Women are too often given the green light, when they really should be given the yellow light. Although a lot of healing has happened by 6 weeks, there’s still a lot more healing to do. In general, the pelvic floor and core needs more strength and endurance—it’s gone through a lot over the course of pregnancy. And a lot over the course of birth—whether it was a belly birth or vaginal birth. Women should be advised to still take it easy for a little bit longer, then gradually and progressively return to running. 

The American College of Obstetrics and Gynecology (ACOG) agrees that we need a new paradigm for postpartum care. The first step is agreeance, but now it needs to be implemented. We want more appointments beyond the 6 weeks for check-ins. We want better referrals to women’s health therapists who are going to work on the core, help women return to fitness, and help with any other movements they want to do postpartum. 

Running is a tough one, because runners often want to get back to it as soon as they’re able to. It’s very high impact, which means it’s going to put a lot of impact on that pelvic floor and the core in general. It requires a lot of pelvic stability, because it’s technically a single stance. So we need to work on single stance work. It requires a lot of core stability, balance, and endurance of all the core muscles. We want to have optimal posture. If we’re rounded over from feeding and holding our baby and have a curve of our back, it’s going to be difficult to breathe deeply. We want mobility and good posture for our mid back, so we can take a deep breath and get that oxygen so we’re not having cramps or other issues that result from not having good posture while we’re running. 

Why do we need to wait that long? Partially because this is a better healing timeline. You’ve healed so much more when you add another 2 to 6 weeks onto that 6 week clearance. It allows that initial fatigue of early motherhood to lessen—you’re likely a little bit more energized if you wait a little longer. The bleeding should be gone at this point after birth, and the hormones are starting to regulate a little bit more. It also gives you more time to build up that core and pelvic strength, as well as the muscle endurance of the pelvic floor.

• Pressure/bulge/dragging in the vagina prior to or during commencement of running.
• Urinary and/or faecal incontinence prior to or during commencement of running.
• Ongoing or onset of vaginal bleeding, not related to menstrual cycle, during or after attempted low impact or high impact exercise (refer back to care provider).
• Musculoskeletal (MSK) pain e.g. pelvic pain prior to or during commencement of running.

If you’re wanting to run postpartum, I highly recommend finding a women’s health therapist like myself, or a pelvic floor PT, to walk you through the steps so that you can be assessed the right way. There are specific running guidelines outlined in the Return to Running Guidelines: 

In order to successfully complete this assessment, the postnatal mother needs to achieve the following without pain, heaviness, dragging or incontinence:

• 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

Strength Testing:

In order to ensure key muscle groups are prepared for running, each of the following movements should be performed with the number of repetitions counted to fatigue. Aim for 20 repetitions of each test.

• Single leg calf raise
• Single leg bridge
• Single leg sit to stand
• Side lying abduction

Those are just a few examples of some strength training and some challenges to that pelvic floor to see if you’re ready to start running. Because the body goes through a lot during pregnancy and has so many transitions, a lot happens to the core during birth.

1. Breath

Your breathing will change substantially because the diaphragm gets locked up by the baby is taking up that space. And that diaphragm is fatigued after birth because it’s been worked so much that all the deep breathing that happens during birth. So we want to get that breath pattern back. A nice deep breath, a nice rib cage breath to make sure that you’re getting good oxygen is running. 

2. Posture

3. Balance

Can you balance for 10 seconds? How about with your eyes closed? I like adding in the single-leg arc to see how your balance is with this movement. Is your pelvis up really high, or are your feet wobbling a lot, is your knee dipping in, are your toes gripping the ground? We want this balance movement to be nice and easy. And if it’s not, that’s okay, we’re going to work towards it. 

4. Core Muscles

We want to be able to connect to our deep core. Can you easily tell your body to turn on your transverse abdominis—the deepest abdominal wall layer. Can you tell your body to activate the pelvic floor? What’s the endurance of that pelvic floor? Can you do 10 quick reps? Can you do 10 reps in a row of 6 to 8 second holds? Can you hold for 60 seconds at a minimal contraction of a 30 50% contraction? We want to rebuild that connection because the core is really paramount to running. 

5. Mobility

We want to make sure that that the mid-back and hips are mobile. Try doing cat-cow exercises on the ground. 

6. Stability 

We really want to work on pelvic stability and strength because it plays a big huge in running. In order to have good stability, we want to strengthen the pelvis. You can take a band and work on lateral walks and squats. Try glute bridges, deadlifts—the list goes on. 

7. Impact

There’s a lot of different things you can do to add impact to start preparing that pelvic floor for running, which is impact with every step. Consider trying lateral jumps so the pelvic floor gets used to it. You can start playing around with a few jumps on one leg, or go to a stair and jump off. 

Check in with yourself: You got your breath down, you got your posture down, your balance is great, you reconnected to your core, you feel great with core stability, pelvic stability, and impact. Now it’s time to see what’s up for the run. To start, you shouldn’t just go out on a 3 mile run. Ideally, you’ll go out on a run for two minutes, walk for five, run for two, walk for five, etc. Then see, do you have any leaking? Do you have any heaviness or dragging? Any pain? Always check in with those symptoms. 

To finalize the return to running postpartum, here are a final few tips: if you’re breastfeeding or producing milk, make sure that you pump before or feed your baby before. Also be sure to find a good bra that will support the new breasts that you have. 

So how long after birth until you can run? The best answer is roughly 8 to 12 weeks if you have a good plan, and pay attention to the way you feel.

Keep up the great work and Live LOUD!