New Postpartum Running Guidelines Part 1

A long time ago I wrote a blog about my return to running post baby #1. I learned some pretty significant lessons about the reality of postpartum return to exercise 10 years ago. I ran and did strength training to the last minutes of pregnancy (not high mileage or fast, so maybe a jog?) I learned that despite being in great shape prior to pregnancy I won no free passes in the healing process post baby. I learned that the path to recovery is NOT an event, but a process. (I say that about many things, but, it
is true!)

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There Isn't One Answer That Fits Every Postpartum Momma

Many of my clients are so eager to hit the road and return to pre-baby exercise and body ASAP after baby is born. I was there too. I get it. But, not everyone has the same pregnancy, delivery or postpartum experience. In an age where googling an answer to everything is possible, it isn’t fair to yourself to do that with postpartum recovery. It is really hard to hear that there isn’t a one answer fits all response to postpartum return to exercise. To be honest, I have felt a bit over-conservative at times. But, now there is a publication that lends support to the clinical reasoning I have shared with my clients over the years.

What Research Has Found About The Effects of Delivery on a Momma's Body
There is a group of rock star clinician’s who have dedicated endless hours into reviewing research and reaching out to other clinical experts to create a template for returning to running or high impact activity post baby! I am so grateful to these clinicians for organizing the hard work many of us clinicians have tried to do over the years on our own and taking it a step further to create a template for decision making. I am going to take a few weeks to go through some of the highlights with readers to help them better understand the importance of a postnatal wellness check, overall pelvic health and individualized return to high impact exercise. Read further moms that have big baby’s now. This info will help you understand your body too!
What happens to your body during labor & delivery (PS- this is not an exhaustive list. I could go on for pages about the potential short and long term effects of pregnancy and delivery on a woman’s body.)

• Bladder neck mobility increases after vaginal delivery (resulting in less support to your bladder postpartum)
• Uterine scar healing is not complete at 6 weeks post c-section
• Abdominal fascia (a type of soft tissue we all have) is only 51-59% back to baseline at 6 weeks postpartum and only 73-93% of baseline at 6-7 months postnatal.
• Rib and breathing dysfunction can occur prior to or during pregnancy. Improper pressure management can negatively impact your back, abdomen and pelvic floor.
• Women with long second stage of delivery, anal tearing or elevated maternal age are prone to pubic bone swelling, pelvic floor muscle tearing and swelling. Swelling of the pelvic floor and pubic bone can take up to 8 months to resolve. Tearing showed no change in 8 months in one study.
• Urinary incontinence during late pregnancy is predictive of  incontinence 1 year post partum.

What this means…
This just highlights some facts to support my earlier blog about return to exercise post baby. Many of us need it for our mental sanity. But, we definitely need to ratchet back our expectations according to the signs our body is giving us. There is NOT a one size fits all return to exercise plan for all new moms. There isn’t even one for Veteran Moms who may finally be finding the time to exercise 3,5, or 10 years out. The faulty mechanics that can arise from birthing or injuries years ago might impact a women’s plan to return to exercise.

Signs That Your Body Isn’t Ready To Run (from Return to Running Postnatal Guidelines..):

• Urinary and/or fecal incontinence
• Urinary and/or faecal urgency that is difficult to defer 
•  Heaviness/pressure/bulge/dragging in the pelvic area
• Pain with intercourse
• Obstructive defecation
• Pendular abdomen, separated abdominal muscles and/or decreased abdominal strength and function
• Musculoskeletal lumbopelvic pain

References:
Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, 220–5. 

Goom, Donelly, Brockwell, Return To Running Postnatal Guidelines for Medical, Health and Fitness Professionals, 2019

Hamar, B.D., Saber, S.B., Cackovic, M., Magloire, L.K., Pettker, C.M., Abdel-Razeq, S.S., Rosenberg, V.A., Buhimschi, I.A. and Buhimschi, C.S. (2007) Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two- layer closure. Obstet Gynecol 110, 808–13. 

Stær-Jensen, J., Siafarikas, F., Hilde, G., Benth, J.Š., Bø, K. and Engh, M.E. (2015) Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol 125, 531–539.