As a new mum its very tempting and incredibly normal to want to ease your way back into your pre-pregnancy exercise routine after your six-week check with the GP. Returning to exercise postnatally is most definitely encouraged, research shows that it has a positive impact on reducing the onset of postnatal depression and can help in improving body confidence too. It is important to remember though that no matter how fit you are on the outside or were before the birth of your baby, it is your pelvic floor, back and pelvis that you are trying to rehabilitate and protect. A return to exercise too early can cause immediate or long-term problems to these areas that may, in some cases, be irreversible. Common problems that can occur from returning to exercise too soon can include musculoskeletal pain and dysfunction, urinary incontinence, abdominal separation and pelvic organ prolapse.
So, you might be asking what it is exactly that we need to rehabilitate from? This is a good question because you might feel fine and that you are mentally ready and raring to go. However, a recent paper, published in June 2019 by Science Advances, found that pregnancy pushes the boundaries of human endurance, like elite cyclists on the Tour De France. Just as these elite athletes would allow their body to recover from this, so should any new mum after pregnancy and childbirth. The fundamental changes that happen during pregnancy are the changes in some of our hormone levels and the adaptations that can happen to our posture and the ‘core cylinder’.
A postnatal check at any point from 6 weeks onwards can really help you to understand whether this is something you are prepared for and if not, what the next steps are to help you achieve your fitness goals.
Our core is made up of four crucial muscles, and they make a cylinder like shape in our abdomen. All four of them must adapt to allow the growth of the baby, whether that is being shortened, stretched or loaded. Your physiotherapist will be able to educate you on the function of all these muscles and assess them during your consultation, either virtually or in real life.
After having a baby, the pelvic floor is weak and injured in most women and you may need instruction and supervision to be able to perform a correct pelvic floor muscle contraction, especially if you were not informed to train these muscles before birth.
Research shows that it can take collagen 6 months to regain its pre-pregnancy strength post-delivery, and that is in women who have decided not to breastfeed. This will be longer in women who have decided to breastfeed, because of the different levels of certain hormones, but is not a reason to avoid breastfeeding.
What do we need to do to be able to run?
The main challenge of running is that it is a single leg sport. This means that we bound from one leg to the other and there is no point when both feet touch the floor at the same time. The force that travels through each leg can be in excess of three times our body weight. This force therefore also needs to be absorbed by our pelvic structures and pelvic floor. Over a 5km run we could take up to 4000 steps which when added up, can be a huge demand on our joints, tendons and muscles and they may not be used to it. Therefore it is so important that we gradually build up strength for them being able to cope with this.
What do we assess during a postnatal assessment?
A postnatal assessment is a very comprehensive assessment to not only help you safely back to high level sports and activities but also to help you feel that you can return to your day to day activities too.
We fundamentally want to assess the things that may have changed and been affected by your pregnancy and the delivery of your child. We will also take into consideration certain hormonal and healing times scales too. We will look at your posture and pelvic alignment, breathing, c-section scar if you have one, abdominal muscles and the possible presence of a diastasis recti. We will also conduct some functional strength tests to look at how you are moving and transferring load through your lower limbs. It helps to give us a huge amount of information to know how to tailor your post-natal rehab programme to you and your needs.
How we increase strength to help return to running
From this assessment we will tailor build a plan for you that will encompass how to rehabilitate your pelvic floor and pelvic structures. We will discuss how we can strengthen all four aspects of your core and work on building strength in your pelvis and legs which is fundamental for running and any high impact sport.
Some guidelines were written last year, by two pelvic health physios and another physio who specializes in running. They have summarized that all women can consider returning to running at 3-6 months post birth, after they have completed at least 4-8 weeks of essential pelvic floor related rehab and single leg strengthening.
Your Mummy MOT practitioner may refer to these guidelines and use some of the single leg strength test that they have highlighted as being good indicators of a safe return to running.
Couch to 5k
It’s also important to consider using a couch to 5k programme when returning to the sport. This is essential for all women, regardless of previous running experience. It helps to ensure that you progressively and safely load the tissues in their pelvis and abdomen. Research evidences that this will help to dramatically reduce the chance of developing urinary incontinence or pelvic organ prolapse symptoms later. You will thank yourself for having invested in this time later down the line – I promise!
The course that I have written – The complete postnatal return to running course can help you to firstly understand these changes and give you some useful hints and tips to get back running again, safely and free from injury and pelvic floor dysfunction.