Are You Ready to Return to Running Postnatal?!
I’m going to try and summarize some of the main points from the recent guidelines that were published on return to running postnatal by the following three physical therapists: Tom Goom, Emma Brockwell, and Grainne Donnelly. They also had many other physical therapists provide expert opinion that influenced the guidelines and overall, it is very helpful as there is not a ton of research out there on return to running for postnatal women!
So, let’s dive in!
First of all, high impact activity like running has been shown to create a sudden rise in intra-abdominal pressure as well as is associated with large ground reaction forces. We can thus assume that some of this force is translated up to the pelvic floor muscles.
The pelvic floor then has to be able to contract with enough strength and at the right speed in order to support the pelvic organs and prevent incontinence during running. Since running places such a high demand on the body, it is crucial in the postpartum period, that we take all precautions to ensure you are ready to return to running!
We need to allow adequate time in the fourth trimester (healing trimester) to heal, reconnect/retrain, and regain strength of the inner core system (diaphragm, deep abdominals, and pelvic floor).
Check out this video on diaphragmatic (360) breathing for a good place to start learning how to reconnect to all the players of your core canister:
https://www.youtube.com/watch?v=SyEViLElmcc&t=8s
The recommendation consensus of the postnatal return to running guidelines recommend a low impact exercise progression during the first 3 months postpartum, followed by a gradual return to running program between 3-6 months postpartum at the earliest. However, this may look different for EVERY woman! Your ability to handle the high demands of running may be different than someone else’s and thus, we cannot fall into the trap of thinking “I’m now 3 months postpartum, I can start running.” Maybe you can! Maybe you have great ability to connect with your inner core and have regained significant strength, have no pain, and have no symptoms of urinary leakage!
It is so important to have a team of health professionals with training in postpartum care to help guide you in your return to exercise, which may include a pelvic floor physical therapist, a postpartum or orthopedic physical therapist, and a trainer with certifications in postnatal fitness!
Here are some risk factors stated in Table 2 of the guidelines for potential issues with return to running:
● < 3 months postnatal
● Pre-existing hypermobility conditions
● Breastfeeding (due to the hormone changes)
● Pre-existing pelvic floor or lumbopelvic dysfunction
● Psychological issues
● Obesity
● C-section or perineal scarring in addition to knowing these risk factors for potential issues when returning to running, it is also very important to know reasons in which it is recommended to hold off on running temporarily until you are seen by a physical therapist:
● Heaviness in the pelvic region
● Leaking urine or inability to control bowels
● Pendular abdomen or noticeable gap along midline of abdominal wall (diastasis recti if not functional, meaning you are not able to manage intra-abdominal pressure and transfer load through the abdomen -- may see bulging/doming along the midline of the abdomen)
● Pelvic or lower back pain
● Ongoing or increased blood loss beyond 8 weeks postpartum (not associated with menstrual cycle)
If you have any of the above listed symptoms prior to or after attempting running, it is very important that you see a pelvic floor or postpartum physical therapist!
In addition to assessing for pelvic floor dysfunction and other aches/pains, there are also numerous strength and plyometric tests to ensure an individual is ready to return to running. Your physical therapist will look at things like your single leg balance, single leg squat, hopping tests, single leg calf raises, hip strength and stability, etc. Running is essentially a series of single leg hops and thus, it is important to ensure adequate strength and stability prior to being cleared to return to running in order to prevent injuries.
What about if you are breastfeeding??
If you are still breastfeeding and returning to running, it’s important to recognize that breastfeeding prolongs the altered hormones in a woman’s body. It is suggested that estrogen levels are decreased and the levels of the hormone relaxin remain increased. Although it hasn’t been proven in research, relaxin increases joint laxity in women and thus, may put you at potential increased risk of injury.
This should be considered in the evaluation of determining whether you are ready to return to running postnatal, especially if you have a prior history of a hypermobility condition, pelvic organ prolapse, or other pelvic floor dysfunction.
If you are wishing to return to high impact exercise such as running in the postnatal period, see a postpartum or pelvic floor physical therapist to help guide you in determining whether or not you are ready to return to running safely! This will help save you from developing injuries or other issues down the road. It’s important to have a solid foundation prior to returning to high impact exercise!
Email me directly at khartley@grandviewprimarycare.com with questions or for scheduling!
Happy Running,
Kaitlin Hartley, PT, DPT
References:
1. Leitner, M., Moser, H., Eichelberger, P., Kuhn, A. and Radlinger, L. (2016) Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study. Neurol Urodynam. 9999, 1-7. 2. Goom, T., Donnelly G., Brockwell E. Returning to running postnatal-guidelines for medical, health and fitness professionals managing this population. 2019. 1-40.