By Calesse Smith
Disclaimer: *Please note that the information, recommendations, and exercise progressions described in this article were prescribed specifically for me based upon the evaluation of my PT and my strength coach. I am not a medical professional, just a runner and a mom like you! I highly recommend any mama who’s planning to return to exercise postpartum seeks guidance from a licensed pelvic floor physical therapist before doing so. Everyone’s birth story and journey is different, and so will you return to running!
How It Started:
I grew up as a very active kid and remained active into my college years running cross-country and track at a Division I university. Into adulthood, I’ve raced triathlon, running road races including 5ks up to the marathon. I also enjoy rock climbing, kayaking, hiking, and basically anything involving being active or outdoors. Sound familiar to any of you mamas?
When I found out I was pregnant with my first child in October 2020, I was overjoyed, but I also felt nervous. What would this process do to the body I’d worked so long to develop and make strong and fast? Would I be able to continue the activities I loved during pregnancy, and especially, postpartum? Many fears and anxieties flooded my mind during an otherwise extremely exciting time.
Luckily, I was able to continue running and many of my other favorite activities right up until the day I went into labor. This was such a blessing both for my physical and my mental health. Although my body was changing in ways it never had before, running in particular helped to ground me and gave me some connection to the person I was before I became pregnant.
I received regular chiropractic care and had an evaluation from a pelvic floor physical therapist while I was pregnant. I’d heard from many of my runner friends who’d had babies that taking care of my pelvic floor both pre and postnatally was critical if I wanted to avoid potential long term effects of pelvic floor disfunction, including incontinence, diastasis recti (separation of the abdominal muscles), as well as other hip, pelvic, and bone injuries down the line.
My PT was wonderful! She specialized in working with athletes like myself, and was very encouraging. At about 34 weeks pregnant during my initial evaluation, she had me demonstrate a series of exercises such as squats and single leg balances to assess my weaknesses. She also performed an internal pelvic exam. She showed me how to perform self perineal massage and recommended I spend 5-10 minutes a day a few times per week doing the massage to help my perineum prepare for the intense stretching that would occur during labor. I have to be honest, I tried the perineal massage once and never made it a priority again. It was difficult to do one myself with my big belly, and it was uncomfortable.
My PT told me what to expect in regards to returning to running postpartum. I would begin with some gentle core and pelvic floor activation exercises beginning 2-3 weeks postpartum in addition to walking, then I’d add in other low impact cardio activities such as swimming and elliptical, followed by a 6 week walk-run progression.
My son Levi was born on June 21 at 3:05 am after a long and rather complicated labor including three hours of pushing! I was thankful I didn’t have to have a C-section because I knew the recovery would be longer, but due to his vacuum extraction when he went into acute cardiac distress, I did have an episiotomy.
I distinctly recall waking up after a few glorious hours of sleep in our recovery room later in the morning he was born feeling as if I’d been run over by a truck. Every muscle in my body ached! Boy, giving birth sure was a full body experience! I couldn’t fathom how women who didn’t exercise regularly, particularly during their pregnancies, could manage! But I was thankful for my strength and endurance because I know it helped me push through my long labor, and possibly helped me to avoid further complications.
Postpartum Journey Begins:
That morning I walked up and down the halls of the recovery wing in my very fashionable hospital issue grippy socks and gown chatting on the phone with my mom while my husband tended to our son in our room. My muscles ached, I was stiff, and I was in a fair amount of pain from the labor itself, as well as my fresh episiotomy stitches. But I knew getting up and moving around a bit would help me feel better and recover faster
Beginning the day we returned home from the hospital I walked each morning with my mom (who was visiting for a few weeks to help us out) and Levi in the stroller or the baby carrier. Soon we were walking 4, 5, even 6 miles a day and every day I was feeling stronger and more recovered. Although it was warm and humid (thank you Virginia swamp season), it felt good to get moving every day, and Levi seemed to enjoy it, too, usually falling asleep not long into our walks.
I checked in with my pelvic floor PT right after I gave birth and she prescribed me a handful of exercises I could start doing daily at home. They included lots of Kegals (she recommended doing a set after every feeding session to help me remember), leg raises (side and laying on my back), deep breathing engaging my pelvic floor, planks (side and front), pelvic tilts, bird dogs, squats, and lunges. I often did these exercises when I could get my little guy down for a nap (sometimes in his nursery while I watched him in his crib), or while he was enjoying some time under his play gym.
