Step by Step: The Runner’s Guide to Postpartum Recovery

We runners are an impatient bunch. After a year or so of downshifting our running due to pregnancy and childbirth, we’re raring to find that running identity again. But physical changes mean physical challenges. Runners who’ve ever been pregnant often joke about peeing our pants – just a little! – on the run. Is it sweat on those gray shorts, or is it pee? Tee hee. And we laugh at the outdated medical advice that women shouldn’t run because their uterus might fall out, but pelvic organ prolapse is a real phenomenon (read Poppy’s guide to pelvic floor 101!)

Plus, pregnancy and childbirth can affect running in ways we don’t expect. For instance, pelvic and core weakness led Wintergreen to sprain her sacroiliac joint, delaying her return to peak performance. But the answer here isn’t to stop running completely: it’s to take charge of your pelvic health and learn how it relates to other aspects of running and injury.

We spoke to three experts who train pregnant and postpartum runners about the most important things runners should know. (Note: Some experts were more conservative than others on precautions for pregnant athletes, but each encouraged runners to consult a women’s health physical therapist for your individual case.) 

Can you tell us a bit about yourself and your experience in training pregnant and/or postpartum women runners? What led you to develop your interest and expertise in women athletes? 

Brianna Battles, women’s strength and conditioning coach, founder of Pregnancy and Postpartum AthleticismAs a pregnant and postpartum athlete myself over five years ago, the information I got was either too broad (listen to your body, do what you’ve always done) or too conservative (walk, yoga, pelvic floor exercise).

Celeste Goodson, runner and Medical Exercise Specialist, founder of ReCORE Fitness:  I first started my business back in 2010 when I saw a missing link in postpartum recovery. I felt that moms were getting cleared without being given any direction on what to do first. I felt strongly that women would benefit from reconditioning their inner/outer core first before returning to typical gym exercises, bootcamps, running or Crossfit, etc. I also dealt with issues myself and knew we should be doing better. It didn’t make sense to me that the core gets stretched out for 9 months and then nothing specific is given to women to help reactivate and re-strengthen it.

Nicole Radiziszewski, personal trainer, founder of Mama’s Gotta Move: I started specializing in training pre/postnatal women after my second child was born in 2014, taking courses on pelvic floor function and fitness, training postpartum women, and restorative exercise. I became interested in working with female athletes after realizing how much my own body had changed due to pregnancy and childbirth, and feeling that there were very few trainers focusing on this population’s unique needs.

What are the most important things pregnant and postpartum runners should know and practice? How can we slowly and systematically return to the sport we love, safely and injury-free?

Brianna: Even for my high-level athletes, I do not suggest running through the entire pregnancy. At some point during pregnancy, there will be added repetitive stress to the pelvic floor, and your gait may change.

Return to running should come after an assessment from a pelvic floor physical therapist, and should take the delivery into consideration. If a woman is experiencing symptoms such as pee leakage while sneezing or coughing, or pain or a ‘pulling’ sensation like a tampon falling out, she should be working closely with a professional to help guide her return. She should be able to control basic bodyweight movements (squat, lunge). Then she can introduce short bursts of running (say from one lamp-post to the next) interspersed with walking, and add volume, speed and duration from there. For an athlete who is used to knocking out a 5K with no problem, this can be a big adjustment!

Celeste: First – listen to your body. You will slow down as a pregnant runner and it’s perfectly okay if you don’t or can’t run through pregnancy. A proper belly support can help to reduce bladder pressure, back pain and stabilize the belly, but some things are out of our control.

Second – don’t compare your pregnancy with another woman’s pregnancy.

Third – pay more attention to rate of exertion during pregnancy instead of a specific heart rate. It is outdated to stay under 140 beats per minute. Instead on a scale of 1-10 with 10 being really hard, stay around an effort of 4-7 in your workouts and hydrate well.

Fourth – learn how to engage and control your core during exercise. This will help prepare you for pushing during labor and possibly prevent a larger diastasis (where connective tissue stretches out between the right and left sides of the rectus abdominis muscle). Core control also help you stabilize the spine/pelvis better during exercise. Diastasis occurs in almost all women by the third trimester and is a typical occurrence as the belly grows, but it can stretch out more with poor core control or by other factors we can’t control (size of baby, body frame, short torso, ligament conditions etc).

Nicole: I think all pregnant and postpartum runners should be aware of how their deep core muscles– specifically pelvic floor, transversus abdominus and diaphragm– play a role in running, and how pregnancy and childbirth affect the function of these muscles. If we understand and can address the changes that occur due to relaxin, the weight of a growing baby, and possible damage that occurs during delivery (whether vaginal or cesarean), we can make appropriate modifications and gradually and safely return to running postpartum.

There are definitely things female runners can do to support their return to sport, including:

  • Strengthening their glutes and hip stabilizer muscles
  • Addressing any weakness or tightness of the pelvic floor muscles
  • Learning how to coordinate their breathing, abs and pelvic floor, and
  • Adjusting their alignment to promote better communication and function of these deep core muscles.

I would advise every postpartum runner to see a women’s health physical therapist to learn specifically what she might need to work on before jumping back into running.

There’s a lot of information out there today, but what’s one thing most people *don’t* know about pregnancy and postpartum running?

Nicole: One thing I think most people don’t realize about pregnancy and postpartum running is that your pelvic floor doesn’t just keep you continent; it also helps provide core stability. If these muscles are not working properly, you are more susceptible to other running injuries (note: links to Runner’s World article by Nicole) because your other muscles have to work harder to compensate.

Celeste: Can I share two?

First – Train the core and pelvic floor outside of running so that it has the strength and coordination to respond each foot strike. Don’t purposely engage the core and pelvic floor while running. Let the brain recruit the muscles as needed and run relaxed as usual. Your core/ pelvic floor can tire quickly when you are holding too much tension, making leaking even more of a problem.

Second – proper postpartum core/pelvic floor recovery is important no matter what…even if you don’t have much ab separation. Spending a few weeks to rebuild (reactivate, re-strengthen and recondition) the core/pelvic floor will build a foundation and prep your body for harder core exercises, heavier lifting and higher-impact activities like running or jumping. If the foundation is not coordinating well and strength is not there, the larger outside muscles just have to work harder and can put women at risk for injury and pelvic issues down the line.

Brianna: During pregnancy, your gait changes: the position of your pelvis and your ribcage is altered, or you run with your butt tucked under and with your glutes not working effectively. If these habits are built during pregnancy, they can carry over postpartum.

Time and healing are critical. Pregnancy is a temporary chapter; as a runner, you don’t want to be sidelined for a lifetime because you were impatient. Maybe you don’t mind if you leak a little pee while running, but your performance may be impacted.

Did you experience pelvic floor issues during and after pregnancy?  Did these perspectives make you reconsider your pregnancy/ postpartum running plans? 

Tropical transplant to the chilly Northeast. Professional writer and researcher, cantankerous editor, mom to one inquisitive toddler, asker of inconvenient questions.

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