Following on from our Pelvic Floor and Diastasis Recti posts earlier this year, here are some must know facts about returning to running after giving birth. Having a baby vaginally or via caesarean section places huge stress on your body and results in a number of changes to the muscles, ligaments and fascia of your pelvic floor, pelvis and spine.
As with any other major injury or surgery, it is important to follow a rehab program specific to your body when returning to running after having a baby. Musculo-skeletal pain, urinary incontinence, abdominal separation, and pelvic organ prolapse are all prevalent conditions seen in post-natal women. Although they are common, they are not normal, and it is imperative to have good post natal guidance to return to running in order to manage and prevent these conditions.
The first evidence based guidelines about post natal running were released this year, and the consensus is that post natal women should wait at least 3 months, with some experts recommending up to 6 months of rehab, before returning to running!
1. Acknowledge That Pregnancy and Birth Place High Demands on the Body!Post natal women need adequate time to heal and rehabilitate before returning to high impact tasks. No matter how fit you were in your pregnancy or how strong you are feeling now, there are many changes you may not be aware of that will impact your ability to run safely.
- Your uterus becomes ~1000x bigger than its usual size during pregnancy. Your body has undergone a lot of changes to accommodate this!
- The Levator Ani muscle group (which lifts up to support your pelvic organs and assists with continence) can stretch up to 350% of its resting length during vaginal birth!
- Recovery of the Levator Ani muscle group and associated connective tissue and nerves is generally not maximised for 4-6 months!
- Following caesarean section, the uterine scar thickness is still increased at 6 weeks. The abdominal fascia has only regained about 50% of its original strength at 6 weeks and is still not completely regained by 6 months.
- Your pregnancy postures and feeding postures may have left you with muscle imbalances and changes to the mobility and stability of your joints.
- You may have an abdominal separation, which will affect your ability to generate tension in your core and adequately support your back, pelvis and pelvic floor. This leaves you much more susceptible to injury when running.
- Like most mums you may also be energy deficient, sleep deprived, have low immunity, be affected by the physiological effects of breast feeding, have low bone density or may be struggling with the psychological stressors of having a newborn. These are all potential contributors to injury.
2. Wait! Running Too Early After Having a Baby Can Negatively Affect Your Sexual Function, and Cause Incontinence and Pelvic Organ Prolapse.Post birth, the pelvic floor can be weak and injured, and many women need instruction to correctly perform a pelvic floor contraction and relaxation. Even with a caesarean birth, there is significant stress placed on your pelvic floor during your pregnancy which can cause dysfunction. A high impact activity like running is associated with a rise in intra-abdominal pressure and generates ground reaction forces that are transmitted up to your pelvic floor. In order to run, we need a strong and functional ‘core’. This means that we need our diaphragm, pelvic floor, and the muscles of our back and abdominals to be working in co-ordination with each other. We also need our pelvic floor muscles to not only switch on correctly, but also to be able to have the strength, speed and co-ordination to support our pelvic organs (bladder, uterus and bowel) during high impact activities. Placing high amounts of stress on already weakened muscles puts the fascia supporting our organs under more pressure and can result in pelvic organ prolapse (where one or more of your pelvic organs begins to descend into or outside your vaginal canal).
3. Understand: There Are Many Risk Factors For Potential Issues Returning to RunningWe need to consider a holistic approach and take into account that there are many potential risk factors when returning to running:
- Starting less than 3 months post natal
- Pre-existing hypermobility conditions
- Breastfeeding (your lower estrogen levels and slightly raised relaxin levels impact joint and muscle function)
- Pre-existing pelvic floor dysfunction or lumbopelvic dysfunction
- Psychological issues which may predispose mothers to inappropriate intensity /duration as a coping mechanism
- Obesity (Increased load on your pelvic floor)
- Caesarean section or perineal scarring
- RED-S or Female Athlete Triad Syndrome
4. Stop Running if You Have any Symptoms of Pelvic Floor Dysfunction or Musculoskeletal Pain.Based on all this information, it is now recommended that a low impact exercise program is followed within the first 3 months of the postnatal period, progressing to return to running between 3 and 6 months post natal (at the earliest). Return to running or sport is not advisable prior to 3 months postnatal or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running. If you have symptoms, STOP running and cease help from a Physio. Though common, they are not normal. These symptoms include:
- Heaviness/dragging in the pelvic area
- Leaking urine or inability to control bowel movements/wind
- Bulging abdomen or noticeable gap along the midline of your abdominal wall
- Pelvic or lower back pain
- Ongoing or increased blood loss beyond 8 weeks that is not linked to your monthly cycle
5. Consult: You Should See a Physiotherapist with an Interest in Women's Health Prior to Running!So, is there any good news!? Yes, at Thrive Health we can help you navigate all of this! Remember to give yourself plenty of time to rehab your body properly before returning to running, just like you would with any other major injury or surgery. Follow a safe program to rebuild your strength and co-ordination in order to meet the demands of high impact activity. Prevention is much better than cure! It is simply not worth the risk of returning to running before your pelvic floor can handle it. There is very high-level evidence that supports individualised Physiotherapy assessment and pelvic floor rehabilitation for prevention and management of prolapse, urinary incontinence and for improved sexual function postnatally. Your risk of pelvic floor dysfunction increases with each pregnancy and childbirth, so the sooner you have an assessment and management program, the better your pelvic health will be!
We can provide you with a personalised program to make sure you come back to running stronger and faster, while preventing potential complications. Come and see us during your pregnancy or as soon as you feel able to after having the baby for exercise guidance, and any time after your 6 week medical review for internal pelvic floor help. Trust us, your body will be thankful later!