One of the most common questions from postpartum mothers is “When can I safely return to running?” or “When can I start HIIT workouts again?”. The short answer is...it depends. When beginning running or higher intensity exercise postpartum there are many factors to consider and the timeline will vary for every individual.
The Factors Affecting Your Abilities
Your prenatal fitness level, postural changes during pregnancy, the mode of delivery, the size of your baby, and whether or not there was tearing or an episiotomy will all have an effect on your body’s recovery and what is required to rehabilitate postpartum. Other factors such as hormones, breastfeeding and sleep deprivation will also play a role in how quickly your body is able to recover. Pregnancy and childbirth, whether vaginal or by Cesarian section, have a significant impact on your body, core and pelvic floor, and this recovery takes time - more than just 6 weeks! Six weeks is the absolute minimum amount of time required for tissues to heal. In reality, recovery can take several months.
Why You Should Wait
During pregnancy the abdominal and pelvic floor muscles are stretched considerably as the baby grows. With a vaginal delivery, the pelvic floor muscles and nerves are stretched even more, and can be damaged, torn or cut. Following a Cesarian section birth the pelvic floor muscles remain intact, however there is disruption to the abdominal muscles and fascia from the incision. One study showed abdominal fascia does not regain more than half of its strength until 6-7 months postpartum (Ceydeli et al, 2005). Easing back into activity gradually is an important component to a successful recovery.
In 2019 a guideline for returning to running postpartum was released advising women to wait a minimum of 3 months after delivery to begin running. However, running should not be resumed or continue if any signs or symptoms of pelvic floor dysfunction are identified (Goom et al, 2019). The following signs and symptoms are not normal and can indicate pelvic floor dysfunction:
Any leaking of urine or feces
Urinary or fecal urgency (needing to rush to the washroom quickly)
Heaviness/pressure or a dragging sensation in the pelvic area (symptoms of pelvic organ prolapse)
Pain with intercourse
Lower back, abdominal or pelvic pain
Bulging or doming of the abdominal wall or decreased abdominal strength/function
Experiencing any or all of these symptoms may be a sign of pelvic floor muscle dysfunction and it is important to modify, taper or cease the activity until they can be properly evaluated.
The strength, speed and timing of your pelvic floor muscles contracting is an essential component to success in all levels of physical activity, but particularly in higher impact exercise. The pelvic floor muscles work to support the pelvic organs and provide continence during heavy loads and at higher impacts (Leitner et al 2016). Pelvic floor muscle strength, endurance and coordination should be assessed by a qualified Pelvic Floor Physiotherapist who can then provide insight and feedback about the strength and preparedness of these muscles for running or high load activities.
Physiotherapy Can Help
Your Physiotherapist can also assess for the presence of a diastasis recti, which is when the fascia that runs down the midline of your abdomen is overstretched, causing a separation of the abdominal wall. A diastasis recti may impact your ability to effectively manage intra-abdominal pressure and transfer load when you are lifting, running or exercising. Signs of failed load transfer or abdominal weakness are doming or sinking along the midline of your abdomen. Although more research is needed, the consensus among experts is that regaining functional strength and control of the abdominal wall is likely beneficial for preventing injury and pelvic floor dysfunction prior to returning to running (Goom et all, 2019).
In summary, there are many factors contributing to readiness to run and exact timing is best determined in a consultation with a Pelvic Floor Physiotherapist. Together, you and your Physiotherapist will be able to ascertain your current needs and develop a tailored program to work towards your goals.
Sarah Wattam, Registered Physiotherapist Pelvic Health & Mechanical Diagnosis and Therapy Certified
April Gillies, Registered Physiotherapist Pelvic Health
Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, 220–5.
Goom, T., Donnelly, G., Brockwell, E. (2019) Returning to running postnatal –guidelines for medical, health and fitness professionals managing this population. The Association of Chartered Physiotherapists in Sports and Exercise Medicine.
Leitner, M., Moser, H., Eichelberger, P., Kuhn, A. and Radlinger, L. (2016) Evaluation of pelvic floor muscle activity during running in continence and incontinence women: An exploratory study. Neurourol Urodynam 9999, 1–7.