The plan outlined here is reflective of my personal experience and conversations with my physical therapist. It should not be taken as medical advice. Every woman and every pregnancy is different, so you should consult your medical provider when considering postpartum running.
I walked into my physical therapists office at five weeks postpartum with confidence, hoping to get a green light on running. I had been working on core and pelvic floor strength consistently since the birth of my son. And for the year prior to that I had made pelvic floor strength a priority.
She put me through a series of moves: twist here, drive with the glute, pull up the pelvic floor. I felt like I performed them with strength, aware of each muscle as it moved. But her trained eye saw what I could not feel: weakness. I was collapsing there and twisting here. I’m realized I was not as strong as I felt I was. Even though I had had a quick and smooth natural delivery, with active labor around two hours and a push and half to delivery my son, my body was still weakened. I’ve been consistent with core and pelvic floor strengthening postpartum but there is still work to be done.
This is why my return to running after my third pregnancy will be far more gradual and conservative than either of my other two pregnancies. My goal is to build strength and correct imbalances that may affect my running later on down the road. If I’m smart and honest with myself now, I could potentially avoid injuries that could sideline me for more time later on, even though everything in me wants to sign up for a race and get to training.
Like an injured runner I’m anxious to get back and don’t like the idea of a gradual return, but I know it’s best. My physical therapist advised me to treat my return to running postpartum the same as a return from injury. It needs to be slow, gradual and build strength sequentially.
Pelvic Floor Rehab
In the first few weeks after giving birth, rehabilitating the muscles of the pelvic floor should be a priority. In weeks 1-2 postpartum, I focused solely on kegel contractions and did moves that targeted the transverse abdomen. These moves are subtle and involve becoming aware of and relearning the contraction of muscles that have been stretched during labor and delivery.
Since key muscles that support the torso (think abs, obliques and pelvic floor) have been weakened it becomes important to learn to coordinate these again with the muscles of the hips and glutes (the primary drivers in running). In weeks 3-5 postpartum, I focused on breathing and form drills to try to relearn and practice how to maintain stability. Running is a single leg activity so stabilization is very important. If your core is not stabilized in a balanced way you’re more susceptible to common running injuries. Hip and glute strength are also an important component to the stabilization of the body during running, so drills and exercises that strengthen those will be key to this “layer” of training.
My first postpartum run was hill repeats and it will continue to be the only type of running I do until 8-10 weeks postpartum. Running uphill is a great way to work on form and stability. Often times form breaks down at higher speeds. Meaning running uphill can prevent that because you are running at slower speeds. In addition, the incline of the hill allows you to practice a more erect form while driving from the glutes. Both are necessary for good running form.
The hill I’m currently running my repeats on is about 200 ft in elevation and over a half-mile. I run up, then walk down. Walking down is essential for keeping this activity low impact. Running down hill should be avoided postpartum as it increases the impact on the pelvic floor.
Another added benefit of hills is that it builds fitness, so I’m secretly increasing my cardiovascular capacity without doing speed work. I plan to keep hill repeats as part of my weekly routine until I start incorporating track workouts and tempo runs. So it’s time to Embrace the Hill!
After hill repeats, my focus will shift to building mileage slowly. I’ll build sequentially in frequency (days per week I’m running) and distance. My plan is to work towards getting back into half marathon shape. For me, that would mean long runs of 15-16 miles and about 45-55 miles a week. Building from a base of 6 miles per week to potentially 55 miles per week will take a while.
My runs will gradually grow to longer distances and most of them will be “easy paced,” meaning my goal is to build endurance and increase mitochondrial density, not to increase speed. Speed will come later. I’m currently running twice a week. I’ll increase frequency to three times, then four, then five and so on. But that increase will happen gradually.
I anticipate waiting until six months postpartum before incorporating any track workouts or tempo runs. I know I’ll be building fitness with hill repeats and mileage, so the final “layer” of training will be to add in speed. Running around the track can be high impact on the pelvic floor and if running form isn’t properly stabilized, it could lead to injury.
I have no scheduled races until five months postpartum. My plan isn’t to race at all until then. I don’t think my body will be ready, in terms of strength and stability, to maintain proper form until then. So as much as I really want to get out there this summer, racing will have to take a backseat while I build fitness and strength. It doesn’t mean I won’t run in a race, I may use a few races as training runs. I just won’t be “racing.”
This may sound like a very conservative plan. It is. Currently, there is not enough research regarding running’s affect on the pelvic floor with quick return to running postpartum. With that in mind a conservative approach is wise. Especially with the experience I had postpartum with my second pregnancy.
Even if you have never had issues with leakage while running or you consider yourself a strong runner, I would advise seeking out the expert opinion of a physical therapist who specializes in women’s health. Their input to you postpartum return to running could potentially prevent complications, leakage or prolapse in the future.
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