One of the things that seems to surprise a lot of my new postnatal clients is when I advise them on appropriate timelines before they start running again. In fact, a lot of mums I see had listed getting out for runs as one of their main planned activities to help shed weight post-childbirth. The common assumption is that once you have had your 6 week check, all exercise is OK. Even some well known organisations still suggest that once you have had your 6 week check you can start higher impact exercise such as running. I’m afraid this is an over simplification and not in line with the guidance we as movement specialists and fitness professionals give to our clients.
Women’s health fitness instructors and physios simply saying “Don’t run until you are at least 3-6 months postnatal” isn’t all that helpful either. If we are encouraging Mums to take ownership of their own bodies and wellbeing, we need to be providing information and support, not simply a list of do’s and don’ts. So here’s a little bit of explanation why I advise my Mums to wait until they are at least 3-6 months postnatal before returning to running, and how to take a progressive approach when the time is right.
WHY IS RUNNING CONSIDERED HIGH IMPACT?
The Ground Reaction Force (GRF) is the force exerted by the ground on a body in contact with it. When running at a moderate speed (11 km/hr or 6.8 miles/hr), estimated ground reaction forces of between 1.6 - 2.5 times body weight occur (Gottschall JS & Kram R 2005). This gives you an idea of the impact experienced by the body when you run.
Some of you reading this might wear a fitness tracker when running, in which case you will see the number of steps you take in an average run. For a 3 mile run at moderate speed, you could be taking as many as 4500 steps (VeryWellFit.com). That is 4500 times that increased forces are applied through the body! That impact is going to be felt throughout the body including at the joints, particularly the ankles and knees, the pelvis, spine, plus through the pelvic floor and abdominal musculature.
So let’s think about some of these areas in more detail
THE PELVIC FLOOR
The first thing I will say here is that if you are reading this thinking “my pelvic floor seems fine, this doesn’t apply to me, I’m off for a run”, hold on and keep reading.
At least some of the impact of each ground strike in your run will be absorbed by the pelvic floor. Those repetitive ground strikes give rise to increased pressure through the abdomen and pelvic region. Therefore your pelvic floor needs to be functioning well to be able to react to these sudden increases, performing its function in supporting the pelvic organs and maintaining continence.
So you are early postnatal, you took a quick jog round the block this morning, and you didn’t wet yourself, hooray! So does that mean all is well down there and you are OK to get straight back to running 5K, 10K…? No, not really. You see pelvic floor dysfunction isn’t always something that presents symptoms immediately after childbirth. It is something that, if not addressed, can worsen and start to show symptoms over time. That repetitive pressure exerted on the pelvic floor with each ground strike can, overtime, further weaken a pelvic floor that is not functioning well. You may start to experience leaking during or towards the end of your run, or even develop pelvic organ prolapse.
Pelvic Floor First, an initiative of the Continence Foundation of Australia, use a great analogy of a boat in water to explain how prolapse can develop. They imagine the pelvic organs as a boat, the pelvic floor as the water level, and the supporting ligaments as ropes attaching the boat to the jetty. When the pelvic floor is functioning well, the water level is normal and there is very little tension on the ropes. However after childbirth the pelvic floor can be stretched and lose some of its resistance, so the water level is lower and the ropes are under increased tension. Imagine this persists, the ropes will overtime stretch and weaken, increasing the risk of prolapse. Now imagine adding jumping, running or bouncing activities. This can result in further over-stretching and weakening of the muscles and connective ligaments, thus increasing the risk of the pelvic organs dropping down and a prolapse occurring. I have seen too many women, some very young, who have prolapse and tell me it is because they starting running too early after childbirth. With this in mind, I encourage all new Mums to spend time working on pelvic floor restoration work before starting high impact activities such as running.
WHAT ABOUT THE REST OF THE BODY?
The pelvic floor is a significant factor when it comes to running post childbirth, but what about the impact on the rest of the body.
The repetitive impact of running can affect our joints, which may be less stable following childbirth due to laxity of the connective tissues. Also consider that, depending on how active you were towards the end of your pregnancy, your body may be slightly deconditioned compared to its pre-pregnancy state, and is very likely to be more fatigued now that you have a small human requiring your attention day and night.
Furthermore, if the abdominal muscles have not regained sufficient integrity and strength to properly support the lower back and pelvis you will be placing additional strain on the spine, opening yourself up to back pain and pelvic pain.
Running increases intra-abdominal pressure, which can exacerbate an abdominal separation. This is why I advise my ladies with Diastasis Recti to avoid running until they have been able to sufficiently restore the integrity of the abdominal musculature.
