Returning to running postpartum in Philadelphia
As we passed the Philadelphia marathon sign-up window, I was reminded of the training windows for races. Typically I have followed the 4 months out for Marathons (admittedly I've only done 1) about 2 months for ½ Marathons and about 6 weeks for Broad Street (10 miles). But looking at windows of time for training also gets me thinking of the 6 weeks postpartum when you essentially get “cleared” for everything and yet nothing. Your OB did not extensively study biomechanics and exercise science to determine when exercise activity should resume. In that same context, if you report that you don't have any pelvic floor (PF) type symptoms at that follow up or pain, you essentially are left to figure that out on your own. (And that will be another blog post at some point: Why every mom should have PT postpartum)
Fortunately for the vast majority of us existing in the last decade, searching for this information is plenty, and you do get an idea of what a ‘return to run’ or ‘return to the gym’ routine is, if you search for it. But what if you don't? Or what if there is actually just too much?
For the number of people that prep with all the pregnancy knowledge and birth prep, there are just as many people not doing that, and a far greater amount of people that lie somewhere in between. And honestly there is just time and bandwidth to think through all of this postpartum.
So this is for those people lingering in the middle of the super planning to I didn’t do anything: you did the search but overwhelmed with the info, but know more than just to wing it.
The Mindset:
A good way to approach returning to running is a bit of structure, and a bit more intuition of your body. If you are experiencing no pain or symptoms (think PF symptoms, heaviness) then you are listening to your body for a safe progression. And what that means is thinking about pressure, discomfort and even pain, as signals and warnings, not necessarily stopping indicators.
Listening to your body for a runner or athlete brain though is a different mindset postpartum then pre. This is your reminder that your body is no longer the one you were running with before creating life and carrying that life for the last 9 months. It's the reminder that your body is tired, you are recovering from a birth, not just a couple weeks of not training.
Someone returning to running with no symptoms leading up to your clearance, you are going to listen to your body for things such as pressure, pain, discomfort, difficulty breathing, general increased fatigue. Again, not indicating an automatic stop, but more of a consideration that the training load might have to be changed. It’s recognizing the system may not be ready for the demand yet.
You ran 1 mile, and felt heaviness starting at mile .5, or leaking .25 into it? Then modify it. Run 0.1-0.2 then walk 0.25-0.5. Build off of that.
Sometimes we like to keep people in these rigid programs, and while some people like the structure, it is also totally fine to wing it, with the understanding of what you might be experiencing. For the same amount of people that I have programmed some very thorough return to running programs, I have also had just as many clients tell me “I just went for it” and they were fine.
Other things to consider:
While walking/running can be an easy avenue to return to, there are some other things I like to remind my clients. No just endurance or running stamina was affected and these are also not the only systems that need to be looked at.
Biomechanics: Hips widened. Load was changed(hello to me gaining an extra 50lbs with my first pregnancy). Abdominal muscles were stretched. Muscles or hips, back and legs potentially were weakened due to changing structures or decreased activity.
Cardiovascular: Heart rate changes. Blood volume changes. Cardiac output changes. Fluid redistribution (ie reducing swelling in body)
Mental Health: Identity changes. Postpartum depression/anxiety. Sleep deprivation. Caregiver responsibility.
Calorie Demand: Recovering postpartum alone requires 300-500 of additional calories as compared to a pre-pregnancy need, and if you are breast feeding, those numbers are even higher.
And this is by no means an extensive list, nor a specific list to you. I have had clients over the years that had no ability to maintain a typical exercise routine during pregnancy due to severe morning sickness or Hyperemesis Gravidarum, so their concern for just being able to keep enough calories in their body to make it through a pregnancy was a bigger priority.
There is no perfect plan:
Research is very supportive of the benefits of being active during a pregnancy to improve outcomes postpartum. And we know of all the benefits of general exercise for humans and longevity and health, as well as those benefits of postpartum mothers. But this is also the reminder that if your return to running or gym is just not in your priority list now, thats ok. We don’t have anything yet that says whether you return at 6-12 weeks vs 6-12 months is any different in long term outcomes. But what we do know is returning to exercise should be a goal.
Too often we are falling into the extremes: our bodies can do anything and can push through anything, OR everything must be progressed steadily and slowly. I have known people in both camps and have been successful, but our bodies and their capabilities are so much more nuanced than that. We have sleep schedules we are working on, breastfeeding happening in the middle of the night, returning to an office setting, worrying about the sound of congestion.
And while I will always support exercise as a necessary part of our health, what the exercise is, does not nearly hold as much weight. I will always be supportive of what you are able to do, and do consistently over time. Activities that can be modified I will always direct people towards just because it's something that can still be done with different lenses. A return to running can be changed with walking intermixed, speed, distance, elevation etc. And if that modification can get someone back to a goal of theres sooner, I will always be in support of that.