Gasping for air, sides cramping, breasts sore, and body aching everywhere, all while awkwardly pushing a jogging stroller are my memories from that first run following the birth of my son. You could say I was less than prepared! All I had in my mind at the time was how this would be such a great way to get back into shape and lose those last few pregnancy pounds, but instead I got a rude awakening. The body I was inhabiting during that run was far different from the one in which I had run two marathons only 3 short years earlier. My doctor had given me the all-clear to exercise back at my 6 week postpartum appointment so I figured I was good to go. If only I had known then what I know now...
When is it safe to start running in the postpartum period?
The answer is surprisingly complex. The best guidance we have, based on the limited evidence available, is from an excellent guide released in the UK in March 2019 by Goom et al. Their recommendation may come as a shock to some, but they recommend waiting 12 weeks after giving birth before resuming running. This is double the time at which most women are cleared for return to exercise, typically at the 6 week postnatal appointment. What's behind the 12 week wait?
A lot of healing. Giving birth is a herculean task which takes an obvious toll on one's body, and it takes time for that healing to take place. Consider the findings of this recent study in 2017 by Blyholder et al. of 507 postnatal runners:
35% of participants experienced musculoskeletal pain (usually in the low back, pelvis, and/or hips)
27% experienced stress urinary incontinence after their first pregnancy
32% of women who had given birth to a child within the past 2 years perceived a separation of their abdominals
The study also found that “women with musculoskeletal pain during pregnancy were more likely to experience pain on return to running postpartum”.
So the stakes for running too soon appear to be quite high—hence the 12 week recommendation. By following Goom's recommendations of a graded return to running following adequate postnatal pelvic floor and abdominal muscle recovery, you may be able to prevent these problems from occurring in the first place.
Another thing to consider: there can be a huge difference in the time needed for recovery from one woman to the next. Factors such as your pre-pregnancy core strength level, whether you were able to continue to run during pregnancy, whether you delivered vaginally or via C-section, as well as any strength training you did prior to giving birth can significantly affect your timetable for return to running.
For example, a new mom who gives birth to 8-pound twins via C-section, was too sick to run or exercise during her pregnancy, and had pelvic pain while pregnant will have a radically different return to running schedule than a woman who delivers a 5 1/2 pound baby via an uncomplicated vaginal birth, ran 3 times per week and did strength training throughout most of her pregnancy, and began gentle pelvic floor, hip and abdominal muscle strengthening exercises shortly after giving birth.
Bottom line: you need to take into account your fitness level both before and during pregnancy, your delivery details and recovery, whether you experienced lumbopelvic pain during your pregnancy, your pelvic floor and core recovery, and how much time has passed since giving birth when deciding when to safely return to running. Remember: every person's body heals at a different rate and has its own unique needs; don't fall into the trap of holding yourself up against your friends' or some celebrity's timetable for returning to running—you do you.
When to see a healthcare professional before running
It is important to assess the current state of your pelvic floor and core before considering starting to run. If you have any of the following persistent symptoms, it may indicate you have pelvic floor muscle dysfunction and/or core weakness and instability which will impair your ability to return to running safely:
Pelvic pain, hip pain and/or low back pain
Leakage of urine and/or stool with running, lifting, sneezing, and/or coughing
“Doming” or bulging of your abdomen when you try to sit up out of bed
Pressure, heaviness, or a dragging feeling in the vagina with standing, walking or running
Pain with sitting, standing, and/or running
Pain with sex
If you are experiencing any of these symptoms, return to running is not advisable until you see your pelvic floor physical therapist or other healthcare provider for guidance. In the meantime, you can try a less intense workout, such as brisk walking, to see if you can lessen or eliminate the above symptoms.
Tips for success when you are finally ready to run
So you're 12 weeks or more postpartum, you've taken care to rebuild your pelvic floor and core strength, you're free of any of the above signs of dysfunction, and you're feeling well overall. Finally—it's time to run! Before heading out, keep in mind the following points to help stack the odds in your favor of running safely:
Pace yourself: Goom et al. suggests starting small, with 1-2 minutes of running at a time and at an easy pace. For example, try a brisk 5-minute walk, then 1-2 minutes of running; repeat this for 2-3 sets. Over time, increase the amount of running vs. walking, depending on what your body is telling you. Your muscles may be sore during the first 24 to 48 hours after exercise, but you shouldn’t feel moderate to severe pain during or after your workout. Consult a physical therapist if you have any worrisome symptoms, or symptoms that persist or worsen.
