The return to running after delivery

By Bryn Zolty, PT, DPT

*This article is based on Return to running postnatal-guidelines for medical, health and fitness professionals managing this population. Tom Groom, Grainne Donnelly and Emma Brockwell

Taking time off from running, crossfit, or high impact sports for pregnancy and postpartum can be very difficult for a woman. The 6-week postpartum visit is highly anticipated by many women so that they may be cleared to return to running or the gym. Is a woman ready at just 6 weeks after having a baby to run and jump? A recent article published in March 2019, Returning to running postnatal-guidelines for medical, health and fitness professionals managing this population, outlines the current evidence in return to sport. 

Most orthopedic injuries have protocols after surgery for rehabilitation prior to returning to sport. However, there is not a set protocol for women after giving birth to return to their prior level of activity safely. Many women have very limited knowledge of their pelvic floor or ability to strengthen the muscles to support their organs and keep them from leaking urine or bowel movements. Very frequently, women are not even aware of pelvic organ prolapse (POP). POP occurs when the pelvic floor muscles are weakened and the bladder, uterus, or rectum can start to press into or drop out of the vagina.  ​

​The research shows that women should wait until 3-6 months postpartum to return to running. For women anxious to return to running, that seems forever! The reason to wait is based on healing time. For vaginal births, the pelvic floor muscles are stretched greatly, and the levator hiatus (pictured below) can take as long as 12 months to become closer to baseline. In addition, the pelvic floor muscles, connective tissue and nerve healing is maximized by 4-6 months (Staer-Jensen et al. 2015). That means that women should seek a pelvic floor physical therapist after vaginal births as soon as they are cleared in order to maximize their ability to heal these tissues.

After a cesarean birth, the research shows that the abdominal fascia has around half of its original tensile strength at 6 weeks, and 73-93% at 6-7 months (Ceydeli et al 2005). This means after c-section, the abdominal wall is still undergoing significant healing and low impact exercise is recommended for the first 3 months.

In both cases, vaginal or cesarean, the recommendation is to have a pelvic health physical therapist evaluate the pelvic floor and abdomen prior to returning to high impact exercise. High impact exercise in female athletes was found to have a 4.59 fold increase in risk of developing pelvic floor dysfunction compared to low impact (De Mattos Lorenco et al 2018).  Running has been associated with a rise in intra-abdominal pressure and increased ground reaction force between 1.6 and 2.5 times bodyweight when running at a moderate pace (Gottschall and Kram 2005). These statistics are not to show that women should avoid high impact exercise, but should make sure women are physically prepared to return to sport.  

The article concluded that return to running should occur 3-6 months postpartum in the absence of the following symptoms:

• Urinary and/or fecal incontinence prior to or during commencement of running
• Pressure/bulge/dragging in the vagina prior to or during commencement of running
• Ongoing or onset of vaginal bleeding, not related to menstrual cycle, during or after attempted low impact or high impact exercise
• Musculoskeletal pain e.g. pelvic pain prior to or during commencement of running

Other symptoms in addition to those listed above, that if experienced a woman should seek out a physical therapist include:

• Urinary and/or fecal urgency that is difficult to defer
• Pain with intercourse
• Pendular abdomen, separated abdominal muscles and/or decreased abdominal strength and function

In addition, there are recommendations on the amount of strength and endurance in the pelvic floor and fascial support that should be present for running to prevent pelvic floor dysfunction. These measurements can be evaluated by a pelvic floor physical therapist.  

The full article can be found for free here.
Goom, Tom & Donnelly, Grainne & Brockwell, Emma. (2019). Returning to running postnatal – guideline for medical, health and fitness professionals managing this population. ​