Post-Natal Return to Running
Running is a high impact activity that has many physical and mental health benefits for postnatal women. However, the post-baby body is going to be substantially different and it comes with new challenges for women wanting to return to safe running. Conditions such as musculoskeletal pain, urinary incontinence, abdominal separation and pelvic organ prolapse can become barriers to women returning to running after delivery (Goom, Donnelly & Brockwell, 2019). While very common, these conditions aren’t normal and should be managed as part of your return to running program.
After delivery (both vaginal delivery and caesarean section) it is recommended that all postnatal women consult with a medical caregiver before returning to running and other pre-pregnancy physical activity (Goom et al., 2019). Whilst low impact exercises such as transverse abdominal and pelvic floor muscle strengthening, cycling and cross trainer use can be included in a return to running program at approximately six weeks post-delivery, running and other high impact exercises are not recommended for the first three to six months post delivery (Goom et al., 2019). Goom et al. (2019) found that assessment from both a musculoskeletal/sports Physiotherapist as well as a specialist pelvic health Physiotherapist can best determine individual readiness to return to running and provide a safe exercise program that address any/all body impairments that may be a barrier to safe running.
Transverse abdominal and pelvic floor muscle strength are both major factors in determining the time at which you can start safe running post delivery (Goom et al., 2019).
"High impact exercise was found to have a 4.59 fold increased risk
of pelvic floor dysfunction compared to low impact exercise",
(De Mattos Lorenco, Matsuoka, Baracat & Haddad, 2018)
For this reason it is essential to discuss any symptoms of pelvic floor or abdominal wall dysfunction with your medical caregiver.
Symptoms of pelvic floor and/or abdominal wall dysfunction:
Urinary and/or faecal incontinence
Urinary and/or faecal urgency that is difficult to defer
Heaviness/pressure/bulge/dragging in the pelvic area
Pain with intercourse
Obstructed defecation
Pendular abdomen, separated abdominal muscles and/or decreased abdominal strength
Musculoskeletal; lumbopelvic pain (Goom et al., 2019, p. 10).
In addition to weakness of the pelvic floor muscles and transverse abdominal muscles, other risk factors (and potential barriers) that will influence the time at which you can return to safe running include the following:
Less than three months postnatal
Preexisting hypermobility disorder
Breastfeeding
Preexisting pelvic floor or lumbopelvic dysfunction
Psychological issues that may predispose a postnatal mother to inappropriate intensity or duration of running as a coping strategy
Obesity
Caesarean Section or perineal scarring
Relative Energy Deficiency in Sports (Red-S) (Goom et al., 2019, p. 11).
During the first 3-6 months post delivery, a Sports Physiotherapist and Pelvic Health Physiotherapist will work with you to treat and manage all identified risk factors to ensure a safe timely return to running. With resolution of pelvic floor and abdominal wall symptoms, your health provider will have you perform a battery of physical tests that, from a physical standpoint, will determine your body's readiness to return to running. These test include, but are not limited to, walking for 30 minutes, jogging on the spot for one minute, hopping in place for one minute and muscle strength testing of the major muscle groups in the legs and core (Goom et al., 2019). To clear all physical testing you must be able to perform each test without pelvic floor symptoms including incontinence, pelvic pain, pressure or heaviness (Goom et al., 2019).
Once you are cleared to run, the following factors should be worked into every running program:
Start at slow pace where you can comfortably hold a conversation (Goom et al., 2019).
Start with interval walk - jog program with approximately 1-2 minutes jogging to 1 minute walking for up to 20 minutes (running parameters will be different person to person and should be discussed with your medical provider before commencing) (Goom et al., 2019).
Progression should be made by increasing running time and distance before increasing running speed/intensity (Goom et al., 2019).
Apps such as couch to 5k can be used in addition to, but not instead of an individualized running program provided by your medical caregiver (Goom et al., 2019).
If pelvic floor symptoms increase during a running program, the intensity and volume of running will need to be reduced until symptoms improve (Goom et al., 2019).
Running with a buggy is not recommended until your baby is between six to nine months of age and has developed adequate head and neck control (Goom et al., 2019).
If you decide to run with a buggy, ensure it is a buggy that is designed for running (Goom et al., 2019).
Two hand method of running with a buggy encourages better biomechanics than one hand method (Goom et al., 2019).
References:
De Mattos Lourenco, T., Matsuoka, P., Baracat, C., & Haddad, J. (2018). Urinary incontinence in female athletes: a systematic review. International Urogynecology Journal, 29(12), 1757-1763. doi: 10.1007/s00192-018-3629-z.
https://link.springer.com/article/10.1007%2Fs00192-018-3629-z