In the first part on postpartum running, I covered how long you should wait before running. In the second part of this series, I will address exactly how to resume running – because it’s not just jumping back into a three-mile easy run. A postpartum return to running is a gradual and deliberate process that begins before you even actually start running again.
Every coach’s philosophy on postpartum running will differ slightly. However, overarching principles are the same: build back slowly, with a foundation of strength.
Throughout all of these phases, it is of the utmost importance to fuel and hydrate your body well. Restriction can hinder your body’s ability to produce breastmilk. Whether you are breastfeeding or not, energy deficiency while increasing your training load highly increases the risk of injury. Treat your body well! (For more on breastfeeding and running, read this post.)
1. Walk Before You Run
Walking is one of the best forms of exercise in the acute and subacute postpartum phase (from birth to six weeks postpartum). Your OB may encourage you to take short walks within even 24 hours of birth to aid in recovery and reduce the risk of blood clots or other complications.
In the first six weeks postpartum, walk as your body permits. If you had a C-section, you may find yourself limited to short walks for the first couple weeks; make it a point to take these walks. Even if you walk just half a mile, you are rebuilding your fitness.
As your fitness builds and you recover, gradually lengthen walks. Pushing the stroller adds a gentle level of resistance while also providing some support as you rebuild. Once you can rebuild to regularly walking 30 minutes or more without any pain, pressure, or leakage, you are ready to run (once cleared).
2. Rebuild Your Core and Pelvic Floor
Whether you had a vaginal or Cesarean delivery, your core and pelvic floor muscles will be weaker. Pregnancy stretches out your abdominal muscles and strains your pelvic floor.
Core and pelvic floor strength work during pregnancy mitigates some of the potential loss of muscle tone. After delivery (once you are cleared – this may be ~2-4 weeks for vaginal delivery and 6+ for C-sections), start performing rehabilitative core and pelvic floor exercises. (Be sure to check with your doctor first!)
Many women develop an anterior pelvic tilt after pregnancy. A C-section can exacerbate this. Excessive lumbar arching and a bulging low abdomen often indicate an anterior pelvic tilt. This leads to poor firing of glute muscles and overuse of the quads, thus causing inefficient form and increased risk of injury. While some arch to the low back is natural, you want to strengthen your core and glutes and mobilize your hips to counteract any pelvic tilt. Lying pelvic tilts are one of the best exercises to counter this and should be a foundation of postpartum core work.
An effective postpartum core and pelvic floor program will not only strengthen those muscle groups. Strength means very little if your brain is not wired to activate and use those muscle groups. A postpartum core and pelvic floor program should also train activation, stability, and control.
3. Use Run-Walk Intervals
When you finally are both cleared and ready to run, do not just start where you left off before delivery. Do not even begin with a continuous 30-minute run! You want to gradually reload with run-walk intervals first.
This stage begins once you have completed a few weeks of core work and walking. You should be free of pain and not showing signs of incontinence or prolapse.
Run-walk intervals are extremely beneficial for postpartum women, especially if you are resuming running with a couple months of giving birth. The inclusion of walk intervals reduces the impact of running, which is vital as the postpartum athlete rebuilds her core and pelvic floor.
Run-walk intervals reduce risk of injury, especially when you are returning to running after six or more weeks of rest. You are reloading your musculoskeletal system after several physiological changes. Relaxin, a hormone responsible for loosening joints and ligaments to prepare for delivery, remains at elevated levels for weeks, if not months, after labor and delivery. Too much musculoskeletal stress in the presence of high relaxin levels can increase risk of injury.
Begin with conservative run-walk intervals. Just because you can run for longer does not mean you should. Generally, I recommend starting with 1-2 minutes run and 2 minutes walk for 20-25 minutes total. Spend several weeks gradually increasing the length of the run intervals and decrease the length of the walk intervals until you are running 30 minutes continuously.
Start with runs on non-consecutive days (three per week). Do not jump back into running four or more days per week! If you want to do more, cross-train on the other days.
