Also published in Better Humans.
I’m a new mum. Before having my daughter, I had a very specific idea of what my pregnancy would look like. It would involve a lot of running. After all, running through pregnancy is safe, and keeping fit during pregnancy is beneficial for both mother and baby.
I know a bit about running — I’m a physiotherapist with a special interest in rehabilitating runners and I’m a licensed UK Athletics running coach. I’ve completed six marathons and an ultramarathon. The only training concession I planned to make during my pregnancy was to reduce the overall speed of my runs as my weight inevitably increased. I had every intention of continuing running upwards of 50 miles per week and running the odd half marathon here and there.
Paula Radcliffe, my personal hero, was running right up to the day before the birth of her daughter, Isla, and she started running again only 12 days after. For feats while pregnant, I only needed to watch Lizette Perez completing the Boston Marathon in 2019 at eight months pregnant.
Best Laid Plans
The issue was, my pregnancy did not unfold the way I had intended. I’m extremely lucky, and I didn’t experience anything that put either myself or my unborn child at risk, but the svelte running gazelle with a tidy bump that I had imagined myself to become never materialised. Instead, I developed debilitating pelvic girdle pain contributing to me piling on 15kg. Running was out. Walking was out. Sitting on the edge of my bed crying because I couldn’t climb the stairs without pain was very much in.
I consoled myself during this time with the thought of my return to running after my baby had been born. The loss of baby weight would ease the pelvic girdle pain and I’d soon lose the additional weight I’d gained when I returned to my normal running routine.
Unfortunately, my experience of labour was more traumatic than I’d expected, and my recovery took far longer than I’d prepared for. I delivered vaginally but forceps were required. I had an episiotomy and also haemorrhaged from a tear in my posterior vaginal wall. Lovely.
My baby girl was born healthy and wonderful and I knew instantly that she was the single best thing I had ever done. But I wasn’t going to be running any time soon. My episiotomy scar did not heal correctly and I was left with residual pain and bleeding months after the birth. I needed a plan.
Finding the Evidence
Thankfully, in my work as a physiotherapist, I had come across these evidence-based guidelines published by Tom Goom, Gráinne Donnelly, and Emma Brockwell — specialist physiotherapists working in running rehab and in women’s health. I needed to forget everything I thought I knew about my abilities as a runner, and approach the situation clinically. My goal was to start running and stay running, rather than to damage my long-term running potential for short-term gain.
Here’s what I took from the guidelines and how they took me from not being able to run a step to running 5k consistently four times a week.
Note: If you are returning to running postpartum or after layoff/injury, you should seek the advice of a medical professional before doing so. I especially recommend the input of a pelvic floor specialist in the case of postpartum runners.
Fixing Up My Pelvic Floor
Before I could think about running, I needed to work on my pelvic floor. I’d just given birth to 8-lb 12 oz of beautiful baby, and significant weight had been weighing on my pelvic floor for the majority of my pregnancy. The return to running guidelines states that running should be avoided if there is any sign of continuing damage to the pelvic floor. These signs include incontinence of either bladder or bowel, heaviness in the pelvic area, or pain.
I was experiencing a definite heaviness in the pelvic region, especially after walking for a few minutes, so I knew that the muscles of my pelvic floor needed some urgent love and attention. The very last thing I wanted was to have a prolapse.
The best advice I can give to women who want to return to running postpartum is to seek out a pelvic floor specialist for an assessment. They will be able to tailor a rehab programme to your individual needs. I also used an app called Squeezy, designed by pelvic floor physiotherapists in the U.K. The app allowed me to work on the strength and endurance of my pelvic floor muscles. This was an essential first step in applying an evidence-based approach to my return to running.
Hurry Up and Wait
Next, I needed to ensure I gave myself adequate time to recover from the birth. While Paula Radcliffe had managed to get back to running in just 12 days, the guidelines state waiting a minimum of 12 weeks before getting back out to run. I have to be honest — I didn’t think I would need to wait that long. I was arrogant, expecting my running history would see me quickly through.
It turns out that childbirth is no joke. Pushing a small human through the muscles that normally keep your pelvic organs inside you changes things. To get technical about it, the levator ani is a group of muscles that work like a hammock. They keep your rectum, vagina or prostate, and bladder in place. There are a couple of essential openings in the muscles to accommodate the genitals and urinary tracts, and the rectum. These openings are good things — they mean we can have sex, pass urine, and poop.
Having a child weakens and distorts this pelvic floor of muscle. The return to running guidelines reports that the muscles themselves take between four to six months to recover, although they will never return to their prenatal state.
Waiting for this muscle group to recover as much as possible before returning to running is really important. You might get lucky and not have a problem, but if you are unlucky, you could be risking pelvic organ prolapse. That will most definitely stop you from running.
So taking that into consideration, I waited 12 weeks after having my baby before I ran a single step.
