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Postpartum Return to Run
Rachel Cortright, PT, DP

Postpartum women can absolutely return to activities participated in prior to pregnancy, running included, and goal-setting should reflect this. There are just a few things to consider prior to beginning a “return to run” program postpartum. Main concerns include pelvic organ prolapse (POP), incisional healing, whether that be perineal or abdominal, and any vaginal bleeding. 

Pelvic Organ Prolapse (POP) guideline: 

  • Anterior wall = Cystocele (bladder) or Urethrocele
  • Posterior wall = Rectocele (rectum) or Enterocele
  • Apical = Uterine
  • Common complaints: pressure, heaviness, difficulty fully voiding, sexual dysfunction
  • Classification:
    • Stage 0 = no prolapse
    • Stage 1 = criteria for stage 0 not met
    • Stage 2 = most distal prolapse 1 cm above or below hymen/ “to” opening
    • Stage 3 = most distal prolapse >1 cm below hymen/ “through” opening
    • Stage 4 = complete procidentia or vault eversion

ACOG/AUGS Guidance Update: Diagnosis and Management of Pelvic Organ Prolapse Including Role of Mesh – The ObG Project

 

In clinic, we can determine if an individual may be ready to begin a “return to run” program through subjective and objective assessment, including orthopedic and pelvic assessment. 

  • Subjective 
    • >3 months postpartum
    • No leaking prior to running
    • No report of heaviness of vulva bulging (POP) prior to running
    • No non-menstrual cycle related bleeding
  • Orthopedic assessment (all symptom free)
    • 25 Single leg calf raises
    • 10 Squats
    • 10 Squat jumps
    • Ladder drills: quick feet, lateral quick feet
  • Pelvic Strength assessment (conducted by trained pelvic PT)
    • 10x fast pelvic contractions
    • 8-12 reps of 6-8 second Max holds
    • 60 sec sub max pelvic hold 

Infographic. Guidance for medical, health and fitness professionals to support women in returning to running postnatally | British Journal of Sports Medicine (bmj.com)

 

Strengthening can and should begin as soon as a patient feels ready, do not have to wait until the 6 week check-in with OB to be seen by pelvic PT. This includes core, hip and general lower extremity strengthening. 

Once cleared, patients should continue to focus on strengthening in combination with a “return to run” program. To prepare patients for running, exercises such as squats, step-ups, lunges, plyometric and agility drills are useful. Focus should be on activation of pelvic floor muscles and avoidance of symptoms with these exercises. 

Return to run: 

  • 1 minute jog, 1 minute walk
  • Start with up to 10 repetitions (20 minutes of activity total)
  • Start flat, no hills
  • Can try 2x/week
  • Can perform on treadmill or outside, patient preference 
  • If on treadmill, start 5.5-6.0 MPH

 

Running photo citation: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.nicepng.com%2Fourpic%2Fu2q8a9i1w7q8o0i1_female-runner-2-icons-png-running-clipart%2F&psig=AOvVaw2tEQ6S-_SFaxUjCJATYlIS&ust=1704807728506000&source=images&cd=vfe&opi=89978449&ved=0CBIQjRxqFwoTCLjKn_T1zYMDFQAAAAAdAAAAABAE