Breathing: On initial return to running, walk/jog/run at a pace which allows you to comfortably maintain a conversation.
Breastfeeding: The overall environment of hormones during the postpartum period and up to 3 months following weaning may influence joint laxity; especially if you know you already have a propensity for laxity (for example with Ehlers-Danlos Syndrome), take extra care to ease back into running to help avoid injury. Also consider timing of nursing around running, to ensure that the breasts are not overly full or likely to become uncomfortably full during the run. And remember hydration!
Supportive clothing: Consider a personally fitted sports bra that offers support rather than an off-the-shelf compression bra, to help avoid mastitis. Also consider supportive footwear, and remember that shoe size can be permanently altered with pregnancy (i.e., you might need new shoes!).
Mental health: Running can have a powerful beneficial effect on our mental health, and can help relieve some of the stresses associated with new motherhood. However, keep in mind that postpartum depression is experienced by approximately 10-15% of mothers; be sure to speak with your healthcare provider if you feel you may be suffering from this, before you try to self-treat with running.
Scar mobility: Both c-section and perineal scars can result in pain and restriction, which can impact your comfort as well as core function while running; be sure to speak with your pelvic floor PT or other healthcare provider about tips to improve your scar's mobility to help improve your core function and decrease any pain.
Sleep: Sleep is key for recovery from both physical and psychological stress; however, it also usually a scarce commodity during the postpartum period. Sleep deprivation can impact your injury risk, general health, and stress levels. Some tips to help increase your total shut-eye time and improve your sleep quality include taking daytime naps, decreasing screen time, creating a cool and comfortable sleep environment, and avoiding alcohol or caffeine. Prioritizing your sleep over your housework can help as well.
Weight: If your BMI is greater than 30, you are at higher risk of pelvic floor-related symptoms and musculoskeletal injuries with high impact exercise; you may want to consider lower impact forms of exercise, or keep the running to walking ratio low until your BMI reaches 30 or lower.
Vaginal bleeding: Ongoing or onset of vaginal bleeding, not related to your menstrual cycle, during or after running should be discussed with your healthcare practitioner.
Running with a jogging stroller
Before deciding to run with a jogging stroller, realize that it does take more energy than running alone, and it can be physically awkward. That being said, taking your baby with you on your run is an extremely convenient way to fit in a workout, so if you are up for the challenge, here are some tips to help make that run a success:
Use a stroller designed for running
Trying to run with a standard stroller can set you up for failure, as they are usually heavier and more difficult to maneuver than a jogging stroller when running.
Wait until your baby is 6 months old
Most jogging strollers recommend waiting until your baby is 6 months or older to protect baby's health; be sure to check the manufacturer's guidelines that come with your stroller, to ensure your baby is old enough to safely ride in the jogger.
Try different techniques of pushing
Pushing a jogging stroller can be challenging biomechanically, and overall takes more energy than running alone. There are generally three methods of pushing when you run, and each has its benefits and drawbacks:
Push/chase—this is just like it sounds: you push the stroller a little distance ahead of you, then chase it down. Obviously not an ideal choice on a busy street! But it does free your hands for a more normal jogging gait momentarily.
1-handed—this offers you the control of using one hand, and allows you to use your other arm for running. It can cause some obvious asymmetry in your trunk and gait pattern however.
2-handed—running with 2 hands keeps your speed and stride length most similar to non-stroller running; however, you eliminate the biomechanical benefit of swinging your arms.
We need to start giving pregnancy and childbirth the same level of consideration for recovery that we do for other ligament, tendon, muscle and nerve injuries. We have a plan for giving birth--shouldn't we have a plan for our postpartum recovery as well? Planning for a graded return to running following pelvic floor and abdominal muscle recovery over the first 3 months postpartum can give yourself the best odds of avoiding pain and/or injury when it's finally time to hit the pavement. Happy Running!
Remember: If you have just had a baby, your physician/healthcare provider will tell you when it is safe to return to exercise. If you are having any symptoms of pelvic floor or core muscle dysfunction, or you need any guidance with the above recommendations, schedule a virtual appointment with me or consult with your healthcare provider for assistance.
"Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population”. By Tom Goom, Gráinne Donnelly & Emma Brockwell. Published March 2019.
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About the Author:
Angela is the owner of My Pelvic Therapy, PLLC and a licensed physical therapist. Prior to starting her telehealth private practice, she worked as a senior physical therapist for 17 years at Advocate Lutheran General Hospital in Park Ridge, IL, specializing in helping both women and men overcome their pelvic floor challenges. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and is a lifelong learner of all things PT.