No-one would contest the statement that being pregnant and giving birth is probably one of the most life-changing experiences you can have. Of course, there is this tiny human being you have brought into the world. He or she will turn your whole life upside down. But it also comes with major physical changes and challenges.
Those changes are obvious while you are carrying this big bump around, but the don’t dissolve once you have given birth. In fact, I’d almost say the majority of physical challenges started after birth for me. As a runner, it has been on my mind throughout pregnancy how to keep fit and how to return to running after birth. And for me, that means returning to running safely without risking long-term injury.
Below, I will summarise what I have learnt.
Factors To Consider
As a scientist, I’m always looking to base my decisions on facts. That might sound trivial, but I want to see solid evidence rather than reading an anecdote-based article on some website. Just because something worked for one person, doesn’t mean it’ll work for others. So, for my planned return to running post partum, I started to dig my way through the available literature and evidence.
I was surprised to find that there is a rather small amount of studies or evidence on the topic. There are even fewer guidelines for women wanting to return to running after giving birth. In fact, the first set of guidelines for the UK was published in March 2019. Considering that running has been a popular sport for men and women alike for decades, this comes as a surprise and was long overdue.
It is no secret that the pelvic region is heavily impacted by pregnancy and delivery. After birth, this can for example lead to urinary or faecal incontinence, or pelvic organ prolapses. There is a high level of evidence that pelvic floor rehalbilitation can help with these issues. However, recovery time for tissues is between 4-6 months. This is way longer than the 6 week until the postnatal check-up, when women are usually discharged as “recovered” and cleared for exercise.
With this background, the authors of the mentioned guidelines recommend a comprehensive assessment by a pelvic health physiotherapist before resuming a high-impact sport like running.
Chances are that over the course of pregnancy and the early postnatal period, a pregnant women won’t be able to keep up her pre-pregnancy routine. As a result, she will inevitably loose some of her fitness. Before returning to running, it is important to do safe fitness work in the early postnatal period. This can for example be a slow progression of walking from short strolls to longer power-walks, adding cycling and gentle strength work or swimming.
Sleep is key for recovery and unfortunately mostly restricted when you have a newborn at home. Scientific studies have shown that a lack of sleep makes athletes more injury-prone, increases their stress levels and also lowers their general health. Hence, it is important to try and do daytime naps to increase sleep and maximise sleep quality in order to promote sufficient recovery.
Separation Of Abdominal Muscles
Diasis Rectus Abdominis occurs in pregnancy fairly frequently. It describes the separation of the outer most abdominal muscles. Basically, if you had a sixpack before pregnancy, it would be split down the middle now. This can decrease trunk stability and mobility. As a consequence, women might experience lower back pain, constipation or bloating. Running before having regained control of the abdominal wall can lead to increased strain of the pelvic floor as compensation.
Thus, working on the rehabilitation of the abdominal muscles is necessary before considering a return to running. Especially in trail running, a strong core is necessary to cope with the constantly changing stride pattern on uneven or steep ground.
Relative Energy Deficiency in Sport
Relative Energy Deficiency in Sport, also known as RED-S, describes the impairment of various body functions due to lack of energy replacement after exercise. Women may be prone to this condition after birth as their lifestyle changes. Demands of breastfeeding, lack of routine, sleep deprivation and changed dietary habits all contribute to RED-S. In addition, new mothers face pressure (imposed by society or themselves) to return to their prenatal fitness and bodies as soon as possible.
The consequences of RED-S can be severe: Impaired metabolic health, reduced bone density, compromised immune function, misregulated menstrual periods and infertility are just a few examples.
So When Can I Start Running Again?
The authors of the new guidelines for returning to running post partum recommend to wait at least three months before starting again. They recommend assessment by a pelvic health specialist to design a personalised fitness regime. The aim is to slowly rebuild fitness before being cleared for high-impact exercise. A gentle “Couch to 5k” programme would be adequate to resume running.
As with any return to running after a significant time off, it is important to increase volume and intensity gradually and eliminate risk factors for injury as they arise. Doing too much too soon can lead to all sorts of injuries that runners dread, like IT band issues.
For me, that means being annoyingly conservative with my fitness regime. I wish I could just lace up my trainers and head out for a run, but I have little interest in long-term damage to my pelvic health. Instead, I am going on regular walks and have started a very gentle strenght work routine as well as some indoor cycling. Before actually running again, a visit to a pelvic health physio seems like a good idea. And then hopefully, when my daughter is 3 months old, I can start to jog along the river outside our house again.
In a way, pregnancy and childbirth should be treated like other injuries that force athletes into extended breaks from their sport. Ensuring physical recovery and rehabilitation, especially of the pelvic floor, before recommencing running is key. This will take around 3-6 months. The authors of the new UK guidelines have summarised their recommendations in the graphic below. In any case, this strategy should be discussed individually with health professionals to tailor it according to the new mother’s needs.