Amy and I both LOVE to run! We both used to run competitively and now we will 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 on them during these pregnancy and postpartum years I am currently in.
If running has never felt right to you after having kiddos, or if you were given the clear to exercise and started running right away at 6 weeks, or if you just love running and want to know the “right way” to return to it, then this blog post is for you.
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 out of The University of Wisconsin has shown that the changes that occur during pregnancy, last long AFTER too. What do these changes mean for you as a runner? 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 boney structures and soft tissue. In the 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?
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 off of clinical expertise, our opinion is that you shouldn’t return to running until 12 weeks postpartum. Strength training prior to returning is a MUST- this is important for reconnecting your brain to your core, rebuilding the muscles of your core which are very 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 causing 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.
In addition, you should be taking into consideration the surface upon which you choose to run. A study out of the Nicholas Institute of Sports Medicine 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. That being said, it is probably a good idea to start running on the treadmill first and 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.
Other considerations: This may not be time to increase your mileage or make running gains. Starting back slow and for fun would be advised until you rebuild your foundation.
ABSOLUTE CONTRAINDICATIONS (until fixed)
If you have a grade 2, 3 or 4 prolapse.
If you have any stress urinary incontinence while running
If you have diastasis recti, I would not recommend running until it’s healed OR at a 2 finger separation or less.
Sacroiliac pain, pubic symphysis pain, or sciatica
You can heal all of these conditions with some time and effort, but returning to running too soon if you have them will only cause more damage.
Ways to ease back into running once cleared:
An option is to start a couch to 5k program = 3 runs in week 1 beginning with brisk 5 min walk than alt. 1 min running with 90 sec of walking and continue for a total for 20 mins. When you move onto later weeks the suggested increase is 10% in distance or intensity each week, only in one not both.
Screening for running postpartum
We have to rebuild our motor patterns so that our bodies can get back to functioning properly for running. You have to pass the prerequisites to be able to get back to running. I have seen clinically that people who return to running too quickly after having babies have done damage to their bodies that is very difficult to undo. You should start with testing the following areas for strength (see videos below):
Hip abduction strength (gluteus medius)
Hip abduction strength (gluteus minimus)
Ankle ROM: 4 inches from wall
Calf raises 20 each leg
Single leg RDL x 10 using cup
At the bottom of this post we will attach a FREEBIE that includes exercises that EVERY postpartum runner should be doing. They are exercises that are straight from our guides and will help you in your quest to returning to running safely during pregnancy. If you haven't already, jump on our email list to get this goodness using this form:
AREAS To focus on for running in the postpartum period:
Recruiting your transverse abdominals: This is subtle recruitment. Let’s start slow! Lay on your back with your knees on the couch and inhale. 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 during the contraction you should feel the muscle stiffen under your fingers.
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.
Runners are very strong when it comes to their leg muscles, but much to their surprise most do not have lateral hip strength. Even worse, women are more prone to poor hip control because our pelvis’ are wider than our male counterparts. During pregnancy, these issues are compounded because once our center of gravity starts to change, our feet rotate outward to increase our body’s base of support. Rotating the legs outward shortens the hip muscles, which place 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.
That FREEBIE I talked about earlier includes exercises to do this! So look for that in your inbox!
Believe it or not, most runners also have weak hip extension regardless of pregnancy. 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 out of 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 WHAT ABOUT RETURNING TO RUNNING AFTER PREGNANCY?
Our guide covers a lot of these exercise in the proper sequence at the proper time. 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 as well to get you fully prepared for running! If you are already using our guide, I would suggest adding these exercises in before every run!
Krystle Howald, PT, DPT
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.