Postpartum Running: Safety Tips and Strengthening Freebie
Amy and I both LOVE to run! We both used to run competitively and today we’ll still jump into the occasional 5K or two throughout the year. I've even dipped into marathons, completing both the Denver Rock 'n' Roll and the Boston Marathon. However, due to the current research on instability during pregnancy, our running shoes haven’t seen as many miles during these pregnancy and postpartum years.
This post is perfect for you if:
Running has never felt right to you after having kiddos.
You were given the clear to exercise and started running right away at 6 weeks.
You just love running and want to know the “right way” to return to it after baby.
Why should I be cautious running postpartum?
A woman’s body goes through many changes during pregnancy. These changes include weight gain, a shift in your center of gravity, and excessive laxity in your ligaments. New research from the University of Wisconsin has shown that the changes that occur during pregnancy stick around postpartum, too.
These changes alter a mama's stride and will continue to do so after pregnancy.1 An altered stride can leave runners at risk for injuries, both during pregnancy as well as postpartum. These types of injuries are caused by excessive force that would normally be absorbed by properly positioned muscles, but now can break down bony structures and soft tissue. According to these studies, common running injuries in pregnant women included: low back pain, buttock symptoms (numbness and tingling), high hamstring pulls and knee pain.
When is it safe for me to return to running?
The guidelines set by the American College of Obstetrics state that running is usually okay at 4-6 weeks postpartum with doctor’s approval. However, based on clinical expertise, our opinion is that you shouldn’t return to running until 12 weeks postpartum.
Strength training prior to returning is a must — it’s so important for reconnecting your brain to your core, rebuilding the muscles of your core that are important for running, and re-coordinating your muscle groups. Running is very high impact, and our muscles should be able to absorb some of the impact, but if they are not working properly yet, the joints will take a beating. Additionally, if you are a breastfeeding mama, you have relaxin in your system, which causes your ligaments to be more lax — so if you do not have the proper strength training, you will be putting a beating on your bones.
Do not run if you currently have any of the following:
Grade 2, 3 or 4 prolapse
Any stress urinary incontinence while running
I would not recommend running until it’s healed OR at a 2 finger separation or less.
You can heal all of these conditions with some time and effort, but returning to running without healing them will only cause more damage.
Strength and Mobility Screening for Postpartum Running
After having a baby, we have to rebuild our motor patterns so that our bodies can get back to functioning properly for running. This starts with being able to pass a few prerequisites. In my own clinical experience, I have seen people who return to running too quickly after having babies do damage to their bodies that is very difficult to undo. You should start with the tests listed in the PDF below. You need to have the ability to complete all the tests below without leaking, pelvic “heaviness” or “dragging” sensation, noticeable gap along the midline of your abdominal wall, bleeding, or pelvic girdle/low back pain.
Areas to focus on before you start running again:
ABDOMINALS
Recruiting your transverse abdominals: This is subtle recruitment. Let’s start slow! Lie on the ground on your back with your legs on the couch at a 90 degree angle. As you exhale, hum and draw your tailbone towards the beltline.
To check if you are getting the transverse abdominal to work: place both hands at the pointy part of your hip bones and bring your fingers one inch towards your belly button and then one inch downward. Once your fingers are there, you should feel the muscle stiffen under your fingers during the contraction.
People that experience low back pain usually have a difficult time recruiting this muscle. Be patient and focus on trying it multiple times before it clicks.
Tip: If you perform a crunch/sit-up and see your stomach rise instead of flatten you are recruiting the wrong muscle (rectus abdominis!). If you are using the correct muscle, you should see your belly button draw towards your spine.
2. PELVIC FLOOR
Especially during running, it is important for pregnant women to develop pelvic floor awareness. The goal is to automatically activate the pelvic floor muscles with good running form and proper breathing instead of having to think about continually activating it. A great trick is to exhale every third stride on the right, then on the left.
3. GLUTEALS
Runners are very strong when it comes to their leg muscles, but it might come as a surprise that most do not have lateral hip strength. Even worse, women are more prone to poor hip control because our pelvises are wider than our male counterparts’.
During pregnancy, these issues are compounded because once our center of gravity starts to change as our bellies grow, our feet rotate outward to increase our base of support. Rotating the legs outward shortens the hip muscles, which places them into a less optimal position to perform the muscle contractions needed for running. To combat this, we need to strengthen our gluteus medius and minimus.
