Returning to Running Postpartum
The sport of running is amazing because it’s a way to stay active and fit while being cheap and convenient. When it comes to running postpartum, many want to return as soon as possible. But because running is a high impact sport, it is highly recommended to build a foundation of strength and control first before hitting pavement.
This blog post will highlight some of the training details that are important for postpartum runners to consider.
The 6-week clearance day
This is most often the timeline that one will be “cleared” by their medical provider to resume exercise again. However, it is incredibly rare for any OB-GYN to do any sort of movement screen or even provide education on symptoms to look out for. While your acute recovery from birth may be over, the 6 week mark really should be thought of as the starting line.
If you are feeling ready to start exercising, I always recommend starting with strength training first. If running is the goal, it would be particularly beneficial to focus on building lower body strength in the muscles needed for running like the quads, hamstrings, glutes, and calves. Asymmetrical and unilateral movements are great as well since running is a single leg sport. Tempo training and eccentric lengthening are crucial for practicing deceleration and control.
One particular study that compared postpartum runners to those that were not pregnant or postpartum, showed that the postpartum group had increased braking forces (landed harder/difficulty decelerating/shock absorption), decreased hip strength in the abductors and adductors, as well as decreased hamstring flexibility (Shefali, 2002). We also know that the prevalence of low back, hip, pelvic and knee pain are quite high amongst postpartum runners which often takes them out of the sport completely. All of these can be address through proper exercise prescription seeing a physical therapist.
I tell my clients: use weeks 6-12 postpartum to focus on your strength. Build your foundation. This is be hugely beneficial for injury prevention, treating any current issues, and adding to your performance as a runner.
Waiting until 12 weeks postpartum to run again
To simply state it, we don’t have a lot of research in this area. In 2019, some postpartum return to run guidelines were published and this provided some guidance for clinicians to help patients navigate the process. Based on these guidelines, the timeline to begin returning to run starts at 12 weeks postpartum. The reason for this is to allow time for the pelvic floor to continue healing, and provide time for the patient to work on re-building their foundation of strength and control before jumping back into the high intensity sport.
As with most areas of advice, it is never black or white. I provide this timeline simply as a guide. Each patient is their own athlete, with their own running experience, their own pregnancy and birth outcomes. Return to run really should be based off of performance, but also allowing time for healing and strength-building to occur. This could look like 10 weeks for a seasoned runner with no pelvic floor symptoms or 20 weeks for someone that needed more time to strengthen.
Strength training that supports running
When we look at how running can be supported through strength, we build a program that focuses on what was mentioned above: lower body focus (quads, glutes, hamstrings, adductors, calves), single leg and asymmetrical moves for balance and coordination, tempo and eccentric training to handle deceleration. We look at incorporating rotation as well as plyometric training when ready. All of these are components of a thorough program that really all runners should be supplementing into their routine.
Examples of lower body strength movements:
Glutes: squats, lunges, deadlifts, romanian deadlifts, lateral lunges, curtsy lunges, step ups, hip thrusters
Quads: front squats, leg press, knee extensions, heel-elevated squats, lunges, step ups
Hamstrings: deadlifts, romanian deadlifts, hamstring curls, nordic curls
Adductors: copenhagen planks, sumo squats
Calves: heel raises with knees straight and slightly flexed
Examples of single leg and asymmetrical movements:
Single leg or staggered romanian deadlift
Single leg hip thruster
Single leg bridges
Curtsy lunges
Lateral lunges
Step ups to knee drive
Tempo/eccentric training:
Lateral or forward step downs: 3 seconds down, 1 second up
Reverse nordics: 3 seconds back
Adding in plyometric work
Once there has been some consistency in strength training, and pelvic floor symptoms are controlled (leaking, pain, pressure), it is time to add in plyometric (jumping) training to prime the body and tendons for tolerating more impact. Around weeks 10-11, I’ll start to program things like double leg hops, squat jumps, jumping jacks, mountain climbers, plank jacks, jog in place, etc.
It is important to assess tolerance to this and make sure no symptoms are introduced.
Performance assessment
If all of the above is going well, it is time to implement some testing to make sure you are ready to run. This includes some baseline strength movements to be tested on each side and compared. This instagram post below dives more into the self-assessment movements:
Following a running plan for graded exposure
Once you are cleared to start running, it is recommended to follow a program that gradually increases in difficulty (distance, speed, hills), instead of just “seeing how it feels”. Not only does it make it easier to know when you’ve reached a threshold that potentially contributed to symptoms, but it also gives your tendons time to adapt which helps prevent issues like glute, patellar and Achilles tendinopathy.
Here is just one example of what a gradual running plan looks like:
LEVEL 1: 0.1 mile walk / 0.1 mile jog- repeat 10 times
LEVEL 2: Alternate 0.1 mile walk / 0.2 mile jog - 2 miles total
LEVEL 3: Alternate 0.1 mile walk / 0.3 mile jog - 2 miles total
LEVEL 4: Alternate 0.1 mile walk / 0.4 mile jog - 2 miles total
LEVEL 5: Jog 2 miles
LEVEL 6: Increase workout to 2 1/2 miles
LEVEL 7: Increase workout to 3 miles
LEVEL 8: Alternate between running /jogging every 0.25 miles
Instructions:
Do not advance more than 2 levels per week.
Two days rest mandatory between levels 1, 2, and 3 workouts.
One day rest mandatory between levels 4-8 workouts.
After level 8, continue to progress distance, pace or intensity at ~10% increment each week.
Prioritize recovery methods including sleep, nutrition, and cross-training days.
You may think about working with a running coach for longer, more intense, distances.
When to reduce, modify or stop:
Vaginal heaviness or dragging
Urinary or fecal incontinence
Moderate to severe musculoskeletal (including pelvic) pain
Mild pain (0-3/10 scale) that resolves during or quickly after the run and does not linger into the next day is acceptable.
Why working with a physical therapist is helpful
All of the information above is great to use as a guideline. But, also as mentioned above, we are all different in how we perform and present. Working with a pelvic floor or orthopedic physical therapist to gather baseline testing and get an individualized program to address your specific needs, takes all of the guesswork out of it. Ultimately, I want my clients to get back to the sport as quickly and smoothly as possible and much of that comes by easing in the right way.
