June 26, 2019

A common question I get asked is 'when is it ok to start exercising again after giving birth?' One type of exercise inparticular is popular - running..


According to THE RETURN TO RUNNING GUIDELINES for health and fitness professionals, put together by a team of advanced physiotherapists, there are a few important factors for the individual to consider when it comes to getting started again.


There are currently no national/international guidelines that standardise practice to support health and fitness professionals working with women who wish to return to running after having a baby so this guide is really helpful and why I wanted to share. 


Musculoskeletal pain,urinary incontinence, abdominal separation and pelvic organ prolapse are prevalent conditions amongst postnatal runners. Awareness and understanding of the importance of optimal postnatal recovery in the prevention and management of these 'common but not normal" conditions is increasing which is great for the women of today. I actually have a client that 15 years ago had no idea of the consequences returning to running too early after her third natural birth would have on her years down the line, suffering now with a level four prolapse in her early 50's.


After having a baby, the pelvic floor is weak and injured so most women would benefit from being assessed before returning to high impact exercise. They should be able to perform a correct pelvic floor muscle contraction, especially if they did not train these muscles before birth. High impact activity, such as running, can cause a sudden rise in intra-abdominal pressure and the impact can be transmitted to the pelvic floor so it is important that healing recovery and strength is adequate before getting straight back to it. 


Following a Caesarean section delivery, consideration should be given to the healing of the uterine scar. It has been shown by ultrasound investigation that the uterine scar thickness is still increased at 6 weeks post natal and the abdominal fascia has only regained around 51-59% of its original strength- not regaining at least 73-93% by 6-7 MONTHS postnatal.



- Urinary/faecal incontinence

-Heaviness/pressure/bulge/dragging in the pelvic area

-Pain with intercourse

-Pendular abdomen, abdominal separation or decreased abdominal strength or function

-Musculoskeletal lumbopelvic pain


It is recommend that a low impact exercise timeline is followed within the first 3 months of the post natal period followed by a return to running between 3 and 6 months AT THE EARLIEST. Every post natal mother should be offered the opportunity to receive a pelvic health assessment (from 6 weeks post natal )with a specialist physiotherapist. 


Breastfeeding is something else to consider when determining when to get back into running. Hydration and the degree of exertion on the body while running can have an impact on the supply of milk.It also prolongs the low levels of oestrogen and maybe still high levels of relaxin in the body which may increase joint laxity and therefore the risk of injury.



Once you feel fit and ready to get back to it after everything is recovered and assessed, some things that are helpful even when you have no major issues are:


-Making sure you have a good supportive sports bra!

-Getting quality sleep! Sounds easier said the done but by 3-6 months you should be in some sort of routine where daytime naps can be used to catch up on missed sleep during the night. Sleep deprivation can reduce muscle protein synthesis and impair strength so its important to optimise sleep quality- reducing 'screen time', limiting caffeine and creating a cool comfortable environment to rest

-Taking it slow and steady.Start small and often with around 1 to 2 minutes at an easy pace. Setting short term goals, such as reaching a target distance, can be helpful alongside the more long term goals that will take time.Include walk breaks to reduce fatigue initially and can be gradually reduced or removed.

-Running with a buggy. The Return to Running Guidelines recommend that some do not consider running with a buggy until their baby is at least 6-9 months old. When they do start buggy running, make sure that the buggy is designed for running and commence slowly using the two-handed technique.A strength and stretch programme for the spine, pelvis and hips should work alongside this.



I hope you all find this summary helpful, for more information please check the full guidelines on www.runningphysio.com


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