When can I start running after having a baby?
Ooohhh….the million dollar question.
As a physiotherapist working with the postnatal population, I get asked this a lot. My answer is always…it depends.
Gosh, that is a bit vague isn’t? Why can’t there just be a set time frame for this?
Well, the reality is that what is right for you, is not necessarily right for your friend/sister/cousin (I think you get the gist!). Let’s discuss some of the variables that we need to consider.
If you were my client, here are some of the things that I would want to know
- Are you normally a runner? Did you run a lot prior to and during pregnancy?
- How was your birth and recovery? Did they use any instruments during the birth (eg forceps/ventouse)? Did you have a c-section? Did you have any issues around that time – eg haemorrhaging?
- How many weeks/months are you postnatal?
- Have you seen any health professionals since your birth?
- Do you have a tummy muscle gap (diastasis)?
- Do you have any back or pelvic pain?
- Are you hypermobile (someone who can bend their body into interesting positions!)?
- Do you have any symptoms of pelvic floor dysfunction (incontinence, pain with intercourse, constipation, heaviness/dragging in the perineum etc)?
Did you answer these questions? How do you think these variables impact on your return to running?
I think you can see where I am going with this. The recovery in the postnatal period is extremely variable. And I do mean extremely.
Let’s give 2 example clients.
“Amy” is 4 months postnatal. She is a keen runner and has run marathons in the past. She had a difficult birth and required forceps for delivery, resulting in an episiotomy and stitches. Since the birth she has had some incontinence when she coughs/sneezes (stress incontinence) and has had some pain in the right buttock with long periods of walking.
“Jessica” is also 4 months postnatal – she had an elective c-section. She has done some running in the past and is keen to lose weight since the birth of her second baby. She has a large tummy muscle gap and has difficult balancing on one leg.
Now “Amy” and “Jessica” are fairly typical clients that I would see clinically. Would I suggest to either woman to run at this point? My answer is no. Now you might say “hang on, they are 4 months down the track! Isn’t that long enough?”
The problem is that often women return to high impact activities sooner than their bodies would like. Women’s health physiotherapists see clients who have developed incontinence or symptoms of prolapse (heaviness/dragging) as a result of this. As a musculoskeletal physiotherapist, I tend to see more of the back/hip/knee pains that result.
So what are the “rules” for returning to running?
There are no set guidelines, so I am going to give you some of my thoughts:
- Most women should wait a minimum of 3 months postnatally before returning to running. I find clinically that a lot of women are still not physically ready by this time (but that may just be the clients who come and see me). Most women’s health physiotherapists agree that it takes 9 months to make a baby and at least 9-12 months to recover. We do see some women return to running before the 12 week mark, but typically they are long-term runners (who need to run for the sake of their mental health) who have (hopefully) had simple births and straight-forward recoveries.
- If you had an instrumental delivery or have any of the pelvic floor symptoms mentioned above, see a women’s health physiotherapist prior to returning to running to check your pelvic floor muscle strength. I consider this vital – we know from the research that often when women think they are doing a pelvic floor contraction they are actually doing it incorrectly.
- Embark on a strength training regime prior to running. I would prioritise glutes, quads, calf and abdominal muscles. It is preferable that this is individually designed but that is not always possible. Make sure that you work on your single leg balance and alignment. I think postnatal pilates is fantastic (I might be a bit biased!) as it works on all of these aspects.
- Want to get your heart rate up and get some muscle burn? No problem – there is still a lot you can do that isn’t running. Start with the lower impact exercises that are going to be more pelvic floor friendly – such as swimimng, hydrotherapy classes or riding a bike. You could also consider a modified gym class.
- Get your tummy muscle gap checked by a physiotherapist or suitably qualified personal trainer. If it is wide or deep, then get a specific training regime to work on your abdominal muscle strength and coordination.
- When you think you are ready to start, then commence a walk-jog-walk program (eg 5 min walk, 1 min jog, 5 min walk), slowly building up the interval of running and then the speed.
- LISTEN TO YOUR BODY! I can’t emphasise this enough (hence the capitals). If you get pain, heaviness in the perineum, symptoms of incontinence, or anything else that is unusual, then STOP straight away and follow up with your doctor or physiotherapist. You want to be exercising for the next 50+ years, so don’t push your body too hard, too soon.
What about netball, basketball, volleyball, boot camp etc etc?
Now I will freely admit that I am on the conservative side when it comes to returning to high impact exercise, but my clinical experience tells me that people do well when they have a structured return to sport rather than just “hey, you’re 12 weeks now – you are fine to just get back into normal activities.”
When I worked in a knee injury clinic in London, I treated so many people post ACL reconstruction. We never said to our clients “well, you’re 12 weeks post-op now – off you go!” – so why do we do that do postnatal women? Don’t they deserve better?
My preference is for all women to go through the following basic program prior to returning to sport:
- For the first 6 weeks – RECOVER from birth. Get to know your baby. Establish breast/bottle feeding. Get some rest. Do some pelvic floor exercises. Go for a walk. Get some rest (yes, I did say that twice). Eat well – nourish your body
- Do a little more walking. Have a check up with your doctor/physio. Start some strengthening exercises, focusing on pelvic floor, deep abdominals and major muscle groups of the body
- Start some balance and proprioceptive work. Progress the strength work – adding resistance. Make sure you can coordinate breath and pelvic floor.
- Add a little impact work when you feel ready (or when your physiotherapist clears you!). Slowly progress the speed and distance.
- Before going back into dynamic sports, train some agility work (eg go down to the park or court and do some zig-zags, hops, side steps, acceleration work etc). Try and make this specific to the intended sport. For example, for basketball you need to be able to run in one direction while looking in another. You need to be able to jump high, reaching up with one or both hands. You need to be able to accelerate and change direction quickly. You need to be able to move backwards and sideways. You need to be able to cope with some physical contact.
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