As mentioned in our previous blog, there are a lot of changes that occur to the body during pregnancy. After pregnancy, the hormone Relaxin can stay in your body for up to 4-6 months postnatally, leaving your ligaments and pelvic floor muscles more vulnerable to injury in the postnatal period. You will have reduced core stability and mechanical control as your abdominal muscles have naturally stretched during pregnancy and require time and care to recover, particularly following a caesarean section. For these reasons, it is important to increase your exercise intensity slowly. There is also the risk of incontinence/prolapse if you resume strenuous exercise too soon after your baby has been born and your pelvic floor muscles haven’t fully recovered.
Running is a high impact sport that places a lot of demand on the body. Postnatal women need adequate time to heal and regain strength, particularly in the abdominal and pelvic floor muscles. It is therefore recommended that a low impact exercise timeline is followed within the first 3 months of the postnatal period, followed by a return to running between 3-6 months postnatal, at the earliest. It is recommended that all women, regardless of how they deliver, seek out a pelvic health assessment with a specialist physiotherapist to evaluate strength, function and co-ordination of the abdominal and pelvic floor muscles which are often impacted by pregnancy and delivery.
The importance of seeing a pelvic health physiotherapist is further highlighted if any of the following signs and symptoms are experienced prior to, or after attempting, return to running:
- Heaviness / dragging in the pelvic area (can be associated with prolapse)
- Leaking urine or inability to control bowel movements
- Noticeable gap along the midline of your abdominal wall (this may indicate Diastasis Rectus Abdominis)
- Pelvic or lower back pain
- Ongoing or increased blood loss beyond 8 weeks postnatal that is not linked to your monthly cycle
Step 1 of your return to running plan is to get your pelvic floor run ready. If your pelvic floor doesn’t contract the way it should – every time your foot hits the ground, you will have a force of 1.6 to 2.5 times your body weight going through a pelvic floor which is unable to handle it. Before you run you should be able to activate your pelvic floor in standing as well as being able to do:
- 10x fast reps
- 8-12 reps of 6-8 second maximum voluntary contraction
- 60 seconds submaximal 30-50% contraction
The 2019 Returning to Running Postnatal Guidelines recommend that you should be able to achieve the following exercises without pain, heaviness, dragging or incontinence before starting running.
- Walking for 30 minutes
- Single leg balance 10 seconds
- Single leg squat 10 repetitions on each side
- Jog on the spot for 1 minute
- Forward bounds 10 repetitions
- Hop in place 10 repetitions on each leg
- Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10 repetitions on each side
Additionally, you should be able to complete 20 full repetitions of each of the following strength exercises:
- Single-leg calf raise
- Single-leg bridge
- Single-leg sit to stand
- Side-lying abduction
Weakness in these areas of strength testing should not be considered a barrier for return to running but instead identify where strength work can be directed.
Postnatal women can benefit from individualised assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse. We strongly recommend having a pelvic floor assessment with our Women’s Health Physiotherapist, Roshini Nadarajah, to better understand specific changes to your pelvic floor options for management. For more factors to be considered prior to returning to running, see Part 2 of this blog post.
- Goom, T., Donnelly, G. and Brockwell, E. (2019) Returning to running postnatal – guideline for medical, health and fitness professionals managing this population.