Part 1 of 2
I remember my first run after being cleared for exercise at my six-week check up. I finished feeding my baby boy, handed him over, laced up my sneakers, did a few dynamic stretches and was off. It felt great being outside, hands free, and feeling like the owner of my body again….until about a mile in when I felt this warm, wet sensation in my capri stretch pants. I was drenched. It wasn’t just a dribble or two—my whole pant leg was soaked. I had peed myself, and had no idea what was happening.
What was going on? I felt like a foreigner in my own skin. I’d been cleared for exercise, so why was this happening? I’m a physical therapist; I’m strong and athletic. I ran through pregnancy until the day I gave birth, so of course I could run now that the baby was out and I had “healed”, right? Wrong. I was devastated, lost and worried.
If I had only known then what I know now.
Returning to running (RTR) in the early postpartum time is attractive to women for many reasons. For me it, was a combination of restoring my identity as physically fit, proving I bounced back quickly, and it was a major form of stress relief. Whether for mental health, getting your body back, societal expectations, identity, social engagement or being able to play with your kids, I understand—but I experienced what can happen when going too hard too fast. My hope is that sharing these insights will help guide a safe, effective and long-lasting RTR.
Though it feels urgent, some things are worth waiting for..
We can tell ourselves all sorts of stories about why we need to start now. The truth is, postpartum or not, running is highly demanding on a body—a single-leg, dynamic, plyometric activity. Our bodies need healing and a strong base to work from to meet the demands of running and to avoid injury.
It can be tricky to know when you are ready to start running again. Luckily, in March 2019, guidelines were published by Goom, Donnelly & Brockwell with recommendations for women to RTR. In my opinion, many of these apply to anyone beginning to run again after injury or time off.
What the guidelines tell us
The recommendations are based on time, pelvic floor symptoms, load impact management and strength criteria. When met, risk of pelvic floor dysfunction (incontinence, pelvic organ prolapse, ongoing diastasis recti, pelvic and musculoskeletal pain) will be significantly reduced.
Time-Based Criteria
Returning to running is “not advisable prior to three months postnatal or beyond this if symptoms of pelvic-floor dysfunction are identified prior to, or after attempting, return to running.” My recommendation would be closer to six months.
Any injury takes time to heal. Pregnancy and delivery are no different. The tissues have been stretched, torn or even cut through (c-section). Tissue healing following pregnancy and birth happens between months four and six postpartum (Shek et al.2010, Staer-Jensen et al. 2015). Six weeks after caesarean section deliveries, abdominal fascia has regained about 50% of its original tensile strength and 73% to 93% by six to seven months (Ceydeli et al. 2005). Healing takes much longer than the six-week check up mark.
Does this mean I can’t exercise prior to 12 weeks?
Heck no. Let’s be real: You are probably doing over 100 squats and hinges a day picking stuff up off the floor, carrying an awkward, wiggly load plus all the stuff that goes with it, and are in constant demand. So it is absolutely recommended to do activities to help your body recover prior to the 12-week mark.
And if you are getting into running years after having a baby, it is also highly recommended to go through a similar process to prepare your body.
What You Can Do?
This is an opportunity to slow down, tune in and get to know your body and build a strong, resilient foundation. Once this foundation is built, then we can progress intentionally.
The goal of the first three to six months is to (re)build a solid base, get the pelvic floor and core working in coordination with our breathing, optimizing movement patterns and balancing our systems.
*More detailed info on exercises and approximate time frames coming soon!
In the next post, I will suggest a criteria and set of exercises for determining whether you are ready to RTR, based on the published guidelines mentioned above and why a pelvic floor PT may be worth considering.