The Green Light To Exercise Postpartum Comes With An Asterisk
At my six-week postpartum appointment, I felt ready, but not necessarily eager, to exercise again. My bleeding had stopped, my walks were much easier, even when wearing my 11-pound baby in a carrier, and I had made it through an easy yoga class the weekend before. I was pretty sure I would get the green light to resume physical activity postpartum, but I had some questions about how to do so safely.
My main goal was to get back into running, my sport of choice. I was able to run for about a third of my pregnancy, shifting mostly to run-walking after 20 weeks, when it started to feel impossible to make it more than a mile without needing a bathroom stop. I stopped running in the third trimester, save for the charity race I did at 33 weeks as a volunteer coach for middle-school girls. I needed both a bathroom break and multiple water stops during those 3.1 miles — not my usual plan for a 5K! — but hey, I finished in under an hour and didn’t go into labor. Success!
I’d gotten a coveted bib for the Marine Corps Marathon in 2017, but at 7 months pregnant, I made the easy choice to defer. Now, I was hoping to ramp back up to marathon-running shape 10 months after birthing a human to run MCM 2018. Lofty, sure, but crazier things have been done! (Kara Goucher, one of our fastest American marathoners, ran the Boston Marathon when her son was six months old. I’m certainly not on her level, but hey, I have almost twice as much time to get marathon-ready!)
I asked for a referral to see a postpartum physical therapist. 'Why?' he said. 'What’s wrong?'
At six weeks postpartum, I prepared for what I hoped would be the first step toward getting back on the road. I undressed from the waist down and got ready for an uncomfortable assessment. (Spoiler alert: Things still feel quite sensitive!) What I wasn’t prepared for was an “assessment” that took less than 10 seconds and was entirely hands-off before my doctor declared, “You’re fine! You can do whatever you want!”
FINE? Whatever I want?! Well, Doc, what I want is to run a marathon. Can I do that? Safely? Without risk of injury? Are my abdominal muscles separated? Is my pelvic floor weak? If I go for a run today and it doesn’t feel “FINE”, then what?!
I condensed this internal monologue into something akin to the following: “I’m a runner. I want to do a marathon this year, if possible, and am wondering how to safely ease back into running.”
His responses continued to lack concern — which I found anything but reassuring. Wasn’t there more to this? I asked for a referral to see a postpartum physical therapist. “Why?” he said. “What’s wrong?”
Well: I pushed a human out of my vagina (for four hours), for starters. At two weeks postpartum I could barely walk around the block (which is “normal”). It took another two weeks to make it up to two miles pushing a stroller. Only by week five had I stopped bleeding daily, or had my nipples adjusted to nursing and no longer felt like they’ were on fire when my baby latched. Oh, and it just now got a little easier to poop. After all of that, I was more than a little nervous to start running — an activity that, despite my love for it, is not renowned for being gentle on the body — after three months without running and six weeks of no exercise at all, not to mention the 10 months of literally growing another person inside of me before ejecting it into the world. WHAT’S WRONG? I don’t know! But probably something!
I condensed that internal monologue into something like, “I want to make sure everything is OK — you know, ab separation, pelvic floor health, things like that.” He agreed to give me a referral.
Because of the research I did for myself, and the expertise from that postpartum PT, I didn’t run for yet another six weeks. And I’m so glad I waited.
What your doctor may not be telling you about postpartum running — what mine certainly couldn’t or didn’t tell me — is that you need to rehab your pelvic floor and transverse abdominal muscles first. He or she may not tell you that, if you’re nursing, your estrogen levels are low (which is why you most likely aren’t ovulating), putting you at a higher risk for stress fractures. He or she may not tell you that it will help to build strength first, and that you probably shouldn’t focus on endurance running for at least a few months.
Though my doctor had cleared me to do 'anything,' I chose to start working out with a stroller-friendly mom group.
Thanks to social media, I know Abby Bales, a physical therapist and the owner of Reform PT in New York City. Before that disappointing appointment with my doctor, I reached out to Bales, who specializes in helping women safely return to activity post-baby, for guidance on getting back to exercise in a healthy way. She convinced me to take my time, focus on strength, and get an in-person full body assessment from a local specialist before lacing up — and, ahem, dusting off — my running shoes.
“Get an internal pelvic floor assessment by a PT,” Bales advises. “Recommendations that follow will probably include pelvic floor strengthening, soft tissue work, resolving diastasis recti (if needed), and a reintroduction to core stability.”
After consulting with Bales remotely, and wrangling that referral from my OB, I did see a local postpartum PT — who confirmed that I have no ab separation, and gave me exercises for restoring pelvic floor health — and started with strength workouts first. Though my doctor had cleared me to do “anything,” I chose to start working out with a stroller-friendly mom group (S.L.A.M.’s D.C. chapter), which provides full-body strength training a few times a week.
As cautious as I felt like I was being, I could still feel the effects of pregnancy and delivery on my body. During my strength workouts, we had the occasional short run as a warm-up or as a cardio interval during circuit training day. At first, even when I made sure to go to the bathroom before the start of class, things didn’t feel quite right and I struggled with even a few laps around the gym.
One of the major issues for many women returning to running post-baby is incontinence. “What most people don’t know is that your bladder always has about 1/8 cup of urine in it,” says Nancy Branberg, a postpartum Physical Therapist in Falls Church, Virginia. Even when you think you’ve “emptied” your bladder before a run, you may still experience some leaking. Bales assures that this doesn’t necessarily mean you shouldn’t be running at all — on the flip side, she notes, “just because you’re continent doesn’t mean every layer of your pelvic floor is contracting.” In other words, incontinence is just one sign that your body is still putting itself back together.
I waited until I was 12 weeks postpartum before going for my first official run, and I’m so glad I was patient.
As a nursing mom, I was warned to be especially cautious with running, and any other impact exercise, because of the higher risk of stress fractures. Breastfeeding moms have low estrogen levels, and breast milk essentially leaches calcium before it gets to the rest of your body.
“There’s no estrogen supporting connective tissue, and these low estrogen levels also make it hard to build muscle while nursing,” Bales says. In addition, if like me, you’ve experienced hypothalamic amenorrhea, or had late-onset menstruation (older than 16 years of age), your bone density may already be lower than average.
Having learned all of that, I waited until I was 12 weeks postpartum before going for my first official run, and I’m so glad I was patient. Between the extra rest, added strength, and slightly warmer weather now that we’re fully into spring, I felt great on my first postpartum run. Even so, I’ve been taking it slow.
“Have you ever come back from a running injury?” Bales asks me when we speak. “You don’t want to overexert the muscles that haven’t done this type of exercise or movement in a long time.” As a runner who’s been injured, and as a running coach who has helped other runners get back to training after layoffs, that helped me understand how to ease back in. Bales recommends starting with 30 seconds of running followed by 30 seconds of walking for as long as you can tolerate. I hired a running coach for myself — which is what I would recommend to anyone else — and we started with a program of a walking warm-up followed by 15-20 minutes of intervals, three days per week, with three other days of strength training and at least one session of light yoga.
There’s no shame in waiting to run after your doctor “clears” you if you aren’t feeling ready. There’s no shame if your “running” is a lot of walking at first. There’s no shame if you did none of the above and jumped right back into running, and are now realizing why it doesn’t feel so great. (Go get that assessment!) I’m certainly no elite marathoner, nor do I aspire to be, but I’m glad that my postpartum running feels good to me. And like everything else in parenting, patience and persistence are key.
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