As a pelvic floor physiotherapist and new mother myself, I have experienced the recovery and return to running and exercise after having a baby. The birth of my daughter was traumatic; I pushed for the maximum allowed time (3 hours) and eventually delivered her vacuum-assisted and required several stitches. I knew ahead of time what to do for my recovery, and in those first few sleep-deprived, overwhelming yet amazing weeks, I did not have to go searching for this information. I began with simple breathing exercises engaging the pelvic floor (it's so hard at first), lots of rest and very short walks. At first, I felt symptoms of pelvic organ prolapse (heaviness, dragging, pressure in the pelvis) and I backed off how far I walked significantly. I also made sure not to carry my daughter on my chest in the ergo and always use the stroller for the first 4-6 weeks. I started to feel better and gradually started adding in more strengthening exercises around 6 weeks, mostly gentle deep core exercises, glut strengthening and upper body/posture exercises to counterbalance all the poor positions associated with breastfeeding. I also began to do some road biking, hiking and swimming for some cardio. Around 3 months postpartum, I joined a mom and baby postpartum exercise class and stepped up my strengthening regime. It felt great to get out of the house, socialize, meet other new moms and finally get in a good workout, all while being aware of my pelvic floor and core throughout all the workouts. I finally began to run around 3.5 months postpartum, and I started very slowly, doing 1-2 minute runs with 3-4 minute walking breaks in between. I gradually built upon this, following somewhat of a "couch to 5k" training plan. At 6 months postpartum, I started back playing ultimate frisbee and soccer.
In March 2019, experts Tom Goom, Gráinne Donnelly and Emma Brockwell published the much needed document "Returning to running postnatal - guidelines for medical, health and fitness professionals managing this population." It was excellent timing for my physio nerd brain and being 1 month postpartum myself to really enjoy reading this document. Below are some highlights from the guideline, which I followed throughout my postpartum journey.
Running is a high impact sport placing a lot of demand on the body. In a recent systematic review investigating urinary incontinence in female athletes (De Mattos Lorenco et al. 2018), high impact exercise was found to have a 4.59 fold increased risk of pelvic floor dysfunction compared to low impact exercise. Postnatal women need adequate time to heal and regain strength, particularly in the abdominal and pelvic floor muscles after pregnancy and delivery.
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. In addition to this, every postnatal mother, regardless of delivery mode, should be offered the opportunity to receive a pelvic health assessment (from 6-weeks postnatal) with a specialist physiotherapist to comprehensively assess the abdominal wall and pelvic floor including vaginal +/- anorectal examination as indicated.
Return to running is not advisable if any of the following symptoms are present:
✓Urinary and/or faecal incontinence prior to or during commencement of running ✓Pressure/bulge/dragging in the vagina prior to or during commencement of running.
✓Ongoing or onset of vaginal bleeding, not related to menstrual cycle, during or after
attempted low impact or high impact exercise (refer back to care provider).
✓Musculoskeletal (MSK) pain e.g. pelvic pain prior to or during commencement of
running
Objectively, the following criteria must be met regarding strength of the pelvic floor in standing:
✓ 10x fast reps
✓ 8-12 reps of 6-8 second maximum voluntary contraction
✓ 60 seconds submaximal 30-50% contraction
And impact loading specific to running without any symptoms of pain, heaviness, dragging or incontinence:
✓ Walking 30 minutes
✓ Single leg balance 10 seconds
✓ Single leg squat 10 repetitions each side
✓ Jog on the spot 1 minute
✓ Forward bounds 10 repetitions
✓ Hop in place 10 repetitions each leg
✓ Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10
repetitions each side
Take Home Message: Return to running is not advisable prior to 3 months postnatal or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running.
If you would like a copy of the full guideline, please contact me at clairemcdonaldpt@gmail.com. Happy Running Moms :)
Claire McDonald
Registered Physiotherapist
