I am often asked this seemingly simple question via email, Facebook or IG, and I cringe every time it comes up. Why?
Because the short answer is,
While expert options suggests 12 weeks, there is no black and white answer based on current research. The gold standard is a thorough, individual assessment from a women’s health physiotherapist who is trained in pelvic floor internal examinations.
Let me explain……
When someone sends me the general question “when can I run again after giving birth?” to me, it is exactly like asking me “when can I run again after my leg injury?” It’s simply not enough information for me to give an answer!!
I need to know all of the following details and more…
🤔 Did you have a spontaneous vaginal delivery, instrumental delivery or caesarian section?
🤔 Is your perineum intact or did you tear, or have an episiotomy?
🤔 Do you have a family history of prolapse?
🤔 Did you have pelvic joint pain during pregnancy and has that resolved?
🤔 Do you have an abdominal muscle separation?
🤔 Do you normally run? What volume are we talking? What’s your technique like?
🤔 Are you breastfeeding?
🤔 How does your pelvic floor feel? Are you leaking? Do you have any pelvic floor pain? Can you contract your pelvic floor? Can you relax your pelvic floor? Does it feel heavy?
🤔 Do do you have any other musculoskeletal injuries?
🤔 Are you within a healthy weight range?
🤔 How is your sleep?
🤔 How is your nutrition?
Why do I need to know all this? Well, did you know that:
🤓 ‘75% of women develop at least some degree of pelvic organ prolapse during their lifetime and 1 in 3 will have prolapse to the level of the vaginal entrance or beyond.’
(Nygaard et al 2007, International Urogynaecology Journal)
‘1 in 3 women who have ever had a baby will wet themselves!’
(Australian Continence Association).
Frightening facts don’t you think?
Let’s not get too freaked out by this information. We know there are certain things that place a woman at high risk of prolapse and incontinence post birth. Now, this is not to say that these high risk women, absolutely cannot ever run again. No. We simply need to identify if you are a high risk and guide you as to the best way to return to the form of exercise you want to do. It’s just not as simple as wait 6 weeks or wait 12 months!! You need a structured, progressive rehabilitation program that takes into account your pelvic health, general strength and fitness, weight range, nutrition and so much more.
I was fortunate to commence my return to running program 6 weeks after the birth of my first baby and ran the New York marathon 8 month later. So yes it can be done! I was grateful to experience a straight forward, spontaneous vaginal birth, with an intact perineum, no abdominal muscle separation, and commenced pelvic floor and abdominal corset retraining the day after my birth. I progressed slowly and started a general strength training pro-gram at 6 weeks, slowly built my running volume as soon as it was appropriate for me. Having had a history of RED-S (relative energy deficiency syndrome – previously known as the female triad) as a junior athlete in my teens I focused on my nutrition to ensure I was fueling my body to both breast feed my baby and support my training. It wasn’t without minor barriers. I had the occasional leak running down hill, particularly when I was tired and fatigued in the early days and had to work on my pelvic floor with vaginal weights, but I got there!
It is important to be aware that certain things can be going on internally in our bodies that we are simply unaware of. The state of our fascial structures (ligaments and connective tissue) is a major one. The integrity of our fascial support structures is partly genetic. Some of us adapt to stretch and mechanical stress better than others. Some of us can be ultra fit and healthy, with strong pelvic floor muscles yet still prolapse! It’s also worth noting that prolapse can occur at any stage during our lives. We may feel good and re-turn to running, cross-fit or any other high intensity, high impact exercise weeks after giving birth and months later, feel a drop, bulge or heaviness and discover we have a prolapse. This is what we are trying to prevent. Our tissue adapts to progressive overload and a structured return to training pro-gram is vital for good health and long term outcomes.
These structures that support our pelvic organs and hold them in place can be assessed internally, by a trained physiotherapist. There are a number of different things a pelvic floor physio will assess and consider when providing individualised advice on return to exercise.
So what are some of the factors that increase your risk of incontinence and prolapse post birth?
• Forcep Delivery
• Baby over 4kg
• Lengthy second stage (pushing phase >2 hours)
• Family history of prolapse
• Levator Avulsion (tear of the pelvic floor off the pubic bone)
• 3rd and 4th degree tears (involving an anal sphincter injury)
• Increased size of the Levator hiatus (the size of the opening of the pelvic floor)
Remember ladies, it’s best to get professional advice before returning to sport or exercise. Don’t be afraid to see your physio out of fear that they will say NO, YOU CAN NEVER RUN AGAIN!!
We want ALL women exercising and it is our job to help you find a way to do that. For the majority of my patients, it’s a YES, lets follow this structured and progressive program and get you there.
According to the Centre for Disease Control and Prevention, it is recommended that adults do either:
1/ 150 minutes of moderate intensity aerobic activity per week OR
2/ 75 minutes of vigorous intensity aerobic activity per week OR
3/ 150 minutes of an equivalent mix of moderate and vigorous intensity activity per week.
To be consistent with an exercise program you need to find a form of exercise you enjoy. For some, that’s running. From my experience, you simply can’t tell a runner that she can’t run because of her pelvic floor and that she should swim instead! I for one, understand the need to run. For some, it’s a case of ‘running keeps me sane’, for others, ‘running is the only thing that keeps the weight off.’ For women who desperately want to run but are high risk, there are options such as a pessaries for support of your pelvic organs while exercising.
If you have any questions, please see you local women’s health physio.
Remember, prevention is key!
Enjoy your run!
1/ Couch to 5km