Return Safely to Running Postpartum
Lots of women are keen to start running postpartum, and I totally get why - it’s such a convenient way to exercise. You just whack on some trainers and a sports bra and shoot out your door and you’re exercising. No equipment. No driving to a gym. No class times. No interaction with other humans (this is the biggest draw). Just you and the road and OUTSIDE.
It can be a relief to feel our bodies and breathe fresh air when we’re trapped in the house all day with a newborn.
But like all activities, it has risks and rewards within the context of that postpartum period.
I hear a lot of proud statements like “I started running 2 weeks postpartum”. I always ask clients their goals and more than a few times I’ve been told bold assertions like “I signed up to a half marathon 6 months after the birth. I need to train for it”
Bearing in mind that you can’t actually do formal exercise until 6 weeks post birth, this is a tall ask. Add to that the fact that your body is recovering, your pelvic floor is still healing, you might be sleeping nowhere near enough and you have to take care of a tiny but demanding little human 24/7, this might not be a realistic goal, and you’re likely to run yourself into the ground.
In this blog post, I’m going to:
Break down the risks vs rewards of running postpartum
Layout some conditions that you should meet BEFORE you start running postpartum (and a possible timeline)
Describe what sort of PREPARATION you should do before returning to running
Give you some ideas for implementing running GRADUALLY (rather than going from 0-10K in one run)
What’s the big deal?
The biggest concern when we talk about running postpartum is the pelvic floor, which goes through an awful lot during pregnancy and birth. Even in a birth with no tears or episiotomy, the pelvic floor muscles will have been stretched to their very limits. They remain quite stretched out for sometime after, and the entrance to the vagina is quite wide.
This means that there is far less support for your pelvic organs, which have also been through a bit of a whirlwind. Your uterus in particular. The uterus weighs over a kilogram at the end of pregnancy (not including its contents which could weigh up to 6 or more kilos depending on the weight of the baby).
After the baby is born, the uterus takes quite some time to shrink, and so while the pelvic floor muscles are still healing from birth, they are having to cope with this additional weight. This is why it is so important to take weight OFF your feet and get your hips at least in line with your chest).
The ligaments holding your uterus up are likely to have also been stretched out a lot, and it will take time for them to regain their tone (again, while dealing with the 10-fold weight of the uterus).
Add to that the fact that you’re still swimming in a sea of hormones designed to make birth easier and make your ligaments more lax. It will take some time for everything to return to pre-pregnancy levels, especially if you are breastfeeding, which prolongs the hormonal shit-show of pregnancy.
Our biggest worry with postpartum running is the risk for POP - or pelvic organ prolapse, where the pelvic organs (bladder, uterus and rectum) fall into the vaginal wall.
POP is measured in grades (1-4) - 1 being not a big deal and a slight descent of one or more of the organs (most women will have this after a birth or two), and 4 being a really quite disastrous, with the organs emerging out of the vulva.
Ok, I know, this all sounds scary, but my goal, as always is to SHARE not SCARE: I have seen women online and in my work who have said “why did no one tell me?!” - It’s important that women have this information so that we can make informed decisions and weigh up the risks vs rewards.
In terms of running in the postpartum period, the REWARDS are:
Getting your heart-rate up,
Improved cardiovascular fitness,
Much needed ALONE TIME,
Increased blood flow.
That’s no small reward! All this is massive and needs to be taken into account too - holistic women’s health is about more than vaginas. Your mental health is just as important as your pelvic health.
*Note, though, that what running WON’T do is get rid of your belly, help you get strong or even lose weight (you have to be in a caloric deficit to do that).
The RISKS may be pelvic floor and joint health. Women may be at a greater risk of incontinence and prolapse if they start running before the pelvic floor has healed, the uterus has returned to its original size and pregnancy hormones have returned to baseline.
An additional risk is your joint health - all of the factors that we discussed before affect your connective tissues and joints. Add to that the fact that during pregnancy and the postpartum period you lose muscle mass and strength - this combination leaves you more prone to injuries, and the impact of running can be particularly problematic because it involves a lot of single leg hip stability - the massive joint that is most affected by hormones and birth.
