Returning to Running Postpartum
Monday, May 9, 2022
By Alicia Ferriere, Founder of Fortify PT, PTDPT, FAFS, PRC
In my experience working with runners, the return to running after any forced time off can be an exciting time. When working with my postpartum population, I always feel the need to remind them- returning to exercise is one hurdle, returning to running is another. Running is a more complex form of exercise- it requires a lot from the body. Cardiovascular stress aside, running requires your body to respond to increased gravitational forces, sometimes putting 2-4x your body weight into one leg. It requires your muscles to be explosive as well as responsive to your environment. As postpartum mothers or birth parents return to running, it is important to take steps to get there safely so we can minimize injury.
If you’re unsure about starting with basic exercise, check out my return to exercise blog here. We cover what happens to the body during pregnancy and delivery, as well as some steps to get back to basic exercise safely.
First let’s go over some basics of running..
Running consists of transferring your weight from one foot to the other, separated by a “flight” phase. Flight phase is what differentiates running from walking, and is also what makes running more impactful on your body. You’re essentially hopping from one foot to the other on repeat. Depending on your run form/ speed, the amount of force going through your joints varies. Regardless, if you’re doing anything that looks like running, you’re likely putting increased force through your body. There is also torsion (rotational force) going through your body with each step. Without going too heavy into biomechanics, just understand that running, even though you’re moving your body straight forward, requires control in multiple planes of motion.
_What does this mean for the postpartum body? _
During pregnancy, the body adapts to accommodate the growing baby which can change the muscular system and overall posture. After the labor and delivery process, the body not only has to heal and recover, but also has to adapt to no longer being pregnant. Certain muscles may get over lengthened/weak, while others can become tight/overworked. Relaxin may also be present in your system ( the hormone that increases laxity during pregnancy and delivery). Due to the increased demand and force placed on the body while running, we want to make sure your body starts out in a balanced, stable state.
Where to start?
If there was any severe trauma to the pelvic floor or abdominal wall during labor and delivery, that must be addressed first. Muscles need proper rehabilitation to be able to function effectively when returning to exercise. It’s important to note here that the trauma of the labor and delivery process matters. Cesarean section, grade 3 and grade 4 tears are all treated differently when it comes to returning to high impact exercise. If you’re unsure about rehab, reach out to a professional! Overall, we want to make sure the pelvic floor and abdominal muscles are contracting, relaxing and functioning properly before we return to any exercise, let alone anything high impact.
_Getting strong _
Running requires a lot of control against gravity, so a baseline level of strength is a must. You want to make sure your core, hips and legs are conditioned enough to allow you to participate in more running specific exercises. Core work can progress from basic breathing, to more dynamic movements such as dead bugs or dynamic planking. Leg strengthening can start with bilateral activity (2 legs on the ground- think squats and deadlifts), with a progression to single leg work. Running is effectively a single leg activity, so making sure you feel stable with single leg squats or lunges is key. This will also help you uncover any right to left muscle imbalances which can help you avoid injury. Feeling stable in your body is the theme here. Your body has gone through several transformations in a relatively short amount of time. Prior to getting into running you want to feel comfortable moving your body through space.
_Return to running specifics_
This concept is something I go over with all my runners as a basic form of injury prevention. Running is a predominantly sagittal plane activity ( meaning you only really run in the forward direction). However, your body is still adapting to rotational and side to side forces as you land and push off. Training the muscles that help stabilize you in the other two planes of motion can help make you a more efficient runner and will help to prevent injury. Start to incorporate variability in your strength training, trying to include both rotational and side to side movements. This can look like side lunges, rotational lunges, or adding any sort of load that challenges your body in another plane ( think med ball rotational chops or overhead side to side reaching). Not only will this type of training help to improve your stability postpartum, it will help you prevent injury along your running journey.
Running is a fast moving activity (even if you’re not running fast). Your body is required to adapt and respond to forces in a very short amount of time with each step. Incorporating a speed component to your strength training can be a great way to start to see how your body responds to faster activity. This can be anything from simply moving faster through your strength movements, to changing the tempo of the movement ( think 4 counts into the movement, 1 count to explode out). I find this most helpful for patients that may be struggling with incontinence or the “feeling” of having to urinate with impact. This can be a great place to start that is low impact, but is training your body to respond quickly.
Impact comes with the territory when it comes to running, and this can be where issues start to arise. Training jumping and hopping in concentrated exercise before demanding it of your body for a long period of time is a great way to stimulate stabilization and endurance in your body. Keeping with the above “triplanar strengthening”, jumping in multiple planes of motion is a great way to train those ankle and hip stabilizers. Start by seeing how light “bunny hopping” on two feet feels. Make sure to jump forward, side to side, and in a circle/ twisting motion. Once this feels good, start to see how single leg hopping feels. Checking in with your body at this point is key. Do you have any urinary urgency? Any pelvic pressure? Do you feel in control? Any hint of instability or lack of control may be a sign to spend a little longer with strength or speed.
Running is a skill. Running drills are a great way to build proper movement patterns and specificity in your body. Drills can be a really helpful way to check in with your form postpartum. Some common changes to form that I see postpartum are less knee drive, poor pelvic drive, deceased arm swing and decreased cadence ( steps per minute). Running drills can help work on all of these so that your form can be as efficient as possible. High knees, butt kicks, and skipping are all examples of running drills. They can be performed, again, in multiple planes of motion to ensure you’re getting all the stabilization training you need.
And now we run! Intervals are my top choice for getting back into running ( at any point really). Intervals of walking and running allows your body to be focused and strong for a condensed period of time, followed by low impact recovery. Depending on the above steps, the intervals can be 1:1 ( run/ walk), or 1:2. The progression from here will be dependent on how much you can get out there to practice, how things are feeling, and what your goals are.
Some things to remember
Running takes a lot of energy, so your recovery and fueling process may be different compared to pre pregnancy with the addition of childcare and potential breastfeeding status. Running also may just feel different compared to before. That’s okay! It takes time for your body to fully recover from pregnancy and labor/delivery.
_Be gentle with yourself. _
I know it seems like a lot of training to get back to something that seemed so effortless before, but these are also the steps that I’d say everyone needs to take to get into running safely, not just postpartum. Each step and the amount of time you need to spend at each step can be really unique to you. Your training pre pregnancy and during pregnancy will affect how your muscles respond to work. How you’ve recovered from your particular labor and delivery also plays a really big role. Overall, checking in with your body every step along the way is KEY. Aches, pains or pelvic symptoms are all signs you want to pay attention to. If the goal is to get back to running, we want to make sure we’re getting there safely and injury free. If you have questions, reach out! We are here to help you feel empowered and confident in your body as you get back into any goal you have for yourself.
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