If muscles are weak, and ligaments lax, this compromises the framework of the body and may result in compromised form in our running. This can open us up for injuries, particularly those that can appear over time as a result of repetitive action with poor form or body mechanics, such as knee problems, hip bursitis, lower back pain etc.
WHERE DOES THE 3-6 MONTH ADVISED WAITING PERIOD COME FROM?
Running is a high impact activity. The body needs time to heal and restore strength before it is ready to safely withstand the impact of running. Published studies have shown that recovery of the pelvic floor and abdominal musculature can take far longer than the standard milestone of your 6 week check.
In March 2019 evidence based guidelines for the postnatal return to running were published (Groom T, Donnelly G, Brockwell E, 2019). The guidelines recommend “following an initial low impact exercises timeline followed by return to running between 3-6 months postnatal”.
It is important to note that the timeline goes beyond this if you have any symptoms of pelvic floor dysfunction or musculoskeletal pain, or if such symptoms appear when you attempt your return to running.
The timeframe is a guideline and I encourage my clients to focus on listening to their body to know when they might be ready to run. As a general rule, if you think you are pushing it too early you probably are!
TIME TO GET OUT FOR THAT RUN?
When thinking about returning to running postnatally, a lot of the advice I give my clients is very much based on the guidelines published by Groom, Donnelly and Brockwell. They are evidence based and provide a logical, progressive approach to rehabbing, restoring and preparing the body to be properly run ready.
In general, for any new mum thinking about returning to running post childbirth I recommend the following:
Start by rehabbing / restoring the pelvic floor and abdominal musculature.
I believe this should be a starting point for everyone, regardless of whether you think you have a weakness there or not. Ideally find a movement specialist who is well qualified in working with postnatal women to help guide and support you. I include a strong focus on pelvic floor and abdominal restoration in all my postnatal classes and 1:1s.
Get out and walk in the fresh air
Not only are you getting a great dose of fresh air and cardiovascular exercise, walking is a low impact way to help develop strength and stability in preparation for running. Plus it is free and you can take your baby with you - just make sure your buggy or carrier is set up properly so that you can walk with good posture. Do pay attention to your pelvic floor and note any discomfort or heaviness felt during a walk. If you are unable to take a 30 minute walk without feeling pelvic discomfort, heaviness or maintaining continence without leaks, running is not going to be appropriate for you at this time.
Work on improving whole body strength and stability.
The Return to Running guidelines recommend a series of load & impact management assessments and strength tests for professionals to apply when assessing a postnatal client’s run readiness. This encourages a whole body approach. Low impact exercises that focus on developing strength and stability through the lower extremities, pelvis and torso are a great way to prepare your body to be run ready. If, for example, you lack the strength to be able to comfortably perform single leg shoulder bridge or side lying leg lifts with good technique, then you may wish to further develop strength in the key muscle groups involved before running. Exercises such as shoulder bridge (including single leg) and side lying abduction are included in my postnatal Pilates classes, and we take a whole body approach to our restorative movements.
When you are ready to run, take a progressive approach.
I always encourage my Mums to start with a couch to 5K program. Not only does this provide a gentle return to running, the interval based approach gives you the opportunity to check in on how your body is feeling during each walking interval. Did you leak in the last run interval? (in which case please stop your run), how are your ankles, knees, hips, and back feeling? Are you managing to keep your form? As intervals get longer, are you able to maintain continence throughout the entire interval? Start learning how to tune into your body and listen to what it is telling you.
Ultimately you are in charge of your body. I am able to give you information and guidance that will help you make informed decisions. I encourage every new Mum to start to tune into their body, listen to it and work with it, not fight against it. Your body will thank you for it in the long term!
Gottschall, J.S. and Kram, R. (2005) Ground reaction forces during downhill and uphill running. Journal of Biomechanics 38, 445-452.
Pelvic Floor First: www.pelvicfloorfirst.org.au. Returning to sport or exercise after the birth
Groom T, Donnelly G, Brockwell E. Returning to Running Postnatal - Guidelines for Medical, Health and Fitness Professionals Managing this Population
Pelvic Floor First, The Pregnancy Center. Returning to sport or exercise after the birth
Return to Running (Groom T, Donnelly G, Brockwell E) Guidance for patients and non-clinical persons in evaluating readiness to return to running following pregnancy. Adapted into a client information sheet by Precision Poise and available on request (firstname.lastname@example.org).
Note: If you are experiencing symptoms of pelvic floor dysfunction or prolapse, I recommend seeking the advice of a Women’s Health Physiotherapist.