Women are 4-6 times more likely than men to experience knee and ankle injuries because of both the shape of their hips and because of these factors involved in childbirth.
The Mental Battle
Why do you want to run? What do you believe you will achieve? Most of us are completely shocked by the changes postpartum and are desperate to feel "normal" again. We want to prove to ourselves and others that we can do it. We desperately want our bodies to return to what they were before pregnancy and birth.
Sometimes, though, in our attempts to "get back into things" we actually set ourselves back.
Perhaps there is an activity that better suits your physiology at this time?
Perhaps there are exercises that help you respect the massive amount of physical and emotional stress your body is under right now?
Perhaps there is a way to BUILD UP into the kind of exerise you would like to do in a way that safeguards your pelvic floor?
When can you start?
While some start as early as 2 weeks (when none of us should be undertaking formal exercise - we should wait AT LEAST for the 6 week check up from our gynecologist) many see that 6 week green light as permission to do anything and everything. Tissue healing can take up to 12 months, so 6 weeks might be a little early.
Running involves impact, as we land, 3 times our body weight goes through each foot. Taking into account what I described above about the weight of the uterus, the potentially weaker ligaments holding it up, and a weaker pelvic floor that is still healing, imagine your abdominal organs moving up and down with each stride, and your pelvic floor dealing with the descent of the pelvic organs with each foot strike. It simply might not be ready for this, but it also depends on the integrity of your pelvic floor and factors such as:
Did you tear or have an episiotomy?
What grade tear?
Are your pelvic floor muscles weak? (And have you been assessed by a pelvic floor physio?
How is the scar healing?
Do you leak?
Did you have a vacuum or forceps delivery? (Which may have put more strain on both your pelvic floor and the ligaments holding your uterus up).
And there are other factors too, like:
Do you have any pain? (hip, knee, pelvic, vaginal?)
What are your tummy muscles doing? (Are they weak and distended? If so, they will be offering less support to your pelvic organs.)
Did you have a c-section?
How much are you sleeping? This will affect your recovery massively.
When a pelvic floor physiotherapist is assessing whether or not you are ready to start running, they will consider all these factors.
Again, I want to stress that the message here is not RUNNING IS DANGEROUS… if you want to run, you should, and I support you 100% in doing so. But the activity poses certain risks in the context of having given birth and your pelvic floor being weaker and uterus being heavier. We must be aware of these risks in order to make informed decisions.
There are no dangerous exercises, just exercises that we are not ready for, exercises that demand too much from injured muscles and joints that are still healing. It is sensible to give the body both time and to undergo a programme to strengthen all the musculoskeletal framework necessary for running.
Now that we understand that running poses a risk to your pelvic floor and joints postpartum, let’s talk about what some guidelines for returning to running postpartum might look like.
Guidelines for returning to running postpartum
Firstly, here are the conditions I recommend you meet first:
1. Are you 4-6 months postpartum?
I would recommend waiting 4-6 months after having a baby before returning to running. This isn’t even the most conservative of guidelines. There are many physios that would recommend waiting at least a year. Of course, it’s so hard to put a one-size-fits-all number on this - if you had a c-section, or an uncomplicated vaginal birth, your abdominal muscles are strong and you have no pelvic floor symptoms, you might be able to start much earlier than someone who had a grade 3 tear, leaks and isn’t sleeping.
2. Go and see a pelvic floor physiotherapist
As much as I can give you guidelines, there are things that are just so individual. The safest thing to do is to see a good physiotherapist, check that everything is in order and get personalized guidelines. No blog or course on the internet can replace this.
3. You are no longer breastfeeding.
As mentioned before, breastfeeding does impact your hormonal milieu and will affect the elasticity of your connective tissues.
* Again, your pelvic floor health isn’t the ONLY thing that matters. If running is a massive part of your life and helps you prevent depression, this needs to be taken into account to, and you may decide that the risk/reward ratio is worth it for you. If this is the case, I really recommend at least doing it under the guidance of a pelvic floor physio.
