Return to running

postpartum a guide to health.

With the weather changing and the shackles of winter starting to loosen their grip…many women are itching to get outside and go for a jog!

One of the hardest things to put a postpartum body through is running. Let me explain:

Running is literally jumping off one foot and landing on the other potentially thousands of times in a relatively short period. This prolonged, repetitive, vertical impact on a hard surface challenges the postpartum body in several ways:

1) It’s jarring for your pelvic organs- organs that have undergone a tremendous amount of anatomical shift during pregnancy and again in the postpartum period. Usually, there are ligaments that firmly tether your organs to their anchor spots inside your body. Under the influence of pregnancy hormones, these ligaments become lax so that your uterus can grow and everything else can get out of the way. Pregnancy hormones take months to be flushed from your body postpartum; and, breastfeeding hormones keep ligaments lax until you’re done weaning. This means that for as long as you’re nursing your baby, your organs are more susceptible to further shift. The direction of organ shift that will occur in response to running is downwards. Read: pelvic organ prolapse.

2) The force exerted on your pelvic floor as you hit the ground is significant. Because of the amount of stretch and potential tearing that occurred during pregnancy and birth, postpartum pelvic floor muscles often can’t match the amount of force exerted on them during running and they fail – leading to urinary (or less commonly fecal) incontinence.

As a Pelvic Physio, I’m ultimately concerned about matching your physical abilities to your physical demands. Motherhood is a physically demanding job requiring lots of lifting, carrying, pushing, pulling, squatting, bending, etc… – but steady state running is not actually one of the requirements for Motherhood.

I totally get it though, running gets your blood pumping, gets your sweat glands going, is helpful for clearing your head, and is a great way to get some exercise in without much more than a pair of runners. These are all very real and very valid. But you know what else is very real? Pelvic floor dysfunction like prolapse and incontinence. Please do not ignore these things. They’re major. And although common – it is not normal to pee or to feel vaginal or rectal heaviness when you run.

You may be wondering: is it even possible to return to running postpartum? ABSOLUTELY! I just urge you to take your time with it and take the appropriate steps that I’ll discuss below.

I’m going to start out with a few statements that we’ll have to agree upon as fact:

1) Pregnancy has changed your body. Your abdominal wall was stretched significantly and your pelvic floor was under significant load for the past 9 months.

2) Your organs have shifted in position during pregnancy. After your baby has vacated your abdominal/pelvic cavity, your organs are shifting again.

3) Vaginal childbirth is analogous to a musculoskeletal injury involving stretch and potential tearing (or cutting) of contractile (muscular) tissue and non-contractile (connective, ligamentous) tissue. Scar tissue is likely present within your pelvic floor tissues.

4) Caesarean childbirth is a major abdominal surgery involving the cutting through and sewing back up of many layers of muscular, fascial, and organ tissues. Scar tissue is present in any/all of these layers of tissue.

5) There are natural healing timelines that have been studied pretty rigorously for musculoskeletal injuries. Healing timelines should be respected after childbirth with the appropriate interventions/activities introduced at the appropriate time in the healing process.

Ok, so if we can agree on all of these statements above, then we must also agree that a rehabilitation program is warranted before resuming higher level activity – including running. Medical professionals design rehab programs based on healing timelines for all kinds of injuries and surgeries. They are designed to ensure that outcome is optimal, full return to symptom free-function can be achieved and that rates of re-injury are as minimal as possible. No surgeon or Physiotherapist in their right mind would see you after significant injury or surgery, tell you to wait 6 weeks, and then return to high impact sport or heavy work duties. Why are postpartum women the exception?

The most appropriate person to guide you through the process of return to activity postpartum is a Pelvic Physiotherapist. Seek one out for yourself because chances are that you won’t be referred to one. We’re direct access – meaning you don’t need a referral and most people have extended health coverage that cover Physiotherapy…so it’s basically free. Why wouldn’t you go? Another very valuable team member would be a personal trainer or fitness professional with specific education and training working with postnatal women (I have some favorite recommendations).

Now, more about running:

My advice would be to not even think about running until you’ve had a good conversation with your Pelvic Physio discussing the following:

1) What was your level of activity going into pregnancy?

2) What was your level of activity during pregnancy?

3) How was your core function during pregnancy?

4) How was your birth experience?

5) How was your healing postpartum? Were there any complications?

6) Are you breastfeeding? Has your lochia (bleeding) stopped? Has your menstrual cycle returned? Are you sleep deprived?

Then you guys would work together to:

1) Work first on inner core (deep abdominal wall and pelvic floor) rehab. There are two components to this.

a. First, re-connecting or re-strengthening to where you can control basic bodily functions like coughing, sneezing, laughing.

b. Then strengthening on top of that to control extra pressure from the impact associated with running/jumping.

2) Work on outer core (superficial abdominal, glute, etc.) strength

a. Again, re-strengthen to a baseline level

b. Further strengthening

3) Talk about the biomechanics of running

a. how you strike the ground to minimize impact on the pelvic floor

b. how you align your body

c. how you breathe while running

4) Talk about footwear

5) Practice impact

6) Practice interval jogging

7) Change up surfaces, speed and incline

8) Last is to add back in extended running

Sometimes, this whole process takes a matter of weeks. Other times, we’re talking more like months. But moving through this process can mean avoiding incontinence and/or prolapse…so worth it!!!

OK, so now that I’ve burst your bubble about return to running (sorrynotsorry), book an appointment with a Pelvic Physio! Get the ball rolling!