How do I know if I am ready to run during the postpartum period?

Entering motherhood brings joy, but it also accompanies a period of postpartum recovery, a crucial phase for a woman's health. The 6-weeks mark is often a much anticipated moment by a new mother, as they this often includes a 6-week postpartum visit with your OB-GYN. This visit can come with the ever awaited “clearance” to return to exercise and intercourse. In this blog, we will discuss what this clearance for exercise means and how this 6 week postpartum visit is not all encompassing. We will also discuss why a pelvic floor therapy visit is beneficial in the postpartum period and how this visit will differ from the OB-GYN visit.  

The purpose of the 6 week postpartum medical visit

The visit with your medical provider at 6 weeks postpartum is to ensure your uterus is healing properly and discuss any ongoing medical issues since delivery. Your OB will look at any scars to ensure proper healing and might do a pelvic exam if determined necessary. It is also a time for a mental health check-in to determine how you are adjusting to the new addition and make appropriate referrals if necessary. This appointment is oftentimes when women are “cleared for exercise” and “cleared for intercourse”. These recommendations are purely based off a generic timeline and do not consider any personal factors such as your pre-pregnancy activity level, your activity level in the past 6 weeks, or current symptoms you are having.

What the 6 week postpartum medical visit is NOT

The visit with your medical provider at 6 weeks postpartum is not to assess how your pregnancy has impacted your musculoskeletal system and help you address these changes. Your OB is a medical expert. Your OB is not a musculoskeletal expert. Your OB did not have years of training specific to the muscles and nerves at the pelvis and how they function with daily life and with exercise. Therefore, they will not assess your readiness to return to exercise. Your OB also will likely not screen for pelvic floor issues. They don’t always even ask if you have incontinence, pain at your scar or issues with pooping. In theory, this is a time your OB will make a referral to a pelvic floor therapist if you are having some of these symptoms, however, this is not yet the standard of care in the United States and therefore, oftentimes not even discussed.

So, how do you know if you are ready to run?

Pelvic floor therapists are musculoskeletal experts specifically of all things pregnancy, postpartum, and bladder, sexual, and bowel health. An evaluation with a pelvic floor therapist during the postpartum period is a vital piece in determining readiness to run. A postpartum pelvic floor therapy visit will screen for pelvic floor issues that are common to what you’ve been through. Common pelvic floor issues a pelvic floor therapist will screen for are:

• Urinary dysfunction: urinary incontinence, urinary frequency or urgency

• Pelvic organ prolapse

• Diastasis recti

• C-section scar pain

• Perineal scar pain

• Pain with intercourse

• Bowel dysfunction

• Pelvic pain

• Hip pain

• Low back pain

• Pain related to postpartum childcare tasks

How do pelvic floor therapists determine return to running readiness?

There are several factors that are taken into consideration when determining return to run readiness. Running is a dynamic task that involves control of the pelvis, repeatedly, during a single leg stance with impact. The following are factors that your pelvic floor therapist should consider when guiding you to return to running.

• Core strength: this includes your pelvic floor! The core is impacted by the growing baby during pregnancy and it typically doesn’t remember how to work unless we train it.

• Core coordination: you can have a strong core when lying on your back doing “core exercises”, but this doesn’t always translate to running (or whatever other exercise you desire to do). Core coordination is the ability for the core to properly engage and disengage during actual exercise.

• Posture: the pelvic floor is influenced by our posture during running. If we do not have posture that supports proper pelvic control, this can contribute to pelvic floor issues

• Intra-abdominal pressure mechanics: when our abdominal pressure is too high, this can put excess stress on the pelvic floor, leading to pelvic floor symptoms. We need to be able to manage this pressure during running.

• Single leg stability: running requires a repetitive single leg stance motion. Our core is part of this single leg stability, along with our hip muscles.

• Force absorption: running is an impact activity. All of our joints need to respond properly to impact so that we are not putting access force through a singular area, such as the pelvic floor.

• Your individualized symptoms: our bodies are all very different. We have all come from a different baseline of fitness and strength and we have all experienced different deliveries. Part of the return to running process is based off of a close monitoring of symptoms as volume and training is increased. Your pelvic floor therapist can help guide you on interpreting symptoms you may have and how to modify or continue what you are doing.

If you are planning to return to running during the postpartum period, consider a visit to your local pelvic floor therapist. It is essential that progression to running to gradual and accompanied by proper strengthening. Pelvic floor therapists are experts in evaluating the readiness for running and it is extremely difficult for one to know independently if their body is ready for this dynamic task. If you need help finding a specialist in pelvic floor therapy, see our previous post here on how to find a provider near you with proper training.