• When can I start running after giving birth? A Physios Guide

  • Until recently the guidance around returning to running after giving birth has been unclear for postnatal women. Fortunately, guidelines for the return to running postnatally have now been developed by three extremely well known and accredited Physiotherapists(1). Their aim is to provide a beginning point to have a standardised and researched based guideline for Fitness Instructors, Health Professionals, and non-Pelvic Health Physiotherapist. This will provide these people with the knowledge to recognize signs and symptoms that flag the lack of readiness of these patients. But of course, no one will know your body better than yourself. So, if individuals can recognise common pelvic symptoms on their journey to return to running, they will be able to self-refer to discuss these with health professionals.

    During pregnancy and birth the pelvic floor and abdominal muscles weaken and injury to these muscles and fascia (which is the connective tissue between muscles) can occur with either caesarean or vaginal deliveries.

    At six weeks after a caesarean the abdominal fascia that gets cut has only regained 50% of its tensile strength and up to 80% at 6-9months postnatally.

    The vagina widens during pregnancy (especially in the last trimester) and more so with vaginal delivery and will not return to its original size. All these factors can contribute to experiencing pelvic floor dysfunction. Therefore, it is essential to ensure your body has had enough time to heal sufficiently and is strong enough to return to running.

    Running is a high impact activity and while running at a moderate speed of 11km/hr there is actually a ground reaction force of 1.6-2.5 times your bodyweight! It is still unknown how much of this ground reaction force is absorbed through the lower limb and is assumed that some (if not all) of this force is transmitted through the pelvic floor.

    The likelihood of experiencing pelvic floor dysfunction is 4.5 times greater with high impact activity compared to low impact. It is also known that the healing times of pelvic floor muscles, connective tissues, nerves, and abdominal tissue are maximised approximately 6 months postnatally. Therefore, when considering these high impact forces and healing times it is recommended that return to running should not commence until 3 months postnatally.

    This does not mean that you will be unable to do anything for 12 weeks. It is recommended to slowly progress your activity levels and include strengthening for your pelvic floor muscles (Your local women’s health Physio can guide you with these). Activities such as walking, body weight exercises and core/pelvic strengthening are great to start with and then to progress into higher intensity walking/cycling and weighted exercises that are all low impact.

    Signs that you may not be ready to return to running are symptoms such as:

    • Pelvic or lower back pain
    • Leaking of urine or faeces
    • Sensation of heaviness or dragging
    • Painful sex and
    • Large separation of abdominal muscles.

    The separation of abdominal muscles is called Diastasis Recti and should be considered a potential risk for pelvic floor dysfunction despite there being a continued debated on this relationship between the two. Heaviness, dragging or feeling a bulge are common signs of pelvic prolapse. Leaking can indicate pelvic floor muscle dysfunction and painful sex can indicate prolapse, a hypertonic (or overactive/tight) pelvic floor or other conditions.

    It is important to note that these symptoms are common but not normal and require assessment by a Pelvic Health Physiotherapist or Gynaecologist.

     

    For more information on the return to running guidelines and other postnatal factors to take into consideration when getting to running and being active, call the clinic to book in with Kristin for a thorough assessment and rehab plan that is individualised to you, your history and your goals.

    Remember: Leaking of urine is not something you should put up with and ignore and is common but not normal.

    Author: Kristin is our expert in Women’s health here at Physiosteps. You can book in with her by calling or booking online and if you have any questions, get in touch and we will put you in touch with her.