This is one of the questions that I get asked the most as a postnatal exercise specialist. I really wish there was a more straightforward answer to ‘When can I run after giving birth?’!

It’s frustrating because there IS no definitive answer to the question. The truth is the time since you gave birth is almost irrelevant as it is much more about how well you can control intra-abdominal pressure, support the load on your abdominals and how ready your body is for running in terms of glut and leg strength. However, there are some key points to consider that are definite red flags and some ‘goals’ you can make sure you are able to do before going for a run.

Running postpartum

The first thing to understand is that you shouldn’t be running postpartum until you have fully rehabilitated your core. As the first 4-6 weeks should be mostly about rest and gentle restorative movement, the rehab doesn’t really begin until around 6 weeks (and more like 8-12 weeks if you had a caesarean birth). No matter how strong you were pre-pregnancy, you need at least 6 weeks of building up strength before you should consider adding running into the equation so the ABSOLUTE EARLIEST would be 3 months. However, realistically for most women around 6 months is when you may have had the time to put in to your rehabilitation and be able to consider running again.

Running is a high impact form of exercise – every time your heel strikes against the floor it causes a huge impact throughout your whole body. The pounding motion of high impact exercise like running has a high impact on the pelvic floor and can have a negative impact on vulnerable tissues that have already been weakened by pregnancy and childbirth. When the stride is repeated again and again, the impact forces the pelvic floor downwards and the abdominal wall is pushed outwards which can exacerbate issues like abdominal separation (Diastasis Recti) and Pelvic Organ Prolapse.

Did you know that 1 in 3 new mums experiences postpartum urinary incontinence and over half of women over 50 suffer from some form of pelvic organ prolapse (where 1 or more of the organs in the pelvis slip down from their normal position and bulge into the vagina)?

So when can I run again after giving birth?

The key to running again after having your baby is that there is no ‘one size fits all’ rule to follow. Every birth is different, every body is different, every baby is different and all of these things will affect how your recovery goes and as a result how and when you can return to exercise.

However, I would generally advise to wait until around 3 – 6 months before running again. This is to give your body a decent recovery time and minimise the risk of causing long term issues. If you wait 6 months, it gives you time to build yourself up with low impact exercise and, crucially, learn how to control intra-abdominal pressure (IAP), which is created in high impact exercise like running. Your level of control of IAP is actually more important than how many weeks (or months or years!) postnatal you are – plenty of people who haven’t been through a rehab programme after their babies have poor control over their abdominals or pelvic floor and therefore are likely to have almost as many problems with running as a new mum.

Can I run after my 6-week check-up?

Often women are cleared to return to exercise at their 6-week check at the GP but many have little understanding about what a safe return to exercise means. The postnatal healing process is only really just beginning at 6 weeks when the organs have returned to their usual positions and you may be feeling like you want to start doing more. But, particularly if you are breastfeeding, there are still hormonal changes, healing taking place and lots of things going on in your body that mean intense and high impact exercise is not what you need. When you add to that the fact that most new mums are sleep deprived and nutritionally depleted following their pregnancy, it makes sense to nourish your body rather than punishing it.

The ideal first step in working out whether you are able to start running again is to visit a Women’s Health Physio so they can assess you internally and check your pelvic floor function and abdominals as well as an overview of your physical well being such as glut and hamstring function. They should perform a few assessments to give you an idea of whether running is a good option for you.

How do I know if I shouldn’t be running?

Immediate red flags are:

* Leaking urine or faeces – and actually that’s not only when running – if you don’t have ‘accidents’ when you run but are unable to withstand the IAP created by a sneeze or a star jump that is still an indication that you shouldn’t be putting your pelvic floor under undue pressure – go and see a Women’s Health Physio and work out what is going wrong. Leaking may be normalised within our society but that doesn’t mean you should just put up with it, there is lots that can be done!

* Heaviness/dragging feeling in your pelvis – this is a common indicator of POP and should be investigated. Go to your GP and insist on a referral or find a Pelvic Health Physio privately.

* Pain during intercourse can indicate tightness in the pelvic floor which is a sign that things are functioning as they should be so again this is worth investigating.

* Diastasis Recti – severe abdominal separation often goes hand in hand with pelvic floor dysfunction and both of these are a sign that you are not controlling your intra-abdominal pressure. This means you need to work on this and make sure you abdominals can take a level of loading before you are ready to add high impact exercise into the equation.

