Returning to running (or cross fit, netball, dance - whatever your aim) after having a baby can be an incredibly important goal for lots of new mums. Getting back to a beloved form of exercise can feel incredibly freeing and provide an outlet to burn off steam, fight fatigue and build a renewed sense of self amidst the new-baby new-mum haze.
As Physios, it’s in our nature to love and promote movement and exercise and we have a passion for supporting women to achieve their fitness goals - whether that be to complete a half marathon or half hour jog (after maybe a 9 month hiatus!).
But before you pull on the running shoes - It’s also our obligation to give you a heads up on what you should do to prepare your body to get back on the road/gym/court - without any hiccups (and we really mean without any ‘wee’ issues or prolapse ).
You will probably come across a minefield of conflicting advice surrounding return to ‘high impact’ exercise after birth from your obstetrician, GP, personal trainer, Google and Instagram; So… who should you listen to and what is the truth?
Thanks to a fantastic bunch of physios and academics in the UK - we now have a comprehensive, evidence and expert-based guideline to ensure we can give you advice which has a solid and reliable basis.
And while we found it an absolutely riveting read (not joking), we are guessing that you probably don’t want to (have time to) trawl through 40 pages of research so here are the “take home” points.
Pregnancy weakens the pelvic floor (even if you’ve had a caesarean!).
The pelvic floor muscles stretch up to 2 and a half times their original length during a vaginal birth! It can take 4-6 months for full recovery.
A caesarean scar can take more than 7 months to reach full strength.
Running (= high impact exercise) has almost 5 times the risk of creating pelvic floor problems compared to low impact exercise (eg walking, swimming).
You are more likely to encounter pelvic floor problems caused by running if:
You start running before your baby is 3 months old
You have any pre-existing hyper-mobility conditions (e.g. Ehlers-Danlos)
You are Breastfeeding
You have pre-existing pelvic floor problems or back or pelvic pain
You have a c-section or perineal scar
So based on all that, when is the ideal time to return to running after birth?
The recommendations are: No earlier than 3 months but probably somewhere between 3-6 months post partum is the right time to try.
What else?
All women - regardless of how they deliver - are advised to seek a postnatal Pelvic Floor assessment with a Women’s Health and Pelvic Floor Physiotherapist to evaluate strength, function and coordination of the abdominal and pelvic floor muscles
A Women’s Health Physio can also look at the ‘bigger picture’ and assess the strength and control of other muscle groups that are needed for effective high impact exercise without injury (Gluts, quads and calves to name a few).
If you get any of the following symptoms when attempting to return to exercise; STOP and see a pelvic floor trained physio:
Bladder or bowel leakage or near misses
Needing to rush to the toilet (bladder or bowel)
Heaviness/pressure/bulge/dragging in the pelvic area
Feeling of weakness or lack of control in any muscle group - particularly the abs
Pain in the lower back or pelvic pain
Another useful point to note: Pram manufacturers advise that running with a pram should not commence until baby is between 6-9 months old to protect the baby’s neck and spine.
So, there you have it…the expert’s advice hot off the press.
So where to now?
At MPPP, we now offer a specialised “return to exercise” assessment where we will assess and give feedback on your pelvic floor, abdominal and lower body strength and control. We can then work with you to develop a realistic return to exercise plan that is safe and keeps you happy and motivated. Lastly, don’t panic - we are not likely to suggest a life-long ban on running! We get it (we exercise too and know how important it is) - It’s always our aim to get you doing what you love and there is always a way!
Special acknowledgement to Jemma Dusink, pelvic floor physiotherapist, for her expert contribution to this post. Jemma is a high level competitive runner and consults at MPPP on Tuesdays and Thursdays.