Get Up and Move
Monique Serpas, PT, DPT, OCS
Welcoming a new baby into the world is a special moment full of love and new perspective in which it feels like time stops for just a while. Alternately, time can also feel like it’s rushing past like a freight train. Adjusting to a new family member and the associated new routines can be just crazy at times. After giving birth, many mothers are eager to feel “normal” again and gain some control, not only physically but mentally.
“For some women, running is their sanity,” says Lauren Chappetta King, Doctor of Physical Therapy specializing in Pelvic Health, and also a runner herself, having completed a marathon. She helps women, before and after birth, addresses issues related to pelvic pain and dysfunction. As physical therapists, who have both had children, we understand the desire new moms have to exercise again. I recently chatted with Dr. King and Dr. Rebecca Perret, a Medical Doctor who is Board-Certified in Obstetrics and Gynecology, about their recommendations to safely return to running postpartum.
How Soon is Too Soon to Run?
During pregnancy hormones cause increased joint laxity. Ligaments, connective tissue that lend stability to joints and organs, become loose or lax, as the body prepares for birth. In the postpartum period, this laxity continues for a time, especially if mom is breastfeeding. In the six weeks after birth, prior to the OB-GYN checkup, Dr. Perret and Dr. King do not recommend running.
Dr. Perret says, “The uterus needs to undergo involution. Basically, it shrinks during this time.” The increased size of the uterus and the laxity of the ligaments that support it, increases demand on the pelvic floor muscles, which function to support the pelvic organs including the bladder, uterus, and bowels. The pelvic floor muscles are recovering from being stretched by the weight of the baby during pregnancy and the strain of labor and adding increased demand on them by running before the body is ready, could cause dysfunction.
Running puts a lot of demand on the pelvis, absorbing up to 4 times your body weight with each step. Pelvic organ prolapse could arise from running too early or without proper conditioning and stability of the pelvis. It’s a condition in which a pelvic organ, for example the bladder, descends from its usual location. It creates a painful pressure and, in more severe cases, can require surgery.
In the immediate postpartum time frame from 0-6 weeks, it’s good to walk and do exercises to promote pelvic and lumbar stability, which will get your body ready for running again. If you’ve had a C-section, advice may differ, so ask your OB-GYN. Kegels will help strengthen the pelvic floor muscles. Other exercises such as pelvic tilts, transverse abdominal contractions, and clamshells will help with pelvic and lumbar stability.
At four weeks postpartum, Dr. Perret recommends increasing activity slowly, by walking briskly or returning to the gym and working on the elliptical to get the body ready to run again. Also, because of the ligaments being lax, she mentions to be careful to prevent ankle sprain by walking on a level surface.
Assuming your OB-GYN gives you the thumbs up at the check-up, you’re ready to return to running, but it’s important to do this gradually to avoid potential injuries. I usually recommend alternating walking with fast walking, followed by walking/jogging intervals, and then running. I instruct my patients to gradually progress through these phases, allowing their body to accommodate and get comfortable with each phase for at least two weeks before moving on.
Dr. Perret instructs patients to empty their bladders and be sure to not run on a full gut, as this increased intra-abdominal pressure can strain the pelvic floor muscles. It’s important to keep in mind that your body has undergone a lot of change. Even though you’ve been given clearance by your doctor to run again, your body is going to continue to adjust for several months, which is why it’s especially important for a runner in the postpartum period to have good pelvic stability.
Here are two simple tests you can do at home to test your pelvic stability.
- Single Leg Stance:Stand in front of a mirror and put your hands on your hips. Slowly pick one leg up bringing your knee up to hip height. Stand and balance for two minutes. If at any point your hands are not at the same level or your hip drops, the test is over and you should work more on strengthening your hips before returning to run.
- Jump Test:Stand in place and jump up and down with both feet. Then hop on one leg. If you have pain or lose urine with either of these moves, ask for pelvic PT as this can indicate pelvic instability and incontinence. On this common postpartum problem, Dr. King says, “Within 6 to 8 weeks, incontinence should resolve. After that period, urinary incontinence issues are not normal with walking, jumping, running, or any type of activity. Leaking is not normal or ok.” Some amount of leaking is normal early on and will resolve on its own in the first few weeks, but if it persists beyond this point, look for the help of a physical therapist that specializes in pelvic health, such as Touro’s Dr. King. Working with a physical therapist will help to improve pelvic stability and postural alignment in these cases, which makes returning to running and exercising a speedier process.
If you’ve ever had sacroiliac (SI) dysfunction, return to running cautiously. Dr. King recommends using an SI belt to help compress the SI joint, which aides in stability of the pelvis by stimulating the pelvic muscles to contract in a supportive way. If you have pubic pain, especially with lifting objects, stair climbing, lunging, or separating your knees, avoid running until the condition has been treated by a medical professional.
There are a few other cautionary symptoms to look out for when returning to running postpartum. If you have pain or increased bleeding when running, stop and discuss this with your OB-GYN. Dr. Perret also mentions that if breastfeeding, be sure to maintain good hydration and nutrition in order to keep a good milk supply.
Running is a sport that requires good pelvic stability due to the forces it places across the pelvis. In the postpartum period, pelvic instability is common and return to running too soon could lead to injury, incontinence, or painful conditions like pelvic organ prolapse. Take care of yourself by safely returning to running, reminding yourself that your body is going to take time to recover. With time, patience, and proper preparation, you will achieve your fitness goals and return to your pre-baby running routine. In the meantime, enjoy getting to know your new baby and allow yourself to let time stop for just a while.
Monique Serpas, PT, DPT, OCS, is a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at Touro Infirmary in New Orleans, LA. Monique realizes how difficult it can be to overcome an injury or manage a chronic condition and is focused on helping her clients achieve wellness through a physically active lifestyle. Monique treats orthopaedic, balance, and vestibular disorders using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables patients to assist in their own recovery and injury prevention. Monique holds a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). She is a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.