If you feel pain or experience any incontinence, stop running. Cross-train and see a pelvic floor physical therapist before you resume running.
4. Concurrently Rebuild Strength
Strength training remains important even after core strength is initially rebuilt. Once you rehab your core and pelvic floor, introduce functional strength exercises (squat, push, pull, hinge, carry). Begin with bodyweight and then introduce more resistance as you progress.
This is particularly important because of the physical toll that childcare takes on the body. Breastfeeding places the upper body in a slumped position. Carrying an infant can encourage an anterior pelvic tilt. If left unchecked, these increase the risk of injury postpartum. Strength training can correct and prevent poor posture habits, thus improving your running form and decreasing the risk of injury.
Aim for two total body sessions per week (20-60 min) and one to two core/mobility sessions (10-15 min) per week. If this seems challenging, aim for five minutes after each run. It is worth running less to have more time for strength!
5. Continue to Build Conservatively
Once you resume continuous running, you want to continue a conservative build. Even if you had run a certain mileage before, train as if it was your first time building up to it. This process may take months, but it will allow your body to adapt and avoid applying too much stress. Every four weeks, take a cutback week to facilitate recovery and adaptation.
Most likely, you will start back with running every other day (three days per week). Running on non-consecutive days allows for appropriate recovery between runs. Once you can run continuously for ~30 minutes, then you can carefully start increasing run frequency. Build up one day per week and maintain for a couple of weeks, until you are returned to your previous mileage.
When building mileage postpartum, be mindful to allow for adaptation. Generally, a sound pattern is to build mileage one week and then hold that mileage for one to two more weeks. Be generous with cutback weeks. Take one every 4-5 weeks and do not hesitate to take more if your baby experiences a sleep regression or you physically need a week of lower mileage.
6. Do Not Rush High Intensity
One of the biggest mistakes of postpartum running is rushing back too quickly into high intensity running. You may be eager to prove your fitness after a few weeks of mileage. However, mental readiness does not indicate physical readiness.
Relaxin remains elevated for up to six months postpartum. Kindly disregard anyone who claims you should not run at all with relaxin present. If this were true, then you would not run during your luteal phase either. However, increased relaxin levels do require mindfulness of the intensity of your running. If your joints or core still feel weak, continue more strength training before introducing faster running.
You can never go wrong with easy runs. Easy runs build fitness! Allow your body time to adapt to running at an easy intensity before even considering intervals or a tempo run. If you are breastfeeding, you may still be experiencing hormonal shifts that affect your recovery rate.
Some faster running offers neuromuscular benefits. Generally, I introduce uphill strides (which reinforce good biomechanics) or strides around 4-6 months postpartum (or after the athlete demonstrates the ability to handle approximately 15-20 miles per week and has been running for at least two months). If no contraindications occur (injury, pain, or leaking), then I will have the athlete continue these for a few months. I often do not prescribe any quality sessions beyond strides until ~6 months postpartum.
Some athletes will feel ready for high-intensity workouts before this mark. It is important to individualize postpartum training! Again though, I cannot emphasize enough a cautious, gradual approach and a long time spent building a base.
If you are not sleeping well (six hours or fewer per night), you want to maintain low intensity on all of your runs. Sleep deprivation hinders recovery, which in turn inhibits adaptation. Hard workouts would just pile on extra stress for a sleep-deprived parent and yield very little training adaptation.
Bonus: Find a Coach with Experience
If this all seems a bit overwhelming (especially when you are caring for a very small person), you may want to reach out to a knowledgeable coach. There are dozens out there; take the time to interview them and find one whose personality and philosophy are a match for you.
Recommended running coaches for postpartum athletes:
- Myself! I have worked with numerous postpartum athletes, bringing them back without injury and to all-time PRs.
- The Mother Runners. Whitney and I co-coach this group targeted to pregnant, postpartum, and mother runners.
- Lift Run Perform, particularly Montana Depasquale (running) and Mary Johnson (strength).
- Up & Running, particularly Lauren Floris
- Team Sugar Runs