk 1 min, repeat x 5
f) Add more pace & inclines
g) Run 3 km and build up in increments of 1 km until you reach desired goal
If you experience any unwanted symptoms with running please cease and consult with your trained health professional.
We advise sticking to each level of this RTR program for 1-3 sessions before progressing to the next level.
As you progress if you experience any unwanted symptoms (vaginal heaviness, incontinence, aches/pains) regress back to the previous level that felt comfortable, and again consult with your qualified health professional.