Almost every new mother runner has two things in common: 1. They are tired. 2. BUT, they aren’t too tired to want to run ASAP. But running postpartum requires a bit more than finding the will and the way. (Usually, that’s the hardest part for starting a running habit, right?). No, it requires ensuring your body is READY when your head is. Jump in too quickly and we could get seriously hurt — not ideal when we’re trying to care for a tiny human.
I remember wanting to run a couple of days after I got home from the hospital. Like many new moms, I wanted to feel like my old self again. I wanted that time to myself. I wanted to be outdoors and feel free! And, sure, like many new moms, I wanted to lose the baby weight and LOOK like my old self again, too.
And, I wish I could tell you I was responsible…that I saw a pelvic floor specialist, diligently strengthened my floor and deep core, and walked for weeks before starting to run again.
No, I did not do that. Why not? Because no one told me to. After I got the all-clear from my doctor about one month postpartum, I started running again.
Thankfully, medical professionals are now filling in the gap around postpartum health. Physical therapists worldwide are clamoring to be heard loud and clear that women are returning to running postpartum TOO SOON and it is creating a host of issues related to pelvic floor health and running injuries. They want more information available about our floor and core, and a better rehab plan standardized so that we can return to running postpartum safely.
So, How soon after giving birth can you run?
You’ll hear a lot of different answers to this question. Some will say, you can run after giving birth as long as you are no longer bleeding. Some will say you can run after giving birth 3 weeks postpartum. The typical timeline is 6 weeks postpartum as long as you are feeling fine.
But, many professionals advise doubling that number. A 2019 study by famed UK physiotherapist Tom Goom (who has incredible information for runners), and colleagues Grainne Donnelly, and Emma Brockwell, strongly suggests women wait 12 weeks before resuming running. (Walking and other lower-impact impact activities are encouraged!).
Why the new timeline? Well, the truth is, many of us are mentally ready to run before our bodies are. Some may be ready before that 12-week mark but it’s important to be screened for readiness. The researchers explain what happens biologically that needs to reverse before we hit the pavement or trails:
“The levator hiatus widens during pregnancy and increases significantly during vaginal birth. Recovery time for the tissues is understood to be between 4-6 months, well beyond the traditional concept of full recovery by the 6-week postnatal check,” states the study. “If we consider cesarean section deliveries, we understand that abdominal fascia has only regained just over 50% of original tensile strength by 6-weeks post abdominal surgery and 73%-93% of original tensile strength by 6-7 months.”
The researchers note that pelvic health physiotherapists around the world are passionate about raising awareness of the extended recovery period that is actually needed. Indeed, soft tissue is only about 75% healed at 6 weeks.
“Often for litigation purposes, the 6-week milestone is one that serves as a tick box confirming readiness and suitability to return to an exercise class, sporting activity, or elite training. The healing process, however, extends well beyond this, and it is essential that the narrative on this subject changes and adapts to better serve our sporting women.”
So, how do you get back into running postpartum?
Here’s your step-by-step guide to start running postpartum.
Step 1: See a pelvic floor specialist
First thing’s first, you need to figure out if your body is ready to start running postpartum.
Dr. Carrie Pagliano, a physical therapist and pelvic floor specialist, just released a free at-home 10 step screen based on the new UK guidelines that help assess whether you’re ready to return to running. The exercise test can help you pinpoint trouble spots to work on so that you’re using your time most productively.
Some warning signs that you may have pelvic floor dysfunction include if you:
- leak when running or sneezing, coughing, or jumping (which is common among 15-30% of first-time moms)
- have pressure in the pelvic area
- have low back pain or lumbar pelvic pain,
- or have pain during intercourse.
Even if you don’t have these issues, it’s important to see a pelvic floor specialist for hidden or underlying issues.
“How much you ran during pregnancy or how you delivered does not necessarily dictate your postpartum pelvic floor health,” shares Dr. Carrie, who has helped hundreds of moms with postpartum rehabilitation. “I actually worry more about those that don’t have early symptoms. They push too early and end up falling backward fast sometimes…It’s harder physically because they didn’t take the time to build a foundation and mentally because they feel like the rug was pulled out from under them.”
