Postpartum running is a hot topic on social media. It is a question that a majority of female runners asks at some point in her life. How long should you wait until running after giving birth? Must you wait twelve whole weeks before you can run again? Or are you clear at six weeks? Ultimately, postpartum running is highly individualized, not just woman to woman, but pregnancy to pregnancy.
This is part one of a two-part series. Part one explores how long you should wait to resume running postpartum. Part two delves into how to safely return to running after giving birth.
How Long Should I Wait to Run After Giving Birth?
Generally speaking, six to eight weeks is a common recommendation for returning to exercise (but not necessarily running). By six weeks postpartum, your uterus has returned to normal size (if breastfeeding) and lochia (bleeding) has likely stopped. However, not every woman is ready to run at six weeks – nor does clearance for exercise equate to clearance for running for every woman.
The timeline for return to running varies widely. Some women will be ready to start run-walk intervals at six to eight weeks, while others may need to spend more time on rehabilitation and wait until approximately twelve weeks or longer. (Do not run prior to six weeks postpartum, unless discussed with your OB.)
Talk to your OB before resuming exercise. Don’t make an impulsive decision based on a desire for normalcy. A multitude of factors – your labor and delivery experience, postpartum complications, fitness prior to and during pregnancy, etc – determine the duration of your postpartum recovery. You do not want to resume running if you are still experiencing postpartum bleeding or if any incisions have not fully healed.
If in doubt, wait. If you do not feel ready upon clearance from your doctor, listen to your body. It is more than okay to wait 8 weeks or 12 weeks before you start to run! If you are experiencing issues at six weeks postpartum, ask your doctor for a referral to a pelvic PT.
Some physical therapists suggest waiting until 12 weeks postpartum to resume running. A white paper published in the British Journal of Sports Medicine suggests a 12-week timeline, with a focus on cross-training and weight lifting for weeks 6-12. (I need to emphasize here that this recommendation is the lowest level of evidence.) The paper notes that this 12-week waiting period is a level-4 recommendation; it is an opinion, not a conclusion from any randomized controlled trial, systematic review, or meta-analysis. Twelve weeks is not the definitive timeline for every runner.
(This does not discredit the paper; there is fantastic information in the BJSM paper that encourages us to think more critically about postpartum running. However, this is simply encouraging mindfulness of how to understand the information you encounter. Simply because something is published in a journal does not mean it is a definitive conclusion. Guidelines are not a strict rule nor are they a study; they are a consensus from a group of experts. A study involves controlling trials and reducing the risk of confounding variables, bias, etc.)
While not every woman must wait twelve weeks, the recommended guidelines encourage every postpartum runner to assess their physical readiness. Simply being six or twelve weeks postpartum does not equate to clearance if evidence of prolapse or musculoskeletal pain is present.
The twelve-week timeline is ideal for women suffering from prolapse, incontinence, diastasis recti, or other pelvic floor issues. If you are also injury-prone or did not run in your pregnancy, this timeline may be more prudent for you. It is also worth noting that if you have pelvic floor issues, you may be off of running for longer than 12 weeks – 12 is not some magical point. For women who had a smooth delivery and quick recovery without issues, they may be ready to run sooner than twelve weeks (but no earlier than six to eight weeks).
Your OB is a doctor; do not let anyone on social media convince you otherwise. It may seem like a “short visit” but they do check indications of healing. Ultimately, follow the suggestions of your OB combined with how your own body feels. Every postpartum runner operates on a different timeline once they are out of the subacute phase (six weeks postpartum).
Contraindications for Resuming for Running
Running before six weeks postpartum is not recommended. In the first six weeks postpartum, your uterus is still healing from the removal of the placenta and still shrinking. Resumption of running too early risk pelvic prolapse.
There are physical contraindications to returning to running after giving birth. Your OB may address these at the six week appointment; if not, advocate for yourself with your doctor. If you experience any of the following, hold off on running and seek help from a pelvic PT.
- Sensation of heaviness or dragging in pelvic area
- Noticeable gap in abdominal wall
- Pelvic pain
- Low back pain
- C-section scar that is not fully healed
- Bleeding beyond six weeks (that is not resumption of menses)
- Urinary incontinence (including leakage when sneezing, laughing, or hopping)
- You mentally do not feel ready
If any of these occur after the commencement of running, cease running until you can speak to your OB or a pelvic floor PT. For example, if you pee yourself on that first run, don’t just slap a pantyliner on next time. Switch to cross-training or walking and devote time to pelvic floor rehab.
What Else Affects Postpartum Recovery?
In addition to the above considerations, other factors affect individual recovery. Once you are cleared by your doctor and possess no counterindications, you still must consider your previous fitness level and activity during pregnancy.
While labor and delivery are not an injury, one must always consider the time off during pregnancy and postpartum like the time off for an injury. The longer you are off, the more cautious a return must be. (This is not a reason to rush back to running though!)
If you ran through the end of your pregnancy, you will likely be able to resume running sooner and rebuild at a quicker rate. If you stopped running partway through pregnancy, you may need to approach your return to running as you would for any prolonged layoff. An athlete who did not run after the first trimester, for example, should spend more time cross-training and strength training before returning to running.
Likewise, your level of muscular strength during pregnancy contributes to your ability to resume running after childbirth. A 2017 study in Sports Health (Byholder et al) concluded that women who strength trained prior to childbirth (including during pregnancy) experienced less musculoskeletal pain, lower rates of stress urinary incontinence, and diastasis recti. If you did not strength train during pregnancy, you may need to hold off running for longer as you build back strength.
Finally, there is mental readiness. No study or coach can tell you when you will feel ready. Some women feel ready to run as soon as they are cleared. Others wait months until they physically and mentally are prepared to run. Embrace your own timeline and do not rush yourself.
Running and Postpartum Depression/Anxiety
I feel it would be a disservice to women everywhere to ignore the topic of postpartum depression and anxiety. Every year, thousands of women struggle with anxiety, depression, and other mood disorders after delivery
This is one of the reasons that I as a coach do not prescribe to the 12 weeks off of running recommendation for every single runner. Assuming the athlete has been cleared by her OB and does not demonstrate any contraindications, carefully resuming running starting at 6-11 weeks postpartum can have a positive effect on PPD/PPA.
Research indicates that exercise has a powerful effect on depression and anxiety. A 2015 observational, cross-sectional study in Sports Health (Tenforde et al) found a statically significant difference in rates of postpartum depression between breastfeeding runners who resumed training and those who did not.
Now it’s worth noting that heterogeneity and bias may affect those studies. However, research on depression and anxiety (not just postpartum in the context of postpartum) reinforces the likelihood that exercise can decrease depression and anxiety in general – and therefore in postpartum women.
That does not mean you should rush back into exercise. Nor does it mean that exercise is a panacea for PPD/PPA. But if you are at risk for PPD/PPA or have a high Edinburgh score and have been cleared for return to exercise, carefully resuming running may be helpful.
The exact timeline will vary on when you can return to running postpartum; you may be ready at 6-8 weeks, or you may need to wait 12 weeks or more, depending on issues that arise. Be sure to get clearance from your doctor. Do not run if you have incontinence, pain, or other problems. See a PT if you experience contraindications. Once you are ready to start running, though, do not jump back into previous mileage. The second part of this series will cover how to safely resume running after giving birth.
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How long did you wait to run postpartum?
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