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Your body changes significantly during pregnancy and delivery. The pelvic floor may be stretched, injured, or weak. Ligaments are looser and less able to protect joints. You may be carrying extra weight. The abdominal wall can be stretched, separated, or cut in the case of a C-section.

Running is a high impact sport placing a lot of demand on the body. Muscles need to recover to properly support the lower back, pelvis, and pelvic organs. Recovery of muscle, connective tissue, and nerves generally takes four to six months and there are many factors to consider including the impact on the body in both vaginal delivery and Caesarean section. For example, six weeks after Caesarean section, the abdominal wall has only regained 50% of its original strength and 75-90% by six or seven months.

Getting Back with Incremental and Low Impact Plan
You should always talk to your physician or provider before taking on any form of exercise or activity following birth. With their guidance, a low impact exercise plan is key to incrementally getting active after birth. In the first three months, it’s essential to let muscles and ligaments heal and recover. In the first month after birth, work on pelvic floor strengthening, basic core exercise, and walking. In the second month, you can advance your core exercise to include squats, lunges, and bridges and introduce stationary bike or other low-impact cross-training. In the third month, advance to power walking, cycling, and swimming (if bleeding has stopped). Be sure to wear a supportive bra and proper shoes.

After 12 weeks, if you are hitting your goals, making progress, and cleared by your provider, you can start to run a few minutes at a time at an easy pace with walking breaks splitting up the periods of hard effort. Slowly increase running time and gradually decrease walking breaks. Work to increase your time to 30 minutes before working to increase speed.

How to Determine if You are Ready to Run Again
Can you do the following without pain, heaviness, dragging, or urinary leakage?

• Walk for 30 minutes
• Single-leg balance for 10 seconds
• Single-leg squat 10 repetitions each side
• Jog in place for 1 minute
• Forward bounds 10 repetitions
• Hop in place 10 repetitions each leg
• Single-leg calf raise for 20 repetitions
• Single-leg bridge for 20 repetitions
• Single-leg sit to stand for 20 repetitions
• Side-lying leg left for 20 repetitions

Signs that You May Not be Ready to Return to Running
Monitor yourself closely for the following signs of overtraining and adjust your intensity accordingly.

• Heaviness or dragging in the pelvic area
• Leaking urine or inability to control bowel movements
• Bulging abdominals or a noticeable gap in the midline of the abdominal wall
• Pelvic or lower back pain
• Ongoing blood loss beyond eight weeks after birth, that is not linked to your monthly cycle

If you are struggling to progress, experiencing symptoms, or just want to optimize your recovery and prevent injury, a physical therapist specially trained in pelvic health can assist you. Talk to your provider to see if working with a physical therapist can help you get back in the race.

Shari Berthold, DPT, is a physical therapist with Pain Management and Rehabilitation Services at UPMC Williamsport. For more information, visith UPMC.com/ReabNCPA.