So, When Can I Start Running Again?? Part 2

Mums On The Runs USA is excited and honored to announce we have teamed up with women's health guru Shereen Sairafi PT, DPT, WCS. Shereen is a pelvic health physical therapist and Women's Health Clinical Specialist who lives and works in Denver, CO. She is an expert in everything pelvic health related including orthopedics, and is also an avid runner and marathoner!

Shereen has kindly agreed to share her expertise about returning to run postpartum, including her favorite exercises and how to do them!!

Returning to run postpartum

As a pelvic health physical therapist I see many patients in the early postpartum period and once they are cleared for exercise at their 6 week postpartum appointment they are ready to hit the road and resume the activities they missed while pregnant. I’d like to share the advice that I give my patients to help each of them have the best outcomes as they return to run.

Six weeks might be too early…

I know that can be hard to hear, I’ve worked with enough runners and triathletes to know

that this is not what you want to hear postpartum. However, something to consider is that the 6 week clearance for exercise is based on tissue healing of the your abdominal wall after a cesarean delivery or the vaginal tissues and pelvic floor muscles after a vaginal delivery. Unlike orthopedic injuries there is no return to sport testing or careful thought as to individualizing a patient’s plan for return to activity after having a baby.

As a result I think returning to run too early can lead to disappointment and frustration in both performance and in feeling like yourself again.

Your body has ongoing hormonal changes while you are newly postpartum and while

you are still breast feeding. This can impact feelings of pressure in the pelvis while running as well as increased laxity in your joints. It is also important to remember that it took your body 40 weeks to grow your beautiful babe and it can take just as long afterward to feel like yourself. As a result, I usually recommend my patients return to running no sooner than 12 weeks postpartum and that they keep a close monitor on any symptoms they experience. I also educate patients that it will likely take 6 months until you feel like yourself again on runs.

Signs you may have returned to running too early:

It feels like there is something bulging and/or falling out of the vagina

• This may be a pelvic organ prolapse and is something that you should mention to your midwife or OB/GYN. A pelvic organ prolapse is not harmful but the symptoms can be uncomfortable and limiting to every day activities. Luckily though, many prolapses respond well to pelvic health physical therapy intervention.

You’re leaking

• Urinary incontinence in pregnancy is the biggest indicator that you might leak postpartum.

• Leaking urine or stool while running is a sign of pelvic floor dysfunction and is something that can be addressed with physical therapy.

That low back/ pubic symphysis/ hip/ pelvic pain you had in pregnancy has returned.

• This indicates the muscle imbalances and movement patterns that caused this pain in pregnancy haven’t been addressed appropriately postpartum. Again, this is something that can be addressed with physical therapy!

How to set yourself up for success

Start with the walk run plan Emily shared in Part 1 of this post!

This is the program I give to all of my postpartum patients, we talk about modifications for each one but but it is a great jump off point!

Strengthen!!

As runners we are not always great about doing anything besides running, especially when we are on a time crunch, but below are some important areas to address.

Putting in this work ahead time helps prepare you for the best results postpartum.

Transverse abdominus (your deep core)

• The transverse abdominus is the deepest abdominal muscle and provides support and stability to the low back.

• Hooklying single knee fall out: While lying on your back bend both your knees so that your feet are flat on the floor as pictured. Put your hands on your hip bones on both sides and then move then down and in about an inch (toward your pubic bone). Exhale as you lightly flatten your lower belly muscles as if you were putting on a tight pair of pants. Another way to think about this is to imagine tightening your belly muscles to hug the baby that was in your belly! You should feel the muscles lightly tense underneath your fingers but not push

up into your fingers. Once you have the muscles engaged let one knee fall out to the side, move it only so far that your opposite hip does not come up off of the table. Then bring the leg back to the starting position and move the opposite leg. Alternate this motion between sides. Ensure that you are keeping the muscles engaged as you move the hips and keep breathing!!! This motion of core engagement is very subtle, it should not feel like you are flexing your belly muscles.

