Criteria for Return to Running Postpartum — It’s Not Just a Matter of Time

You may have heard that it is okay to return to running at six weeks post-partum, but there is nothing magical about the number six.  Period. Believing that you should not run at five weeks and six days postpartum, but you can run following your six-week postpartum check-up, is a common misunderstanding that needs to be de-bunked.  Just because the doctor may “clear” you to return to exercise does not mean that you should immediately hit the trails again. Continue reading if you want to learn what is actually even more important than time-based healing, when you consider when it might be time to return to running.

Today’s topic provides examples of tests and measures that must be met, in addition to specific signs and symptoms to be aware of, in order to keep your body healthy. By meeting these guidelines, you are more likely to be successful at achieving a safe and effective return to physical activity in the postpartum period.

A recent research study from the University of Michigan reveals that there are specific changes in running biomechanics between pre- and post-partum runners. The study found that there is a significant decrease in pelvis and trunk rotation from pre-pregnancy to postpartum. Additionally, the running cadence decreased and stance time and step width increased postpartum, as compared to baseline. The lay person translation: new moms are running at a slower pace, with a wider gait, and spending more time in stance phase than flight phase. Why? Because our postpartum bodies are different. These modifications all promote gait stability to compensate for inherent weaknesses that are likely correlated to  pregnancy, labor, and delivery.

 Although this research is simply a pilot study, they conclude a very powerful statement:

“Our results suggest that pelvis and trunk motion does not resolve to pre-pregnancy patterns by the time physicians often clear women to return to running.”

Now, it’d be erroneous for me to say that time doesn’t matter at all. Yes, in fact, the body does need to endure an adequate healing period. There is time-based criteria that needs to be met such as uterine scar development following a caesarean section, or regaining abdominal tensile strength, and closure of the widened levator hiatus area following a vaginal delivery. Nevertheless, when considering returning to running, time is simply not enough.

It is more important as to what you do to facilitate healing during that time that matters the most. 

Expert opinion reveals that activation and movement prep exercise as soon as one week status post a vaginal delivery and two weeks after a caesarean section is beneficial in “waking” the muscles back up so you can move and function properly.

For example, this could be as simple as re-learning to breathe. During pregnancy, the baby tends to take over primary real estate when it comes to breathing effectively. A mother’s body changes in numerous ways, but the rib cage being pushed up, abdominal wall being stretched, and posture being altered with a bigger anterior center of gravity are just a few examples of changes that could affect how you can breathe. Many women become upper chest breathers during this time, and without mindful practice, this pattern often sticks. Relearning to breathe, with a 360 degree breathing pattern, is the first step in recovery to return to running post-partum. 

Next, consider core activation. Oftentimes, core stability and motor control are lacking, and we need to reconnect the dots by activating your deep abdominal muscles, primarily the transversus abdominis.

1112 Muscles of the Abdomen Anterolateral

Are you able to roll from your back to your stomach using your arms and abs only as leading movement expert in physical therapy, Gray Cook, suggests?  If not, you haven’t regained functional control of the abdominal wall and will have difficulty managing intra-abdominal pressure and load transfer. This is detrimental as it could result in overloading of the pelvic floor. Try this: Start on your back and roll over by leading with your eyes and your head followed by your arms, upper back, hips and lastly, your legs, BUT keep your legs motionless. See video.

Finally, gluteal strength must be mentioned. The gluteus medius muscle, specifically, is a major muscle that promotes pelvic stability. Try this: Can you stand on one leg and keep your pelvis level? Look in the mirror. Are your shoulders level? Knee slightly bent but knee-cap still facing forward? Belt line on your pants straight across? Good. Now can you maintain this posture while you move the opposite leg out to the side or up towards your elbow. For an added stability challenge, raise onto your tip toes and let go of holding on to any supports.

Video: Single Leg Stance Dynamic Balance

The evidence base for return to running in the postnatal period is limited. However, in March of 2019, the first ever UK guideline was released: “Returning to running postnatal  – guidelines for medical, health and fitness professionals managing this population” (Goom, Donnelly & Brockwell 2019). 

Of course, they recommend best practice is to see a pelvic floor PT who can: assess digital vaginal manual muscle testing with the goal of 3/5 on the Laycock scale, use video analysis to assess running gait to evaluate for signs of failed lumbopelvic or abdominal load transfer, and screen for a diastasis rectus abdominis.

However, there are some things that you can do at home on your own too. In their expert opinion, they recommend the following screens to determine how you line up when considering return to running:

Load and impact management assessment:

-walk 30 min

-single leg stance for 10 seconds

-single leg squat x 10/side

-jog in place 1 min

-forward bounds x 10 reps

-single leg hop in place x 10 /leg

-single leg “running man”: opposite arm and hip flexion/extension x 10/side with no loss of balance

Strength testing: Aim for 20 reps of each on each leg.

-single leg calf raise

-single leg bridge

-single leg sit to stand

-side lying hip abduction

Are you able to do all of these things without any of the dreaded “P’s” during or after exercise? These subjective reports could be a sign of pelvic floor dysfunction.

The P’s that potentially present as pelvic floor dysfunction:

-Pelvic pain

-Peeing (urinary or fecal incontinence)

-Pressure or heaviness in the vagina because of a pelvic organ prolapse

-Persistent vaginal bleeding, not related to your menstrual cycle

If you are experiencing any of these “4 P’s” or aren’t able to effectively complete all of the criteria of the load and impact management screen and strength testing, additional strengthening prior to return to running is encouraged.

Begin with static body weight exercises. Try this sideplank progression gradually working up to performing the last position in the video. Hold each position for 10 seconds.

Video: Static Sideplank Progression

Next, progress to dynamic body weight work. Try this sideplank and frontplank variation. Perform each movement for 10 repetitions per side.

Video: Dynamic Sideplank and Frontplank Variation

For a more personalized exercise approach, seek out the help from a physical therapist trained in women’s health and treating the pelvic floor. Ultimately, you need to consider time-based healing criteria, specific signs and symptoms, and a variety of tests and measures to determine if you are ready to return to running. If you can honestly answer yes, or meet all of these recommendations, then lace up your shoes and gradually hit the running trails with a graded progression to return to running.

You deserve to move better. When you move better, you will mom better. And six (weeks) isn’t the magic number. 

4 thoughts on “Criteria for Return to Running Postpartum — It’s Not Just a Matter of Time”

  1. I am not a “runner” but I am sure I’m no exception when I say that my 6-week postpartum check-up did not involve any sort of assessment for return to physical activity OR instruction on how to return safely. Makes me wonder if it really would do newly postpartum women good to be working with a team of professionals to cover all bases…including PT as well as a mental health professional…maybe someday that will be the structure of routine care with all professionals in the same place at the same time (versus referrals here and there) to give new moms a complete 6-week exam.

    1. I agree. It should be the standard of care. Love your idea of a “team of professionals” to cover all bases. That’s truly what it would take to give mommas not only what they need, but what they deserve!

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