by Kat Suchet, Women's Health Physio and Founder of Hatch Athletic

How long do you wait? How do you prepare to return to running? What does the road back to running look like for you?

(ppst we also have a Running in Pregnancy Blog if you want to read that it's here)

Return to Running Postpartum

You’ve had your baby - massive congratulations! - and you’re busting to return to running. Turns out only 31% of us receive the correct advice when it comes to return to running guidance, and 25% of us never return to running after having a baby. 

We want to change this!

I'm hoping to make this as simple and as clear cut as possible so you too can have the most up to date guidelines on Return to Running Postpartum. 

What does the research say?

Well, the reality is we are still somewhat lacking the hard hitting evidence from a research perspective. In the absence of such, we have an excellent 2-part consensus statement published in the BMJ in Jan and March 2024 respectively (Deering, Christopher, Donnelly, Brockwell, Bo, Davenport, De Vivo, Dufour, Forner, Mills, Moore, Olsen, 2004) which builds upon an excellent clinical guideline written by a similar team in March 2019. This compiles the best available evidence alongside experienced clinical opinion from physiotherapists across the profession.

I'm going to combine this with some clinical observations that I'd like you to also consider and hopefully this will have you armed with all the info you need to make your decision about your return to running.

I think it's prudent to mention here that anyone who identifies as a runner and anyone who has had a baby, be it 2 months or 2 years ago, still qualifies as a postpartum runner, therefore someone for whom these guidelines apply. 

How long do I wait?

Argh this is such a tough one, for many reasons. Largely because, for the most part, we're still told to wait around 6 weeks/the time of your GP check to be cleared to resume gentle exercise. This, typically speaking would be your gentle and graded postpartum rehab, limiting high impact in the first instance and building your strength back up gradually. 

On top of this, for some years now physiotherapists and medical professionals have loosely held that a typical 12 week wait to return to running and high impact activities is to be recommended. This was largely due to our understanding of tissue healing times, which can then be followed by a couch-to-5km approach, given that some fairly standard strength, balance and coordination markers have been achieved. 

The problem with this is it has never factored in that every athlete/runner/person is going to present differently postpartum. Their musculoskeletal system will be different; their injury history will be different; as will their pregnancy and birth history; as will their experience level as a runner.

Research shows us that elite runners who return to running prior to 6 weeks postpartum show no significant increased incidence of incontinence. However, the data for recreational runners is more varied, with Moore & Brockwell (2021) finding that returning-to-running increased the odds of developing stress urinary incontinence (SUI) regardless of time-frame. Remember though, these are just two slices of data. A lot of pelvic floor dysfunction in athletes and recreational runners will, naturally, be underreported. As will a lot of postpartum running success stories. We're simply unable to capture a good global experience here. What we know from these examples are that we are all different. 

I think it's important to recognise that ALL runners will experience some regression and reconditioning following birth that will require a rehabilitative approach. 

At the time of publishing this blog, a period of relative rest comes strongly recommended. An absolute bare-minimum recommendation is a 3 week-wait. And at the very least you should wait until any lochea (postpartum bleeding) has stopped. 

As a Hatch gold-standard we still stick with a fairly generic 6 week wait to resume our 12-week postpartum programme, because we generally cater for an online population - one we cannot assess in person. Also, the reason being is the general thinking is it is better to progress a little more conservatively, than progress too fast too soon. However, I acknowledge that every athlete will be able to start running, and also for that matter to start our postpartum training programme, at a different time.

In order to encourage autonomous decision making as an athlete, be sure to factor in the following milestones when making the best, most educated decision for yourself. 

Key milestones to run-readiness

Experienced professionals have now conceded that there are a series of milestones that can be used to determine run-readiness postpartum. 

Key Areas to Assess

Prior to running, either assess or have an assessment for any symptoms of pelvic floor dysfunction. It's also vital to assess your legs, pelvic floor and core strength, coordination and balance. 

What does the green light look like for this then? In terms of severity of these symptoms no consensus was made. As a gold-standard from a Hatch perspective, you'd typically be symptom-free regarding any pelvic floor dysfunction. This means no symptoms of urinary or anal incontinence - no leaking - no symptoms of pelvic organ prolapse (POP) no pelvic discomfort, bulging, dragging or heaviness. If you experience any of the above I would highly advise seeing a pelvic health physiotherapist prior to making your decision on when to return to running.

A pelvic floor physiotherapist can also take a measurement of your pelvic floor called a GH+PB. This measurement basically gives us a good indication of your risk level for pelvic organ prolapse. Paired with knowledge about your pelvic floor strength, resting tone, endurance and coordination this can be a really good assessment to add to the mix when assessing when is right for you to return to running. 

There is currently no evidence or no consensus amongst professionals to suggest that diastasis/abdominal separation should be a reason not to return to running - but of course to recommend seeing a professional for assessment if you have abdominal pain. 