* Lower back pain – while this can be a normal part of the physicality of caring for a baby, it can also indicate pelvic floor dysfunction so it is worth getting this investigated before you add running into the equation

Our advice is to err on the side of caution when it comes to pelvic floor health. While there is no need to be afraid, so many people do too much too soon and regret it later on. If you can afford to, go and see a Pelvic Health Physio before you start running even if you don’t have any symptoms – they can assess whether running is appropriate for you at this time and give advice about what you need to do to bring yourself up to appropriate strength.

The Return to Running Guidelines was written by 2 Pelvic Health Physios and is a fantastic resource for anyone who wants to ensure they are running safely.

These guidelines include a list of exercises you should be able to do without any sign of pain, dragging, heaviness or incontinence before you start to run.

• Walking for 30 minutes
• Single leg balance for 10 seconds
• Single leg squat – 10 repetitions each side
• Jog on the spot for 1 minute
• Forward bounds – 10 repetitions
• Hop in place – 10 repetitions each leg
• Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10 repetitions each side

Our Centred Mums in Motion online programme builds you up to this in a safe and thorough way. We take you from the very basics in pelvic floor health all the way through to full classes including many of the exercises above.

Sorry to say this, but… please don’t!

It isn’t easy to be told that you should stop doing something that is so intrinsic to your physical and mental wellbeing. Many women we meet, see running as an amazing release and a core part of looking after their mind and body. But please remember if you’re running with incontinence, it doesn’t have to be forever. But it’s best to stop whilst you have the symptoms.

What to do if you are struggling with incontinence

There is so much you can do to ensure that your pelvic floor is supporting you effectively. Sometimes it just requires a few weeks of focusing on other types of exercise to encourage your core to support you more productively. Once you know that a few simple movements are easily do-able, you can go back to doing what you love – jogging, jumping and skipping without the wet pants!

Running heavily impacts your core. Each time your heel strikes, a huge load moves through your body and, if your pelvic floor is struggling, this really needs to be addressed.

Einstein gave the definition of insanity as “doing the same thing over and over again and expecting different results”. And, forgive us for saying this, but we see a lot of people who fall into this bracket!

Many women think that incontinence will get better as their children grow up, but this is rarely the case. If anything, our pelvic floor health tends to decline with age. As we hit menopause and oestrogen levels drop, pelvic floor trouble becomes prevalent, in fact over 50% of women over 50 have a degree of prolapse.

Increasing your understanding of the way you use your body and growing your knowledge of what you can do to help it, can only be a positive thing.

If you would like more guidance of what is and isn’t advisable in this area, the ‘Returning to Running Postnatal Guidelines’ are an excellent starting point. These guidelines were written by two women’s health physios who were frustrated by the frankly abysmal postnatal guidance that was previously available, and they are applicable to all women, whatever age your baby is.

Here are some important recommendations from the guidelines:

• Individualised care is important, if you can visit a women’s health physio it is highly recommended. Rather than generalised advice, you will be able to understand exactly what is happening in your pelvic floor.
• It is not advisable to run before 3-months postnatal under any circumstances, and if you are experiencing any symptoms of pelvic floor dysfunction then you shouldn’t be running at all, no matter how old your baby is.
• Symptoms of pelvic floor dysfunction can include urinary/faecal incontinence, urinary / faecal urgency, heaviness, pressure, bulging or dragging in the pelvic area, pain during intercourse, obstructive defecation, bulging of the abdominal wall, abdominal separation and lower back pain.

When it comes to pelvic floor health, you should always err on the side of caution as any stresses to this area can have lasting a impact on the way your body functions.

* Other risk factors for returning to running include hypermobility, breastfeeding, previous pelvic floor conditions or issues/pain in the pelvis and lower back, obesity, a caesarean birth or perennial scarring and vaginal bleeding that isn’t related to your menstrual cycle.

Our top tips on getting yourself ‘running ready’:

1. Sleep

It is difficult to say this to parents, as sleep is at such a premium for everyone, but please be kind to yourself and, if you are sleep deprived, do not feel under any pressure to get back to exercise. Sleep is absolutely vital to allow your body to recover from both physical and psychological stress. There is a clear link between increased injury risk and sleep deprivation in athletes (Milewski et al. 2014). Sleep deprivation lowers your general health and increases stress levels as well as impairing maximal muscle strength (Biggins et al. 2017, Knowles et al. 2018). If you aren’t getting 7-9 hours a night, it is more than okay not to be pushing yourself physically.

2. Fitness

Your fitness needs to be considered as low fitness levels will make running more difficult. It is really important to ensure you have a safe and appropriate build up to exercise. Our Centred Mums in Motion online pilates classes are all about building up your fitness in a safe and individualised way. The structure of our classes depends on your birth experience, the way your body works and the pace at which you are able to progress. Everyone is different and there is no hurry!

