Rosie Cardale, Bristol-based musculoskeletal physiotherapist and Mummy MOT practitioner talks about the importance of getting a postnatal assessment and working through fundamental strength training before being tempted to dust off your trainers and get out running.
As a new mum, it is normal to want to ease your way back into your pre-pregnancy exercise routine after your six-week check with the GP. Returning to exercise postnatally is definitely encouraged, research shows that it has a positive impact on reducing the onset of postnatal depression and helps improve body confidence. It’s important to remember though, that no matter how fit you were before the birth of your baby, it is your pelvic floor, back, and pelvis that you are trying to rehabilitate and protect. A return to exercise too early can cause immediate or long-term problems to these areas that may, in some cases, be irreversible. Common problems that can occur include musculoskeletal pain and dysfunction, urinary incontinence, abdominal separation, and pelvic organ prolapse.
At present, due to the current lockdown restrictions, the temptation to get out running is even higher for new mums. A Mummy MOT or postnatal check at any point can help you to understand whether this is something you are prepared for and if not, how to achieve your fitness goals.
So what do we need to rehabilitate from? A paper published in June 2019 by Science Advances, found that pregnancy pushes the boundaries of human endurance, like elite cyclists on the Tour de France. Just as these athletes allow their body time to recover, so should any new mum. During pregnancy, there are fundamental changes in hormone levels, posture, and the ‘core cylinder’.
Our core is made up of four muscles which form a cylinder-like shape in our abdomen. All four adapt to allow the growth of the baby, whether that is being shortened, stretched or loaded. Your Mummy MOT practitioner will educate you on the function of these muscles and assess them during your consultation.
After having a baby, the pelvic floor is weak and injured in most women and you may need instruction and supervision to be able to perform a correct pelvic floor muscle contraction, especially if you were not informed to train these muscles before birth.
Research shows that it can take collagen six months to regain its pre-pregnancy strength post-delivery, and longer in women who are breastfeeding, because of the different levels of certain hormones, but is not a reason to avoid breastfeeding.
What do we need to do to be able to run?
The main challenge of running is that it is a single-leg sport. This means that we shift from one leg to the other. The force that travels through each leg can be in excess of three times our body weight. This force therefore also needs to be absorbed by our pelvic structures and pelvic floor. Over a 5km run, we could take up to 4,000 steps which impact joints, tendons, and muscles. This is why it is so important that we gradually build up strength to cope with this.
What do we assess during a Mummy MOT Consultation?
The Mummy MOT is a comprehensive assessment to help you safely return to high-level sports and your normal daily activities. We assess what may have changed and been affected by pregnancy and childbirth. We also consider hormonal and healing time scales. We look at posture and pelvic alignment, breathing, C-section scar if you have one, abdominal muscles, and the possible presence of a diastasis recti. We conduct functional strength tests to examine how you are moving and transferring load through your lower limbs. There is the option to have an internal examination which helps determine the condition and strength of the pelvic floor.
How we increase strength to help return to running
From this assessment we tailor a plan for you that encompasses how to rehabilitate your pelvic floor and pelvic structures. We discuss how we can strengthen all four aspects of your core and work on building strength in your pelvis and legs which is fundamental for running and any high impact sport.
Some fantastic guidelines were written last year, by two pelvic health physios and another physio who specialises in running. They summarised that all women can consider returning to running at 3-6 months post-birth after they have completed at least 4-8 weeks of essential pelvic floor related to rehab and single-leg strengthening.
Your Mummy MOT practitioner may refer to these guidelines and use some of the single-leg strength tests that they have highlighted as being good indicators of a safe return to running.
Couch to 5k
It’s also important to consider using a couch to 5k programme when returning to the sport. This is essential for all women, regardless of previous running experience. It helps to ensure that you progressively and safely load the tissues in their pelvis and abdomen. Research shows that this will help dramatically reduce the chance of developing urinary incontinence or pelvic organ prolapse symptoms later. You will thank yourself for having invested in this time down the line – I promise!
Slow and steady wins the race, and if you can, consider having a professional opinion so you can ease back in to exercise post-baby, in the right way and at the right time. Find out more about The Mummy MOT here.