This month I have had 2 clients working towards running after having a baby; one with prolapse and one with diastasis recti. I would consider these women to be quite active and refer to them as ‘everyday athletes’. Not quite your professional level athlete, but they both value training and performance as part of their lifestyle and have regularly competed in marathon events.
I have treated quite a few runners and have no hesitations around programming from a pelvic health perspective, but last week I found myself on google scholar searching ‘running recommendations for postpartum athletes.’
And this paper came up:
Christopher, S. M., Donnelly, G., Brockwell, E., Bø, K., Davenport, M. H., & De Vivo, M. (2024). Clinical and exercise professional opinion of return-to-running readiness after childbirth: An international Delphi study and consensus statement. British Journal of Sports Medicine, 58(6), 299–312. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement – PubMed (nih.gov)
A very interesting read for a number of reasons:
- It was not a RCT, systematic review or meta-analysis but a consensus from professionals – can honestly say I have not read many of these before.
- It was framed by research but influenced by clinical experience of the professionals who took part in the survey. – I find so much more value in clinical experience versus research.
- It covered multiple components of ‘run readiness’ – not just is their pelvic floor ready.
Let’s talk about how the consensus was determined.
- Study participants consisted of Professionals around the world who worked with postpartum runners and were surveyed on multiple postpartum topics:
- Professionals must be health, rehabilitation and/or fitness professionals with more than 5 years experiences treating postpartum runners. If experience was less than 5 years 50% or more of their caseload had to be postpartum runners.
- Topics explored were key musculoskeletal assessments, key milestones and screening that should be used when determining readiness for running postpartum.
- Study participants were surveyed using a 3-round Delphi survey where questions were designed based around a literature review on postpartum physiology/biomechanics, running, running-related injuries and existing run-readiness frameworks.
- 95 study participants completed all 3 rounds of the Delphi surveys. After completion of all 3 rounds, current scientific evidence was summarised to determine if the consensus of professionals was in line with current research.
- Authors reviewed survey results and current literature and participated in a final discussion to develop the recommendations.
- Recommendations were formed and authors were sent out via anonymous survey to determine consensus on the recommendations.
What were the recommendations?
The paper presents the consensus, current evidence and recommendations for each topic. If you want to dive right into all the details I’d recommend reading the paper yourself.
But for now let’s dive into the recommendations that were presented:
The Consensus was reached on the following categories:
- Definition of ‘runner’ and ‘postpartum’
- Key Milestones that need to be addresses before postpartum return to running
- Load and impact screening
- Screening for biopsychosocial milestones
- Support items/adjuncts for return to running
- Other considerations for readiness to return-to-running after childbirth
- Education topics for postpartum runners
- Timeline for returning to running
Definition of ‘runner’ and ‘postpartum’
A runner was defined as ‘anyone who runs’. Anyone who self identifies as a runner should be considered one. Postpartum was not defined however it was agreed that it does not confine someone to the first 12 weeks post birth. Anyone who desires to return to running should be individually assessed to determine how they have recovered from pregnancy and childbirth.
Key Milestones that need to be addressed before postpartum return to running
10 milestones met consensus. However there was no consensus on what the minimum benchmarks are for these assessments due to lack of evidence surrounding these measures in return to running readiness.
Milestones for evaluation were:
- Pelvic floor strength
- Pelvic floor endurance
- Pelvic floor coordination
- Symptoms of urinary incontinence
- Symptoms of anal incontinence
- Symptoms of pelvic organ prolapse
- Lumbopelvic strength
- Balance and proprioception
- Lower extremity strength
- Running gait analysis
Load and impact screening
Before moving into running activities a runner should be able to do the following without any musculoskeletal or pelvic health symptoms:
- Walk for 30 mins
- Achieve 10 sec in a single leg balance assessment
- Execute 10 single leg squats
- Jog on the spot for 1 min
- Bound forward 10 times
- Single leg hop for 10 reps on each leg
- 10 reps of single leg running man on each side
- Calf raise 20 times
- Single leg bridge for 20 seconds
- Achieve 20 reps of single leg sit to stands on each leg
Screening for biopsychosocial milestones
All runners should be screened for concerns or issues with sleep, lactation status/concerns, hydration, fatigue, energy availability, pre-existing musculoskeletal conditions, pre-existing pelvic floor symptoms and mental health. Any issues that arise from this screening should be addressed by appropriate professionals where care is provided in a multi-disciplinary way.
Support items/adjuncts for return to running
Support items such as intravaginal supports, continence devices, absorbent products, may be beneficial for runners. Professional bra fitting, footwear and the use of compression garments may also be beneficial for individuals when returning to running. When using a stroller, runners should be educated on appropriateness and that a two handed approach may be more favourable.
Other considerations for readiness to return-to-running after childbirth
Things that need to be considered when supporting a postpartum runner:
- Prior running habits (before and during pregnancy)
- Current training and performance goals
- It is important that the runner plays an active role in the return-to-running plan including identifying barriers
- Honour the runners wishes even if key milestones are not met
- Stress levels should be considered
- Social support network
- Breath technique assessment prior to returning to running
- Biopsychosocial red flags need to be identified and addressed with a multidisciplinary team
Education topics for postpartum runners
Education specific for running during and after pregnancy should be individualised to the training level and goals of the runner. Education should include postpartum physiological and musculoskeletal recovery, what a gradual return to running looks like, key milestones that are indicative of readiness to run, the difference between nutrition and hydration for postpartum runners versus those who are not and the importance of expressing milk before going for a run.
Timeline for returning to running
The timeline on return to running should be 100% individualised. As a minimum the runner should have appropriate rest and recovery following childbirth where any birth injuries have fully healed. No running to commence before 3 weeks postpartum and a gradual progressive program that includes aerobic conditioning and strength training should be followed.
I guess it boils down to ‘there is no one size fits all’ return to run program only recommendations based on evaluating the research alongside years of clinical experience.
After reading this paper it was evident to me that there is still so much flexibility in how we program for postpartum runners. When we take into account every one of those categories and the finer layers within each category, one persons return to run program could look drastically different to another persons. I have found this to be true clinically, where some clients are ready to return to running much earlier than others and their body tolerates the load of running extremely well. As clinicians this population often requires clinical judgement and discretion after a full assessment of the individual. We need to foster safe return to running but also support the runner with their decision to begin when they desire, even if physically they are not quite ready. I often find this line to be very fine and found this paper extremely helpful to back my decisions for programming and guidance for these clients and I hope you do too.
So there you have it, how to determine if your client is ready to return to running post childbirth. And in the case that you’d like to learn more about pelvic health post birth and how to bridge the gap between pelvic floor exercises and high impact activities like running, I cover this step by step inside my mentorship program.
If you would like to join the waitlist for the 2025 program click here and be the first to know all the juicy details and have the opportunity to apply before anyone else. I will have very minimal positions inside this program next year all thanks to some exciting things happening in the background. So be sure to join the waitlist otherwise you may miss the once a year opportunity!
Have fabulous day wherever you are and I’ll catch you in the next one… BYE!