My postnatal journey back to running
As a physiotherapist with a special interest in pelvic floor function, I have enjoyed guiding many women in their return to exercise after pregnancy. When I was pregnant I was confident that I was well placed to make a smooth and timely return to exercise myself. Prior to having children, I enjoyed running, competed in triathlons and played competitive hockey and planned to get back to these as soon as possible.
I have since had two gorgeous (and exhausting) children and I have discovered that the reality of this journey back to exercise was longer and more difficult than I anticipated. It is easy to look at stories in the media of mums ‘bouncing back’ quickly, or get to your 6 week check up and be told ‘everything has healed well’ and feel disappointed or frustrated that you or your body does not feel ready to exercise. Everyone’s journey will be different and I am writing this blog to share some of the hurdles I overcame in my return to running.
Firstly it is most important to consider what the evidence base recommends in return to running. Specialist physiotherapists in the UK produced comprehensive evidence based guidelines by review of the available literature in 2019. This review suggested that based on physical healing and recovery, women should commence low impact exercise to begin with and not resume high impact exercise including running until 3-6 months at the earliest.
Knowing this, after the birth of my children, I started out walking and doing pelvic floor exercises and at 5 months I felt ready to start running. There is highest level evidence that postnatal women can benefit from specialised and individualised pelvic floor assessment and rehabilitation to prevent and manage symptoms of pelvic floor dysfunction (such as prolapse, incontinence and sexual function). For this reason, I saw a colleague of mine for a pelvic floor assessment to get the all clear before starting running. I was feeling confident and excited.
The first difficulty I had to manage was related to breastfeeding and my issues with oversupply and recurrent mastitis. After my first jog and first time wearing a fitted sports bra, I ended up with another bout of mastitis which set my return to running back a few weeks. I realised I had to time my runs so that I went out just after a feed. This added a degree of difficulty as feed times were not always regular and I also needed someone to be around to look after the kids!
Once I started running a bit more I noted that I experienced a small amount of stress urinary incontinence. Stress urinary incontinence is the leakage of urine related to physical activity (such as running) and affects 1 in 3 women who have had children. Despite having done (some) pelvic floor exercises and having been checked by a pelvic floor physiotherapist, this was a sign that my body was not ready. So I stopped running and continued pelvic floor exercises intensively for 2 months before restarting.
I learnt from this that there is a good reason that the guidelines suggest 3-6 months at the earliest. We need to consider the significant changes that occur to the body during pregnancy and with labour. High impact exercise is associated with increased intra-abdominal pressure of which some is absorbed by your lower limbs and some is transferred through the pelvic floor. After a vaginal delivery, recovery of the pelvic floor muscle can be seen by 4-6 months postnatally but structural changes within the pelvis have been shown to continue for a year after birth. After a caesarean delivery, scar tissue needs adequate time to heal and remodel and studies have shown that between 73-93% of tensile strength is restored by 6-7 months. From this it is clear that everyone’s body will recover differently and it is important to allow our bodies time while recovering from the amazing feat that is pregnancy and birth.
While I completed my pelvic floor strengthening program, I also stepped up low intensity exercise as I was deconditioned- I hadn’t run in over a year, and I had had a baby in this time! I thought of all the training I did for an event pre-kids and I was doing nowhere near this so how could I expect my body to keep up? I started going out for fast paced walks in place of runs. I also started a home program of low impact general strength exercises to improve my general conditioning so that my leg muscles could absorb more of that increased pressure generated with running and relieve my pelvic floor muscles.
Another hurdle I had to learn to overcome was my time management. It took time for me to be able to prioritise my own exercise amongst all of the daily tasks involved with small children and working. This was even more of an issue when I returned to exercise following the birth of my second child. I found my exercise was very boom bust, where I would be making progress for a few weeks, then something came up (kids and colds!) and I would get out of routine and feel like I was starting from scratch again.
After some time of this pattern, I realised I had to really think about why I was exercising and set some goals. I know the benefits of exercise and wanted to run for numerous reasons; my general health, to improve my general fitness to cope with the physicality of chasing young children around, improve my sleep, reduce stress and for enjoyment (yes- I do enjoy running!). As physio’s we often talk about setting ‘SMART’ goals. Goals that are specific, measurable, achievable, realistic and have a time frame. My goal became to exercise 4 times a week (swimming and running)- even if this meant going for a 10 minute run or even a walk if I was tired as something is better than nothing. I didn’t track my distance or time (shocking to my pre-child self) and worked to a self perceived moderate intensity which took a lot of pressure off and made my runs more enjoyable.
I am happy to say that once I made time to go for 10-15 minute walks/runs regularly, I was noticing that gradually I was doing less walking, more running and for longer time. It soon became the norm to factor in exercise into my week rather than only doing it if time permitted. Building up slowly, having a realistic goal and having done the appropriate strength training beforehand also meant that I felt good while doing it. It wasn’t until 9-12 months post-natal (a bit slower with my second child) that I was able to run a reasonable distance comfortably.
Stress urinary incontinence is no longer an issue and I can vouch first hand for the high level of evidence that supports pelvic floor muscle training to resolve incontinence. Often symptoms of pelvic floor muscle dysfunction such as incontinence and prolapse are considered normal after having kids. While they are common, they are not normal and can be addressed- so speak to your friendly Flex Pelvic Floor Physiotherapist. We also run Mums and Bubs classes and can provide individualised exercise programs and advice postnatally.
A few weeks ago I competed in my first triathlon in 5 years which felt hard but fantastic! I have now just started my first hockey season in as many years!