What do ACL tears and Birth have in common?
When I have an ACL repair, no one thinks I’m crazy to recommend they hold off from running for 2-3 months. It’s standard. No argument. But tell an active postpartum woman they shouldn’t run before 3 months and it’s like you took away a piece of them.
I have always had this saying with my patients ---Your body CAN do it, but SHOULD you do it. You can run across the parking lot to chase after your toddler before 3 months. You can play at field day with your child at school. But can you run a 5K? This usually isn’t the best choice for your overall recovery.
Some very talented physios from the UK have come out with some great evidence based guidelines that finally put some research into what we have been recommending for a while (see below for link). These guidelines highlight why we as professionals and experts in the human body have your best long term interests at heart.
After having a baby, your pelvic floor is weak and most women need help to be able to perform a correct pelvic floor muscle contraction. (1) Any high impact activity, such as running, is associated with a sudden rise in intra-abdominal pressure and puts a ton of strain on your body. (2) This means things like box jumps, jump rope and those things we love to do to train require a significant amount of control of our pelvic floor that we may not have.
Think about how your belly grows. 100% of women will have that split at the end of pregnancy called a diastasis recti . This is NORMAL to make room for the baby. This split of the fascia has only about half of its original strength by your “6 week clearance” post c section and 73-93% of its original strength by 6-7 months post natal (3).
Think of this---would any doctor or PT let anyone with half the muscle strength needed after an ACL repair return to full running? I hope not, yet we have these expectations as mothers to do everything right away. You need enough recovery time and sleep post baby, whether you had a c section or natural birth, to heal these overstretched muscles and fascia. Putting a full body load like running can set you up for more injuries down the road when you want to ramp your program up.
Yup you saw it , sleep. Sleep plays an integral role in every person’s recovery. Sleep deprivation in athletes is associated with increased injury risk .(4) Training overtired can lead to using muscles and techniques that aren’t optimal and put your body at risk. There are better choices during this time. Yes we are superheroes, but there is a limit to our powers, especially during the times where we are struggling to get 4 linked hours of good sleep.
So when can you go back to running? Again, 3 months is a guideline and your physical therapist will ask a full history of symptoms and have you do some tests like standing on one foot , hopping activities, walking tolerance and other functional tests as well as a full strength assessment and to evaluate if you are ready to start a supervised program. One thing is for certain, there is definitely a better way to start so you have continued success in meeting your goals for the future. Consult a female athlete specialist who is an expert in postpartum athleticism to get the best programming and care possible to keep you on the right track to a full and healthy recovery.
1.Bø, K. Artal, R., Barakat, R., Brown, W. J., Davies, G. A. L., Dooley, M., Evenson, K. R., Haakstad, L. A. H., Kayser, B., Kinnunen, T. I., Larsénm K., Mottola, M. F., Nygaard, I., van Poppel, M., Stuge, B., Khan, K. M. (2017) Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med 51(21), 1516-1525.
2. Leitner, M., Moser, H., Eichelberger, P., Kuhn, A. and Radlinger, L. (2016) Evaluation of pelvic floor muscle activity during running in continence and incontinence women: An exploratory study. Neurourol Urodynam 9999, 1–7.
3. Leitner, M., Moser, H., Eichelberger, P., Kuhn, A. and Radlinger, L. (2016) Evaluation of pelvic floor muscle activity during running in continence and incontinence women: An exploratory study. Neurourol Urodynam 9999, 1–7.
4.Milewski, M., Skaggs, D., Bishop, G., Pace, J., Ibrahim, D., Wren, T. and Barzdukas, A. (2014). Chronic Lack of Sleep is Associated With Increased Sports Injuries in Adolescent Athletes. Journal of Pediatric Orthopaedics 34(2), 129-133.