PREPARING for Running
Let’s talk about what to do BEFORE you attempt that first run. This is what a programme that PREPARES your body for running might look like:
1. Address breathing mechanics
Happily, more and more postnatal programmes are bringing attention to the breath and establishing helpful breathing mechanics. Breathing is a powerful tool for connecting physically and mentally to your core and pelvic floor and for ensuring that you are not bearing down and putting unnecessary pressure on your pelvic floor.
Here's a tutorial I made on breathing to get you started:
Breathing exercises can be done very early on after giving birth along with other gentle movement and exercise that you can do in the first 6 weeks - I wrote a whole blog post on that here.
2. Strength training
It's important to undergo a sensible strength training programme designed for postpartum women.
In particular we want to focus on strengthening the muscles in your bum, legs and hips which you can start doing as early as 6 weeks postpartum.
It should include exercises like a glute bridge:
And a clam shell:
As these exercises help recruit the glutes (bum muscles), strengthen them and begin to build them while keeping weight off the pelvic floor (that may still be recovering).
Happily, I happen to have an online programme that does exactly that.
(Bonus: many women can start these sorts of exercises as little as 2 weeks postpartum).
3. Single leg exercises.
Your strength training programme should also include single leg exercises that will help with balance and hip stability.
Exercises like a single leg deadlift are great for balance, hip stability and are very easy on the pelvic floor:
Lunges are far more challenging, but a good postpartum programme (especially one for women who want to return to running) will build you up to them:
These exercises help you specifically for running as it mimics the sort of work the muscles have to do when landing.
(Again - my online programme does just that)
4. Core training programme
You do also want to strengthen your abdominal muscles as this will help you transfer load diagonally through the trunk when running.
This isn't about just smashing away at your abs - it's about connecting to your abdominal muscles and retraining them. Exercises like this Pullover + Heel slide can be quite challenging in the beginning:
The Complete Postpartum Programme has an entire section dedicated to building strength in the abdominal muscles over time. It has 5 levels and teaches you to recognise if an exercise is to easy or too hard (causing bulging in the abdominal muscles) It's almost time to Start Running! (Finally!)
1. Start with walking
You can and should start walking early on postpartum - start with short 10 minute walks outside and build up. While it is good to start walking early postpartum, it is important to also ensure that you are not spending too long on your feet and weaving rest (for your pelvic floor) into the bouts of walking - by taking weight off your feet and getting your hips above your chest. Build up to longer bouts of walking.
You also want to ensure that you are leaning slightly forward, - this gets your pelvic floor and diaphragm into alignment, and ensures that you use your glutes (bum muscles) more. It can really help with leaking.
2. Walk on an incline
Try to find some hills or steps and pace uphill for short intervals during your walks. This helps you get your heartrate up without putting uncessary impact on your pelvic floor. It's also great to get you into good alignment and to get you using your bum more when walking
3. Start running in intervals
Now that you have strengthened your legs, hips, bum, you have given your pelvic floor time to heal (you're at least 4 months postpartum) and have seen a pelvic floor physio AND you have no pain, no leaking and no heaviness in your vagina in everyday tasks and when walking, you should start to add short intervals of running into your walks. You can start with 30 seconds of running, followed by 1 minute of walking.
4. Increase length of intervals
Each time you go out for a run, increase the length of the intervals by 10 seconds.
REMEMBER that if at any stage you experience leaking, heaviness or pain throughout this process, you need to take a step back and see a pelvic floor physio. We are gradually increasing the load on the pelvic floor, and if it isn't coping, it isn't ready yet.
You can continue to increase the length of the intervals and decrease the length of the rest until you are running for a solid period of time.
Obligatory shameless plug at the end of a long blog post:
If you are looking for a programme that does everything mentioned in this blog post
Addresses breathing mechanics
Strengthens the hips and bum in preparation for running
Strengthens the abdominal muscles
Check out The Complete Postpartum Programme. We'll get you running strong and safely after giving birth.