How To Return To Running After Birth
Running is an excellent way to get your heart rate up, break a sweat, and boost your fitness. It’s time-efficient, can be a great solo activity for some well-deserved "me time."
While running is a great form of physical activity, it puts a massive load on the pelvic floor! We need to make sure that your pelvic floor has enough strength and endurance to cope with the loads of running, especially when it has been weakened after pregnancy and birth.
Historically, there haven’t been many guidelines to help new mums learn how to safely return to running postpartum. In 2019, three physiotherapists in the UK published the first such guidelines, providing much-needed direction for postpartum runners. These guidelines bridge the gap between pelvic health and the musculoskeletal demands of running, using current research to guide individualised return-to-running programs.
Since running is a high-impact exercise, your body needs to be ready before jumping back into it postpartum. Returning to running too soon can potentially do more harm than good, impacting your recovery and increasing the risk of issues like weakened pelvic floor muscles, abdominal separation, bladder or bowel leakage, pelvic pain, or even prolapse.
On the flip side, if you take the time to rebuild your strength and conditioning first, you’ll be setting yourself up for a much safer and more enjoyable return to running with a lower risk of injury.
When Should You Return to Running?
Research suggests waiting at least 3 months postpartum before resuming high-impact exercise. However, since there’s limited research specifically on postpartum return to running, most guidelines are based on expert recommendations. Everyone’s journey is different, so the ideal timing will vary from person to person.
Your return-to-running timeline may be influenced by:
Any existing pain (lower back, pelvic girdle, hip pain)
Incontinence (bladder or bowel leakage, loss of wind control)
Prolapse symptoms (vaginal heaviness, bulging sensation)
Bladder urgency or frequency
Obstetric history (eg: long labor, large baby, perineal tearing, or nerve injury)
Even if you had a smooth pregnancy and birth, a postnatal assessment with a pelvic floor physiotherapist at around 6 weeks postpartum is highly recommended. A follow-up assessment before you start running, ideally after 3 months, can help determine if your body is ready and provide a structured plan to support your return.
Key Factors to Consider Before Running Again
Several physical factors can impact your readiness to return to running, including:
Pelvic floor weakness or prolapse
Abdominal separation (diastasis recti) and core strength
Weak glutes
Poor balance
Limited control or stability through the back, hips, and pelvis
Breastfeeding and hormonal status
If your core and pelvic floor aren’t strong enough, running could over-stress these areas, leading to issues like prolapse, incontinence, or even injuries like back or knee pain. The pelvic floor can take an average of 4-6 months to recover well. That means that while some women may be ready to run at 3-6 months postpartum, others may need a year or more before it’s safe to do so.
The most important thing? Don’t go from zero to full-speed running overnight. Gradually build up your strength, endurance, and stability over 6-12 weeks with low-impact strength training, Pilates, yoga, or functional gym work before you start running.
How to Assess Your Readiness to Return to Running
There are three key areas to assess before returning to running:
Pelvic Floor Strength (As assessed by your Physio)
10 quick pelvic floor contractions with good coordination
Hold a strong pelvic floor contraction for 6-8 seconds x 10 repetitions
Maintain a gentle (30% effort) pelvic floor contraction for 60 seconds while breathing normally
Strength Tests (Should be completed without pain, heaviness, or leakage):
20 x side-lying leg lifts per side
20 x single-leg bridges per side
20 x single-leg sit-to-stands
20 x single-leg calf raises
Impact Readiness Tests (Should be done symptom-free and usually done with your Pelvic Health Physio):
Walk for 30 minutes, including inclines/declines
10 seconds x single-leg balance
10 x single-leg running man
10 x single-leg squats
Jog on the spot for 1 minute
10 x forward bounds
10 x single-leg hops on the spot
A Gradual Return-to-Running Program
Once you pass the above tests, it’s best to follow a structured, progressive return to running program rather than jumping straight into long runs. A good approach is interval-based running, such as:
Run 1 min, walk 2 min (repeat x5)
Run 2 min, walk 2 min (repeat x5)
Run 3 min, walk 2 min (repeat x5)
Gradually add pace and inclines
Run 5 min, walk 1 min (repeat x5)
Increase pace and inclines further
Run 3 km, then build up 1 km at a time to reach your goal
Stay at each level for 1-3 sessions before progressing. If you experience any symptoms like vaginal heaviness, incontinence, or pain, scale back and consult your pelvic floor physiotherapist.
Red Flags to Watch For
Even if you feel symptom-free, it’s crucial to be aware of signs of pelvic floor dysfunction when returning to running postpartum:
Leaking urine or feces
Difficulty pooping
Painful sex
Pelvic and/or low back pain
Heaviness, pressure, or bulging in the low pelvis
Increased bleeding or pain
Working with a pelvic floor physiotherapist can help create a plan to safely reach your running goals. Knowing how your body is healing and understanding what steps to take for your specific needs is empowering. By balancing risk and reward wisely, you can confidently return to the activities you love.
Not a Runner?
These principles apply to all high-impact activities, including netball, tennis, basketball, and hockey.
By taking the time to strengthen and condition your body before returning to running, you’ll reduce your risk of injury and ensure a smoother, more enjoyable return to exercise. Prioritizing your recovery now will help you stay active, strong, and injury-free in the long run!
To book in with with me and discuss your individualised Return To Running program click HERE, or you find a Pelvic Health Physio closer to you, click HERE.
Ref: Tom Goom, Gráinne Donnelly and Emma Brockwell (2019): Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population