Are you a runner itching to get back to running after pregnancy and birth? Returning to running after having a baby is not as straightforward as lacing those shoes on and stepping outside at 6 weeks post-partum. This is despite the common advice being given that one can return to exercise 6 weeks after having a baby.
In fact, from a pelvic physiotherapy perspective, there are more than a few things to bear in mind before returning to running. Some of these things include how pregnancy and birth affect the pelvic floor, pelvic floor fitness for running, and general strength and conditioning for muscles required for running. Have a read below to find out more about considerations and factors influencing return to running after having a baby.
How does pregnancy and birth affect the pelvic floor and abs?
During pregnancy, the pregnant person's body expands to accommodate the growth of the baby. Due to the increased weight and size (all normal during pregnancy!), there is increased pressure and work placed on the ab muscles and pelvic floor. Moreover, in a vaginal birth, the pelvic floor stretches up to 250 percent of its length to allow the baby to enter the world. Normally, muscles will tear when stretched to 150 percent of their
length. This means the pelvic floor can be weaker due to the increased demands from the pregnancy and during birth, and to an extent has undergone a stretch injury. On the C-section front, an incision to the abdominal muscles is also an injury. This means in both vaginal and C-section births, there is a priority to promote rest, recovery and healing in the first six weeks post-partum. Why six weeks? This is because muscles and structures in the body take at least six weeks to go through the healing process with further refinement of the injury site after this period of time.
Some recovery facts about pelvic floor and abdominal muscles post-partum
Fact 1: The pelvic floor opening is the same size 12 months post-natally as someone who is assessed immediately after a C-section. It can take 4-6 months, if not longer, for the pelvic floor to recover in a normal vagnal delivery.
Fact 2: The abdominal tissue at six weeks post-partum is 51-59 percent of the original tensile strength. This continues to improve to 73-93 percent of pre-pregnancy tensile strength at 6-7 months post-partum.
The above might induce some worry (it is okay to feel wary) when considering return to running. What the above highlights is several things; one is that recovery of tissues post-partum can take at least a year and two, is that it is pertinent to rehab-rehab-rehab the pelvic floor, abdominal muscles and other muscles one needs for running. Starting with a higher baseline of muscle strength, endurance and power across muscles required for running places one in a position that can protect the pelvic floor and the organs it supports.
When and how can I start running again?
The current recommendations outline a return to running starting at 12 weeks post-partum at the earliest. This does not mean at the 12-week mark running the distance and intensity one was doing pre-pregnancy. Prior to 12 weeks, between 6-12 weeks post-partum, one can be re-strengthening the pelvic floor, abdominal muscles and lower leg muscles to be prepared for the demands of running. Once one starts running, your program may be one that is a mix of walking and running (e.g. 1 minute walk, 1 minute run, then repeat for 20 minutes), to build up running fitness gradually to reduce overuse injuries.
See our blog When Can I Start Exercising After Having A Baby? for some extra details about starting exercise again after birth and read up on what should I NOT feel when exercising?
This is a general timeline for return to running. It is important to remember that each birthing person has had a unique pregnancy, birth and post-partum experience. And this means the journey back to running will also be unique and may not necessarily take 12 weeks. For some, it may take 6 months or over a year and this is one hundred percent okay!
What are some things pelvic physios look for before giving the green light to running?
Here are some criteria we like our post-partum persons to achieve before starting the first run. All of these need to be completed without bleeding, pelvic pain, heaviness/dragging and incontinence.
Criteria 1: Pelvic floor fitness
Pelvic floor exercises in standing
Strength 10 reps, 10 second, 3 sets
Power 30 reps in 1 minutes
Endurance 8-10 reps, 10 second holds AND 1 rep, 1 minute hold
An additional test for those wanting to run post-baby is the pelvic floor "stress test":
With something in your bladder (it's cheating to empty your bladder before this test!) can you:
Do 10 star jumps
Then cough hard twice in a row
Criteria 2: Cardiovascular and general strength
Walking at a moderate intensity for 30 minutes
Single leg balance 10 seconds
Single leg squat 10 reps per side
Jogging for 1 minute on the spot
Forward bounding 10 reps
Hopping 10 reps per side
Single-leg running man 10 reps
Criteria 3: Endurance and strength
20 reps of
Single-leg calf raises (including fast calf raises)
Single-leg glute bridge
Single leg sit to stand/ Bulgarian split squat
Knee side plank with clam/side lying hip kick
Side lying hip kick
Are you thinking, “Uhhh, this looks overwhelming?”. It does look like an extensive list. However, have faith you will be able to achieve these things so you can return to running in a manner that is protective of your amazing pelvic floor! By laying down a solid foundation for the pelvic floor and other muscles, you place your body in a position to run as safely as possible.
Why do we proceed with caution and gradual loading with running?
Running is a high impact activity where one has increased demands on the muscles, ligaments and skeleton compared to lower impact exercise, such as walking. With each step one takes during a run, there is anything between 1.6 to 2.5 times the body weight going through the leg and the rest of the body. Additionally, due to these demanding but normal forces required for running, there is an increase in the pressure inside the abdomen and thus the pelvic floor. Thus, it is important to have optimal pelvic floor function to manage these forces, particularly post-partum after the demand on the pelvic floor during pregnancy, the stretch for birthing or abdominal healing after a C-section. This is particularly important because running has an increased risk for pelvic floor related issues.
Other factors affecting recovery and return to running
With the new addition to the family, whether it is your first or third, there will be a period of adjustment. There will likely be a change in sleep patterns across the first few years of infancy as well. Changes to sleep, holding emotional and physical space for a new family member on top of existing ones and for yourself, can make it challenging to find the time to rehab, strengthen and run consistently. So, please hold yourself with kindness and compassion if you are taking longer than anticipated to get back to running and to run at a level pre-pregnancy. Factoring in enough recovery between exercise sessions is also important to reduce injuries.
I want to return to running - what should I do next?
If you’re ready to start exercising again, we highly recommend seeking out a pelvic floor health assessment at six weeks and once lochia (post-partum bleeding) has ceased. This will assess your pelvic floor health strength, endurance, power, signs of prolapse and management of diastasis recti abdominal muscle separation. From here, your pelvic health physiotherapist will work together with you to create an exercise and pelvic floor rehabilitation program tailored to suit your current needs and running goals.
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