For many of us, the 6-week postpartum check by one’s health care provider is cursory at best, unhelpful at worst. For uncomplicated births, most women are advised to return to their previous activities at this time. The problem with this advice is that the pelvic floor and abdomen are still recovering from the trauma of birth. If vigorous exercise is undertaken too soon postpartum, it could stress these healing tissues too much, either creating or worsening pelvic floor or abdominal wall dysfunction, which could include, but is not limited to:
- urinary and/or fecal incontinence
- urinary urgency
- pelvic organ prolapse
- constipation
- pelvic/hip/low back pain
- pain with intercourse
- midline abdominal separation (diastasis rectus abdominis)
To assist with navigating a safe return to a high-impact activity such as running, guidelines were developed by 3 physical therapists in the UK based on review of the current research. A summary of their guidelines follows:
- All postpartum women should have access to an assessment of their pelvic floor and abdominal wall, as well as guidance for pelvic floor rehabilitation.
- Exercise within the first 3 months should be a progressive low-impact program.
- Running should NOT be attempted prior to 3 months postpartum, OR beyond 3 months if symptoms of pelvic floor dysfunction, specifically:
- Vaginal bulging or pressure
- Vaginal bleeding
- Pelvic/hip/low back pain
- Urinary or fecal incontinence exist during or after attempts to run.
- Readiness to return to running should be evaluated through pelvic floor assessment, load transfer evaluation, and strength testing specific to running.
Finally, risk factors to consider regarding readiness to return to running are:
- <3 months postpartum
- Joint hypermobility (Ehlers-Danlos)
- Breastfeeding
- Pre-existing pelvic floor dysfunction
- Obesity
- C-section or perineal scarring
- Psychological issues
- Relative Energy Deficiency in Sport (RED-S)
Running is a great form of exercise, but should be resumed following childbirth only after a progressive return to impact exercise over 6 months without symptoms indicating stress to the pelvic floor. An assessment by a pelvic floor PT can be invaluable to help you determine the health of your pelvic floor and abdominal wall in order to determine your readiness to progress. Call us today for more information!
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.