Guidelines for returning to running postnatally

New motherhood is a time in life unlike any other.
Having a baby can bring extreme happiness and excitement along with exhaustion worry and stress.

For many women, returning to exercise can give them an outlet for this roller-coaster of extremes and bring a sense of reassurance and familiarity.
The need to return to running can feel overwhelming for some.

It has become customary for women to get the ‘all clear’ at the 6 week check up and then get back into their running shoes without adequate guidance or information.

And, oftentimes women aren’t aware of the potential consequences of returning to running before they are physically ready.

The structures of the core and pelvic floor have changed in ways that require them to regain strength and function before they can meet the demands of running.
The readiness of these structures is based on individual considerations rather than a one-size-fits -all approach or timeline.

Recognising the lack of accessible evidence based guidance and in order to promote the best outcomes for mothers returning to running, physiotherapists Gráinne Donnelly, Emma Brockwell and Tom Goom released the guidelines “Returning to running postnatal  – guidelines for medical, health and fitness professionals managing this population” .

The guideline is designed to provide information to help women (and health & fitness professionals) to make informed decisions based on evidence and up to date research. You can download the full guideline here.


Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population” published in March 2019 FINDINGS AND recommendATIONs:

1. Pregnancy and childbirth causes some weakness and injury to the pelvic floor in the majority of women.

2. Many women need instruction and supervision to be able to correctly perform a pelvic floor contraction.

3. Running is a high impact activity.
Weakened or uncoordinated pelvic floor muscles may not perform their functions (maintaining continence and supporting the pelvic organs) under such demand.

4. Individualised pelvic floor rehabilitation is recommended for the management and prevention of incontinence, pelvic organ prolapse and sexual dysfunction.

5. Low impact exercise for the first 3 months postpartum with a return to running 3-6 months postpartum at the earliest.

6. Every woman should have the opportunity to have a comprehensive and individualised core and pelvic floor assessment by a specialist physiotherapist.

7. Strength in key muscle groups is required to ensure readiness for returning to returning and specificially the muscles supporting the pelvis and trunk.
Running involves transferring load and impact on one leg therefore run specific exercises are of particular importance, such as:
-Single leg glute bridges
-Single leg sit to stand
-Side lying abduction
-Single leg calf raises
While a weakness in these areas shouldn’t be a barrier to running it is an indicator to where strength work can be directed.

8. Running with a buggy is not recommended until the baby is 6-9 months old (as per buggy manufacturers guideline).
If running with a buggy commences after that time it should be done so slowly and incrementally.
The buggy should be designed specifically for running.
A two handed pushing technique results in a speed and stride length most similar to non-buggy running.
A strength program should be used to strengthen the back pelvis and hips.

9. Scar mobility must be considered as both C-Section and perineal scars can result in pain and restriction. which may have a negative impact on the mobility of the structures around the scar.

10. Breastfeeding creates a hormonally altered environment which may result in a potential for increased joint laxity. A baseline knowledge of preexisting joint hypermobility will be beneficial in identifying any predisposing risk for injury or dysfunction.

11. Supportive underwear/sportswear may play a role alongside pelvic floor rehabilitation. More research is required in this area.

12. Other factors to be considered include; how the mother is feeling generally, her energy levels, the availability of sleep and rest, her psychological state, her stress levels, having adequate breast support and her general fitness levels. These will all have an impact on the bodies ability to function, recover and repair. Energy depletion must be a real consideration for mothers as they recover from childbirth.

13. When the time is right to return to running, do so slowly, running for 1-2 minutes at an easy pace. Gradually build up the running distance. Set small achievable goals. Follow a ‘beginner 5km’ style program for sustainability.

Signs and symptoms to look out for when returning to running:

  • urinary and or faecal stress or urge incontinence
  • heaviness/pressure/bulging/dragging in the pelvic area
  • pain during sex
  • difficulty passing urine or faeces
  • visible doming coning of the abdominal wall
  • altered looking abdomen
  • decreased strength/function of the abdominal wall
  • vaginal bleeding beyond 8 weeks postpartum not associated with menstruation

    Experiencing any of the above is an indicator that running may be an excessive demand on the body at this time. Pelvic health physiotherapy and and working with and experienced coach can help improve or manage symptoms.

References

Brockwell, E., Donnelly, G., Goom, T., 2019. Return to running postnatal – guidelines for medical, health and fitness professionals managing this population.

maggielawler

Pre & postnatal fitness specialist. Co. Kildare.