A healthy return to running for new mothers.

Deciding to return to running after giving birth should not be done in a spur of the moment. It is a multi-step process and I will show you why. For your long-term health, it is important to understand and assess your body's ability to run while preventing any pelvic floor dysfunction (like pelvic organ prolapse, incontinence). The impact can extend to your lower extremities and can also be a reason for back pain.

The latest research suggests not taking up running for until 12 weeks after giving birth.

Those 12 weeks can be used to gradually increase activity levels and improve the strength of the pelvic floor, abdominal wall, cardio-vascular system, and progressing through the functional movement training. Let's look at them in a bit of detail.

There is a lot of emphasis in pelvic health-related literature that postnatal women, regardless of how they delivered, can benefit from pelvic floor assessment and guided pelvic floor rehabilitation. This is to prevent and manage pelvic organ prolapse, urinary incontinence, and issues with sexual function.

A pelvic floor physiotherapist will evaluate strength, function, and coordination of abdominal and pelvic floor muscles which are often impacted by pregnancy and delivery.

The guidelines for pelvic floor strength - when ready to run - are 8-12, grade 3 repetitions of pelvic floor contraction of 6 to 8 seconds hold-time, and 10 fast repetitions.

Manual muscle testing: Laycock [18] developed the Modified Oxford Grading System to evaluate the strength of the pelvic floor muscles by using vaginal palpation. It consists of a six-point scale: 0 = no contraction, 1 = flicker, 2 = weak, 3 = moderate, 4 = good (with lift) and 5 = strong.

If the pelvic floor is weak, gradual use of cueing and breathing helps your pelvic floor regain strength and aids your return to running. Also, since running is a functional activity, slowly progressing strength training in functional positions ranging between lying-down all the way to standing is very useful. Research shows that the use of certain cues (posterior cues) can help get better strength in postpartum women.

Before you begin or return to running, it is important to achieve coordination between breathing, pelvic floor, abdominal wall strength and lower quadrant strength (hips, knees and ankles). There should not be any pelvic floor symptom (pain, heaviness, incontinence) while you do a planned progression of exercises specific to running ( like single-leg running man, jog in place, single-leg bridges and many more)

The presence of Diastasis Rectus Abdominis is common in postpartum and is a potential risk for pelvic floor dysfunction. Having a good abdominal wall control and activation plays an integral role in keeping you away from any the pelvic floor insufficiency while running. Core activation through a series of progressive functional movements is very important before running.

Breathing pattern which is very connected to pelvic floor function is also something to watch for, thoracic mobility, expansion, and pattern of breathing help prevent any pelvic floor issues.

I have posted some pelvic floor exercises on this page for general pelvic floor health. I do recommend that postpartum women follow a gradual 12 weeks strengthening program for a safe return to an active lifestyle. I am eager and available to help you and a quick e-consult should help especially if you are experiencing any pelvic floor symptoms (incontinence, heaviness in the vaginal wall, urgency) or pain.

Happy running mama!