19 Oct Postnatal Exercise: How Soon Can I Return To Running?
There is much pressure in the media for postnatal women to get their figures back and return to previous sports.
It is important however, that women take the time to let their bodies heal and prepare properly before resuming or indeed starting new sports such as running.
After having a baby, the pelvic floor is weak and injured in most women and may need instruction and supervision in being able to perform correct pelvic floor contractions, especially in women who didn’t practice these before birth (Bo et al, 2017).
High impact activities such as running cause a sudden rise in intra-abdominal pressure (Leitner et al, 2016); with ground reaction forces of between 1.6 and 2.5 times bodyweight occurring at moderate running speeds (Gottschall & Kram, 2005). It’s not known how much of this force is absorbed through the lower limbs, and so it can be assumed that some, (if not all) of these forces could be transmitted to the pelvic floor. This emphasises the importance of strength and speed of contraction in the pelvic floor muscles to support the pelvic organs and ensure continence during sports (Leitner et al, 2016). When investigating urinary incontinence in female athletes (De Mattos Lorenco et al 2018) found high impact activity to have a 4.59 fold increased risk of pelvic floor dysfunction, compared with low impact exercise. Recovery of the pelvic floor postnatally is usually maximized at 4 – 6 months.
If a woman has had a Caesarean section, the abdominal fascia which is made up of connective tissue and attaches into the abdominal muscle wall, only achieves 73 – 93% of it’s original tensile strength at 6-7 months postnatally (Ceydeli et al, 2005).
It is therefore recommended that only low impact exercise is performed in the first three postnatal months, with a gradual return to running at 3 – 6 months.
Symptoms which may indicate pelvic floor or abdominal wall dysfunction are:
- Leaking urine or inability to control bowel movements
- Heaviness / pressure / bulge / dragging in the pelvic area (could indicate prolapse)
- Pain with intercourse
- Pendular abdomen, a noticeable gap along the midline of the abdominal wall, and / or decreased abdominal strength
- Musculoskeletal lumbopelvic pain
Risk factors for potential issues returning to running are:
- Less than 3 months postnatal
- Pre-existing hypermobility conditions such as Ehlers-Danlos
- Pre-existing pelvic floor dysfunction or lumbopelvic pain
- Caesarean section or perineal scarring
Physiotherapists are well placed to assess pelvic floor and abdominal wall function. We will also look at specific load bearing tests to assess the readiness of the body to return to sport. The key muscle groups in the lower limbs will also be screened.
Once a woman is 12 weeks postnatal and has passed the physical screening tests, a graded return to running can be resumed. Training should be progressed gradually and adapted to the individual with risk factors considered. The response to running should be monitored and modified if needed. Running with a buggy is an option, although this is not recommended until the baby is 6-9 months old (once they have gained sufficient head and neck control).
At Halo, Senior Physiotherapist, Nicki Bradshaw has an interest in Women’s Health Physiotherapy and has undertaken postgraduate courses on the subject as well as being Pilates-trained. She is able to assess pelvic floor function externally as well as assess for diastasis recti and treat accordingly.
For more information, or to discuss whether an appointment would be appropriate for you, call Halo on 01926 257 255