Running is, in some ways, the perfect exercise to return to after having a baby.
You don’t need to travel to a gym or studio – simply head out your front door and get straight into it. Efficient, effective, it can be done with your baby in the pram, and it allows you to get out in the fresh air.
However, the mistake that many women make is not considering the ‘prehab’ that needs to be done before running. Because unlike other commonly chosen forms of postnatal exercise, such as yoga, pilates or aqua aerobics, running is an impact exercise and involves much higher ground reaction forces than it’s low impact counterparts. And if not properly prepared for, this can lead to issues with your pelvic organ support, your bladder control, your joints etc, and inadequate preparation could end up bringing your return to exercise to an abrupt halt.
Keep in mind that you’ve had up to nine months of modifying exercise during your pregnancy (and sometimes in the lead up to pregnancy too!). Any other athlete going back into chosen sport after an injury or time off would need a rehab program, and you do too.
So how do you get back into running after having a baby the right way?
If you ask health and fitness professionals whether you are ready for running after having a baby, there will be a spectrum of answers and opinions. This ranges from the very conservative approaches of not doing any high impact exercise in the first year as a blanket rule, to the blase comments sometimes given at postnatal check ups – “yes, you’re six weeks postnatal now and medically well, you should be fine to return to running”.
So how do you know whether you are ready for running? How do you make sure that you’re empowered to understand your personal risk profile for injuries, and how to properly prepare yourself before running to minimise the chances that you’ll develop any issues?
The good news is, that we have some really great international return to running guidelines to refer to which give health and fitness professionals, and new Mums, a plan of attack with regards to restarting running (or starting for the first time!).
Here are 5 steps that all women should know about when running after having a baby.
1. Get Your Pelvic Floor ‘Running Ready’
Is your pelvic floor in tip-top function for running?
Can you do 10 quick pelvic floor contractions in a row? Can you hold 6-8 seconds maximal hold up to about 8-10 times in a row without fatiguing? Can you hold at 50% of your maximum hold, for up to a minute? These are things that are tested by a Women’s Health Physiotherapist with a vaginal exam, who will then put in place a pelvic floor exercise program for you that focuses on your areas of weakness. These individualised programs are really well supported by evidence in the literature, and having a strong, well functioning pelvic floor before returning to running will mean that issues like bladder leakage and vaginal prolapse are less likely to occur.
Women’s Health Physiotherapists will also look at your ‘risk profile’ for how likely it is that you may develop a prolapse or incontinence in the future. They will test how much your pelvic floor is able to move and distend under load, and how well supported your pelvic organs (bladder, uterus and bowel) are at this early stage after birth.
It’s also important to know if you have any current symptoms of pelvic floor dysfunction, like incontinence of wee, poo or wind. Because if you do, it is recommended that these need to be addressed before starting to run.
And lastly – what kind of birth have you had, and do you have any birth injuries?
Vaginal birth injuries are more common than you might think, and are often asymptomatic and silent. Injuries to the muscles and connective tissue are more likely to have occurred with certain factors. For example, was your baby more than 4kg? Did you push for more than 1.5-2 hours? Were forceps used to help the baby out?
Specialist physiotherapists doing vaginal examinations can test for these types of injuries. If it’s found that you do have an injury of some sort, you might need some extra support from health care providers in your return to running.
2. Get Your Legs Running Ready
Let’s not fall into the trap of thinking that after having a baby, the only muscle group that needs rehabilitating is the pelvic floor – there are some specific muscle groups in our legs that have to manage the impact and load associated with running.
If these have been deconditioned with a break from running, or if you’re new to running, then to prevent injuries like muscle strains, tendinopathies and stress fractures, a good leg strength and agility program needs to be put in place.
The main muscle groups that are likely to need some exercising are your calves, quads, glutes and hamstrings.
Like with the pelvic floor, it’s good to know where your baseline is for these muscle groups and then focus your workout accordingly. A physiotherapist can definitely help you with muscle assessment, but also you can get an idea with the following recommendations from the Postnatal Return To Running Guidelines:
Can you do the following without pain, heaviness, dragging or incontinence?
