If the words light bladder leakage spring to mind when you’re putting on your running shoes for the first time since birth, you’re not alone. Recently released guidelines aim to help postnatal women return to running safely with a few easy to follow recommendations based on the most recent evidence (1).
Recommendation 1: Seek advice from a women's health physiotherapist
Firstly, it is important that all women who have given birth, whether that be vaginally or via caesarean section, seek advice from a women's health physiotherapist around the 6-week mark postnatally. These health professionals are best-placed to be able to provide hollistic and individualised recommendations on return to exercise.
After having a baby, the pelvic floor is weak and injured in most women and many need specific instruction on how to correctly perform a pelvic floor muscle contraction again, particularly if they did not train these muscles before or leading up to the birth. During high-impact activities such as running, there is a rise in intra-abdominal pressure with ground reaction forces reaching between 1.6 to 2.5 times bodyweight at moderate speeds of around 11km/hr (2,3). There is also a 4.59 fold increased risk of pelvic floor dysfunction associated with high-impact exercise. The pelvic floor muscles therefore need to be able to counteract these pressures and contract in a timely and efficient manner. Weak, less-coordinated muscles are not able to provide a level of function that is required during running. It is therefore extremely important that these muscles are adequately rehabilitated.
Following a caesarean section, the abdominal fascia has only regained between 51-50% of its its tensile strength by the 6 week mark, with 73-93% regained by 6-7 months postnatal (4). It is therefore recommended that a low-impact exercise routine devised by your health professional is followed for the first three months with a return to running between 3-6 months postnatally at the earliest.
Recommendation 2: It is not recommended to return to running prior to the 3 month mark
If any symptoms of pelvic floor dysfunction are present, it is not advisable to return to running prior to or beyond the three month mark until these symptoms have resolved. If symptoms are identified after returning to running, then it is recommended that running is stopped, the symptoms are evaluated and the underlying cause(s) treated.
Some signs and symptoms of pelvic floor/abdominal wall dysfunction include:
Urinary and/or faecal incontinence
Urinary and/or faecal urgency that is difficult to defer
Heaviness, dragging or feeling like something is sitting in the vagina
Painful sexual intercourse
Difficulty emptying the bowel
Abdominal ‘tenting’, abdominal muscle separation or decreased abdominal strength and function
Pelvic or lower back pain
If you experience any of these symptoms, seek advice from your GP or women's health physiotherapist to comprehensively assess the pelvic floor and abdominal wall.
Recommendation 3: A comprehensive assessment prior to returning to running should include pelvic health evaluation, load impact management and strength testing
Not only should your pelvic floor be evaluated prior to running, but so should the rest of your body. To be able to return to running safely, the body needs to have developed an adequate amount of strength in order for it to be able to manage the loads associated with running. Your women's health physiotherapist will be able to identify areas that require strengthening and can devise a specific exercise regime to help achieve your goals.
Body weight can also add to the load on the pelvic floor and women with a BMI greater than 30 are at higher risk of developing pelvic floor related symptoms (5). In this case, an appointment with a dietician would also be of great benefit to help reduce this risk. Your dietician can work with your physiotherapist to devise a multi-modal plan related to your specific goals.
Recommendation 4: Return to running gradually
Planning a gradual progression with your women's health physiotherapist is important in reducing the likelihood of injury. Set yourself smaller short-term goals alongside a long-term goal. Start small with 1-2 minutes of running at an easy pace and greadually increase from there. Include breaks to help reduce fatigue initially. Trying a 'couch to 5km' program can be useful in figuring out how to increase slowly. Remember to monitor for latent symptoms, which may occur 24-48 hours after the activity.
The key take away from this blog is that women's health physiotherapists play a vital role in assessing the postnatal woman and planning a return to exercise that is safe and based on each individual's circumstances.
Natalie D'Rozario
Physiotherapist
Origin Physiotherapy & Wellness
1. Goom, T., Donnelly, G. & Brockwell, E., 2019. Returning to running postnatally - guidelines for medical health and fitness professionals managing this population.
2. Leitner, M., Moser, H., Eichelberger, P., Kuhn, A. and Radlinger, L. (2016) Evaluation of pelvic floor muscle activity during running in continence and incontinence women: An exploratory study. Neurourol Urodynam 9999, 1-7.
3. Gottschall, J.S. and Kram, R. (2005) Ground reaction forces during downhill and uphill running. Journal of Biomechanics 38, 445-452.
4. Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Currently Surg 62, 220-5.
5. Pomian, A., Lisik, W., Kosieradzki, M. and Barcz, E. (2016) Obesity and Pelvic Floor Disorders: A Review of the Literature. Med Sci Monit 22, 1880-1886.