It’s been 6 weeks since bubs arrived, and I’m ready for running and impact exercise right?
Em No.
When the clock strikes midnight on Week 6 post natal, the body tissues do not magically heal to allow you to go straight back to pre-pregnancy exercise (sigh…if only it were true though!!)
De Mattos Lorenco et al. 2018 completed a systematic review to look at all the research on urinary incontinence in female athletes. They concluded “High-impact activities showed a 1.9-fold prevalence over medium-impact activities and 4.59-fold prevalence over impact activities”
Running can create ground reaction forces between 1.6 and 2.5 times bodyweight and will increase intra-abdominal pressure, but just how much of this is absorbed by the legs and the pelvic floor? Have a look back at these blogs to understand about the core and pressure system .
The pelvic floor muscles therefore need to be strong enough to support this pressure, but also be able to adapt and move with the changes in pressure to stabilise the pressure in the abdomen.
Pregnancy puts a significant amount of pressure onto the pelvic floor. The pelvic floor has a “U” shaped space (see blue line on the picture to the left) for the urethral and vaginal openings.
The U shaped space actually widens during pregnancy and even more so during a vaginal delivery. After a C-section the space will decrease but it can take up 12 months for this space to return to a similar size after a vaginal delivery. But it will never return to prenatal size. Why is this important? Look from the side
You can see the vagina is in the middle of the pelvic organs and canals. If there is injury or laxity in the tissues that support the organs, the tissues becomes over stretched and the organs will descend into the vagina causing a pelvic organ prolapse. The vagina sits above the levator gap, therefore an increase in this width means less support for the organs.
After a caesarian section, the uterine scar will still be thickened and healing at 6 weeks post natal (which is one reason C-section recover takes longer) . But studies have also shown that abdominal fascial has only 51-59 % of its original strength at 6 weeks, and 73-93% of its original strength at 6-7 months ( Ceydeli et al. 2005, taken from Return to Running Guidelines see reference below)
Looking at the anatomy and statistics above, you can see why these guidelines were needed.
The guidelines state:
“a low impact exercise timeline is followed within the first 3 months of the postnatal period, followed by a return to running between 3-6 months post-natal at the earliest. In addition to this every post natal mother, regardless of delivery mode, should be offered the opportunity o receive a pelvic health assessment (from 6-weeks postnatal) with a specialist physiotherapist to comprehensively assess the abdominal wall and pelvic floor including vaginal exam as indicated”
We also know that:
“The evidence supporting individualised pelvic floor rehabilitation for the management of urinary incontinence (Bo, 2003; Dumoulin et al.2018; Price et al. 2010), POP (Hagen et al. 2013), sexual dysfunction (Braekken et al. 2015) and the prevention of POP (Hagen et al. 2013) is well established. (RTR gudelines).
Although the guidelines recommend 3- 6months, again this does not mean at bang on 3 months you are ready for a 5 km run. If you have any signs and symptoms of abdominal wall or pelvic floor dysfunction, or risk factors then allowing the body as much time to heal AND be symptom free AND reduce your risk factors will give you the safest return to running/impact experience. A pelvic floor assessment is strongly recommended too, there could be a prolapse that is not giving you any symptoms, or you may have risk factors for developing pelvic floor dysfunction later on in life. Simply not having symptoms of dysfunction is not a good enough reason to commence running.
Reference: Reference: Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. Tom Goom, Gráinne Donnelly and Emma Brockwell Published – March 2019