- Walking 30 minutes
- Single leg balance 10 sec
- Single leg squat 10 reps
- Jog on spot 1 minute
- Forward bounds 10 reps
- Hop on spot 10 reps
- Single leg ‘running man’ 10 reps
Can you do 20 reps of each of the following leg strength exercises?
- Single leg calf raise
- Single leg bridge
- Single leg sit to stand
- Side lying abduction
3. Get Your Core and Trunk Running Ready
You may be surprised at how necessary it is to have good shoulder, trunk and core function when you’re running.
We have already talked about the importance of good leg strength and function in the muscles that attach to the bottom of the pelvis, and how important they are for stability in runners.
But what about the muscles that attach to the top of the pelvis? What about the connective tissue in the midline of our trunk (linea alba), which is put on stretch in late pregnancy and has to separate to allow the baby to grow (Known as Rectus Abdominis Diastasis, or Diastasis Recti)?
Abdominal muscles, abdominal connective tissue like the linea alba, and muscles that attach from the trunk to the arms – these aspects of our overall stability and function are essential in transferring load through the trunk. Additionally, we need good mobility and rotation through our trunk when we run too.
Any issue with this load transfer and mobility is likely to lead to secondary issues in the muscles and joints of the pelvis, lower back, hips, knees and ankles.
So – can you transfer load through your trunk?
Attach an exercise band to a door frame or similar, hold it in both hands with arms outstretched with straight elbows, at shoulder height.
Can you do the following without good control, and without any pain or abdominal ‘doming’?
- Side steps – step out 1-2 steps and back
- Chest presses – pushing the band out and in
- Rotations – rotate away from the band and back
It’s advised not to overdo the load that is added (and running is a very big load!) onto a system that isn’t as stable as it could be. Have a read of our blog about Abdominal Muscle Separation to learn more about Diastasis Recti, and for video explanation of the above exercises, plus more specific workouts for the core and trunk, see out FitRight Mums Members Only group on Facebook.
4. Get a good ‘return to running program’ put in place
Establish where you’re at with your ‘run tolerance’ – go for a run and test how far you can go before your symptoms kick in. This might be leaking urine, or vaginal heaviness, or knee pain.
Then you can choose a return to running program that suits you, such as the NHS ‘Couch To 5K’ program.
Keep in mind that a program needs to be chosen that is suitable and appropriate for your previous running experience and how much preparation you have done since your baby was born.
Also be prepared that as new mothers, we might need to stay at a certain week in these programs for longer than usual, because of factors to do with new motherhood – especially fatigue.
Research has shown that you are 50% more likely to be injured if you haven’t had more than 7 hours sleep more than 3 nights in a row – and we know that this is not likely to have happened in the early months with a new baby!
So, find a program that suits you, go through it as the program recommends, but remember – be kind to yourself and understand the extra mental and physical load that you may be under, compared to someone doing the same program who is not in early motherhood.
5. Make sure your baby and your pram are ready
This is an aspect of returning to running that you may not have considered – you might get the all clear to go running at 3 months postnatally, but you need to check the pram manufacturer’s guidelines to see when they advise that your baby is safe for the impact and movements involved with travelling in a running pram.
These guidelines usually stipulate that a baby should be 6-9 months old to go in a running pram. This seems to be decided with regards to the age when a baby has good enough head and trunk control to be independently left in a sitting position, and is based around the safety for their spine and brain with the potential extra impact. .
The safety checklist for prams that are suitable for running is as follows:
- 5 point harness
- Fixed front wheel
- Hand operated brakes
- Rear wheel suspension
- Pneumatic tyres
- 3 wheels
- Wrist strap
Also to note – It is recommended, for the mother’s benefit, to go running initially without the extra load and altered biomechanics of pushing a pram (if possible!). This should allow the Mum to focus on her breathing and technique without the extra load of the pram and the awkward biomechanics of having her arm or arms held out while running.
So there you go! Five steps to know about before returning to running after having a baby.
And remember – if you would like an individual assessment of the movements and exercises described above, it is highly recommended to make an appointment with a physiotherapist. We have a list on our website of those around Perth who are particularly good with pre/postnatal health and pelvic floor health.