Part 2 of 2
In my first post on the topic of RTR postpartum, I talked about my own story and urged patience when it comes to truly being ready to return to such high-impact exercise after pregnancy and giving birth. In this post, I will suggest a criteria, based on the published guidelines mentioned in Part 1, for determining whether you are ready to RTR and why pelvic floor PT may be worth considering. For a return to running checklist click here.
The first priority, as always, is rest and recover. I know, I know—but it’s true! Second is breathing well, connecting pelvic floor and core, and getting strong.
How? With progressive, low-impact activity that’s focused on:
- Establishing optimal breathing pattern
- Building awareness of position and optimizing alignment for healing and function
- ribs stacked over pelvis, untuck booty
- Restoring and coordinating pelvic floor and deep core
- Establishing a solid base of strength in functional movement patterns
- Maintaining/optimizing mobility and tendon/joint health
- Walking
No matter how smoothly a pregnancy and regardless of delivery method, the soft tissues of the pelvic floor and abdomen have done considerable work, undergone significant change and need time to meet the demands of high-impact exercise.
Taking it one, purposeful step at a time will actually get you there the fastest! Sometimes we need to go slow, to go fast!
Pelvic Health Considerations
Every mother should have access to a pelvic health assessment by a pelvic floor physical therapist. This is not currently the standard of care, however it is becoming more prevalent.
Despite being dismissed as “It’s just what happens after you have a baby,” these symptoms can all be addressed, improved tremendously or completely resolved. The following are all common postpartum, but I want to stress that they are not normal and ought to be taken seriously.
- leaking (urinary or fecal incontinence)
- vaginal/rectal heaviness or bulging/prolapse
- painful sex
- persistent gapping of the abdominals (Diastasis Recti)
- feeling disconnected to your midsection
- low back or pelvic pain
Assessing pelvic floor health both subjectively (for signs and symptoms of abdominal and pelvic floor imbalances) and objectively (strength, function and coordination) is highly recommended prior to returning to high-impact activities like running.
Load and Impact Management Criteria
Running requires our bodies to respond to load and to impact. Start with walking, progress to single leg standing activities, double leg dynamic activities, then single-leg dynamic activities like hopping.
Before RTR, be able to perform the following without pain, heaviness, dragging or incontinence:
Walking 30 minutes
Single leg balance x 10 s (each side)
Single leg squat x 10 reps (each side)
Jog in place x 1 minute
Forward bounds x 10 reps
Single leg hop in place x 10 reps (each side)
Single leg “running man” x 10 reps (each side)
Being able to do so can significantly decreased risk for incontinence, prolapse, pelvic and musculoskeletal pain.
Strength based Criteria
The general strength criteria are as follows:
– Perform at least 20 reps of each (on both sides) without pain, heaviness, dragging or incontinence
(Test is performed counting reps until fatigue and …. form matters!)
Single leg calf raise
Single leg bridge
Single leg sit to stand
Sidelying hip abduction
*If you can’t achieve these, it is not necessarily a barrier to beginning returning to running. It will guide where strengthening and training efforts may need to be targeted.
This is not an extensive assessment; there are many more parts of a healthy running program, but these help us in deciding how to proceed for a successful return to running.
Other things to consider…
Determining when and how it’s right for you to start running again is a very personal decision that should not be taken lightly. Many of the these are highlighted in the published guidelines, and I added my own as well.
Breastfeeding
Many moms will be breastfeeding when they RTR and that is OK! It’s important to take into consideration extra demands and altered hormonal environment of breastfeeding and for a few months after. Besides the potential for increased joint laxity, which is not fully understood, there are the increased energy and hydration demands of breastfeeding. Mindfulness around hydration and adequate refueling can reduce the potential impact on milk supply and overall wellbeing. As I have experienced personally, a drop in milk supply can indicate overexertion or under fueling. Fine a balance that works for your body.
Mental Health
Momming is physically and mentally challenging. Postpartum depression is a risk factor for pelvic floor dysfunction as many rely on running to cope. Women may increase duration and /or intensity before they are ready. While physical activity can be an incredible coping mechanism, it can be taken too far (personal experience again), making it crucial to have other strategies. Running is a physical stressor, but stress is not inherently bad. How we manage stress affects how we show up and perform. Things like sleep, nourishment and relationships play a big part. Recognize your stressors and take them into account when embarking on a physical stressor like running.
Relative Energy Deficiency in Sport (RED-S)
This is a big term for what happens when the body is not getting enough fuel to meet all its demands. Basically, you run out of gas so you start burning yourself to keep going. With energy demands already high in, plus feeling pressured to return to pre-pregnancy activities—and being applauded for doing so—it is easy to see how this can occur. Is “go go go” really what we need for our health and wellbeing? Does it allow us to show up as our best selves? It depends and certainly fluctuates. Especially as new moms, we can tend to run our engines ragged. Fueling ourselves adequately to be able to keep up with ourselves is important to consider and be mindful of when RTR.
Diastasis Recti Abdominus (DR)
This is the separation between the 2 halves of the rectus abdominus muscle beyond its normal distance with a thinning of the tissue that holds them together. DR is a normal occurrence with pregnancy and often needs some coaching to return to its optimal state. FYI, this is not something that only occurs in perinatal women, it can and does effect many people- men, women and children. It is all about intra-abdominal pressure management. Back to mom’s though….it’s suggested that RTR prior to regaining functional abdominal control may result in compensatory strategies in the pelvic floor posing greater risk for pelvic floor dysfunction. I would also argue that pelvic floor dysfunction may also impact the healing of/development of DR. Seeking professional help for assessment and management of DR postpartum is highly recommended!
Weight
I do not promote running for postpartum weight loss and am a firm believer in health at every size (HAES) and that weight in general—there are exceptions to this as with my own story with malnourishment—should not be the focus during postpartum. Health is the focus! That being said, weight is important to consider based on physics alone. Weight does impact the load on a pelvic floor, joints, musculoskeletal system, etc.
Breathing
It ALL ties into breathing! This is one of the areas that I am becoming more passionate about as I realize its importance in how we function both mechanically and neurologically. It is the one autonomic function we can also voluntarily control. We have access to it 24 hours a day and we do it about 20,000 times a day. Intentional breathing can support our mental health, physical health, stress tolerance and so much more. Many more posts on this to come!
Know your “why”.
Why are you starting to run again? Listening to what your body wants and needs is extremely difficult, and I continue to work on it, putting aside the pressures of society, aesthetics, status and the need to keep up. Are you running because you love running and the sensations you feel during and after? Are you running because you think it’s what you are supposed to be doing? Is it because you need to “get your body back”? Whatever YOUR reason for RTR, be clear on what that is.
To wrap up
RTR postnatally is absolutely possible to do safely and enjoyably. Get in tune with your changed body, build awareness, connection and strength so you can continue running without the common pelvic floor issues. Whenever someone is RTR after a break or injury, a graded exposure and conservative approach is best, while monitoring for symptoms of musculoskeletal and/or pelvic floor dysfunction. You can do this and I am here to help!
Regardless of whether your baby is 6 weeks old or 60 years old, healing and returning to your desired activities is possible!