My Postpartum Return to Run Blog

Jun 21

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Hi All!

We’ve made it to the other side! If you missed Part 1 where I detailed all the things I did to stay healthy during pregnancy you can check that out! Doing the right things during pregnancy helps set the stage for a smooth return to activity so it is helpful to understand. If you didn’t read part 1, a brief intro…I’m a Physical Therapist and Certified Strength & Conditioning Specialist who specializes in treating and training runner’s, detailed gait analysis and advance certification in pre and postnatal exercise. I’m sharing my story to give a closer look into the personal approach of an expert on the topic of running and exercise during pregnancy and postpartum.

We were overjoyed to welcome our son Hugh on January 12th, 2023 (a mere 10 days late). Being able to spend a full 4 months away from my first baby, The Run Rx, wouldn’t have been possible without the great Dr. Maggie Mullins providing her usual stellar care to our full caseload of clients! My incredible staff of 1, as well as the lovely ladies at The Pilates Rx, were instrumental in holding down the fort in Winter Hill while I got to enjoy peaceful time with my growing family.

Lastly, I will say staying healthy and sane as a pregnant small business owner and now a mom-preneur does take a village, as fellow new mom and owner of the The Pilates Rx, Allie Duffy detailed in her postpartum blog. I couldn’t do it without the support of my husband, friends and family. And I echo her sentiment in a big THANK YOU to all our lovely clients and patients who reached out with gifts and well wishes. We have the absolute best community of people at The Run Rx!

PREGNANCY WEEKS 36-41.5

Woof. We left off at 36 weeks in my previous blog. 36 weeks onward was all about rest, relaxation and lots of trying to walk baby out! This was the “push prep” phase and any “workouts” were limited to walking with the dog and some light exercise like bodyweight deep squats to keep moving and encourage stretching of the pelvic floor and opening of the pelvis.

Primarily it was filled with lots of breathing and stretching in all positions….cat/camel, happy baby pose, figure 4 stretching etc. My only goal was letting muscles of the pelvic floor relax and stretch as best as I could considering a baby was dropping lower and lower.

Welcome Hugh! - 2 WEEKS POSTPARTUM

Delivery

Labor was the lesson of you can do everything right and be as prepared as possible but at some point things will be a bit out of your control. Once labor finally started, things moved quickly.

My only true birth plan was to focus on all the good breathing and pushing techniques that I know very well. I received an epidural but my hope was to reduce it before pushing so I could have a little more sensation and be able to feel what my body needed to do.

Because the baby’s heart rate was dropping, things moved quickly and I lost the chance to lower the epidural before it was time to push. I was told immediately that we needed to “get baby out quickly” and encouraged with pushing to hold my breath and bare down, which I absolutely know to be the opposite of what any pelvic floor PT would tell you. I spoke up but couldn’t deny the feedback I was getting that there was more movement each time I bared down instead of pushing through my exhale as planned.

After only 10 minutes, the MD was grabbing the vacuum due to HR concerns but with one final push Hugh arrived! I ended up with some grade 2 tearing which is normal. I did feel as though if I could have felt my body more and had more time to breathe the way I wanted maybe there would have been less.

The Takeaway: no matter how well you’ve prepared your body, there are things that are going to be out of control. Do your best to advocate for what you want but be prepared to adapt!

0 - 2 weeks

About 12 hours postpartum was really when the first of the recovery work began. As Hughie slept, I laid in the bed and focused on my breathing and reconnecting it with the muscles of my pelvic floor. Beyond that it was all about managing time on my feet so as to not overload a healing pelvic floor.

Side note - many people have a hard time “feeling” their pelvic floor muscles in pregnancy and otherwise. When you’ve JUST had a baby you will suddenly become VERY aware of them. These are the muscles that feel so vulnerable as you first stand and walk around.

I continued to practice breathing daily the first 2 weeks, adding gentle activation of deep transversus abdominis (TA) muscles. I started on my back where there is no gravity demand and progressed to more advanced sitting and quadruped positions. I incorporated some gentle chest stretching and thoracic rotation. Lots of rest and recovery while slowly progressing time on feet and listening to my body. Particularly the pelvic floor muscles and what they were tolerating.

The Takeaway: rest and recovery is most important but early breathing and muscle activation helps aid recovery. Gentle stretch and motion will help with the stiffness that comes with all those feedings.

POSTPARTUM WEEKS 2 - 6: Early Strength

The common belief is no exercise until 6 weeks. Which is just so wrong. You can and should, depending on your personal scenario and factors, be doing some light exercise in this timeframe. If that’s just breathing and activation exercises then fine! Everyone is different but there is usually something that any woman can start working on in this phase. Because realistically you’re carrying, lifting, standing up from chairs and walking around with an 8lb+ baby so why can’t you do a bodyweight squat?

Walking/Cardio

I did my first walk right at 2 weeks pp. No stroller, no dog, just me with good breathing and no distractions from being in touch with how my body was feeling and responding.

I started with 10 minutes and since I was having no symptoms or increased bleeding I was able to safely increase to 30 minutes walking by week 3-4. I then added the dog and/or stroller and slowly increased up to a 50 minute walk by week 6.

Core Specific

Gentle TA activation exercises progressed to adding some light movement like marches or overhead reaches on my back. Then into standing using light bands. I began adding modified oblique work like the side plank and palloff press.

