Returning to Running Postpartum: Guidelines

For many postpartum women, running symbolizes a return to normalcy and independence. However, returning to running after childbirth is complex and requires careful consideration to avoid injury or long-term complications. Grainne Donnelly, Tom Goom and Emma Brockwell have co-authored the Returning to Running Postnatal Guidelines (2019), which offer evidence-based recommendations to help women navigate this transition safely.

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Why Are Guidelines Necessary?

Postpartum recovery is highly individual and depends on factors like the type of delivery (vaginal or C-section), the presence of complications, pre-existing health conditions, and fitness levels before and during pregnancy. Research highlights the increased risk of pelvic floor dysfunction, such as urinary incontinence, prolapse, or pelvic pain, if a return to high-impact exercise is attempted too early.

The guidelines emphasize that running is a high-impact activity requiring adequate pelvic floor and abdominal strength, as well as overall body resilience.

Key Recommendations

1. Timing Matters

The guideline recommends that on average women will be approximately 12 weeks postpartum before returning to running however timelines are very individual and some women may return sooner while some will wait longer.

This delay allows:

• Recovery of pelvic floor muscles and connective tissues, which undergo significant strain during pregnancy and childbirth.
• Time to address any physical or psychological trauma, such as tearing, C-section recovery, or birth-related injuries.

2. Individualised Assessment

Before running, women should undergo a comprehensive postpartum assessment by a pelvic health physiotherapist. This evaluation typically includes:

• Pelvic floor strength testing.
• Assessment of abdominal muscle separation (diastasis recti).
• Screening for symptoms like heaviness, leaking, or pain.

3. Graded Return to Activity

The guidelines recommend starting with lower-impact activities such as walking, Pilates, or swimming to build foundational strength and coordination. High-impact activities like running should only resume once certain criteria are met, including:

• No symptoms of pelvic floor dysfunction (e.g., urinary incontinence, prolapse, or pain).
• Sufficient pelvic and core strength to tolerate impact.
• Passing functional tests such as single-leg bridges, hopping, and jogging on the spot.

What Are the Risks of Returning Too Soon?

Returning to running too early can exacerbate postpartum issues, including:

1. Pelvic Floor Dysfunction
   High-impact activities increase intra-abdominal pressure, potentially weakening or damaging an already strained pelvic floor.
2. Prolapse
   Vaginal heaviness or bulging can result from weakened connective tissues, especially if high-impact forces are introduced too soon.
3. Musculoskeletal Injuries
   Hormonal changes during pregnancy, such as increased relaxin levels, can cause ligament laxity, making postpartum women more prone to injuries like shin splints or knee pain.

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How to Safely Progress

1. Strength Training

Incorporate exercises to build pelvic and core stability, such as:

• Squats.
• Glute bridges.
• Lunges.

Start with low impact activities such as walking and build volume (time/distance). Aim for 30mins without symptoms. Other activities depending on comfort would be the static bike or cross trainer.

2. Impact Preparation

Gradually reintroduce impact through exercises like forward bounds, hopping, or short intervals of jogging on the spot without symptoms of pelvic floor dysfunction.

3. Listen to Your Body

Symptoms like pain, heaviness, or incontinence are signals to slow down or seek further professional advice.

4. Wear Proper Support

Invest in a supportive sports bra and, if needed supportive underwear/sportswear to minimise discomfort and strain.

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Mental and Emotional Considerations

Beyond physical readiness, it’s important to address the mental and emotional aspects of postpartum recovery. Many women feel pressure to "bounce back" quickly, but embracing a gradual approach can lead to longer-term success and enjoyment of running.

Setting realistic expectations and focusing on gradual, symptom-free progression can help women regain confidence in their bodies.

Conclusion

Returning to running postpartum is an achievable goal with the right preparation and support. By following evidence-based guidelines and prioritising pelvic health, women can enjoy running while minimising the risk of complications.

If you’re unsure about your readiness or experiencing symptoms, consulting a pelvic health physiotherapist is the best first step. Remember, your postpartum recovery deserves patience and care—just like your body does.

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References

1. Donnelly, G., Brockwell, E., & Haslam, J. (2019). Returning to Running Postnatal Guidelines. Available at: runningspecialistclinic.co.uk

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