Believe it or not, most runners also have weak hip extension regardless of if they’ve ever been pregnant. Step-ups onto a high box or stairs at home are great exercises to add in to help strengthen this group of muscles.
4. BACK MUSCLES
One study from The University of Wisconsin showed that runners typically suffer from poor back extension strength, leaving their core exposed! We can counteract this by strengthening the back muscles both during and after pregnancy. The low back can get stuck during pregnancy, but one way to combat this is with movement. Your body will thank you for moving and strengthening this area. Having strong hips will also help protect your low back as a runner because these muscles help absorb some of the impact.
Okay, so when can I actually start running again after pregnancy?
Though your doctor might give you the okay to start running at 6 weeks postpartum, it’s important that your body is ready to actually do so. Doing the right exercises can help strengthen your body properly to help you get back to it safely.
Our guide walks you through a lot of these exercises in the proper sequence at the proper time postpartum. If you want to make a smooth transition back to running, it would be great to follow the Pregnancy Guide and then start right away with the Postpartum Guide to get fully prepared for running. If you are already using our guide, I would suggest adding these exercises in before every run!
Also check out the Postpartum Running Checklist PDF we have created based on guidelines created by Tom Goom, Gráinne Donnelly and Emma Brockwell2. This is a great checklist to use to find out when you are ready to start running again!
Tips for Getting Back into Running Postpartum
Keep in mind that this may not be the time to increase your mileage or make running gains. We advise starting back slowly and doing it for fun until you rebuild your foundation. Here are some tips for getting started:
Try a Couch to 5K program
A couch to 5K program will help you ease back into running with a progressive buildup in distance or intensity.
Week 1: 3 runs per week, beginning with a 5 minute brisk walk and then alternating 1 minute of running with 90 seconds of walking. Continue for a total of 20 minutes.
In the following weeks, choose between a 10% increase in distance or intensity each week.
Pay special attention to where you’re running
Not many people realize that you should be taking into consideration the surface upon which you choose to run. A study from the Nicholas Institute of Sports Medicine and Athletic Trauma has shown that there is much more impact on the lower extremities with pavement running than on a treadmill. This particular study showed a 43% decrease in forces on a treadmill vs. on the pavement. Knowing this, it can be helpful to start running on the treadmill first and then work your way back to the pavement. Or, you could start on the treadmill 2x/ week and pavement 1x/ week or however it works best for you.
Form
Check out this graphic for proper form while running.
For mamas running with strollers
Make sure the stroller handles are where you want them — keep your elbow at a 90 degree angle as a starting point
Notice if you have an arm that comes back more easily when running, hold the stroller with that side more often to help the other side learn how to work better. At the very least, be mindful of switching what side holds the stroller (start at 50-50 if you’re unsure)
Focus on extension in hips and arms!
Make sure you’re not bearing down or putting pressure downward on the stroller— this compensation is common if your core is weak. Downward pressure through your arms creates downward pressure on your pelvis potentially leading to urine leaking and prolapse. If you notice yourself doing this, consider further strengthening your core before running more often
Keep your body close to the stroller — pelvis is close and you have a forward lean to your body
Stride it out (letting go of the stroller if it is stable)
Try to run without baby or dog periodically — stroller running is pretty unnatural, it is important to remind yourself and your body what “normal running” is!
LOOK AT THE WHOLE PICTURE
The bottom line is we need to think about fitness, breathing, psychological status, abdominal wall recovery, scar mobility, sleep, breastfeeding status (BF can alter hormone status which can impact prolapse and pelvic stability), supportive wear (for belly, for breasts) and the risk of over-taxing a tired mama.
The full text PDF article of the study can be found here. (Goom, Donnelly and Brockwell, 2019)
Krystle Howald, PT, DPT
References:
1. Thein-Nissenbaum JM1, Thompson EF, Chumanov ES, Heiderscheit BC. Low back and hip pain in a postpartum runner: applying ultrasound imaging and running analysis. J Orthop Sports Phys Ther. 2012 Jul;42(7):615-24.
2. Goom, Tom, et al. Returning to Running Postnatal – Guideline for Medical, Health and Fitness Professionals Managing This Population. Mar. 2019, dugof.dk/siteassets/dokumenter/fagligt/kliniske-retningslinier/returning_to_running_postnatal_guideline_for_medical_health_and_fitness_professionals_managing_this_population.pdf.