Guidelines for Postpartum Return to Running

The existence of the standard six-week postpartum check up for moms often creates the expectation that they can safely begin running again at that time. I certainly thought that was the case, until my pelvic floor physical therapist told me about new (at the time - 2019) guidelines that suggested waiting until at least 12 weeks postpartum to consider a return to running. The guidelines came from an article by Groom, Brockwell, and Donnelly that reviewed the existing evidence-base and returned several recommendations, including:

• that postnatal women can benefit from assessment and rehabilitation for the prevention and management of prolapse, incontinence, and sexual function; 

• that return to running isn’t advisable prior to three months postpartum, or more if pelvic floor dysfunction is identified;

• that pelvic health and strength should be tested to evaluate readiness for return to running; and

• that additional factors such as weight, fitness, breathing, and more should be considered in that evaluation.

It also included very loose guidelines on returning to run at 12 weeks plus, as you can see in the image below. While the overall principles provide some guidance, they do lack specificity.

In 2022, Selman et. al. came out with more detailed recommendations on the timeline for postpartum return to sport. As they note in their introduction, no peer-reviewed return to sport protocols exist for postpartum people, despite the high percentage of runners returning to the sport within eight weeks of delivery and the fact that more than a third of postpartum runners experience pain and some form of urinary incontinence. Selman et. al. provide a rehabilitation timeline for each trimester of pregnancy and the weeks following delivery, with goals and musculoskeletal protocols for each time period. These are accompanied by the recommendation to work with a pelvic floor physical therapist. They recommend, for instance, shorter walks of 10-15 minutes in weeks 3-4, increasing to 20-30 minutes in weeks 5-6, followed by gradual increases in weeks 7-12 as long as no dysfunction is present. They also have important considerations around neuromuscular activity, like diaphragmatic breathing, pelvic floor strength, and general strength. 

Once a postpartum person has passed at least the eight week mark, is able to walk for 30 minutes without symptoms (heaviness, incontinence, etc.), and is able to complete the six components of the authors’ Run Readiness Scale (step ups, wall sits, single leg squats, double leg squats, and a plank hold - each lasting a minute), the authors provide a sample return to run protocol. The sample plan is provided below; each step is completed two times with 48 hours of rest between each session. If the runner doesn’t experience any symptoms during that time, they can progress to the next phase. 

Selman et. al. provide more detail on what return to run can look like, but knowledge of this topic among medical professionals needs to be improved, as does awareness among newly postpartum runners. I was happy to discover, from an English runner, a handout provided by her hospital in the UK. Published in 2021 and based on the 2019 guidelines, it provides a practical timeline and exercises for postpartum people to follow, as well as information on when to contact medical professionals. I would love to see this type of handout being consistently provided to women in the US as well. 

It is important to work with a pelvic floor physical therapist while you are in the early postpartum stages or if you are experiencing any symptoms. Once you are at the point of returning to running, a running coach can be helpful in guiding your progression towards fitness and beyond. Happy running!