Hey Mama, Are you Ready to Run?

(Getting back to Activity Postpartum)

October 22, 2019  

Transitioning into postpartum, also known as the fourth trimester, can be daunting when negotiating the reclaiming of healthy habits like walking, running, yoga, or even boot camp classes. Most doctors will clear new mothers at their 6 week postpartum appointment pending events of the birth and state of recovery. But, what does “cleared for activity” even mean? This is an essential question, so let’s review a few factors involved in making a safe decision.

1. Activity level prior to pregnancy
Start here! If you were an avid walker prior to pregnancy and continued walking throughout pregnancy, start with walking close to or just shy of your normal walking distance, time, and intensity (hills versus flat lands). Adjust according to the stress your tissues took during birth. If you are still healing, try starting with half of your “normal” walking distance prior to birth, then ramp up in time, distance, and intensity as you feel comfortable. Remember no one can run a marathon without first running a mile.

2. Activity level during pregnancy
Activity levels fluctuate a ton in various trimesters due to a variety of reasons such as morning sickness, motivation, time, pain levels, swelling, etc. Deconditioning can easily occur and thus you want to keep in mind what your tolerance to activity was during pregnancy. If you were attending gentle prenatal yoga once a week, postpartum you might want to start with a gentle Vinyasa flow versus power or hot yoga. Always start at a lower intensity and work your way up.

3. Events during birth
LOTS of tissue changes occur as a result of the birth process. Pelvic pain, heaviness, discomfort, and incontinence (leakage) are all symptoms that indicate you are in need of a pelvic health physical therapist. These symptoms need to be minimized before starting a higher intensity or “loading” exercise. However, a pelvic health physical therapist can specialize and individualize a plan of care to get you back to the activities you enjoy! 

4. Tissue healing time
As pelvic tissue and muscles are healing in the fourth trimester, they should be closely monitored. Healing tissues can be easily overstressed resulting in symptoms such as pain, pressure, or leaking of bodily fluids. Tailoring workouts to your tissues tolerance to prevent such symptoms is key to continued healing.

5. Tolerance to progressive loading
After pregnancy, regardless of vaginal or cesarean childbirth, the pelvic floor structures experience 9 months of increased weight and pressure. Thus, our tissues (muscles, ligaments, tendons) require appropriate loading over time for injury prevention. Progressing intensity or load should be done gradually as the muscles develop and gain strength. 

A recent study1 found that high impact exercise had a 4.59 fold increased risk of developing or exacerbating pelvic floor dysfunction compared to low impact exercise. Current literature1 recommends the minimum recovery timeframe before return to running is 3 months.

It is recommended that postpartum women see a pelvic floor physical therapist to have an evaluation to safely guide recovery and return to activity postpartum. Pelvic floor physical therapists can assess your needs postpartum for abdominal muscle strength and integrity, pelvic floor muscle strength and function, and globally address movements of everyday activities. They will guide your exercise progressions and individualize a routine to your needs to help train your body to return to the activities you enjoy doing. They will be able to provide education and guidance to address any potential symptoms to reduce occurrence or progression of pelvic floor muscle or core muscle dysfunction.

Key Signs and Symptoms of Pelvic Floor and/or Abdominal wall dysfunction

  • Urinary and/or fecal incontinence
  • Urinary and/or fecal urgency with difficulty to defer
  • Pain with intercourse
  • Obstructive defecation; Feeling like something is “in the way” when going to the bathroom
  • Separated abdominal muscles and/or decreased abdominal strength
  • Musculoskeletal lumbopelvic pain
If any of the items on this list sound like you, or a friend of yours, please consider seeking out a pelvic health physical therapist for an evaluation and treatment. Even if you don’t have symptoms, but want to prevent injury come see a pelvic health physical therapist to learn more about how your body can recover, heal and strengthen in your fourth trimester and beyond!

Join us Friday October 25th for the community workshop Pelvic Floor 101 at Palomar Health San Marcos Ambulatory Center at 10am to learn more about pelvic floor health, dysfunction, and physical therapy.

Lindsey Paczkowski, PT, DPT

1. Goom, T., Donnelly, G., & Brockwell, E. (n.d.). Returning to running postnatal-guidelines for medical, health and fitness professionals managing this population.