3. Breathing

It is important to establish a good breathing strategy to allow your core to work in the most effective way. In order for your body to function as its best, there needs to be synergy between your diaphragm, abdominals and pelvic floor. You should build up to pushing your breath by starting at a slow pace that allows you to have a conversation while running.

4. Psychological status

If you are having problems with your mental health, exercise can be a great way to support yourself. But, if your body isn’t quite ready to add running into the equation, it is worth being aware of other coping strategies. Relaxation, mindfulness and lower impact exercise like Pilates are great ways to look after your mental state. Speaking to a therapist or counsellor, can also make a real difference.

5. Supportive clothing

A 2019 study showed that supportive underwear could be almost as effective as pelvic floor muscle training – although this wasn’t in relation to high impact exercise, it is definitely worth considering whether you can gain extra support from your pants! A professionally fitted sports bra will also give you increased support and ensure that your breathing is not restricted by your

clothing. It is important to make sure that your leggings are not over-tight around the waist and causing extra pressure by bearing down on your pelvic floor.

6. Supportive footwear

It is common for shoe size to change during pregnancy, so you may find that you no longer have a good fit in your pre-pregnancy running shoes. You can get your gait analysed to ensure you have the support you need from your footwear.

7. Breastfeeding

Whilst breastfeeding shouldn’t put you off returning to running, it is worth taking your breastfeeding status into consideration when planning to exercise. It is important to ensure that you are making your pelvic floor health a priority and that means staying educated about the risks. Breastfeeding keeps your hormones from returning to their pre-pregnancy state, meaning lower levels of oestrogen and the possibility of increased relaxin levels. The overall hormone levels when breastfeeding, and up to 3 months after weaning, can increase the risk of developing an injury or dysfunction, including prolapse or pelvic floor dysfunction.

8. Scar mobilisation

No matter what kind of birth you had, if you have any scarring – either due to a caesarean, episiotomy or tearing – it is really useful to consider scar mobilisation to prevent the potential pain and restriction that scarring can cause. Everything in your body is connected and changes in the tissue around your scar can impact the function of tissues and structures throughout your whole body. Following a caesarean birth; your digestive, urinary and reproductive systems can all be impacted by your scar. (Comesaña et al. 2017). Scar mobilisation or scar massage can reduce inflammation and fibrosis; and improve tissue remodelling. (Benjamin et al. 2008; Bouffard et al. 2008). We regularly refer clients to www.scarworktherapy.com and have only ever had fantastic feedback about their effect on a caesarean scar.

9. DRA

Specialist pelvic health physios agree that it is important to regain functional control of your lower abdominal wall before you start running. It is vital to be able to control the pressure created in the abdominals (IAP) before you add any extra load due to the impact this could have on the pelvic floor. Although not widely researched, abdominal separation should definitely be considered due to potential risk of pelvic floor dysfunction. When exercising, you need to be able to maintain your ability to control IAP and avoid doming in the abdominals.

10. Weight

If you are overweight, this can also increase the load on your pelvic floor. If you have a BMI >30, you are considered at a higher risk of pelvic floor related symptoms (Pomian 2016), and it is advisable to opt for low impact exercise, to help reduce the load on your pelvic floor. Due to pelvic floor impact, and the increased risk of musculoskeletal injury (Nielsen et al. 2013), it is recommended that weight management is addressed before you return to running. There are many ways to address your weight before you begin running, and you will never regret taking good care of your pelvic floor.

The Returning to Running Guidelines have set a series of markers to assess whether you are fit to return to this high impact exercise. These should be able to be done without pain, dragging, heaviness or incontinence before you return to running.

• Walking for 30 minutes
• Single leg balance for 10 seconds
• Single leg squat – 10 repetitions each side
• Jogging on the spot for 1 minute
• Forward bounds – 10 repetitions
• Hop in place – 10 repetitions each leg
• Single leg ‘running man’: with bent knee and opposite arm and hip flexion/extension – 10 repetitions each side

To build up strength for running it is also a good idea to be able to do 20 reps of the following exercises:

• Single leg calf raise
• Single leg bridge
• Single leg sit to stand
• Side lying abduction

As mentioned above, building up to running is extremely important. We highly recommend using a tool like the Couch to 5k app to allow you to build up slowly and ensure you are not experiencing any negative effects from your running programme.

If you’re running with incontinence, we strongly encourage you to see a Pelvic Health Physio for more support if you feel you need it, or if you are experiencing ANY of the symptoms mentioned in this blog post.