Returning to Running after a Baby; the Technical Stuff.

Perfomance Plus Womens Health Practice is situated in Waverley. Their Physiotherapist Samara Nanayakkana discusses returning to running after a baby.

Postnatal women need adequate time to heal and regain strength, particularly in the abdominal and pelvic floor muscles after pregnancy and delivery.

Vaginal delivery

It is understood that the levator hiatus area widens during pregnancy and increases significantly after vaginal delivery. In most women following vaginal delivery, it is thought to return to a similar area by 12-months postnatal as to that seen immediately after caesarean delivery. However it is does not return to prenatal size (Stær-Jensen et al. 2015). Recovery of the levator ani muscle and associated connective tissue and nerves is generally maximized by 4-6 months postnatal and is considered to be a reflection of levator hiatus area recovery (Shek et al. 2010, Stær-Jensen et al. 2015).

Caesarean Section

Following caesarean section delivery, consideration should also be given to the healing and remodeling of the uterine scar. It has been shown by ultrasound investigations that the uterine scar thickness is still increased at 6-weeks postnatal suggesting that the process of scar remodeling after caesarean delivery extends beyond the traditionally accepted period (Hamer et al. 2007). This is further supported by the understanding that abdominal fascia has only regained 51%-59% of its original tensile strength by 6-weeks post caesearean section and 73%-93% of its original tensile strength at 6-7 months postnatal. (Ceydeli et al. 2005).

Return to running objective checklist

Reduced pelvic floor muscle endurance. Recommended baseline in standing:

✓ 10x fast reps

✓ 8-12 reps of 6-8 second maximum voluntary contraction

✓ 60 seconds submaximal 30-50% contraction

• GH+PB ≥7cm on Valsalva

Regardless of MOMMT score, it is advisable that the evaluation of the risk of developing pelvic organ prolapse (POP) should be carried out via the GH+PB component of the POP-Q Assessment (Bump et al. 1996; Reimers et al. 2018) considering that ≥7cm length on valsalva is highly predictive of apical support loss (Khunda et al. 2012). If POP or significant apical loss is identified, a vaginal pessary should be considered to reduce the worsening of fascial support and facilitate return to running.

Women who present with <grade 3 MOMMT score without identifiable compromise in their fascial support (i.e. GH+PB <7cm) may be considered appropriate for graded return to running if no other signs or symptoms are present during load impact testing (p16). Women who present with <grade 3 MOMMT score without identifiable compromise in their fascial support (i.e. GH+PB <7cm) may be considered appropriate for graded return to running if no other signs or symptoms are present during load impact testing (p16).

Similarly, women presenting with ≥grade 3 MOMMT score who demonstrate significant apical loss or ballooning at the hiatal area (GH+PB ≥7cm) should have fascial support deficits addressed via a pessary or other support devices prior to return to running.

Education regarding the identified risk of POP if the fascial support is not addressed should be provided.

How do I know when to load?

In order to successfully complete this assessment, the postnatal mother needs to achieve the following without pain, heaviness, dragging or incontinence:

⁃ Walking 30 minutes

⁃ Single leg balance 10 seconds

⁃ Single leg squat 10 repetitions each side

⁃ Jog on the spot 1 minute

⁃ Forward bounds 10 repetitions

⁃ Hop in place 10 repetitions each leg

⁃ Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10 Repetitions each side

Strength testing

In order to ensure key muscle groups are prepared for running, each of the following movements should be performed with the number of repetitions counted to fatigue. Aim for 20 repetitions of each test.

⁃ Single leg calf raise

⁃ Single leg bridge

⁃ Single leg sit to stand

⁃ Side lying abduction

Assessing the strength of all key hip muscles; abductors, adductors, flexors, extensors and rotators is also recommended (Chumanov et al. 2012). This can be done isometrically and measured with a hand held dynamometer where available. NOTE: Weakness in these areas of strength testing should not be considered a barrier for return to running but instead identify where strength work can be directed.

Performance Plus Women’s Physiotherapy provides the Women’s Health Service at Waverley Private Hospital. Consulting nearby at 40 Lemana Crescent Mount Waverley for outpatients means that all your Women’s Health Services are covered. It’s convenient location means that it services the suburbs of Glen Waverley, Burwood, Chadstone, Oakleigh and Clayton as well as suburbs along the south eastern corridor such as Wheelers Hill, Mulgrave, Dandenong and Springvale.