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When I went to my 6 week postpartum visit after my 3rd baby (now almost 2), I was shocked to say the least. My midwife did not ask if I was having incontinence, pain with sex, back or pelvic pain. Nada. I was a little shocked! Maybe this experience was an anomaly, but this is what patients tell us, too. They are pretty much given the green light to “do the things” like sex, exercise and lifting, but no guidance beyond that. The fact is that nothing magical happens at 6 weeks where your body goes from "rest" to "full steam ahead." The truth is that after birth, the body needs a mix of time and progressive strengthening to be ready for impact activities like running.
When
Guidelines now say you should wait a minimum of 12 weeks post delivery to begin a return to running program. For most people, even those who remain active in their pregnancy, lose muscle mass and strength in pregnancy. Not only is your core and pelvic floor weaker, but everything is weaker. Many people are also surprised to learn that a 2019 article showed that stress urinary incontinence was tied to hip strength, hip muscle performance and hip mobility and there was no difference in pelvic floor strength in those with stress incontinence symptoms and those without. Postpartum people typically have lost mobility, strength and motor control of their hips and core.
Your body just did a miraculous thing! Your abdominal muscles-- your transversus abdominus, obliques and rectus abdominus (6-pack muscles)-- were stretched around your baby for 40-ish weeks and need some time to return to normal length again. 66-100% of women have a diastasis rectus (widening of the abdominal muscles) in their 3rd trimester (Chiarelli) and this, too, takes time to heal. Your pelvic floor, whether you had a vaginal delivery or not, had your baby + uterus weight pressing down on it weakening it. If you had a vaginal delivery, those muscles and tissues stretched 2-4 times their length to birth your baby. If you had a cesarean, your skin, muscles and fascia were cut and need some help restoring their mobility and then getting your muscles back ‘on line.’
How
Once you have hit the 12 week mark, check yourself for a diastasis (video below). There should be less than 2 finger widths along the length of the midline of your belly. If it is wider, reach out to a women’s health physical therapist to get guidance on how to close it.
If
If you are 12+ weeks postpartum AND you can walk for 30 minutes without pain or leaking AND you can do the return to running functional testing (below) with good strength and control, THEN you are ready for a return to running program.
Bottom Line
You are not “good to go” at 6 weeks postpartum
8.5-10.3% of women still report pelvic girdle area pain 2 years after baby , which helps us recognize that some pregnancy related issues do not just go away on their own
20% of women leak at 2 years postpartum
Hip muscle strength, not pelvic floor strength, is associated with women with stress urinary incontinence (like leaking with running) (Hartigan)
Assess. Don't Guess. It is best to have a postpartum evaluation with a pelvic floor physical therapist prior to running after birth
Assess. Don't Guess
Are you ready to run? If so, you should be 12+ weeks postpartum, experience no pelvic symptoms like pressure, heaviness or leaking with walking and be able to do the following functional movements:
Hold a plank for 60 seconds to assess your core strength with good alignment
Do wall jumps at 160 beats per minute to assess your push off control and strength
Do single leg squats at 160 beats per minute with great alignment for 30 seconds on each leg to assess your hip control and loading response
Do 6 inch step ups at 160 beats per minute without leaking or pain and with good pelvic alignment for 30 seconds on each leg to assess your push off and loading muscles
Be able to do a 90/90 wall sit for 1 minute to assess your hips and core for the loading phase of running
Pelvic Floor Physical Therapy helps with assessing where you are and what muscles to target to return to running-- without pain or leaking. If you are in the Richmond Virginia area, book with us! Assess, don't guess!!
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