**All credit to Tom “Running Physio” Goom (@tomgoom) and their team who created this comprehensive running guide
Running is stress relief. Running is fitness. Running is an identity.
I often find myself having the difficult conversation with injured runners of all genders that they will have to stop running for a period of time in order to heal. This conversation is always difficult but I think it’s especially difficult with postpartum runners. After a huge life change like your first baby, many new parents express feelings of loss of control and wanting to get back to old routines or stress relief tactics. Some even joke about their body being “hijacked” during pregnancy and breastfeeding. It’s understandable to want to reclaim that identity but childbirth is an “injury” of sorts and you’re body will need to heal and rehabilitate before you beat your old PR.
Research from Rita Deering and Bryan Heiderscheit recommends we think of that healing and return to sport in three phases:
Phase 1: Recovery
- Healing, healing, healing! C-section and perineal wounds need to heal before you can get back to vigorous exercise.
- This is a good time to establish new routines for your sleep, mental health, and setting up routines for your newborn like bonding and breastfeeding
Phase 2: Rehabilitation / Training
- Focus on recovering strength in your pelvic floor, hip, and abdominal muscles
- Progressively increase your low-impact aerobic exercise to keep your heart and lungs strong. You can start with walking and progress to biking if sitting in the saddle is not too uncomfortable
Phase 3: Competition
- You are ready to start running! Start slow and with walking intervals and progressively increase the amount of time you run. Try a program like Couch to 5K for a more structured guide.
- Start with lower-intensity workouts and plan for a slow progression back to your previous pace to prevent overtraining injuries
How long that will take depends on the intensity you want to get back to and if there were any serious complications during childbirth. The example they use is that an archer with no birth complications will be able to return to sport faster than a gymnast with no complications because of the comparative intensity of their sports. But an archer with serious birth complications will take longer to return to sport because of the extended time needed for healing.
Unfortunately, most people go to their 6-week OBGYN visit and are told that their wounds are healed and they can return to all their favorite activities. That skips right from phase 1 to phase 3 with little regard for training and regaining strength! A good general guideline is 12 weeks before returning to running. Yes, you read that right. 3 months. I know that feels like an eternity but you have training to do before you’re ready!
Remember, running is a high-impact sport that puts a lot of force through the legs and pelvis. It can be up to 2.5x bodyweight at a moderate pace! The pelvic floor functions to support your pelvic organs and stop leaking so if your muscles are weak and you jump into running you have an increased risk of pelvic floor dysfunction. These are signs you should see a pelvic floor PT:
- Incontinence: It is never normal to leak urine or feces (wee or poo) at any time! While it is common to experience some leaking after pregnancy, it is never normal and can be fixed.
- Prolapse: Usually described as a heaviness at the opening of the vagina or “feels like something is falling out.” This happens when the pelvic floor muscles are not strong enough to support the pelvic organs
- Diastasis Recti: This is a vertical separation of the abdominal muscles, sometimes described as tenting out from the belly. This may reduce your abdominal strength and ability to stabilize your low back.
- Musculoskeletal Pain: Aching in the knees, hips, or low back with running that lasts more than 1-2 days may be associated with muscular weakness and instability.
The guide from Tom Goom is designed for health professionals, but there is a lot of useful information for patients as well! I think the most useful pages are the last two which have a sample exercise progression for those first 3 months and some tips for returning to run. But I encourage you to read the whole guide if you have time.
TL;DR
- Do not return to run until 12 weeks postpartum! Focus on strengthening the pelvic floor as well as bridges, calf raises, squats, and side leg raises. Start with double leg and progress to single leg versions.
- Get a pelvic floor PT consultation regardless of how you delivered. They can help evaluate your head to toe before you return to high-level activities.
- When you do start running, find a good walk-run interval training program to progress slowly. Do not increase volume by more than 10% per week. Set short and long-term goals to stay motivated.
- Sleep and eat for proper physical and psychological recovery. You need to fuel your body appropriately. Try to get 7-9 hours of sleep (naps count!) since sleep deprivation is associated with increased risk of injury.
- If you are breastfeeding, time your runs for after feeding to reduce discomfort. Remember to stay hydrated and don’t worry about running affecting your milk quantity or quality.
- Get new shoes and sports bras. These both have likely changed with pregnancy and may need more support. Get professionally sized if you can.
- If you are running with a “buggy” or stroller, make sure it is designed for that purpose. You should also wait until the baby is about 6-9 months old for them to develop proper neck strength before starting stroller running.
One last clinical pearl: Think “Fast Feet, Quiet Feet!” Research from Bryan Heiderscheit indicates that these small verbal cues can significantly improve running mechanics and are easier to implement than formal gait retraining programs.
I hope you feel more prepared to start running now and have the resources to reach out to if you have any issues!