A pelvic floor specialist can also examine for diastasis recti, a separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Diastasis recti is very common postpartum because the uterus stretches the muscles of your stomach as your baby grows.
A specialist like Dr. Carrie is available for further guidance virtually or you can seek a local pelvic floor specialist.
Related: A practical guide to stop leaking
Step 2: Strengthen your core & pelvic floor
A pelvic floor specialist will give you exercises to address issues and restrengthen your core and floor postpartum.
“The muscles, ligaments, and tendons stretch out a bit during pregnancy,” explains Celeste Goodson, founder of ReCORE Fitness, who has helped practically every elite mother runner return to running postpartum. “There are a lot of factors that contribute to this, including hormone levels, genetics, how much room the baby has, how big the baby is, carrying multiples, etc. This makes the muscles lose neural connection and strength.”
Doing a program like ReCORE or tapping into the ReCORE YouTube program will help you strengthen that core. Specifically, look at videos that teach inner core basics (like the Ab Sets) and how to engage the core and pelvic floor. Moves like bird dogs, planks, side planks, bicycles, split tabletop, and bridges are sample exercises to work that core. A pelvic floor specialist or a program like ReCORE will also teach you good breathing mechanics, core control (not letting the belly bulge during an exercise), and rotational resistance exercises. These are excellent strengths to enhance your running and prevent injury. Additionally, a specialist or therapist will be able to release tired muscles readying them for strength work, instead of having them to over-fatigue instead of getting stronger.
Additionally, Jen Le Coguic, a pelvic floor specialist, recommends doing about 30-50 Kegels per day, doing a combination of short contractions (2 seconds) and long (10 seconds) to strengthen that floor. This can be done at any time, while playing with your baby, sitting in the car, or in a meeting.
For extra credit, you can perform “yoga toe” workouts, says Jamie Ligon, a pregnancy and postpartum corrective exercise specialist to strengthen your feet. “The reason feet ‘grow’ during pregnancy is due to ligament laxity and weight gain which leads to weak arches. Performing ‘yoga toes’ is an easy activity to incorporate into a daily routine. I do mine when I’m blow-drying my hair.”
Step 3: Assess your alignment
Many pregnant women have an anterior pelvic tilt which is when your pelvis is tipped forward and downward.
Lauren Levko, physical therapist and founder of PhysioLab PT, says this is common because during and after pregnancy the core stabilizers, primarily the transverse abdominus, are weakened and the pelvis has more laxity due to hormonal changes allowing for a forward tip of the pelvis and a C shape of the spine.
This can lead to increased risk of a hamstring strain, hip flexor tendinopathy, gluteal tendinopathy, and could exacerbate diastasis recti if present. You can tell if you have an anterior pelvic tilt if you have a protruding lower abdomen and tight back and hamstrings. Your pelvic floor specialist can also assess for this and give you exercises you can do at home.
- stretching hip flexors
- performing deep core stabilizing movements
- performing diaphragmatic breathing exercises,
- strengthening the external and internal rotators of your hips, and
- performing eccentric loading hamstring exercises.
Once again, all these exercises are important for runners to perform anyway.
Step 4: Work on your breath
With your body properly aligned with your ribs over your glutes, it’s time to work on diaphragmatic breathing. (You feel your breath coming from your ribs as opposed to your tummy). This type of breathing aids in running while strengthening and healing your inner core and pelvic floor.
“Breathing is the secret sauce to energy efficiency,” explains Melanie Connell is the owner of Remedy Physical Therapy & Wellness. “You can learn simple breathing techniques like diaphragmatic breathing to regulate your breath during a run as well as downregulate your body during recovery.”
Diaphragmatic breathing strengthens the diaphragm, thereby decreasing oxygen demand, slowing your breath, and using less effort and energy to breathe. Melanie adds that with breathing “when you breathe well during running, you can trust that your pelvic floor will work alongside the breath pattern. It happens automatically but where some people make mistakes is when they try to kegel and tense up when they run.”
Here’s how to do diaphragmatic breathing:
- Lie on your back on a flat surface or in bed, with your knees bent and your head supported. You can use a pillow under your knees to support your legs. Place one hand on your upper chest and the other just below your rib cage.
- Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.
- Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible.
- Do this exercise 5-10 minutes about 3-4 times per day.
Related: How to breathe when you run
Step 5: Walk before running
Practically every running coach, pelvic floor specialist, and physical therapist agree that before you run you better WALK.
Step 6: Resume running & pace yourself
Running coach Bobby Holcombe advises to gradually increase mileage, pace, terrain, and the number of days you run gradually. Generally, you should aim to introduce a new variable or increase the distance every 2-3 weeks to allow for the soft tissue to become stronger from the new stimulus. You can increase distance 10-30% every 3 weeks, just as you would when rehabbing a running injury. And just as you would with physical therapy for an injury, as you return to running after having a baby, it is incredibly wise to continue your pelvic floor and core exercises. (Reminder: The Mother Runners offers coaching specifically for mother runners, including NEW mother runners).
Related: How the Pros Return to Running
Throughout this process you should:
Listen to your body
If something feels really uncomfortable, don’t force it. Back off for a couple of days and try to ease back in again. If something’s really hurting, talk to your doctor.
Eat & drink wisely
Up your iron. What’s the biggest mistake new moms make? They cut back calories while simultaneously upping mileage—that’s a recipe for injury, says nutritionist Betsy Johnson. In order to be healthy and energized, new moms need to focus on eating the right foods, like those containing iron. In fact, one in five women is iron deficient. Focus on eating iron-rich foods like meats, fish, leafy greens, and chocolate.
Drink that milk. Be sure to get enough calcium—especially those of you who’re breastfeeding which requires extra calcium intake. The National Academy of Sciences recommends that women who breastfeeding consume 1,000 milligrams of calcium each day. Ask your doctor if it’s a good idea to take a calcium supplement. Consider continuing to take your prenatal vitamins as well if you are still nursing.
Shake up that protein. Breastfeeding moms also need to make sure they’re getting enough protein. After growing a baby for 9 months and then supplying it with protein-rich breast milk, it’s necessary to replenish your own. Aim for five to seven servings of quality protein every day.
Stay hydrated. You need to stay hydrated but don’t gorge yourself on water. Drink what you would normally drink if not breastfeeding (which should be about 1/2 to 3/4 of an ounce of water per pound that you weigh –so 65 ounces for a 130-pound woman) and then more to thirst after that.
Related: The Best Foods to Eat Postpartum
Get the right running gear
Support your middle. ReCORE’s Post-Natal FITSplint supports your abdominal muscles without restricting movement or breathing. It keeps you from getting injured and allows you to safely work on strengthening stretched out muscles.
Make sure the shoe fits. Ensure your running shoes fit your post-partum feet which may have enlarged post-pregnancy. If your shoes still fit, ensure your shoes don’t have too many miles on them and provide plenty of support. If the soles are worn around the sides and on the treads, it’s time to get new ones.
Get the right bra. Chances are your prepartum sports bra isn’t going to fit your postpartum chest. You need more support and room. Popular running bras with “mother runners” are the Motherhood Maternity racerback nursing bra and the Lululemon’s Enlite bra for their support and comfort.
If you’re nursing, be sure to nurse or pump before you head out the door to be more comfortable and bide more time being away from your baby. Also, don’t stay in your sports bra. It could lead to blockage or worse, warns The Mother Runners Head Coach Laura Norris: “The compression of sports bras can block milk ducts which can lead to mastitis,” she explains. “Only wear sports bras to run in. Change in and out of them quickly to avoid blockage.”
Sleep as much as possible!
Make sure you get as much sleep as you can. Your body and mind are working overtime. Sleep experts recommend an extra minute of sleep per weekly mileage. So, if you run 20 miles a week, you need an extra 20 minutes a night to repair from the stress of running. Throw in caring and feeding a baby, and that number goes up. If you have an opportunity to rest, take it. It will help your body recover much faster!
I know many of us are itching to get back to running as fast as possible but patience will pay off! And, thankfully there are plenty of resources out there for you to rehab at home while spending time with your new love.
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PS-I’d love to help you reach your running goals whether it be to run your first 5k or run competitively! Email me at firstname.lastname@example.org with questions or check out my Coaching Services page!