Return to Run, Postpartum Edition

Whether you are an athlete or a weekend warrior, returning to running after having a child comes with unique challenges. I know because I’ve done it twice. After the six or eight-week check-up, it’s typical to get the “green light” to go back to your normal physical activities, but there is limited guidance on how you should do that both safely and effectively. Here I offer my advice from the feet all the way up to the head… 

Feet

Surprise! You might need a new shoe! Did you notice changes to your foot, most likely the size and arch of your foot, while you were pregnant? Since the bones of the foot get so much support from the ligaments, it is significantly impacted by the hormone relaxin which is coursing through you the whole time that you’re pregnant and through the end of breastfeeding. Most women complain about going up a whole shoe size during pregnancy. Besides that, the arch may remain weakened and though you might have been able to run in a low profile shoe, it would behoove you to go to a good running store to get a new profile done on your foot. Many women need a stability shoe upon return to run, especially while breastfeeding.

Knees

If you consider that the pelvis widened during the prenatal period and during labor, it is safe to assume that some of the stabilizing hip muscles have gotten stretched out. If you’re developing knee pain while running, there’s a strong likelihood that you need to incorporate hip strengthening as part of your strengthening/injury prevention program. My favorite for this is lateral band walks. It helps to give some nice compression to the sacroiliac joint and maintain good pelvis stability upon landing on one foot.

Hips

It comes as no surprise that the abdominal muscles have been stretched out. While the core muscles have been on a break to heal, it’s likely those hip flexors have been working overtime. These are likely the first things you’ll feel while returning to running. It might feel like a deep ache in your pelvis or a sharper ache in your groin or front of the hip. Either way, focus in on this hip flexor stretch and get to work making your core muscles the main focus.

Core

If you haven’t already, find out if you have a diastasis recti abdominis-  the separation of the two rectus abdominis heads from the midline (the linea alba). Whether you have one or not, I advocate for at least a month of core exercise before initiating plyometrics like running. Your core muscles underwent significant change over those 10 months and though our bodies are amazing healers, strength doesn’t manifest on its own. Work on your core endurance during daily life, and spend at least a few minutes each day doing some strength exercises. Two of my favorites are dead bugs and suitcase crunches.

Pelvic Floor

If you’re feeling significant heaviness in the pelvis while running, consider getting checked by a pelvic floor therapist for prolapse, which is when an organ (like the bladder or uterus) drops too low. More commonly, women experience leakage or incontinence during return to run. As described above, the pelvic floor muscles have been stretched out and might need to be re-educated to work properly. Most often, a kegel program is a necessary add-on to your core routine. The pelvic floor is a core muscle after all, and deserves the same attention as the abdominals during your fitness routine. 

Upper Trunk

Running requires good thoracic rotation and the ability to maintain upright posture. If you’re breastfeeding, timing will be your biggest concern. The other likely contributors are sports bra selection or upper back tightness from caring for your child. Consider getting fitted for the appropriate sports bra- racerback offers the most support. Be mindful of keeping your chest upright while running. And try these mobility exercises here and here to work out some of the remaining tension. 

Head

Running is mostly mental. Be kind to yourself and respect the changes that have happened to your body since your last run. The struggle is real, but isn’t the challenge half the fun? General rules if you have pain: if it gets better as you keep running or stays the same, it’s probably okay to run. If the pain gets worse as you continue or if your gait mechanics change, don’t push through or you will “run” into trouble. Worst case scenario, reach out to a physical therapist. If you live in Charlotte- give us a call!

~Meg Mizrachi, PT, DPT, OCS