Load and Impact

It's recommended to gradually increase your load (gradual, progressive strength work) and your impact (gradual, progressive jump/plyometric work). You can do this by incrementally strength training your pelvic floor, abdominals, hip abductor muscles and hamstrings with squats, deadlifts, bridges/hip thrusts, lunges, etc and by jump-training by increasing speed, height, duration, direction of jumping. This kind of training ensures that you're testing your body gradually to ensure this kind of demand doesn't provoke any symptoms of pelvic floor dysfunction.

Here are some of the commonly accepted load and impact screens that physiotherapists are now using to decide if a client is ready for running:

Walking for 30 min

Single leg balance for 10 s each leg

Single leg squats × 10 repetitions each leg

Jogging on the spot for 1 min

Forward bounds × 10 repetitions

Hopping in place × 10 repetitions each leg

Single leg ‘running man’ (opposite arm and hip flexion/extension with knee bent) × 10 repetitions each side

Calf raises × 20 repetitions

Single leg bridge × 20 repetitions each leg

Single leg sit to stand × 20 repetitions each leg

How's the Rest of You?

It's important to consider what else is going on in your world and to acknowledge if there are, or might be, any contributing factors that might influence your return to running. Could you be severely lacking in sleep, perhaps you have a very complex birth history, or you've got a prior history of an ankle or a back injury that needs to be factored in. Are you struggling mentally with the new demands of motherhood or life in general? Or have you prioritised mental health as a reason to get back to running sooner.

So you see, each factor can flip both ways. It's about making sure you assess your OWN personal situation in order to make an educated decision on when YOU return to running. 

So What if I Decide to Run?

Girl's gotta run. There are some of you who will make a decision to run even though the coast may not be altogether clear - so to speak. It's our responsibility at Hatch to ensure you feel supported too.

The good news: there are still workarounds if you find yourself in this camp i.e. you have pelvic floor dysfunction, or a niggly injury/discomfort, but you've made an informed decision and you've just gotta get out there and run.

Support Items

There are Support Items out there to help overcome or workaround some of these barriers to keep you running if you decide the benefits outweigh those risks. Continence devices like Contiform or Efemia are popular, as are intravaginal devices i.e. pessaries.

Ensuring you have well-cushioned running shoes, a well-supporting bra or compression garments can all help with the more minor discomforts of the ground reaction forces of running. We have discounts with Natal Active who do really good supportive feeding bras and SRC Health for compression garments (see end of blog for discount details). If you want to buggy-run, be sure to buy one that's been designed for purpose. 

Although not recommended as a true workaround, there are pads and absorbent products like period underwear that can limit the impact of any leaking should you decide to run through this. Having said this, there are methods to combat leaking in much better ways... see above regarding vaginal pessaries/devices and book a womens health physio appointment to establish if there's a reason behind your symptoms that can be retrained, i.e. pelvic floor muscle training. 

Keep Well-Fuelled

Hydrate. Drink water and plenty of it. Especially if you're breastfeeding, so do whatever you can to replenish your lost fluids, keep your bowel movements regular and avoid any supply changes. Supply can be affected at the very extreme limits of training, however those who stay well-hydrated should not experience any change to their milk supply when running at moderate or even short periods of high intensity. Even so it's recommended that runners who are lactating should feed or express milk prior to going for a run to ensure supply maintenance. Try a little pinch of salt in there to help with the absorption if you're training hard.  It's a 'wives tale' if someone tells you your milk might taste sour after exercise. 

Nourish. Keep well nourished with minimally-processed, nutrient-dense foods to encourage recovery and keep any postpartum depletion at bay. 

Supplements. It is recommended to keep taking your pre-natal supplement or a decent breastfeeding support supplement if you are continuing to breastfeed. I would actually advise this even for non-breastfeeding mamas for the first 4-6 months postpartum. Protein shakes post-workout are typically O.K. for breastfeeding if they're just a simple whey protein variety. Go for the ones with minimal additives and I always say, only supplement with protein if you're absolutely sure you're not able to get it from your diet. Natural sources of macro-nutrients are always a better option to the processed alternative. Avoid Kreatine supplements if you're breastfeeding as there is no research to support its use with breastfeeding mothers. 

All in all, what's wonderful about these latest guidelines are that you're not pigeonholed into any specific camp when it comes to your journey on return to running postpartum. Your body, your knowledge and understanding will be able to guide you there at YOUR OWN SPEED. Be that quicker than some or longer than others. And most importantly, you'll be armed with the understanding about it all. 

Hope it's been useful. A massive thank you to the research team who went to such lengths to provide these guidelines for us.

Would love to hear about your experiences postpartum,

Did you catch our article on Running in Pregnancy? Read it here.  

Want to know more or have a consult about your own personal postpartum circumstances? Book a 1-to-1 consult with Women's Health Physio and Hatch Founder, Kat here https://www.hatchathletic.com/1-to-1 

Images with kind permission and thanks to Phoebe Chester who you can find at @buggyrunningwithmarlowe

For discounts with our partners Natal Active click here and use code HATCHATHLETIC to get 10% off. Or SRC Health click here and use code HATCHATHLETIC to get 10% off.