Guest blog written by Emma Jeffery, personal trainer and local mum.
So, you’re postpartum and now you’re looking to lace up those trainers and get running! Perhaps you're training for an upcoming event, or just want to get moving by hitting the pavement - either way, it’s now time to start thinking about your training and how to best support your body.
Maybe you are coming up to that six week check mark with your GP, or maybe you are a bit beyond that. Many of us see that check as clearance to return to exercise, but hold your trainers for just a second! This doesn’t mean you are ready to start hitting the road or the treadmill just yet!
Now by all means, I do not want to curb that enthusiasm, running is one of the most popular sports among my postnatal clients; it’s accessible, it’s freedom, it’s a fantastic stress-reliever, it gets those endorphins pumping, but! We must be mindful that running it is a single leg, dynamic, explosive exercise, which even at a moderate speed can create a ground reaction force of up to 2.5 times your body weight*. This means we need a focused, progressive training programme to which will help strengthen your entire chain, from the foot up, and is super respectful of your shock-absorber, the pelvic-floor.
So, with that in mind, here are my considerations in return to running:
A great place to start is to have a read the Return to Running Postnatal Guidelines. These were released in 2019 and were the first of their kind to be written on this subject. They provide a framework aimed at medical, health and fitness professionals to guide women back to running safely and effectively, but don’t let this stop you, I know my running clients have found them so useful.
At least a third of women experience stress urinary incontinence after childbirth and running is demanding on the body. So, if finances permit, I highly recommend seeing a pelvic health physiotherapist for a personalised assessment and work with a pelvic health physiotherapist and a postnatal personal trainer like me to provide a bespoke programme for you. You can find your nearest women’s health physiotherapist via the NHS Squeezy website.
It is advised that you do not return to running if you are experiencing any symptoms of pelvic health dysfunction. This is not an exhaustive list, but symptoms can include involuntarily leaking of wee, poo or wind, urgency in getting to the toilet, heaviness or dragging in your vaginal or anus, back pain, pain during sex and doming through your tummy’s mid-line. Please do seek advice from your GP or a pelvic health physiotherapist if you are. Pelvic health dysfunction is common, but it should not be considered a normal part of mum life. I want to encourage you that with the right guidance, the pelvic floor can be remodelled, just like any other muscle in our bodies. Padding up should not be considered a coping strategy for us. Pelvic floor dysfunction is treatable!
Are you at least 12 weeks postpartum? It is recommended that a low-impact exercise timeline is followed within the first three months of the postnatal period, and then a return to running between three to six months postnatal, at the earliest. Of course, this varies from one mum to the next and is dependent on your postnatal rehabilitation so far. As frustrating as can be, if you are beyond 12 weeks postpartum and you are yet to start a low-impact aerobic and strength building programme, the same timeline applies. My online programme is a great place to start.
Unfortunately, it’s also not as simple as reaching the three-month postnatal mark and off you go, we also need to make sure that you:
Are not suffering from any pelvic floor dysfunction.
Are able to able to connect with your pelvic floor and perform at least six pelvic floor squeezes (Kegels) for a hold of 8-10 seconds, perform 10 fast repetitions and that you can relax your pelvic floor.
Can hold tension in your core, evenly generate intra-abdominal pressure to stabilise your spine and hips without bearing down on your pelvic floor.
Have been carrying out suitable strength training up until this 12-week point.
The Return to Running Guidelines contain a Load and Impact Management Assessment. If you have met all of the criteria above, the next step is to see if you can manage each of the following free of pelvic floor symptoms:
Walking 30 minutes
Single leg balance 10 seconds
Single leg squat 10 repetitions each side
Jog on the spot 1 minute
Forward bounds 10 repetitions
Hop in place 10 repetitions each leg
Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10 repetitions each side
If you can do all of these movements for the specified length of time or reps, this is a great sign that you can start a graded return to running, such as Couch to 5K and your local Park Run can be a great location to start.
It’s also important for you to have the necessary dynamic strength and stability to help build endurance and reduce the risk of injury. The Return to Running Guidelines do provide the following tests, although I should highlight that if you cannot do these exercises for 20 repetitions on each leg, this isn’t a barrier to running, but will help you identify where you may need to target your strength work.
Single leg calf raise
Single leg bridge
Single leg sit to stand
Side lying abduction
Demonstrations of all the above exercises can be found on the Return to Running Guidelines Postnatal YouTube Channel.
It’s also really important to look at the big rocks that help support of postnatal rehabilitation and well-being; such as getting sufficient sleep or rest (not always easy as a Mum!), are you well-hydrated, are your nutritional needs being met, how are you feeling generally, your stress levels and are you suffering from PND? All of these things will affect your energy levels and how consistent you are able to be in your training. Be gentle on yourself if things start to veer off-plan and adapt your training accordingly.
There are also considerations if you are breastfeeding, how your scars may be healing and the mobilisation of them. Remember, running is a high impact activity which places stress on the body and whilst it can be a stress-reliever, it’s important to keep in mind the other stressors which may be affecting you right now as a Mum, so a holistic approach is so important.
About Emma Jeffery
Emma is a postnatal personal trainer who works with mums of children of all ages, not necessarily in that immediate postnatal period. Her emphasis is on the importance of taking your time, of listening to your body and knowing and accepting where you are right now; physically, mentally and energetically. Emma encourages all mums to take a graded return to movement, to shake off comparison and expectation, and to remember that rehabilitation looks different for everyone. You can work with her on a 1-2-1 basis at her beautiful studio in Hildenborough, Kent or through her online programme, The Postnatal Plan.
* Gottschall, J.S. and Kram, R. (2005) Ground reaction forces during downhill and uphill running. Journal of Biomechanics 38, 445-452.
Donnelly, G., Brockwell, E and Goom, T., Returning to running postnatal: Guidelines for medical, health and fitness professionals managing this population’ (2019). Retrieved from https://absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf (accessed September 2022).