• Hooklying march: Engaging the transverse abdominus as you did above, lightly lift up your foot about an inch from the ground. Once you bring it back to the ground then lift up your opposite foot and lower it back down. Continue to alternate between sides.

Glute maximus

• Our largest glute muscle and the primary hip extender. This muscle is crucial for giving us power and propelling us forward while we run.

• Bridges: Lie on your back with your knees bent and feet flat on the floor. Breathe out and tighten your low belly and your booty as you push your hips into the air. Lift up your bottom just a small amount if this is hard initially, as it becomes easier lift up your hips so that you

are in a straight line from your shoulders to your knees.

• Single leg bridges: This is progression of the exercise above. It is performed the same way as above but push through one leg instead of two.

• Squats: Start with your feet hip width apart. Hinge at your hips and sit your

bottom back as if you were going to sit in a chair. Do not let your knees go over your toes, see the picture below! As you stand up push through your feet, focus on putting your weight in your heels so that you feel this in your booty! Exhale and tighten your belly as you stand up.

• Single leg squats: Do the same exercise as above but this time only on one

leg! Don’t sacrifice form just to do the more challenging exercise. An easier modification of this is when you have your back leg (the leg you aren’t using)

on a chair behind you so that it is supported. Do not let your knee fall in toward midline or let your knee go over your toes. As we spend so much time running on one leg this is an important exercise to do!

Glute medius

• The glute muscle that helps keep our hips level, especially when we run.

• Clamshells: Lie down on your side and form a straight line between your shoulders and your knees. Your knees should be bent at a 90 degree angle and your lower leg and feet should be behind you. Keep your feet together and lift up your top knee so that your legs open up, like a clamshell. Do not lift your leg so high that your hips start to roll back behind you.

• Standing leg lifts to the side: Standing with your hands on your hips or on a chair or table in front of you (for balance), lift up one leg out to the side. Slowly lower it back down and then lift again, try not to let your moving leg rest on the ground until you are done with all of your repetitions. As you do this you should not move any other area besides your hips/ legs, your chest should stay in the same position. To make this exercise more challenging put a band around your ankles as pictured.

• Band side stepping: Start in a mini squat position with a band around your knees (easier) or ankles (harder). While staying in the squat position take a large step sideways and then a small step with the back foot. Slowly you will make your way one direction. Always stay in the squat position and always keep some tension on the band. Walk about 10 ft and then start walking in the opposite direction.

• Breathing

• Your breath changes so much in pregnancy and it can be so challenging to take in a deep, filling breath. Below are a few exercises to help bring back the full excursion of your musculoskeletal system to help take in those deep breaths for your runs!

• Diaphragmatic breathing: Lie down on your back with your knees bent and feet flat on the ground. Put one hand on your belly and one hand on your chest. Focus on inhaling and letting your belly hand rise. Exhale out slowly and then do this again. Perform 2 sets of 5 repetitions of this exercise.

•Crocodile breathing: Lie down on your belly and put your forehand on your hands. Focus on inhaling into the back of your ribs and allowing your ribs to move out and away from your spine. Exhale out slowly and then do this again. Perform 2 sets of 5 repetitions of this exercise.

For all exercises that do not indicate how many exercises to do you can perform 2 sets of 10 and for those exercises there are unilateral perform the exercise on both sides and this will be one repetition. I recommend doing these exercise 3 times a week!

Thank you Shereen for your wisdom and expertise!

Here at Mums On The Run USA we hope you are able to find some helpful information and start doing these exercises so you can begin running again! If you are already running, now is the perfect time to start strengthening and addressing any pelvic health issues.

Questions or insights? Contact us at emily@mumsontherunusa.com

Picture credits:

TrA: https://momentumlab.sg/wp-content/uploads/2015/11/core.jpg

Glutes: https://www.physiospot.com/opinion/my-favourite- gluteal-activation- exercises/

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