In 2019, I started reading books on a more frequent basis. I read a few books on running including “Born to Run” by Christopher McDougall. If you identify as a runner, you would love it. Talk about the ultra-marathon of a century! Who was your favorite character? Somehow I gravitated to barefoot Ted.
After reading this book and connecting with more mom runners in the community, I came across a common theme. We ALL just want to be able to run and run pain-free and know HOW to get back into running postpartum. We don’t want injury or anything else to get in the way of going for a run, especially pelvic floor symptoms. And, there is something about running that gives us mental clarity and freedom, even when it can feel difficult.
Are you recently postpartum and experiencing pain while running OR trying to figure out where to start when getting back to running?
With any sport or activity, there is a risk of injury or pain that can develop. Injuries are the most common reason for a person to stop running. As you read this, can you honestly say you never had any type of running injury before? Well, you are not alone, because injury incidence in runners is over 80%! Something to note, most of these injuries can be prevented with improvements in running programs and slower build-in mileage.
Postpartum runners make up a large portion of runners, and therefore exploring how you can continue to run or stay active during pregnancy will aid in your return to run postpartum, and understanding how to decrease your risk of pain when returning to running after a baby, is imperative.
5 Ways to maximize your return to running postpartum
Be Mindful of Healing Timelines
There are a few things to consider before you return to running postpartum. The first is that your body needs time to HEAL. You had a lot of changes occur to your body over the last 9 months to accommodate for your growing baby, and that is AMAZING! Your body and posture have changed and organs have shifted to make room for the growing baby. It can take months for your organs to go back into the correct position postpartum and that is NORMAL. It can also take months to even years for your core and pelvic floor to function optimally so they can absorb forces that go through your body when you are running. Unfortunately, we can not speed up the healing process, and now is your time to be kind to yourself and work on full-body strengthening, both double and single-leg, and improving core and pelvic floor function.
Consider Obtaining a Return to Run Readiness Screen
Current research suggests waiting until around 12 weeks postpartum to return to run. At the time, you can consider seeking a return to run screen from a postpartum (pelvic health) Physical Therapist. This screen will take you through a series of tests to assess your balance, strength, tolerance to impact, and posture. These tests will determine how your body is moving, how your strength is from right to left, and how you can tolerate the load demands that running places on your body. Doing too much too soon can increase your risk for prolapse, injury, or incontinence to name a few.
In a recent study published in August 2021 by Christopher, Cook, and Snodgrass (1), women who had an increased risk of injury during a run postpartum were found to:
- Had previous running injury
- Sleep less than 6.8 hours a night
- Had a vaginal delivery
- Showed symptoms of incontinence
- Or have less running experience (new to running in the last few months or a new runner)
Postural Control can be a game-changer!
Another study, by Provenzano, et al. suggests that postpartum runners have a more restricted pelvis and trunk motion with increased running gait stability, potentially as a protective response due to the changes that occur to your body during pregnancy (2). What this means is that your running mechanics and posture can change during your walks and runs postpartum due to certain muscles becoming more lengthened, others have become tighten to compensate during pregnancy. This can last for months to years if we do not rehab our bodies postpartum. You can do this by working on your core strength and rotation through your back to start. You can also be more proactive by being more aware of how you are standing and walking throughout the day. This can help you combat some of these changes.
Try this:
Think about keeping your ribs stacked over your pelvis. Check-in and be sure your ribs are not flared up towards the ceiling. Also, check that you are gripping your ribs down and in. In either of these positions, you should be able to breathe in and expand through your sides, back, and slightly into the belly. If you are unsure where your ribs like to rest, check it out in a mirror and find a neutral position, even if that means your shoulders are rounding forward some. We can work on that later! Next, check-in with your pelvis. Do you notice your pelvis tilting forward (anterior pelvic tilt) or your glutes gripping, pulling your pelvis underneath you (posterior pelvic tilt)? Find somewhere in between those positions and practice that first in standing and walking. Again a mirror can be helpful.
Check out the video below to learn more.
Sleep is Crucial
When we think about exercise, sometimes we miss the other factors we should take into consideration outside of the workout. How much are we fueling our bodies is one, as we need the adequate fuel to get through a difficult workout or run. How much sleep are we getting a night is a BIG one. As a new mom, sleep can be disturbed quite frequently, and sometimes this is just out of our control. Be mindful of how much sleep you are getting each night and try (your best) to recover when able. This is especially important on days you are working out. Sleep interruptions leading to fatigue are a predetermined factor in increasing the risk of pain or injury during return to running postpartum (1). Sleep is going to aid in recovery and getting at least 6.8 hours of sleep a night will help decrease your risk of injury.
Previous injuries may arise
If you had an injury or pain in the past, sometimes postpartum this pain can come back with a vengeance. The areas where my clients have the most discomfort are usually their lower back, pelvis, and upper back. This is due to ligament laxity, changes in the center of gravity (the point at which your body feels most centered), and hormonal changes to name a few. These injuries could resurface especially when you are doing an activity your body may not be ready for. Postural changes during pregnancy and into early postpartum, weakness that occurs due to stretching of muscles and tissues during pregnancy, and muscle imbalances to combat all the changes, is a recipe for injuries to arise. Not to fear, if you are proactive and work on restoring mobility in your spine, adding core and pelvic floor strengthening techniques, and you consult a Physical Therapist before you return to run, you are setting yourself up for success. You do not need to have pain to see physical therapist postpartum! There are so many things we can work on and help you with including a walk-run program to safely build mileage.
In conclusion, protective factors for return to run postpartum include the following:
- Waiting at least 12-weeks so your body can heal
- Obtain a return to run readiness screen by a physical therapist
- Work on postural control during and outside of your runs
- Make time to sleep when you are able, even if that means changing your schedule so you can get more Zs
- Previous injuries may arise, so being proactive with strengthening exercises and seeking help from a PT is KEY!
Following these 5 tips will help maximize your return to running postpartum. If you are still unsure schedule a discovery call with me so we can make a return to run plan that works for you!
Keep on running,
Dr. Juliana
Resources:
1) Christopher, Cook, & Snodgrass. What are the biopsychosocial risk factors associated with pain in postpartum runners? Development of a clinical decision tool. PLOS ONE. 2021.
2) Provenzano, Hafer, et al. Restriction in Pelvis and trunk motion in postpartum runners compared with pre-pregnancy. Journal of Women’s Health Physical Therapy. 2019.
