At The Injury Clinic, we work with many women who are keen to get back into running after having their child. We recognise that exercise and/or running is something that is important for a lot of women, and something that is often restricted during pregnancy.
Only recently (2019) have “Return to Running Postpartum” guidelines been formally produced. Which unfortunately means women who return to running are often given little to no guidance on how to do this safely and effectively. Comparatively, the amount of information available on how to return to exercise/sport after an injury such as an ACL injury is staggering. The comparison is important as we should essentially be considering the return to running postpartum similarly to how we treat athletes return to sport following an injury (ie. an ACL injury).
We are now seeing female elite athletes redefining ‘postpartum’ and making rapid returns to high level sport. While this is certainly impressive, especially while balancing their new role and identity as a mother, it will not be appropriate or safe for all women to make rapid returns to running.
As a society, we need to recognise that there cannot be a ‘one size fits all’ approach to returning to running postpartum. The variables that affect the return to running postpartum include:
- Volume of exercise that is maintained during pregnancy
- Complications that may occur during pregnancy, particularly those that limit exercise
- Type of delivery (vaginal, instrumental, c-section)
- The health of the newborn child
- Pelvic floor dysfunction
- Musculoskeletal pain/dysfunction
- Psychosocial factors
Every woman will have a different experience through their pregnancy and early postpartum period, which will influence their ability to return to exercise. We can applaud the women who are able to make this transition rapidly, but we also need to support (and applaud) those who make a more gradual return.
At The Injury Clinic, we have three key recommendations for women returning to running postpartum:
- All postpartum women should have an individualised assessment of their pelvic floor function completed by a women’s health physiotherapist.
- The timeline to return to running should be individualised, and this usually takes a minimum of 12 weeks.
- Before returning to running or high impact exercise, you should see a physiotherapist.
It is important to note, women are considered postpartum from the moment their child is born until their ‘maternal physiology reverts to its non-pregnant state’. This means we need to consider factors such as breastfeeding and hormones when considering returning to activity in the postpartum period.
WHY DO I NEED TO…
SEE A WOMEN’S HEALTH PHYSIO?
A women’s health physio specialises in the assessment of the pelvic floor. A well functioning pelvic floor is essential not only to maintain continence, but also to ensure appropriate trunk and pelvic stability. During a vaginal delivery, the pelvic floor is stretched to 250% of its resting length. The pelvic floor is therefore considered “weak” and “injured” in most postpartum women.
Many women need instruction and supervision to be able to perform a correct pelvic floor muscle contraction, especially those who did not train those muscles prior to birth. A women’s health physio will be able to assess your ability to contract your pelvic floor, and give you any exercises that you may need to improve or modify this contraction. While it is widely recognised that the pelvic floor may be weak, in some women the pelvic floor can become overworked and tired. In these cases, it is often difficult for the pelvic floor to relax, which can lead to the same symptoms of pelvic floor dysfunction that we see in someone who has a weak pelvic floor.
When we look at returning to running specifically, we need our pelvic floor to be strong and well coordinated. This is because when we are running, the pelvic floor is subject to significant force and load. We will experience a sudden rise in intra-abdominal pressure; and a significant amount (1.6-2.5x bodyweight) of ground reaction force, which is translated through the body when running. It is likely some (if not all) of these forces are translated to the pelvic floor. It is these factors that lead to a five-fold increased risk of pelvic floor dysfunction in runners when compared to those who participate in low impact exercise.
TAKE TIME RETURNING TO RUNNING?
It is important to think about the time that it takes to return to running as a continuum, and something that can be changed to suit each individual. There are injury risks associated with returning too soon, and research has indicated that elite athletes agreed that it takes time to ‘rehabilitate’ and learn to train with their new postpartum bodies. How much time will vary between individuals, but the factors that influence the return to running time frames include:
- The volume of running that was maintained during pregnancy, and how far into the pregnancy this was maintained.
- Pain and injury from labour that prevent an early return to walking/exercise postpartum.
- Any injuries that have been sustained during labour have completely healed before resuming running.
- The recovery of the pelvic floor muscles can be slow and is thought to be maximised at 4-6 months postpartum.
- Post caesarean, abdominal muscle tissue and fascia will have only regained approximately 50% of its original strength at 6-weeks postpartum, and 73-93% of the original strength at 6-7 months postpartum.
It is also important to note, there are a lot of guidelines that suggest returning to running from 12 weeks postpartum. This is a general recommendation which can (and should be) adjusted to suit each individual. Just because a woman has reached 12 weeks postpartum does not mean she automatically is ready to run. Conversely, if someone has successfully run throughout the majority of their pregnancy, has been medically cleared to return to running, and has been cleared from a women’s health physio, they may be able to return to running before 12 weeks postpartum. An open discussion with your physio should be considered around when it is right for you to return to running.
SEE A MUSCULOSKELETAL PHYSIO?
To resume running in the postpartum period, it is important to try and reduce any risk of injury. 84% of postpartum runners have running related pain, but there are often things that can be done to avoid this pain developing.
As many women go through a period of relative rest during the late stages of pregnancy, the early postpartum period is often when exercise is resumed. The period of relative rest contributes to a degree of general deconditioning. We therefore need to spend some time building general muscle strength and conditioning before we get into running. A musculoskeletal physio can guide you through how to appropriately achieve this return in a safe and effective manner.
It is also important to know, the changes that happen during pregnancy and childbirth will often not be self corrected. This means we need to retrain our bodies to operate in a non-pregnant manner. An example of this is our core muscles. As your baby grows, your ability to use your core changes, so you develop other strategies to stabilise your trunk and enable movement. In the postpartum period you need to retrain these muscles back to your ‘normal’ strategy.
ARE THERE OTHER THINGS TO CONSIDER?
While addressing these key factors are important, it is also essential to consider:
- Nutrition
- Women who are physically active should be aware of their energy balance and ensure they are eating enough.
- Those who are breastfeeding will have an additional set of requirements:
- An additional 300-500kcal should be consumed per day,
- 1000mg of calcium per day,
- Ensure vitamin D levels are sufficient,
- And ensure you are drinking enough water.
- Calcium intake is particularly important for breastfeeding postpartum runners as there is otherwise a risk of breastfeeding-associated transient osteopenia. This would then increase their risk of developing bone stress injuries.
- Breastfeeding:
- Many women find timing runs around breastfeeding times (ie. just after they have finished breastfeeding/pumping) is important from a comfort perspective. This means they are able to run with relatively empty and lighter breasts.
- Sports Bras:
- Having a professionally fitted sports bra will be important when returning to run postpartum. Women often find they need more support in a different size to what they used previously.
- Footwear:
- Consider having new shoes fitted professionally. Often feet change size and shape during pregnancy, and new shoes will be necessary before we start to run.
- Sleep:
- While this is often not modifiable, sleep deprivation will increase your risk of injury, lower your general health, and increase stress levels. This is something to be mindful of, and adjust the intensity of your exercise accordingly.
IN SUMMARY…
There is a lot to consider when returning to running after having a baby! At The Injury Clinic, we commonly work with women who want to return to running in a safe and efficient manner. For more information and guidelines on how to get back into running, please click here. If you would like to book an appointment to see one of our physios, please click here or call (03) 5229 3911.
