Returning to running after childbirth
Leah contacted me about some information about the pelvic floor and running. I jumped at the chance to answer some questions about it, as it is a topic that really interests me. I am a runner – no crazy distances or anything, but I love the freedom, ease and whole body workout of a run. Plus, I understand how logistically easy going out for a run is for a new mum (once you strap your bazookas into a bra and gather the energy!), compared to hauling yourself to a gym and back.
What is your pelvic floor, and what happens if it is not working properly?
The pelvic floor is the part of the body that sits at the bottom of the pelvis. It includes muscles, ligaments and connective tissue running from the pubic bone at the front, to the tailbone at your back and connect to your sit bones on either side – basically, it is your saddle or gusset area. Think of a hammock, holding everything in. Your bladder, uterus and bowels rest on this hammock, and 3 passages run through it from their corresponding organ: urine tube, vagina and anus.
When your pelvic floor is working well with your abdominals, your diaphragm (breathing muscle) and other muscles, they:
Hold things in (poo, wee and your organs)
Let things out (poo, wee and babies)
Give you sexual function
Pregnancy can make the pelvic floor muscles weaker and more lax. When it comes to delivery, a vaginal delivery stretches the pelvic floor muscles to around 2.5x their resting length. A C-section may disrupt the action of the abdominal wall, and have an effect on the pelvic floor this way. So, all new mums need to give their pelvic floor a little love, and do some rehab.
When these muscles aren’t working properly you may experience one or more of the following:
Leakage of urine or poo
Prolapse (a bulging of your organs into your vagina)
Low back or pelvic pain
Constipation or difficulty pooing
If you experience any of these things, it may be due to a number of factors. It may be that your pelvic floor is weak or torn. It may be spasmed or tight. Conversely, it may be strong, but not working properly with your breathing muscles or abs. You may have a prolapse or laxity in the structures that hold up the bladder and uterus. The only way to know what your pelvic floor function is like, is to be assessed by a pelvic floor physio.
What effect does running have on the pelvic floor?
Running is a form of high impact exercise. As your heel strikes for each step, the force travels up your leg to your pelvic area. A functional pelvic floor will contract on each heel strike (about 3000 times for a 30 min run!) to cushion the force from the leg. Over time, this repetitive force can weaken the pelvic floor muscles.
When you run, the pressure inside your abdomen can increase up to 2.5x the amount of the pressure produced when walking. If the surrounding muscle system (pelvic floor, abdominals and breathing muscles) isn’t working in the correct synchrony, this pressure may be pushed out at the weakest link (usually the pelvic floor area) causing pelvic floor dysfunction. Or it may manifest itself as low back or pelvic joint pain, or abdominal wall hernia. Oooouuuuuuch!
Returning to running too soon may increase your risk of prolapse, leakage of faeces or urine, low back or pelvic pain, or injuries further down the chain into the legs.
When can I return to running after having a baby?
It really is different for everyone! Some women are at high risk for pelvic floor dysfunction and I would really recommend a visit to a pelvic floor physio if you identify with any of these factors. Some people may return to running with absolutely no issues at all. For women with low risk of pelvic floor dysfunction, I recommend the following rough timeframes if you don’t have any musculoskeletal or pelvic floor problems:
0-12 weeks post natal = Low impact exercise:
You still have relaxin (the pregnancy specific ‘stretchy’ hormone) floating around in your connective tissue until about 12 weeks post-natal. In this time, you may be more prone to injury so stick to low impact exercise, and using this time to get your pelvic floor working well
After 12 weeks:
If you are breastfeeding, you may still be dealing with the breastfeeding hormones in your body, which may also be causing some laxity of your tissues. So I usually say, if you’re not desperate to return to running, wait until you’ve finished breastfeeding to be safe. (I know right?!, it’s going to take more than a couple of sports bras and a harness to strap those puppies down anyway!). If you want to run before that time ends, see a pelvic floor physio who can talk you through options like pessaries, running style assessment and other factors to keep your pelvic floor and pelvic organs safe whilst you run.
When you want to return to running, test your pelvic floor first: if you can do 10 star jumps, with a full bladder, whilst coughing at the same time, (WTF?!? Sounds terrifying, ammaright?) and you experience no leakage of urine or bulging in the vaginal area, then you are probably ok to start running slowly.
If you put on quite a bit of weight during pregnancy, choose lower impact exercise before hitting the pavement. The more weight your pelvic floor carries, the bigger the force when your foot hits the ground, and the more damage that may be done. You could try low impact exercises like spinning (stay seated for pelvic floor health), walking uphill or swimming.
Before you go out for a jog, check your shoes. Make sure there is enough support and go for the styles that increase shock absorption. Also, get the largest, harness-y, strap-yourself-in type of sports bra you can find! Your breast tissue is lax from the hormonal changes – so lock those things in. Take it slow, jog for a minute and walk for a minute, and repeat this 5-10 times, and see how that feels. Jog with a tall spine, and soft feet (pretend you’re sneaking up on someone) to decrease the force on your joints and tissues. Good runners glide along with minimal up/down or side to side movement: mimic them! Start on the flat, without the pram. Build up slowly from there.
What can I do to ensure I am not doing damage to my pelvic floor?
See a women’s health physio. Pelvic floor exercises are important after having a baby, but they really should be done correctly (30% of all women are contracting their pelvic floor incorrectly when asked). The only way to know whether you are really doing them right, is by having a pelvic floor check with a physio.
What’s more, the pelvic floor muscles do not work in isolation. We must train them to contract and (just as importantly) relax in synchrony with the other muscles of our body such as our breathing muscles, abdominals, gluts, thighs etc. A fellow pelvic floor physio (and, someone who I totally admire and aspire to be and creepily follow all her blog posts and have a mad girl crush on), Julie Wiebe, made this video on how the use your pelvic floor well with running type exercises: http://www.runnersworld.com/video/body-shop-inner-core
This video is a great start, but the best thing for your pelvic floor is to get individualized advice from your physio. This may be advice to change other activities that may cause overload of the pelvic floor: constipation/straining on the toilet, lifting heavy weights repeatedly, lots of planks or sit-ups, chronic coughing, increased body weight, poor posture etc
What does a pelvic floor physio appointment entail?
What a course of pelvic floor physio sessions will entail depends completely on the individual. A vaginal assessment will give the best assessment of what’s going on down there, but using diagnostic ultrasound (via a probe on your tummy) can also give a picture of what the muscles are doing. From there, you will probably be given pelvic floor exercises based around what you need to work on and what your goals are, advice on bladder and bowel health, general exercise advice, advice on internal support devices such as a pessary or Contiform, manual therapy if needed and how things in your life may be affecting your pelvic floor function (ie lifting your baby, the way you breathe, how you run, your job). You will probably need a few sessions to obtain your goal, and it may take a bit of dedication to your rehab.
To summarise: The pelvic floor can have a big impact on your running, and running can have a big impact on your pelvic floor! Listen to your body and be kind to it, with a supervised, gradual return to running and pelvic floor specific programme.
- the vagina physio