“WHEN CAN I RUN AFTER GIVING BIRTH?” ….. Why I hate this question!!

I am constantly being asked this question via email or Facebook, and I cringe every time it comes up. Why? Because the short answer is, IT DEPENDS!!!

It’s so difficult to give general advice about returning to running and high intensity exercise (e.g. Running, Crossfit) post birth. If you want to know for sure if it is safe for you to return to these activities, you need a thorough and individual assessment from a fully trained women’s health physiotherapist who is proficient 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 inju-ry?” I read that question and think, that is not enough information for me to give an answer!! What exactly is the injury? Was it an ankle sprain or did you have a hamstring grafted ACL reconstruction? Was it a tibial plateau stress fracture or was it just a minor calf tear?

For me to answer the question “when can I run again?” I need to know all of the following details and more…
1/ Did you have a spontaneous vaginal delivery, instrumental delivery or caesarian section?
2/ Is your perineum intact or did you tear, or have an episiotomy?
3/ Do you have a family history of prolapse?
4/ Did you have pelvic joint pain during pregnancy and has that resolved?
5/ Do you have an abdominal muscle separation?
6/ Do you normally run? What volume are we talking? What’s your technique like?
7/ Are you breastfeeding?
8/ 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?
9/ Do do you have any other musculoskeletal injuries?
10/ Are you within a healthy weight range?

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?

But let’s not get to freaked out by this information. We know that 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, but, we need to identify if you are a high risk and guide you as to the best way to re-turn to the form of exercise you want to do. It’s just not as simple as wait 6 weeks or wait 12 months!!

Personally, I commenced running 6 weeks after the birth of my first baby and ran the New York marathon 8 month after. So I’m not being hyper-vigilant and ultra-conservative in my professional opinions here and yes it can be done! I was lucky to have had 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 and progressed to general strength training as soon as it was appropriate for me. This certainly isn’t the ‘norm!’

There are certain things that 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 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 return to running, crossfit or any other high intensity, high impact exercise and boom, 12 months later, feel a massive drop, and prolapse our uterus! This is what we are trying to prevent!!

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)
• 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.

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.

PLUS

1/ Muscle strengthening on 2 or more days per week that work all major muscle groups.

http://www.cdc.gov/physicalactivity/basics/adults/index.htm

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!