Guidelines for Postpartum Return to Running
Thinking about returning to running postpartum but not sure where to start? Today we will discuss a general framework for your return to running plan after having a baby!
The guidelines that I am going to summarize today come from a group of physiotherapists- Tom Goom, Grainne Donnelly, and Emma Brockwell. I will link the full text article to their guidelines down below!
Overview of Recommendations
1. Postnatal women can benefit from individualized assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse, the management of urinary incontinence and for improved sexual function.
2. Return to running is not advisable prior to 3 months postpartum or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running.
3. Assess pelvic health, load impact management and strength testing in order to evaluate readiness to return to running postpartum.
4. Consider additional factors in a woman’s postpartum evaluation such as weight, fitness, breathing, psychological status, DRA, breast support and feeding, RED-S and running with a stroller.
Let’s dive into some details for each recommendation.
Recommendation 1:
Postnatal women can benefit from individualized assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse, the management of urinary incontinence and for improved sexual function.
Given that running is a high-impact sport, the demands placed on the pelvic floor during running need to be considered in the postpartum population. Postpartum women need adequate time to heal and recover before increasing loads on the pelvic floor.
Not sure if you have any pelvic floor symptoms? Here are some signs/symptoms that you have pelvic floor or abdominal wall dysfunction:
· Urinary and/or fecal incontinence
· Urinary and/or fecal urgency
· Heaviness/pressure/bulge/dragging in the pelvic area
· Pain with intercourse
· Obstructive defecation
· Pendular abdomen, separated abdominal muscles
· Lumbopelvic pain
A specialized evaluation by a pelvic floor physical therapist can help you get to the bottom of any pelvic floor symptoms.
Recommendation 2:
Return to running is not advisable prior to 3 months postpartum or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running.
The earliest time to return to running is 3-6 months postpartum. This again is due to healing time for the pelvic floor, abdomen, and if women underwent cesaran delivery, time for the scar to heal.
Return to running is still not advisable if any of the following symptoms are present:
· Urinary or fecal 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 activities
· Musculoskeletal pain prior to or during commencement of running
Recommendation 3:
Assess pelvic health, load impact management and strength testing in order to evaluate readiness to return to running postpartum.
Load impact assessment:
Need to be able to achieve the following without pain, heaviness, dragging, or incontinence:
· Walking 30 minutes
· Single leg balance 10 seconds
· Single leg squat 10 repitions each side
· Jog on the spot 1 minute
· Forward bounds 10 repititions
· Hop in place 10 repetitions each leg
· Single leg running man 10 repetitions each side
Strength testing:
Each of the following movements should be performed with the number of repetitions counted to fatigue.
Aim for 20 reps of each test:
· Single leg calf raise
· Single leg bridge
· Single leg sit to stand
· Side lying hip abduction
Recommendation 4:
Consider additional factors in a woman’s postpartum evaluation such as weight, fitness, breathing, psychological status, DRA, breast support and feeding, RED-S and running with a stroller.
Pain and pelvic floor symptoms are not the only thing to monitor when returning to running postpartum. There are so many new factors to adjust to once you have a baby!
For example, timing runs around breastfeeding and wearing more supportive clothing to accommodate for breast changes is important.
Another important consideration nutritional status-specifically energy (calorie) intake status. Relative Energy Deficiency in Sport (RED-S), formerly known as Female Athlete Triad Syndrome, describes the impaired physiological function caused by relative energy deficiency. In other words, certain bodily functions (metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular function) can be impaired with excess energy expenditure and inadequate energy replacement. This is a concern for postpartum moms because the energy demands of breastfeeding and taking care of a newborn are high. If these energy needs are not met with adequate calorie intake, problems can arise. Ensuring you have proper nutritional intake, as well as proper rest and recovery, is imperative during this time.
Conclusion:
While this might sound like a lot to consider, return to running postpartum is possible and we are here to support you! Remember to give yourself grace, try to avoid rushing into your return, and listen to your body’s cues. You will know when something feels off, and it is important to seek help during this transitional period.
Please let us know if you have any questions!
Take care,
Dr. Gina
Reference
Goom, Tom & Donnelly, Grainne & Brockwell, Emma. (2019). Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. 10.13140/RG.2.2.35256.90880/2.