Individualised assessments and guided pelvic floor rehabilitation can help to prevent and manage pelvic organ prolapse, urinary incontinence and sexual function postnatally. Therefore, health care professionals should screen women for key symptoms and risk factors of pelvic floor and abdominal wall dysfunctions before return to running. Women should follow low impact exercises within the first 3 months postnatally.
Pelvic health assessments
All women should be offered the opportunity to receive a pelvic health assessment postnatally with a specialised physiotherapist and should not return to running prior to 3-6 months.
Low impact exercises and strength testing
Pelvic floor and musculoskeletal physiotherapists should work together to evaluate the ability to return to running postnatally. They should assess on the side of caution and combine time-based criteria with signs, tests and recognised risk factors that are outlined in these guidelines. Postnatal mothers need to receive a series of low impact exercises and extensive strength testing, which are outlined in the guidelines before considering to return to running.
Individualised rehabilitation programme
The authors discuss how further factors such as breathing, psychological status, breastfeeding, et cetera. should be taken into consideration. Prescribed rehabilitation needs to vary depending on individual presentations and needs.
How to return to running?
Women should return to running in a graded approach following adequate postnatal pelvic floor and abdominal muscle recovery. It is a process of balancing risk and reward for each woman. It is sensible to start with 1 to 2 minutes running at an easy pace and to use return to running programmes, such as the NHS “Couch to 5K”. For running training progression, women should focus on training volume (e.g., running distance and/ or time) before increasing training intensity. For more challenging performance, it might be helpful to work with a local running coach. Unfortunately, the research about how to return to running postnatally is still limited.
Running with a stroller
If a women decides to run with her baby in a stroller, the safety of the child needs to be ensured and the stroller needs to be designed for this function. The research on the physical, physiological and biomechanical differences of running with a stroller postnatally are still limited and variable. It is believed that running with a stroller might lead to minor changes in trunk, pelvis and hip movement and gluteal strengthening exercises and additional stetch exercises should be included to address these differences. Women should be aware that energy costs might be increased when running with a stroller.
> From: Donnelly, Br J Sports Med 54 (2020) 1114-1115 . All rights reserved to The Author(s). Click here for the online summary.
Want to read deeper into this topic? You can find the free full text version here!
Besides the full text, the authors of this guideline also wrote an interesting blog post for the British Journal of Sports Medicine.
Expert opinion
The authors developed these guidelines based on critically appraised evidence from the Royal College of Obstetricians and Gynaecologists, alongside extensive clinical expertise. The guidelines are practically oriented and will help health care professionals as well as women who want to return to running after childbirth to archieve this goal.
The authors did not give any explanation of how they developed the guidelines, and the guidelines themselves were not published in a peer-reviewed article. Nevertheless, it should be taken into account that these guidelines have been featured several times by institutions such as the Chartered Society of Physiotherapy. Moreover, a infographic based on these guidelines was published in the British Journal for Sports Medicine.
