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As a self-professed Olympic fangirl, I spent the past couple of weeks marveling at the amazing Olympic athletes in all sports. I was especially impressed by all the mothers of young children competing at both the Olympics and Olympic Trials in track. Their performances may have given the impression that a postpartum return to running is easy or seamless, but for many women, including elite athletes, this is not the case.
Lack of Research on Timeline to Return
While both elite athletes and regular runners can struggle to return to their previous running level after having a baby, a recent survey of pregnant and postpartum runners found that only 31% received advice on how to return. This lack of advice is due in part to a paucity of research on running during pregnancy or after delivery. The guidelines that have been published agree that the time frame for return needs to be runner-specific and take prior running habits and volume into account. Returning less than 3 weeks post-delivery or before any birth injuries have completely healed is not advised. At least one study reports the median return to running time is 12 weeks post-birth, but a large range indicates that some runners do not return until 6 months or more.
Pelvic Floor Dysfunction
One of the most common complaints in postpartum runners is pelvic floor dysfunction. This can take the form of pelvic pain or pressure, urinary or fecal incontinence or pelvic organ prolapse. Pelvic organ prolapse is when an organ such as the bladder or uterus slips down from its usual position causing pain or pressure. One study reports that 57% of postpartum runners experience urinary incontinence and 19% have symptoms of pelvic organ prolapse. Many experts feel the actual numbers may be even higher. While pelvic floor dysfunction is common, these symptoms are not “normal” in the sense that a woman needs to accept incontinence or pelvic pain as a permanent condition after having a baby. If pelvic pain, incontinence or prolapse symptoms are severe, delaying a return to running while checking in with an ob-gyn is a good idea. Symptoms of all three conditions can often be improved with pelvic floor muscle training from a qualified physical therapist.
Musculoskeletal Pain
A recent survey of over 200 postpartum runners found that 35% experienced musculoskeletal pain upon return to running. Interestingly, 72% of that pain was in the lumbar spine, pelvis or hip compared to 20% of complaints in those regions in the general running population. A smaller study found significantly lower hip strength in postpartum runners. Another small study found increased lateral pelvic movement in postpartum running mechanics that did not self-correct by 6 months post-delivery and may increase injury risk. Decreased core strength, especially in a deep core muscle called the transverse abdominis, may also affect running mechanics or lead to low back pain. Many women experience diastasis recti abdominis (DRA)—a separation of the rectus abdominal muscles during pregnancy. While there is insufficient evidence correlating DRA with running injury, expert opinion considers DRA a potential risk factor for pelvic floor dysfunction and low back pain. A physical therapist can also help with postpartum hip and abdominal muscle retraining.
Return to Run Readiness Criteria
Screening criteria has been developed to determine the physical readiness of a postpartum runner to accept the loads and impacts of running. Prior to initiating return to run, they should be able to perform all of the following tests without pain or pelvic floor symptoms:
• Walking for 30 minutes
• Single Leg Balance for 10 seconds on each leg
• Single Leg Squats x 10 repetitions on each leg
• Jogging in place 1 minute
• Forward Bounds x 10 repetitions
• Hopping in place x 10 repetitions on each leg
• Single Leg “Running Man” x 10 repetitions each side
• Calf Raises x 20 repetitions
• Single Leg Bridge x 20 repetitions each leg
• Single Leg Sit to Stand x 20 repetitions
Experts recommend a gentle progression of cardio and strength training with a gradual return to run starting with alternating 1 or 2 minutes of easy running with longer walking intervals. Running volume (distance and time) should be increased before running intensity (speed).
Other Considerations: Stress, Sleep, and Nutrition
Postpartum women should consider more than just physical readiness when determining readiness to run. Mental health, stress levels and the presence or absence of a social support system is also important. Sleep quality and duration is a crucial consideration. Nutritional status can not be over-looked. Women who breast-feed require an extra 24 ounces of fluid and 500 extra calories per day without taking into consideration the extra hydration and caloric demands of running. The energy cost of pushing a stroller is even greater than running the same distance alone. Dehydration and under-fueling can affect both performance and injury risk, as well as milk supply for the infant.
In Summary
Postpartum runners will vary significantly in their return to run timeline and experiences. The right time for you to return to running should be an individualized decision. The physical tests above can be used as a guideline to assess readiness, but always start gradually and progress slowly. If you have trouble returning to run at any time postpartum, seek out comprehensive care from health care providers familiar with working with postpartum runners. This may include an ob-gyn, physical therapist, nutritionist, and /or mental health therapist.
Want to read more on the topics covered here? This excellent review paper was recently published on the subject.
The information provided in this article is for educational purposes only and does not substitute for professional medical advice. Consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment specific to your individual situation.
This article originally appeared in the The Connection, TCM's weekly e-newsletter. Subscribe here.
Kristen Gerlach, PT, PhD, is a physical therapist who specializes in working with runners. She is one of the team of Motion Experts TCM has gathered to help its subscribers and participants get the most out of their running. Have a question for Kristen: [email protected] or website: instridemnpt.com.