Are you ready to return to running?

Earlier this year, three physiotherapists collaborated together to make the first ever “returning to running post natal guidelines for medical, health and fitness professionals managing this population”.

Tom Goom, Emma Brockwell and Gràinne Donnelly all saw a huge void for guidance on postnatal exercise in particular return to running and they decided to tackle it head on.

These guidelines apply to ALL women who have had babies. This could be you recently as in weeks, months or even 2,5,10,20 years post pregnancy and birth.

Are you run ready?

The authors researched the literature and found that a lot of the studies performed lack clarity and focus on the specifics of returning to running.

Running is classed as high impact exercise as it raises intra-abdominal pressure (IAP) within our abdominal canisters. Our abdominal canister is not just our abdominal muscles, but also our pelvic floor (the bottom), diaphragm (the top) and the multifidus muscles of our back.

We also know that when you run, 1.6 to 2.5 times your bodyweight can occur as a ground reaction force which potentially transmits through the leg all the way up to the pelvic floor (this has not been proved/disapproved at this current time).

During any pregnancy, your body has carried and then delivered a baby which causes big impact, load and pressure changes to your pelvic floor muscles.

It is well known that post baby, many ladies will have some form of injury to their pelvic floor muscles regardless of the mode of delivery. This is due to many different factors for example the length of time the baby was in utero, the weight of the baby, the position the baby was in, etc.

If women have weak and injured pelvic floor muscles then it’s paramount that they receive an individual assessment that teaches them how to correctly perform a pelvic floor muscle contraction and relaxation.

It is commonly understood that urinary incontinence is a huge barrier to exercise for the post natal women.

The first recommendation from this study is:

“Postnatal women can benefit from individualised assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse, the management of urinary incontinence and for improved sexual dysfunction”.

If you would like to know where you can find your nearest women health physiotherapist take a look here via my website resources.

However, at this current time, not all women are getting adequate follow up pelvic floor checks in the UK. This is something the NHS Long Term Plan aims to address in the next 10 years.

The guidelines discuss both vagina and caesarean section modes of delivery in regards to returning to running.

So what should we be looking out for as signs of compromise to our post natal bodies when thinking about  returning to high impact exercise?

The key signs and symptoms of pelvic floor and/or abdominal wall dysfunction are defined as:

• Wee/poo incontinence
• Wee/poo urgency that is difficult to defer
• Heaviness/pressure/bulge/dragging in the pelvic area
• Painful sex
• Being unable to evacuate your bowels fully
• Pendular abdomen shape, separated abdominal muscles and/or reduced abdominal muscle strength and function
• Lower back and or pelvic pain

The second recommendation from this study is:

“Return to running is not advisable prior to three months postnatal or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running.”

This study also highlights several risk factors that may cause issue for ladies looking to return to running post birth.

These are:

• Less than three months post natal
• Pre-existing hypermobile conditions (e.g. Ehlers-Danlos)
• Breastfeeding
• Pre-existing pelvic floor or lumbopelvic dysfunction
• Psychological issues which may cause a post natal mummy to run to far or to hard for to long as a coping strategy
•  Obesity
• Caesarean section or perineal scarring (e.g. episiotomy or perineal tear)
• Relative Energy Deficiency in Sport (Red-S).

It is highly recommended throughout these guidelines that all ladies post natal should have the option to access a pelvic health physiotherapist for a thorough pelvic health assessment.

As a guideline they recommend a baseline pelvic floor muscle contraction programme in standing to be:

• x10 fast reps
• 8 – 12 reps of 6 – 8 second maximum squeeze holds
• 60 seconds sub maximal hold at 30 – 50% contraction.

The guidelines also recommend some further functional assessment tests which I have recently posted on my facebook and instagram accounts that you can access.

These include:

• Walking for 30 minutes
• Stand on one leg for 10 seconds, both sides
• Single leg squats x10 on both sides
• Jog on the spot for 1 min
• Forward bounds x10
• Hop on the spot x10 both legs
• Single leg “running man” actions x10 on each side

They also recommend strength testing is performed for these exercises and a recommendation of x20 for each test on each leg.

• Single leg heel raises
• Single leg bridge
• Single leg sit to stand
• Side lying abduction (leg lifts and lowers)

It is identified that any weakness in these areas is not a barrier to returning to running but an area to target where work can be done.

The third evidence based recommendation is:

“The assessment of pelvic health, load impact management, and strength testing described in this section is based on expert clinical consensus drawing from the best available evidence. No studies specific to the postnatal population have been carried out to evaluate readiness to return to exercise’.

The guidelines go on to discuss further additional factors that may contribute to a women’s return to running ability. These include weight, fitness, breathing, psychological status, diastasis recti abdominis, scar mobilisation, breastfeeding, sportswear and clothing, sleep, relate energy deficiency in sport (RED-S).

Due to all of the above variable you can see how every woman will have unique and different rehabilitative needs and goals. Therefore an individual assessment is paramount in order to avoid pelvic health injury now or in years to come.

Returning to running is encouraged with a gentle approach. Using “couch to 5km” programmes that encourage part walking, part jogging is highly recommended. The guidelines also discuss returning to running with a buggy.

Several infographics of the recommendations of the guidelines have been produced since they were published in March 2019. The best ones being from the British Medical Journal of Sports Medicine.

If you would like to read the guidelines for yourself they are accessible here for EVERYONE to read.

Any questions please get in touch or you can freely e-mail the authors who have included their contact e-mails in the guidelines for you.

I hope these guidelines help to educate and inform all women and their health care or fitness professionals looking at returning to running at what ever age post baby they are.

Marie Fell is the founder of The Pilates Physio UK who now lives and works in Luxembourg. She is a qualified physiotherapist with over 12 years NHS experience in a wide array of specialisms and three years experience running her own business. Her passion lies in Posture, Pilates and the Pelvic floor! She is an enthusiastic pelvic health activist and uses her blog to highlight areas of pelvic health that are lacking to others.

She is passionate about improving post natal care for all ladies through education. Her mission is to empower, inspire and educate others to move freely and keep healthy and teaching Pilates with a clinicians hat on allows her the best of both worlds.