I went in for an evaluation with her at 3 weeks postpartum. She ran me through a long series of exercises, again to test my balance and strength, and announced that I was functioning as if I’d never even had a baby! I did have some minor ab separation, but she said that was still very normal at that point, and it should minimize and disappear by 10-12 weeks postpartum.
Despite this, my PT cautioned me that the most recent research recommended women not return to running until 10-12 weeks postpartum. This allowed for the pelvic floor muscles to fully recover and minimized the potential for injury upon returning to running, especially bone injuries such as stress fractures. Relaxin, the hormone that circulates in a woman’s body to help the ligaments and tendons relax during labor to allow the baby to pass through the narrow birth canal, is still present for several months postpartum. This puts women at an increased risk for injury. For breastfeeding moms, relaxin and other similar hormones are present until three months after she stops breastfeeding. Combine that with the increased hydration and caloric requirements of nursing mothers, and this creates significant demands on the mother’s system while she is recovering from birth while also getting back into running.
At my 6 week checkup with my OB, she gave me the green light to slowly begin returning to exercise. But all she said was, “Wow! Your body is bouncing back fast. You’re good to start running again. Just listen to your body, and don’t go out and run a half marathon this weekend!”
I was so glad I was getting more specific and tailored guidance from a pelvic floor PT, because I felt that her advice could be taken the wrong way by many women who are used to doing intense exercise daily and could result in them begin sidelined with an injury not long after returning to running! How disheartening! I feel strongly that an evaluation from a pelvic floor PT should be part of our standard of care for all women in the postpartum period, not a specialty service that only some women have access to.
I also sought guidance from my strength coach, who I work with remotely. He tailors my strength program to my individual needs, time constraints, areas of strength and weakness, and fitness goals. I eased back into my weight routine 8 weeks postpartum after 4 weeks of a bodyweight only routine my pelvic floor therapist gave me, which I did daily for about 10-15 minutes. At first, my exercises consisted mainly of mobility, balance, and core activation activities. We’ve gradually added in weights and some cable machines.
In regards to cardio recommendations, here is the progression my PT laid out (Note: I had a vaginal birth. Time frames would differ for a C-section):
Weeks 1-3 Postpartum:
Gentle walking (as it feels comfortable)
Incorporate stationary bike or elliptical.
Swimming, power walking, light strength training (core exercises, resistance training).
Interval training with power walking, elliptical, swimming, possibly some run/walk.
Build training volume (distance/time) with a run/walk approach before intensity.
Return to Running Test:
My Pelvic floor PT also gave me a list of exercises I should be able to complete without pain or incontinence before returning to running:
· Single leg balance x10 sec. each leg
· Single leg squat x10 reps each leg
· Jog in place for 1 min.
· Forward bounds x10 reps
· Hop in place x10 reps each leg
· Single leg “running” woman x10 each leg
· Single leg calf raise x20 each leg
· Single leg bridge x20 each leg
· Single leg sit to stand x20 each leg
· Side lying leg lift x20 each leg
· Pelvic floor hold (Kegal) 60 sec. x 6-8 reps.
At 10 weeks postpartum, I am just now beginning a very conservative return to running program much like a Couch to 5k plan, with a walk-run approach where gradually the ratio of walking to running adjusts each week so there is relatively more running, and less walking. So far I have done:
*Each run/ walk begins with a 5 minute walk warm-up and ends with a 5 minute walk cool -down.
Saturday - 10 x 30 sec. run/1 min. walk
Sunday - OFF
Monday - core/ weight training
Tuesday - 6 x 1 min. run/ 2 min. walk
Wednesday - core/ weight training
Thursday - 10 x 1 min. run/ 1 min. walk
Friday - OFF
Saturday - 8 x 2 min. run/ 1 min. walk
Sunday - OFF
Monday - 5 x 4 min. run/ 1 min. walk
Tuesday - core/ weight training
Wednesday - 4 x 4 min. run/1 min. walk
Thursday - core/ weight training
Friday - 4 x 8 min. run/ 1 min. walk
As you can see, this is not a linear progression. We go up a little in reps and total duration of running, then go back down. Currently, I am not running on consecutive days, but gradually I will add more running days per week, and then add distance. Eventually I'll reintroduce harder runs, such as track workouts with intervals, tempo runs, and long runs.
This is my journey so far. I wish you a healthy return to exercise in your own time. Part 2 with more updates on the running front to come!