Return to exercise is such a passionate topic of mine. Done right and it can give mama those extra endorphins she’s craving or help her feel in control of her body again. Done wrong and return to exercise/running postpartum can CREATE all sorts of issues.
My Story
I ran track in high school and played a million sports, but I wouldn’t have called myself a “runner”. It wasn’t until I was in college that I ran my first 5K. I ran a couple of 5K’s and then a half marathon before having my daughter (2015). But the vast majority of my running has come after babies. I have done 4 half marathons, a full marathon, and am currently training for my second marathon.
I don’t know about you, but I learn WAY more from my mistakes than I do from someone telling me what to do. So I feel like being honest with all of the things I did wrong has a place in this blog.
I struggled with postpartum depression after my daughter. I had no control over this tiny human that I was trying to keep alive. I felt like I had no control over my body either. I thrive on routine. All 3 of these things got all jacked up after having a baby. I NEEDED the endorphins from exercise to help me feel sane. Just one little problem…. I had problems with moderation.
I went for my first run at 2 weeks postpartum. 2 WEEKS! I wasn’t a pelvic floor therapist yet. I didn’t know any better, so I couldn’t do any better. Let me tell you what happened. I gave myself a prolapse. I cringe even thinking about having one of my patients do that right now.
- Your joints are not ready to take that kind of impact that early.
- Your pelvic floor is still recovering from the pregnancy and delivery process (vaginal or cesarean).
- Your uterus is still larger than it’s pre-pregnancy size.
- Your abdominals are still stretched out and not able to provide stability to your low back or pelvis.
Just…NO. Please don’t do what I did. I’m begging you!
So when can I start running?
Not at 2 weeks like I did. Not even at 6 weeks when you go in for your final postpartum check up. If you’re lucky, you’ll get a provider who does a pelvic exam or asks about pelvic floor symptoms at your 6 week check up. The amount of patients I have that say their provider didn’t even look at them, makes me genuinely sad. The primary goal of this visit is to discuss birth control options and screen for postpartum depression.
They may or may not even ask about pelvic floor symptoms. You’ll probably get the green light to “return to your normal activities”. But I’m here to tell you..
Your 6 week check up is not magical light switch that gets flipped where
your body is suddenly ready to do all the things.
The formal recommendation is to wait until at least 12 weeks postpartum before attempting a return to running program. Even then, it should look more like a walk/run program until your body (including pelvic floor) can adjust to the endurance and strength it takes to support your internal organs throughout jogging.
0-6 weeks
I generally recommend gentle diaphragmatic breathing as the only “exercise” for the first 1-2 weeks. This helps ensure that your pelvic floor and any cesarean incision or vaginal tear gets gentle movement.
Core activation: Once you’ve survived the first couple of weeks, you can begin gentle transverse (lower) abdominal contractions and going for longer walks. Aim for 3 second contraction. You should feel the muscles between your lower pelvic bones (below your belly button) tighten up or even pull together. Try 2 sets of 15 reps.
Spinal mobility: I also suggest working on some gentle mobility stretches focusing on spinal mobility. We tend to spend a lot of time sitting in terrible postures while adjusting to baby cuddles and feedings. Complete 5-10 reps each direction. See 2 of my favorites below:
Postural strengthening: You can also work on squeezing your shoulder blades together to strengthen the muscles that hold you in that better posture. Shoot for 2 sets of 15 squeezes.
Pelvic/hip strengthening: At this point, you can also work on glute squeezes (like you’re trying
to pinch a quarter between your butt cheeks) and bridges (lie on your back with your knees bent. Then lift your bottom up). You can hold each for 3 seconds for 2 sets of 15 reps.
Pelvic floor strengthening: Try to work on squeezing your pelvic floor muscles like you are trying to pick up a blueberry with your vagina, hold back gas, or stop the flow of urine. If you can do this without pain, without leakage, and without pressure, proceed. Start with 5-10 reps each time you feed your baby.
6+ weeks
Once you hit 6 weeks, you should be able to tolerate the above exercises without any issues (pressure, heaviness, leakage, pain, abdominal doming). If your bleeding has stopped, but returns (not your monthly cycle) or your bleeding is slowing and it picks back up again, that could be a sign that you are doing too much too fast.
I am not going to go into a whole workout routine on here, because honestly the best thing to do is see a pelvic floor physical therapist at this point to get a personalized assessment (including internal pelvic floor muscle assessment). Discuss your goals and any issues you’re having so the two of you can come up with the best game plan.
12+ weeks and ready to run?
Once you’re 12 weeks postpartum and ready to progress, you should be able to do the following without leakage, pain, pressure, or abdominal doming before returning to run:
- 10 quick pelvic floor contractions
- 8-12 reps of 6-8 second maximum voluntary contractions
- 60 second submaximal 30-50% contraction
- 20 reps on each side: single leg calf raise, single leg bridge, single leg sit to stand, sidelying hip abduction (knee straight raising top leg to the ceiling)
- Walking 30 minutes
- Single leg balance for 30 seconds (each side) – no rocking of the pelvis
- Single leg squat x10 reps (each side) – no knees caving inward
- Jog in place x 1 minute
- Forward bound x10 reps (each side)
- Hop in place x10 reps (each side)
- Single leg running man (opposite arm/opposite leg) x10 reps (each side)
Once you are able to pass the above test without symptoms, you should feel confident with progressing to a walk/jog interval. The speed at which you progress from the interval to straight jogging will depend on a lot of factors, primarily previous experience with running, fitness through pregnancy, and having an uncomplicated labor and delivery.
An ex-marathoner who ran throughout her pregnancy with an uncomplicated delivery is certainly goin to progress quicker than a weekend warrior who labored for 24 hours and still had an emergency cesarean. You get the picture.
Running with a stroller?
A lot of jogging stroller manufacturers do not recommend using until baby is 6-9 months old. When jogging with baby, start with using both hands.
You are recovering from a major physical event. I highly recommend using the guidance of a pelvic health physical therapist while you go through this journey. Also, you are not a rubber ball. You do not bounce back. You are a human. Moral of the story is…go slow and give yourself grace.
Til next time…Dr. Jen
Jen Dickinson, PT, DPT 