So, you have just had a baby and you are dying to hit the pavement running again or for some reason have this itch to start! It’s amazing you are feeling keen to resume things or to increase your activity and return to running but its key to short and long-term recovery that you go about it the right way.
During pregnancy and regardless of how you gave birth your body underwent massive physiological changes. Your heart, lungs, hormones, muscles, muscle recruitment and movement patterns, centre of gravity, and pelvic floor all changed. And on top of that, your body is still changing and recovering from pregnancy for up to 12 months after birth! Recovering from pregnancy and birth is no different to recovering from a major injury such as ACL reconstruction or shoulder reconstruction and it should be treated with the same respect and be overseen by your medical team and other allied health professionals.
In general, if you are wanting to return to running postpartum the timeline is around 3 to 6 months providing you have NO pelvic floor dysfunction. That is pelvic floor weakness or pelvic organ prolapse (POP) which may include symptoms of pressure, pain, feeling of fullness/bulging in the vagina or downward dragging sensations (like your insides are falling out), incontinence (leaking urine or faeces ), constipation, lack of sexual sensation, painful intercourse or other pelvic pain.
First and foremost, seek an assessment from a women’s health physiotherapist to ensure your pelvic floor and core are functioning correctly. This ensures no dysfunction and even if you are not feeling any symptoms (which doesn’t mean you have no dysfunction) is the gold standard for diagnosis and treatment. Once you are cleared to exercise by your women’s health physio and there is no dysfunction it’s ideal to resume exercise that is low impact for the first 3 to 6 months. This is part of the rehabilitation process where you can work on things like connection breathing (reconnecting with the pelvic floor and core), alignment and exercises that focus on functional movement while gently challenging and restoring function to the pelvic floor and core. When returning to running start small and interval style. This may be 30-second jog and 30-second rest for 10 minutes. If this feels ok during and AFTER (no pelvic floor pain or symptoms) then increase your distance and decrease the rest time SLOWLY.
Be aware of what sensations you are looking for;
- A feeling of fullness or bulging in the vagina
- A feeling of a downward dragging
- Heaviness or like your “insides are falling out
- Incontinence (urinary or fecal)
If you experience this, then please STOP and seek HELP from your women’s health physio. There is no shame in listening to your body, talking about your symptoms and seeking help!
Please be mindful that other factors will impact your return to running postpartum and your performance.
Pregnancy hormones like relaxin are present however it’s yet to be proven if the increase in this hormone increases joint laxity and the risk of injury. Some women however for reasons unknown do have increased joint laxity and therefore may increase your risk of injury and this includes pelvic floor injury. Stress hormones like adrenaline and cortisol from lack of sleep can cause changes to performance, energy and impact your results. If you have gained weight and are now considered overweight this can cause an increased risk to the pelvic floor and more stress on your joints as the load and the demand on your body has increased. Your breathing may be impaired partially if you have not yet regained connection the pelvic floor and core with connection breathing (my postpartum coaching dives into connection breathing to help you reconnect).
Diastasis Recti (abdominal separation)
The debate between the relationship of diastasis recti and pelvic floor function continues and there is no conclusive evidence on running with diastasis recti. However, if you have non-functional diastasis recti then it seems counter-initiative to resume running until you have proper function of the abdominals (intra-abdominal pressure and load transfer across the abdominal wall) to not place extra load on the pelvic floor.
Scar mobilisation both c -section and perineal may case restriction and pain and restrict muscle functions around the scar tissue sites. You can discuss this with your women’s health physiotherapist and they can shown you how to continue massage on the scar tissue at home. Scar mobilisation helps to reduce adhesion, inflammation, fibrosis and improve remodelling.
Supportive clothing like high waist leggings to support the abdominal wall, lower back and pelvis with GENTLE compression can help with recovery postpartum and are great to wear when you resume exercising . It should provide a little support and still allow you to take a deep breath in, you should still be able to move, squat, sit and eat! A good sports bras is essential particularly if you are breastfeeding or have larger breasts as it can help reduce pain and discomfort.
Returning to exercise postpartum often looks different for each woman. The key to recovery (short and long term) is to listen to your body, have an assessment with a women’s health physiotherapist, take things slowly and work on rehabilitation (connection breathing, alignment and functional exercise) before retraining your body to hit the pavement!