Running after a baby
So you’ve just had a baby and you want to quickly whip back into your pre-pregnancy body! You may be a long term runner and it feels natural to jump straight back into running? You may be dying to get out there and pound the pavement for some sanity – as lets face it, having a baby is not easy physically OR emotionally? Or you may not have run for several years, and feel that, surely, running will help to quickly drop your excess baby weight and will help you tone up?
But is it safe after having a baby? If so, when?
Let’s explore this.
Running is a high-impact sport. It not only requires good cardiovascular fitness, it also requires a well-functioning pelvic floor and core, along with excellent hip and pelvic control. It is extremely important that we have both adequate pelvic floor function, as well as excellent functional strength around the pelvic girdle to aid the shock absorption which is required during running and other high impact sports.
So lets consider the effects of pregnancy on our pelvic floor and pelvic girdle?
We already know that pregnancy and labour can be very demanding on the body. The additional weight of a growing baby throughout pregnancy alone (regardless of the mode of delivery) will place considerable load on your pelvic floor. We then have to take into consideration the effects of the various hormones released during pregnancy, as well as throughout the postnatal period. These hormones can affect both the strength of your pelvic floor, as well as your stability around your pelvic joints. Add to this, possible abdominal separation, and potentially a history of back, hip or pelvic girdle pain. So even before your baby is born, your body has changed significantly from what it was nine months ago.
Then comes the delivery and the possible additional considerations including perineal or pelvic floor trauma during vaginal deliveries and/or healing of a caesarean scar.
So, the question of safety with regard to running after a baby isn’t an easy one to answer. The reality is, every pregnancy is different and everyone’s circumstances, strength, control, history, pre-existing conditions and so on must be taken into consideration when deciding whether you are ready to return to running.
At this point in the discussion someone often asks what does pelvic floor weakness mean?
Good question! Your pelvic floor is the group of muscles that attach from your pubic bone at the front of your pelvis all the way around to your coccyx and sit bones. They are a group of muscles that hold your pelvic organs in position and help to control your bladder and bowels. Weakness in these muscles, whether through pregnancy/ labour or otherwise, can lead to incontinence, prolapse and lower back pain. This can feel like heaviness or pressure in the pelvic area, leaking urine, an inability to control bowels and so on. Running increases the demand on all muscles of the body including the pelvic floor. A weak pelvic floor may not handle this additional demand and will increase your risk of developing a pelvic organ prolapse and/or incontinence.
But it’s not all about the pelvic floor.
As mentioned earlier, running requires excellent strength and control of the lumbopelvic region, or in other words, the control of how you move your back, hips and pelvis and how effectively they can absorb the ground/landing forces associated with a high-impact sport such as running. This control and strength is often affected post-pregnancy especially if there was any abdominal separation, pelvic floor or abdominal trauma or a period of pelvic girdle, hip or back pain.
What does the research say about this?
The latest pregnancy guidelines acknowledge that postnatal women need to regain strength in their abdominal and pelvic floor muscles and that individualised assessment and guided pelvic floor rehabilitation is beneficial in the prevention and management of pelvic organ prolapse and/ or urinary incontinence. The guidelines also recommend that you follow a low-impact exercise timeline, particularly within the first three months and consider return to running at the absolute earliest between three to six months post-partum.
Having said that, not everyone recovers at the same rate. All of the factors that we have already spoken about come into play here, for example a caesarean scar, significant perineal tearing, other pre-existing pelvic floor conditions, pelvic floor heaviness or prolapse, issues with continence and even back or pelvic pain. So just because you are three months postpartum, it does NOT mean that you are ready to return to running. There are clear criteria assessing lumbopelvic strength and control, pelvic floor and core strength, activation and timing, as well as adequate load and movement patterning that should be met to ensure your safe return to running.
When it comes to making the decision to start running, it is always best to seek advice from a healthcare professional. A women’s health or pelvic floor physiotherapist will be able to advise you regarding your pelvic floor muscles and whether now is the best time to start running. They will also consider all other factors relevant to your individual pregnancy, delivery as well as your past history.
So, the key here is that a postpartum assessment is extremely beneficial to ensure that you are returning to exercise in a safe manner and at a rate that is appropriate for your body.
What does an assessment involve?
The depth of your assessment can be determined between you and your physiotherapist.
At Healthwise Physiotherapy & Pilates we offer a variety of different assessment options:
- 30minute Assessment – For straightforward postpartum assessment OR musculoskeletal assessment. This would involve assessing your abdominal separation, caesarean scar check, transverse abdominis/ pelvic floor muscle education and teaching correct contraction OR would involve assessing your musculoskeletal or pelvic pain issue.
- 45min Extended Assessment – In addition to the above 30minute assessment, this would allow us extended time to address both of the above areas together and in more detail.
- 45min Pelvic Floor Assessment – This would involve thorough assessment of your pelvic floor via an internal vaginal examination. Here, we would look at pelvic floor strength, co-contraction with TA, contraction timing, abdominal separation, assess for prolapse, and discuss any continence or prolapse issues.
For a thorough postpartum assessment, I would recommend booking an extended 45minute physiotherapy appointment. If you had any pelvic floor or continence concerns, I would recommend you alternatively book a pelvic floor assessment.
We understand that extended sessions are not always viable or necessary, which is why we offer a variety of appointment lengths. If you are unsure whether you require a longer appointment, this can always be discussed with your therapist after your first appointment, and may be organised for a subsequent visit, if necessary.
Who can do this specialised assessment?
At Healthwise Physiotherapy and Pilates, all our physiotherapists are qualified to assess and assist with your management in this postpartum period. It is important to note that if you require a more in depth assessment of your pelvic floor for management of prolapse or incontinence, then you will need to ensure that your pelvic floor physiotherapy assessment is booked in with either Chloe or Josie so that an internal examination can be completed.
Sounds good. Now what?
So, for the safe return to exercise, sport or running, do yourself a favour and book in for an assessment so that you can be confident that you are returning to exercise in a safe manner and at a rate that is appropriate for you!