Lower Extremity Strength

I started adding calf raises immediately as that is pretty low load and so important to runners. Especially one who’s Achilles hadn’t experienced the load of running in months. First double leg and then single as tolerated. Double leg bridges and side lying leg lifts were low load and asymptomatic and those progressed to bodyweight squatting through good breathing patterns and side steps with a very light band.

The Takeaway: As long as you are closely monitoring symptoms and your breathing you can and should begin some of these basic, minimally front-loading exercises to slowly re-introduce movement and strength.

POSTPARTUM WEEKS 6-12: Progressed Strength

The other common belief is at 6 weeks it’s full send back in to your usual exercise. Also a mistake. There’s SO much research supporting 6 weeks is way too early to return to impact. Instead, this is the time to continue to progressively add load to what you’ve started so when return to run arrives, your body can handle it.

At 6 weeks I had my pelvic floor PT assessment. Not because I was having any pain or issues beyond normal but because I think it is SO important to get this guidance even if you’re feeling good. Findings were all good! I was having no prolapse or any concerns beyond expected for 6 weeks pp. Just some mild muscle tightness especially surrounding my scar and a 2 finger diastasis which is to be expected. Pelvic floor and TA was firing well thanks to all the early exercises I started!

Walking/Cardio

Continued walks up to 60 min and added a little pace as able. Introduced some light hikes and some Peloton rides while staying in tuned to pelvic floor awareness with anything out of the saddle.

Core Specific

As abdominal muscles felt like they were kicking in to gear again, core work transitioned into more standing exercises and included adding rotation, diagonal loading and more obliques with exercises like the banded chop, trunk rotation or lunge with Palloff Press.

Lower Extremity Strength

I added double leg deadlift for glute and hamstring lengthening starting at low weights. Single leg strength began with basic step up and reverse lunge and progressed to single leg squats. Upper body resisted rows and pulls to counter the tightness of breast feeding paired with chest stretching and thoracic mobility. Load and resistance progressed pretty quickly from 6-12 weeks as I was feeling strong and symptom free. I introduced some light jumping at 8 weeks. This was my first sense that my body wasn’t prepared for running as I did notice some pelvic floor heaviness. It was box jumps to start, then double leg jump roping and single leg bounding by the end. With a safe progression, I was no longer feeling any heaviness with single leg hopping by 11 weeks and feeling ready to run!

The Takeaway: I started feeling pretty good around 1 week postpartum and generally FELT like I could do a little more than what we instruct patients on each step of the way. Despite this I continued to be patient knowing that I was still healing. So much research supports healing is happening well into the first year pp. You may feel great, but take your time. It’s not worth causing issues down the road to start running a few weeks earlier.

POSTPARTUM WEEKS 12-20: Return to run! And continued work

At 11 weeks I had another pelvic floor appointment to get one more assurance I was ready to run and got 2 thumbs up. There was no prolapse even in standing and everything was progressing nicely.

RUNNING!

Inspired by the Boston Marathon, I went for my first run in 6 months (!) on April 18 at 11 weeks and 5 days postpartum. I haven’t had more than 3 weeks away from running since I started at 18 years old so I was so eager. After checking all the boxes on our R2R checklist and getting clearance from a pelvic floor PT I was ready to go.

I had NO leaking, NO heaviness, NO pain, NO pressure. I slowly progressed duration based on feel and stuck to every other day alternating with strength and rest.

Here are the notable points in my progression..

4/18 (12 weeks pp) — 30 sec - 1 min jog/1 min walk x15
5/11 (14 weeks pp) - first sustained run without walk intervals for 30 min
5/23 (16 weeks pp) - longest run of 4.5 miles
6/6 (20 weeks pp) - fastest run @ 8 min pace and first back to back days

Core Specific

While crunching and rectus abdominis exercises should be avoided early on, they are important (when dosed correctly) in the fascial healing of a diastasis. With clearance from the gang at The Pilates Rx I added mini crunches with the support of a sheet. When they saw I could crunch without coning/doming, I lost the support. I’ve since added planking and front loaded exercises without issue.

Lower Extremity Strength

We’re back to lifting heavy! At 20+ weeks pp I am happily back to some of my heavier lifts like hex bar deadlifting and lots of single leg strength. My strength training is pretty much back to what it was and I plan to continue to stay strong to support my running and health long term!

The Takeaway: listen to your body, listen to the specialists and keep working on getting stronger and you CAN get back to running leaking and symptom free.

Final Thoughts

Treating and knowing so many women who deal with leaking, pain or other symptoms with running after baby had me admittedly a little nervous. Despite knowing it’s not normal and is very much something we can control with the right steps, it was hard to dismiss the sheer number of women who deal with it.

I feel super strong today at 23 weeks postpartum and owe a lot of that to the fact that strength training was a part of my regular routine through pregnancy as well as long before. I’m running up to 5 miles at good pace without any postpartum symptoms. My body may require a little more TLC now than it did before but I’ve never felt stronger.

I hope my story can shed a little light on this confusing process and how to navigate it. We happily offer lots of training and physical therapy options for women at any stage in this process. Whether you’re thinking about children, pregnant, 4 weeks postpartum or 4 years postpartum, you don’t have to settle. We are here to help you feel strong and empowered in your body and all the activities you want to do with it!