Waiting to run doesn’t mean you can’t prepare yourself for the day that you can run. Life will have likely been turned upside down with the arrival of your newest member of the family but it’s important to find some time to get your body ready again for the demands of running.
The return to running guidelines includes a set of tests that ideally should be achieved before running begins. These need to be manageable without any pain, incontinence of bladder or bowel, or heavy/dragging sensations in the pelvic area. So I had a handy checklist of tasks I needed to do before I could sign myself off to start running.
According to the guidelines, I needed to be able to:
- Walk for 30 minutes
- Balance on each leg for 10 seconds
- Do a single leg squat for 10 repetitions
- Jog on the spot for 1 minute
- Do 10 forwards bounds
- Hop on one leg for 10 repetitions
- Hold a runner’s step up for 10 repetitions on each side
Being able to perform these exercises will mean that the body can better tolerate the stresses placed on it by running. For example, if walking for 30 minutes caused me pain or discomfort, there is no way I would be able to run for the same length of time and expect to be OK. This was exactly the case in the first few weeks where I was unable to walk for even short distances. So one of the very first things I did while preparing my body for running was to start increasing my walking distances.
Walk Before You Can Run
The first walk I managed was around the block. It probably took less than 10 minutes and my partner, Lucy, had to carry bubba as I was too sore. A few weeks later I’d extended that out to a couple of miles, always listening to my body. At first, the walks were cut short by that dragging/heavy feeling in my pelvic region I’d been warned about in the guidelines. I knew I was healing when I stopped feeling that sensation.
Before I started running, I got myself to the point where I was comfortable walking an hour and a half with bubba in the sling and I was feeling good. In addition, I purchased an aerobic step. Being in lockdown slashed the opportunities for moving throughout the day so I wanted to try and combat that. My little girl liked being in movement as she dropped to sleep for naps, so instead of relying solely on my swiss ball, I also did low step-ups while I held her to my chest. Within 100 steps, her eyes flutter closed. Within 200 steps, she’s lightly snoring. Within 300 steps, she could be transferred to her cot, and I’d got a work out in.
Step-ups were a considered choice. You can easily elevate the humble step up into a running-specific drill called — funnily enough — a Runner’s Step Up. Instead of just stepping up with one foot and then placing the trailing foot adjacent to it, you bring your trailing leg through so that you are flexed 90˚ at the hip and knee.
I love this exercise for so many reasons. When moving into this position, you’re working your gluteus maximus — or bum muscle — which is a huge driver in running. It also really challenges your hip flexors and quads. And if you pause at the top of the movement, you are working on your single-leg stability. Running is, after all, just a series of single-leg stances at speed. By adding the ever-increasing weight of a baby into the mix, I had a really simple but targeted running exercise I was able to do in short bursts throughout the day. It built up my strength and endurance even when I couldn’t get out and run.
Following the Plan
When I was certain I hit all the prerequisites set out in the return to running guidelines, I felt ready to lace up my trainers and get running. By this time, I’d not run for six months. But I needed to restrain myself and be humble, as much as I just wanted to throw myself in. After having my baby, I definitely wasn’t the runner I once was.
As a qualified running coach, I could’ve written my own plan to ease me back into running. But sometimes it’s better to surrender yourself to someone else’s tried and tested program. It removed the temptation of trying to accelerate when I wasn’t ready. I followed the NHS Couch to 5k plan, something I have often recommended to clients.
When I finished a 50k race in 2019, I didn’t imagine that just a year later I’d be running in slow 60s bursts and find it hard. But I did. At the start of the program, I couldn’t imagine I’d be able to finish it. But nine weeks later, I’m running 5k four times per week. As I wasn’t able to walk without pain in the weeks following my daughter’s birth, it was an amazing achievement for me.
As a runner and a physiotherapist who works closely with runners, I was shocked by my inability to bounce back instantly after the birth of my little girl. The combination of pelvic girdle pain during pregnancy, excessive weight gain due to lack of mobility, and a traumatic labour affected my body to an extent I hadn’t expected.
But I wasn’t going to let that stop me from running. Not only is running part of my work, and a great passion of mine, it’s also essential to keep on top of my mental health. I could already feel the negative consequences of not running seeping into my outlook. Besides, when my girl grows up, I want her to see her mums regularly running. I want exercise and outdoor activity normalised for her. I had to get back out there.
I followed an evidence-based set of guidelines written by specialist physiotherapists, and I combined that with the tried and tested Couch to 5k program. As of now, I’m able to run for 30 minutes four times per week. I feel prouder of myself than I did after my ultramarathon because the training for the 5k I can now run has been much harder than the training for the 50k.
Like me, you might be planning to return to running postpartum. If so, I hope you can take some comfort from my experience that it can be done, even if your body seems like it’s a million miles away from ever running a mile again. Or you may be returning to running for a different reason, in which case, my experience may still be relevant to you. Either way, let me know in the comments how it’s going for you, and I wish you well on your running journey.