I Can Do Hard Things: My Advice for Running Postpartum by Dr. Hannah DePaul
When can I return to running? That is a question that we get asked daily at Adams Sports Medicine & Physical Therapy with the large number of runners we help get back to running after injury. It is also a question I asked myself and my doctors after giving birth to my son, Henry, last October. Every runner has a different reason for their love of running. For myself, it’s an activity that makes me feel like me. It’s my time to be outside in nature, to think about everything or nothing at all. Throughout my pregnancy I tried to keep up running in some aspect, even though it ended up being short intervals when doing longer walks. After I had Henry I found there wasn’t much research and little guidance in terms of knowing when and how to get back to running. Here are some of my tips based on my postpartum return to running journey.
- Consult with your OB/Midwife and go see a Women’s Health Physical Therapist
In my opinion this is the most important thing to do before returning to running, or any high impact activity postpartum. At 6 weeks after birth I saw my Midwife and she assessed my pelvic floor strength and healing. She gave me the clear to slowly return to running. However, with my physical therapy background I knew there was a lot more that needed to be examined for me to feel confident that I was ready to run, so I waited until I saw Dr. Nancy Boyd at Ancoeur Wellness. She is a Women’s Health Physical Therapist, and a runner herself. She examined not only my pelvic floor, but also my hip/core strength, functional tests, and balance. We discussed a return to run plan, my goals, and she provided me with a home exercise program. This was huge as it gave me the confidence that I would be able to get back to running.
The exercise program consisted of hip/core strengthening that was the appropriate level of difficulty for where my strength was. I wanted to get back to doing planks and harder core strengthening, but she pointed out that I was putting too much stress on the small diastasis recti that I had. She gave me modifications to exercises that I wanted to do, and it was things that I could easily do when playing on the floor with Henry. She also discussed urge suppression strategies, which provided me with things to do or think about when I felt like I had to go to the bathroom, especially mid-run.
- Everyone is different, and 6 weeks is not the magic number
I don’t think anything will prepare you for the mental and physical recovery you go through after birth. My experience was way tougher than I imagined, and I knew my return to running would be hard considering my first walk around the block after giving birth I felt like everything down there was going to fall out of me! Significant heaviness, swelling, discomfort, and bleeding were my symptoms that I knew needed to get significantly better before even attempting a run. Also, with the unlimited access we have to social media it is easy to get caught up in what and when other moms are doing exercise-wise postpartum. It is important to realize everyone is different and to not compare your journey to others. How active you were when pregnant, your birth mode, any complications you had, and how you are recovering will all factor in.
The timeline for a return to running is going to be different for everyone, and just because your doctor said you are healed at 6 weeks, for most people, does NOT mean you are ready to run at 6 weeks. Tom Goom, aka the Running Physio, along with two Women’s Health Physiotherapists, Gráinne Donnelly and Emma Brockwell, published “Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population”, and they advised not to return to running until you are 3 months postnatal. I did feel like I was ready to run before 3 months, and needed to for my sanity. My first run/walk workout was about 7 weeks after birth.
A recent article published in the Journal of Orthopaedic & Sports Physical Therapy, “From Childbirth to the Starting Blocks: Are We Providing the Best Care to Our Postpartum Athletes?” proposes three stages when returning to activity postpartum (Deering et al. 2020). These stages include recovery, rehabilitation/training, and competition. Every individual progresses through the stages at their own pace.
- Start slow!
When I got home from the hospital I started walking short distances outside with Henry in the stroller, mostly to get some fresh air. I slowly increased my walking distance as my symptoms allowed. At 7 weeks I created my running program based on how I would initiate a return to running protocol for a patient coming back from a stress fracture. I started with 1 minute running and 3 minutes walking intervals. Then slowly increased run and decreased walk durations. I tracked my weekly mileage to make sure I wasn’t increasing by more than 10% each week to decrease the risk of injury. I started my walk/runs on the treadmill due to it being winter, and logistically was easier to try to get the workout in when Henry was napping. This frequently meant stopping the run early, or going upstairs to soothe him mid-run. Having a treadmill though has been a life saver, and I definitely recommend it for any parents wanting to run with a new baby. I started running with him in the jogging stroller when he was almost six months and could sit unassisted.
My body doesn’t feel like it did pre-Henry, and the jury is still out as to if it will ever feel that way again. Initially, I dealt with heaviness symptoms in my pelvic floor, and had to stop to go to the bathroom often. But that is slowly improving, especially with the urge suppression strategies I was given at physical therapy. With time everything is feeling better and my longest run so far has been 11 miles, with no pain and no potty breaks! A win in my book!
- Leaking is common, but not normal!
Luckily when I first started back running I didn’t have much issue with leakage. However, I did the super bowl 5k around four months postpartum and leaked the entire race! This was a major bummer as I thought I was doing so well. I think the leaking was due to the fact that I didn’t use the porta-potty one last time before the race due to the long line. So my advice is always go to the bathroom before you run, and sometimes you are going to need to stop mid-run.
If you are experiencing leakage with any activity postpartum know that it’s common, but not normal. Talk to your women’s health physical therapist to get appropriate exercises to address the leaking. There is so much more to it than just kegels!
- Get the right sports bra
I’m just going to put this out there that having to stop mid-run to go change into a more supportive sports bra was something I never even considered would be an issue pre-Henry. This has happened multiple times though, and I soon figured which of my sports bras work and which don’t. I also suggest if you are nursing that you either nurse your baby or pump right before your run…just do it. It makes everything more comfortable.
Also, I was worried that my milk production would go down if I ran too much. That has not been the case for me, and I have found no difference in my milk production as my training has increased. I make sure I eat enough to support the energy demands of breastfeeding, running, and just mom life with a nine month old (which is the hardest of all).
- Have a goal
It always helps me get out the door to run when I have something I am working towards. Initially it was helpful to have the Bayshore Half Marathon on my schedule to base my training around, which unfortunately as with all the other races was cancelled. Since COVID-19 I have been trying to get my speed back, and have been doing a 5K from my house about every 6 weeks with the goal of setting a PR later this summer.
I hope this helps current or future runner moms! It may seem near impossible to get back to running after having a baby, but don’t give up on your goals and doing an activity that makes you feel whole. Get help, listen to your body, progress slowly, and set realistic goals. Be patient with the process. It will be hard, but come on, you just grew and birthed a human, you can do hard things!
Hannah DePaul is a sports certified Doctor of Physical Therapy, who specializes in treating endurance athletes. She is a runner and triathlete herself, and has completed the Ironman World Championships 2x.